13 ms·

What kind of society lets a mentally ill man roam the streets, deteriorating, instead of institutionalising him and helping him recover?

hellofunk 11y ago
Unfortunately, many, many societies in this world, including the U.S. and most areas in Asia.
huuu 11y ago
Unfortunately you would be amazed and ashamed. In the USA it's estimated that one third of the homeless people suffer a serious mental illness. I live in the Netherlands and I think the numbers are the same here. Ofcourse there is help but most homeless people move around a lot so it can be difficult to track them and help them. Also: having worked with homeless people I know for sure they will get some kind of mental illness sooner or later.
- skrebbel 11y ago
  I always had the idea that homelessness numbers were way higher in the US than in the Netherlands. This helped keep me firmly on my high horse (I'm Dutch too). Was I wrong?
  - Symbiote 11y ago
    According to [1], the Netherlands has about 0.16% homeless people per capita, and the USA 0.50-1.10%. (If I'm comparing figures correctly, since that page has "counted on one night" and "total for the year" for different countries.) It's probably significant that a lot of the US is a lot warmer year-round. [1] https://www.homelessworldcup.org/homelessness-statistics/#europe https://www.homelessworldcup.org/homelessness-statistics/#eu...
    - zeveb 11y ago
      > It's probably significant that a lot of the US is a lot warmer year-round. Yup, exactly this. It's why there are so many homeless folks in Hawaii: it's easy to live there without shelter. Living in a part of the world where the weather gets cold forces people to make decisions.
  - rfrey 11y ago
    Apparently there are about 27,000 homeless in the Netherlands[1], out of a population of 15.5 million, so 1,742 homeless per million people. In the USA there are apparently 633,782 homeless [2] per night out of 319 million people, or 1,987 per million people. But that's heavily influenced by the way homeless people are counted. The US number is explicitly the number of people homeless on any given night. Estimates of the number of people in the US that will be homeless for some period each year ranges from 2.3 - 3.5 million [3] (7,210 and 10,972 per million resp.) This is estimated from shelter occupancy. I couldn't figure out if the Dutch statistics agency were counting number of people homeless in a year, or number on any particular night, but [4] hints to me that they're estimating the annual population, so I think the best comparison is: Netherlands: ~1,700 homeless per million USA: 9,000 +/- 2000 homeless per million [1] http://www.cbs.nl/en-GB/menu/themas/bevolking/publicaties/artikelen/archief/2013/2013-4016-wm.htm http://www.cbs.nl/en-GB/menu/themas/bevolking/publicaties/ar... [2] https://www.hudexchange.info/resources/documents/2012AHAR_PITestimates.pdf https://www.hudexchange.info/resources/documents/2012AHAR_PI... [3] http://www.familyhomelessness.org/media/306.pdf http://www.familyhomelessness.org/media/306.pdf [4] http://www.cbs.nl/en-GB/menu/methoden/toelichtingen/alfabet/h/homeless-people1.htm http://www.cbs.nl/en-GB/menu/methoden/toelichtingen/alfabet/...
  - Sparq 11y ago
    I think GP means the percentage of homeless people that have a mental illness is similar to the US, not the percentage homeless compared to the total population.
- misja111 11y ago
  >> I live in the Netherlands and I think the numbers are the same here. 80% of the homeless in the Netherlands suffer from mental illnesses. Source (in Dutch): http://www.ontmoeting.org/dak_thuislozen http://www.ontmoeting.org/dak_thuislozen I guess the explanation for the difference is that the social security system in the Netherlands is better, so there's less chance for ending up in the street when you lose your job.
- treehau5 11y ago
  One third? I think it is much higher, simply for the fact that you almost have to be mentally ill in some form of fashion to continue to live on the street. It's an awful place and I wish it upon no one.
s_kilk 11y ago
On my darker days I sometimes think we live in a hell-on-earth. In our fiction we describe whole worlds where the Damned are left to shamble around and fend for themselves, cut off from the warmth of humanity. We depict hell as a plane of the existence where the Lost are cut off from all that is right and good in the world, pitched overboard into un-ending darkness and despair. It's hard not to draw parallels.
- eli_gottlieb 11y ago
  Well maybe if we stopped declaring people Useless or Sinners and deliberately pitching them overboard...
  - s_kilk 11y ago
    My point exactly :)
    - chris_wot 11y ago
      On my darker days I believe the hell I live in is my own mind. It's not really possible to escape it, though sometimes sleeping helps. Luckily dark days are few and far between, and I get help. Medication helps, and when it occurs I tell myself it's not reality because, well, it isn't.
    - eli_gottlieb 11y ago
      Dear Lost and Damned Denizens of Hell, You can leave any time you're willing to stop calling us nasty names and accept our help. Or hell, even stop calling each-other nasty names and accept each-other's help. It's not like you're actually damned in any strictly metaphysical sense. It's just that you've got two primary tools, your intellects and your social abilities, your brains and your hearts, and you vilify the fuck out of both of them in favor of fists and fire! Sincerely, The Other Place
DominikR 11y ago
Mentally ill persons enjoy the same rights that other citizens enjoy and have their own free will. As long as a person didn't commit any crime and is no risk to society or oneself you cannot institutionalize him or her. In any case I would refrain from making such broad generalizations about a society. Some societies prefer strong individual rights and others prefer a strong state that tells them what to do.
- nikolay 11y ago
  I doubled a mentally ill person has anything resembling "free will"...
  - DominikR 11y ago
    You can very objectively prove that a person is missing a limb but often you cannot prove that a person is mentally ill. Often persons will be categorized as mentally ill just because they deviate in their beliefs or lifestyle from the mainstream culture. And yes, mentally ill persons HAVE a free will, don't tell me they don't as this would be equal to declaring that they are not human beings but just a lump of meat. They have feelings, desires and goals like anyone else, it's just that these in some cases may be very different from yours or mine.
    - corin_ 11y ago
      To add to your answer: mental illness isn't all or nothing, it's not either you're a normal person with free will vs. you're crazy and everything you say is crazy. People with depression, bipolar, many other mental illnesses could be completely normal when you meet them but still classified as having a mental illness. It's possible to keep a normal life, a normal job, yet be aware that you are, in some way, "mentally ill".
      - marrs 11y ago
        Add people who don't sleep enough, are pregnant, are facing redundancy, are approaching middle age, have an addiction, etc, ad infinitum.
frobozz 11y ago
In broad terms, I agree, and in many cases it is a societal problem. However, FTA: >He wasn't a danger to himself or to others, he wasn't threatening anyone, he just didn't look very respectable. This is the missing condition required to withdraw a patient's liberty in a secure hospital. Even if he presents with severe enough problems to become a voluntary inpatient, he may still wander off and be difficult to find. Due to the nature of this kind of illness, you are likely to cease seeking care when your problems become that severe, and need someone else to push you into it. Although he had medication that he wasn't taking, it sounds like he was living on his own when his problems became that severe, so he probably had no one to push him to the doctor. All that said, there should be people looking out for the homeless and making sure they get the medical treatment they need, and maybe the definition of "danger to self" needs looking at, as choosing to sleep rough during a hurricane sounds pretty dangerous to me.
onion2k 11y ago
Many mentally ill people are still in a position where they can still make decisions for themselves, but their illness means that they choose things that are ostensibly bad for them eg refusing help to get off the streets, help with addiction, stopping them committing suicide, etc. That means society has to decide between forcing people to do things against their will or respecting their decision even though it's what we as a society believe is bad. In order to intervene in someone's life to help them you have to decide how ill someone has to be before you step in. That is not a straightforward choice, and choosing to let people do things that are bad for them doesn't mean there's anything wrong with the society. It may mean that bad things happen, but the converse, where society steps in when you're deemed 'incapable', might be worse if it's not managed exceptionally well. As an example, consider whether should someone who is depressed to the point of needing medication be banned from buying alcohol (which is a depressant) because it'll make their situation worse, or should society let depressed people use alcohol as an escape from their illness? Does being ill mean you have to give up your right to decide how to live your life?
- eru 11y ago
  > That is not a straightforward choice, [...] And no matter what (sensible) tradeoffs you make, it will always be agonizing around the margin.
- girvo 11y ago
  > * alcohol (which is a depressant)* I thought a depressant in the context of drugs means "central nervous system depressant", not "causes depression"?
  - stan_rogers 11y ago
    ... and alcohol is a CNS depressant. A common "can't afford to smell of booze right now" substitute (at least in the old days; it's been a very long time between drinks for me) was Seconal. It ain't the same, but it takes the edge off in the right way.
    - chris_wot 11y ago
Turukawa 11y ago
Usually, mentally ill people are outpatients of medical facilities. However, if they're not a danger to themselves or society, it's difficult to make a case that they should be imprisoned against their will (which is what it would amount to if one institutionalised a person indefinitely). I'm not saying I know what the answer should be, and this sits on legally and ethically tricky ground all over the world. The mentally ill have been treated pretty badly through history, and I'm not sure that benign neglect is the worst of these options but I do think there should be some formal system of checking on them (informally, there are any number of NGOs and religious groups who tend to keep tabs on the homeless, funding permitting).
happyscrappy 11y ago
Forcibly institutionalizing people is not a panacea.
- jschwartzi 11y ago
  No, but it's worth considering that when this man ended up in the hospital for a physical ailment they started treating him. That, and his daughter, were enough to bring him back. If he were to have been hospitalized, not institutionalized, I wonder if the outcome were the same. Our society assumes mental illness is totally different from physical illness, but in cases like schizophrenia the treatment ends up being very similar. You take your pills and see a doctor. If he had the flu and had suddenly taken a turn for the worse, the discussion wouldn't have been about institutionalization. He would have received treatment in a hospital and then been discharged as soon as possible.
  - corin_ 11y ago
    Mental illness isn't always that simple, though. I don't know much about schizophrenia but I know at least some mental issues won't always respond the same way to medication in different people - sometimes different medicines need to be tried, sometimes they need some sort of therapy e.g. CBT either instead of or along side drugs, sometimes they don't get cured at all. I'm not enough of an expert to talk in much more detail, though.
bsder 11y ago
> What kind of society lets a mentally ill man roam the streets, deteriorating, instead of institutionalising him and helping him recover? What gives you the authority to institutionalize him? This isn't a snide question. It's a very difficult question that leads to a whole raft of difficult questions. How do you force a person to take their medication? Why should you do it for this particular person but not that particular person? Who is responsible for the cost of doing so?
- SpaghettiCat 11y ago
  > What gives you the authority to institutionalize him? A government has the duty to provide for the welfare of their people. It's every government's goal to make their people healthier. > How do you force a person to take their medication? In a psychiatric institution you could for example inject the medicine into them. > Why should you do it for this particular person but not that particular person? If a person's mind is gone so haywire that they're destroying their own body, that they don't have adequate control of their mind (as is the case with schizophrenics), that they don't eat or even respond to human communication, and they have been diagnosed with a mental disorder then you should institutionalize them until their mind regains control. > Who is responsible for the cost of doing so? Taxpayer
  - chrisseaton 11y ago
    But people have rights. They have a right to not live in an institution if they don't want to. You want to disregard that right, because you think you know better for them than they do. Many of these people aren't dangerous and don't have infectious diseases, so there's no public health need to lock them up as you're suggesting.
    - SpaghettiCat 11y ago
      These people don't have control over their mental faculties; they aren't competent enough to make a choice for what is best for them in the same way that minors aren't allowed to go truant or to consent to sex with an adult. If you are all there in the head, by all means live on the streets, stay filthy, don't eat and ignore people, but this man has a brain disease that makes him lose control of his mind. If he was forcefully taken to the hospital, forcefully given medication, and recovered he would exclaim "Thank you for saving me! I had a disease in my brain that lead me to believe in crazy things: to be paranoid of police and even medical personnel. I spent 2 years on the streets suffering like this with no place I believed could help me, but you cured me." If I had a mental disorder that made me go crazy--so crazy that it doesn't even enter my mind that I need help--I would hope that my government would restore my sanity (as I am unable to do so).
Gatsky 11y ago
Institutionalisation can be avoided. Properly staffed and trained community mental health services could have intervened while he was still living in his apartment, and probably kept his lease going while getting his treatment back on track. It's a crying shame to let yet another mentally ill person end up in crisis. He could have easily died or been severely injured.
mattchew 11y ago
The kind that has prior experience with what forced institutionalization actually means. (Hint: it's not about "helping" people.)
vidarh 11y ago
Many other good answers, but here's an anecdote: In Oslo, near the university, there used by a "cave dweller". A by all accounts bright student who at 25 decided to stop washing himself. He was soon thrown out of his student accommodation because of the smell. He then decided to take up residence under a tarp in a makeshift "cave" in a hillside next to the university where he stayed for the following two and half decades. In 1987, he was refused the opportunity to take his astrophysics exam because of the smell, and later given a blanket restriction on participating in any exams unless he washed first. He was repeatedly institutionalised against his will, but in 1988 he won a supreme court decision that made it clear that his unorthodox lifestyle was insufficient grounds for forcing him into mental health institutions. He later sued the University of Oslo over lost income due to the exam ban, but lost. It may seem obvious that this guy had mental problems. The problem is that in court and during psychological examinations he was fully coherent and defended his choices with references to traditions of asceticism and spiritual beliefs. He understood what he was doing. (EDIT: This does not mean that he necessarily didn't have mental problems, but that he was coherent enough to be able to justify his decisions sufficiently that the court found he was competent to make his own decisions about whether or not he needed treatment) This poses a challenge, because it can be superficially extremely hard to distinguish actual mental illness from "crazy" lifestyle choices that the person making them are perfectly happy with. The guy mentioned above was very bright and able to get the resources he needed to protect what he saw as his own best interests in court (all the way to the supreme court 3 times, with one win), but most don't. Many of these people are mentally ill and need treatment, but we also need to protect those who aren't, and especially those who aren't yet are not resourceful enough to mount vigorous legal campaigns to protect their choices. At the same time setting the bar high means there are potential high costs and lots of resources involved in helping people that makes it harder to help those who need it out of a concern for e.g. distinguishing resistance and refusals grounded in mental illness from resistance and refusals from people who are mentally competent. Getting the balance right is hard.
- chris_wot 11y ago
  It is very hard for a mentally ill person to defend themselves. If they are in a mental institution, they can complain but even legitimate complaints get treated like a mentally ill person being difficult or delusional. That's sort of understandable - if you are around people all day who hear Satan, or have obsessive compulsions, complaining that you don't have enough bedclothes or the food is bad is just seen as part of your condition. If you get given the wrong medication, it's assumed you are wrong and you'll be ignored. If you get mad about being ignored, you can't just walk out as they wont let you. In all likelihood you'll be tranquillised to keep you quiet. How do I know this? Everything except the sedation happened to me!
giardini 11y ago
To answer your question in general "Every society!". But if you're talking about the USA and want to understand why so many are not institutionalized see the single-page summary: "A Brief History of Mental Illness and the U.S. Mental Health Care System": http://www.uniteforsight.org/mental-health/module2 http://www.uniteforsight.org/mental-health/module2 From that page: "...the deinstitutionalization movement has been widespread, dramatically changing the nature of modern psychiatric care.(7) The closure of state psychiatric hospitals in the United States was codified by the Community Mental Health Centers Act of 1963, and strict standards were passed so that only individuals “who posed an imminent danger to themselves or someone else” could be committed to state psychiatric hospitals."
harrumph 11y ago
>What kind of society lets a mentally ill man roam the streets, deteriorating, instead of institutionalising him and helping him recover? A society pathologically obsessed with markets, blind to the priceless.

hellofunk 11y ago

Unfortunately, many, many societies in this world, including the U.S. and most areas in Asia.

huuu 11y ago

Unfortunately you would be amazed and ashamed. In the USA it's estimated that one third of the homeless people suffer a serious mental illness. I live in the Netherlands and I think the numbers are the same here. Ofcourse there is help but most homeless people move around a lot so it can be difficult to track them and help them. Also: having worked with homeless people I know for sure they will get some kind of mental illness sooner or later.

skrebbel 11y ago
I always had the idea that homelessness numbers were way higher in the US than in the Netherlands. This helped keep me firmly on my high horse (I'm Dutch too). Was I wrong?
- Symbiote 11y ago
  According to [1], the Netherlands has about 0.16% homeless people per capita, and the USA 0.50-1.10%. (If I'm comparing figures correctly, since that page has "counted on one night" and "total for the year" for different countries.) It's probably significant that a lot of the US is a lot warmer year-round. [1] https://www.homelessworldcup.org/homelessness-statistics/#europe https://www.homelessworldcup.org/homelessness-statistics/#eu...
  - zeveb 11y ago
    > It's probably significant that a lot of the US is a lot warmer year-round. Yup, exactly this. It's why there are so many homeless folks in Hawaii: it's easy to live there without shelter. Living in a part of the world where the weather gets cold forces people to make decisions.
- rfrey 11y ago
  Apparently there are about 27,000 homeless in the Netherlands[1], out of a population of 15.5 million, so 1,742 homeless per million people. In the USA there are apparently 633,782 homeless [2] per night out of 319 million people, or 1,987 per million people. But that's heavily influenced by the way homeless people are counted. The US number is explicitly the number of people homeless on any given night. Estimates of the number of people in the US that will be homeless for some period each year ranges from 2.3 - 3.5 million [3] (7,210 and 10,972 per million resp.) This is estimated from shelter occupancy. I couldn't figure out if the Dutch statistics agency were counting number of people homeless in a year, or number on any particular night, but [4] hints to me that they're estimating the annual population, so I think the best comparison is: Netherlands: ~1,700 homeless per million USA: 9,000 +/- 2000 homeless per million [1] http://www.cbs.nl/en-GB/menu/themas/bevolking/publicaties/artikelen/archief/2013/2013-4016-wm.htm http://www.cbs.nl/en-GB/menu/themas/bevolking/publicaties/ar... [2] https://www.hudexchange.info/resources/documents/2012AHAR_PITestimates.pdf https://www.hudexchange.info/resources/documents/2012AHAR_PI... [3] http://www.familyhomelessness.org/media/306.pdf http://www.familyhomelessness.org/media/306.pdf [4] http://www.cbs.nl/en-GB/menu/methoden/toelichtingen/alfabet/h/homeless-people1.htm http://www.cbs.nl/en-GB/menu/methoden/toelichtingen/alfabet/...
- Sparq 11y ago
  I think GP means the percentage of homeless people that have a mental illness is similar to the US, not the percentage homeless compared to the total population.
misja111 11y ago
>> I live in the Netherlands and I think the numbers are the same here. 80% of the homeless in the Netherlands suffer from mental illnesses. Source (in Dutch): http://www.ontmoeting.org/dak_thuislozen http://www.ontmoeting.org/dak_thuislozen I guess the explanation for the difference is that the social security system in the Netherlands is better, so there's less chance for ending up in the street when you lose your job.
treehau5 11y ago
One third? I think it is much higher, simply for the fact that you almost have to be mentally ill in some form of fashion to continue to live on the street. It's an awful place and I wish it upon no one.

s_kilk 11y ago

On my darker days I sometimes think we live in a hell-on-earth. In our fiction we describe whole worlds where the Damned are left to shamble around and fend for themselves, cut off from the warmth of humanity. We depict hell as a plane of the existence where the Lost are cut off from all that is right and good in the world, pitched overboard into un-ending darkness and despair. It's hard not to draw parallels.

eli_gottlieb 11y ago
Well maybe if we stopped declaring people Useless or Sinners and deliberately pitching them overboard...
- s_kilk 11y ago
  My point exactly :)
  - chris_wot 11y ago
    On my darker days I believe the hell I live in is my own mind. It's not really possible to escape it, though sometimes sleeping helps. Luckily dark days are few and far between, and I get help. Medication helps, and when it occurs I tell myself it's not reality because, well, it isn't.
  - eli_gottlieb 11y ago
    Dear Lost and Damned Denizens of Hell, You can leave any time you're willing to stop calling us nasty names and accept our help. Or hell, even stop calling each-other nasty names and accept each-other's help. It's not like you're actually damned in any strictly metaphysical sense. It's just that you've got two primary tools, your intellects and your social abilities, your brains and your hearts, and you vilify the fuck out of both of them in favor of fists and fire! Sincerely, The Other Place

DominikR 11y ago

Mentally ill persons enjoy the same rights that other citizens enjoy and have their own free will. As long as a person didn't commit any crime and is no risk to society or oneself you cannot institutionalize him or her. In any case I would refrain from making such broad generalizations about a society. Some societies prefer strong individual rights and others prefer a strong state that tells them what to do.

nikolay 11y ago
I doubled a mentally ill person has anything resembling "free will"...
- DominikR 11y ago
  You can very objectively prove that a person is missing a limb but often you cannot prove that a person is mentally ill. Often persons will be categorized as mentally ill just because they deviate in their beliefs or lifestyle from the mainstream culture. And yes, mentally ill persons HAVE a free will, don't tell me they don't as this would be equal to declaring that they are not human beings but just a lump of meat. They have feelings, desires and goals like anyone else, it's just that these in some cases may be very different from yours or mine.
  - corin_ 11y ago
    To add to your answer: mental illness isn't all or nothing, it's not either you're a normal person with free will vs. you're crazy and everything you say is crazy. People with depression, bipolar, many other mental illnesses could be completely normal when you meet them but still classified as having a mental illness. It's possible to keep a normal life, a normal job, yet be aware that you are, in some way, "mentally ill".
    - marrs 11y ago
      Add people who don't sleep enough, are pregnant, are facing redundancy, are approaching middle age, have an addiction, etc, ad infinitum.

frobozz 11y ago

In broad terms, I agree, and in many cases it is a societal problem. However, FTA: >He wasn't a danger to himself or to others, he wasn't threatening anyone, he just didn't look very respectable. This is the missing condition required to withdraw a patient's liberty in a secure hospital. Even if he presents with severe enough problems to become a voluntary inpatient, he may still wander off and be difficult to find. Due to the nature of this kind of illness, you are likely to cease seeking care when your problems become that severe, and need someone else to push you into it. Although he had medication that he wasn't taking, it sounds like he was living on his own when his problems became that severe, so he probably had no one to push him to the doctor. All that said, there should be people looking out for the homeless and making sure they get the medical treatment they need, and maybe the definition of "danger to self" needs looking at, as choosing to sleep rough during a hurricane sounds pretty dangerous to me.

onion2k 11y ago

Many mentally ill people are still in a position where they can still make decisions for themselves, but their illness means that they choose things that are ostensibly bad for them eg refusing help to get off the streets, help with addiction, stopping them committing suicide, etc. That means society has to decide between forcing people to do things against their will or respecting their decision even though it's what we as a society believe is bad. In order to intervene in someone's life to help them you have to decide how ill someone has to be before you step in. That is not a straightforward choice, and choosing to let people do things that are bad for them doesn't mean there's anything wrong with the society. It may mean that bad things happen, but the converse, where society steps in when you're deemed 'incapable', might be worse if it's not managed exceptionally well. As an example, consider whether should someone who is depressed to the point of needing medication be banned from buying alcohol (which is a depressant) because it'll make their situation worse, or should society let depressed people use alcohol as an escape from their illness? Does being ill mean you have to give up your right to decide how to live your life?

eru 11y ago
> That is not a straightforward choice, [...] And no matter what (sensible) tradeoffs you make, it will always be agonizing around the margin.
girvo 11y ago
> * alcohol (which is a depressant)* I thought a depressant in the context of drugs means "central nervous system depressant", not "causes depression"?
- stan_rogers 11y ago
  ... and alcohol is a CNS depressant. A common "can't afford to smell of booze right now" substitute (at least in the old days; it's been a very long time between drinks for me) was Seconal. It ain't the same, but it takes the edge off in the right way.
  - chris_wot 11y ago

Turukawa 11y ago

Usually, mentally ill people are outpatients of medical facilities. However, if they're not a danger to themselves or society, it's difficult to make a case that they should be imprisoned against their will (which is what it would amount to if one institutionalised a person indefinitely). I'm not saying I know what the answer should be, and this sits on legally and ethically tricky ground all over the world. The mentally ill have been treated pretty badly through history, and I'm not sure that benign neglect is the worst of these options but I do think there should be some formal system of checking on them (informally, there are any number of NGOs and religious groups who tend to keep tabs on the homeless, funding permitting).

happyscrappy 11y ago

Forcibly institutionalizing people is not a panacea.

jschwartzi 11y ago
No, but it's worth considering that when this man ended up in the hospital for a physical ailment they started treating him. That, and his daughter, were enough to bring him back. If he were to have been hospitalized, not institutionalized, I wonder if the outcome were the same. Our society assumes mental illness is totally different from physical illness, but in cases like schizophrenia the treatment ends up being very similar. You take your pills and see a doctor. If he had the flu and had suddenly taken a turn for the worse, the discussion wouldn't have been about institutionalization. He would have received treatment in a hospital and then been discharged as soon as possible.
- corin_ 11y ago
  Mental illness isn't always that simple, though. I don't know much about schizophrenia but I know at least some mental issues won't always respond the same way to medication in different people - sometimes different medicines need to be tried, sometimes they need some sort of therapy e.g. CBT either instead of or along side drugs, sometimes they don't get cured at all. I'm not enough of an expert to talk in much more detail, though.

bsder 11y ago

> What kind of society lets a mentally ill man roam the streets, deteriorating, instead of institutionalising him and helping him recover? What gives you the authority to institutionalize him? This isn't a snide question. It's a very difficult question that leads to a whole raft of difficult questions. How do you force a person to take their medication? Why should you do it for this particular person but not that particular person? Who is responsible for the cost of doing so?

SpaghettiCat 11y ago
> What gives you the authority to institutionalize him? A government has the duty to provide for the welfare of their people. It's every government's goal to make their people healthier. > How do you force a person to take their medication? In a psychiatric institution you could for example inject the medicine into them. > Why should you do it for this particular person but not that particular person? If a person's mind is gone so haywire that they're destroying their own body, that they don't have adequate control of their mind (as is the case with schizophrenics), that they don't eat or even respond to human communication, and they have been diagnosed with a mental disorder then you should institutionalize them until their mind regains control. > Who is responsible for the cost of doing so? Taxpayer
- chrisseaton 11y ago
  But people have rights. They have a right to not live in an institution if they don't want to. You want to disregard that right, because you think you know better for them than they do. Many of these people aren't dangerous and don't have infectious diseases, so there's no public health need to lock them up as you're suggesting.
  - SpaghettiCat 11y ago
    These people don't have control over their mental faculties; they aren't competent enough to make a choice for what is best for them in the same way that minors aren't allowed to go truant or to consent to sex with an adult. If you are all there in the head, by all means live on the streets, stay filthy, don't eat and ignore people, but this man has a brain disease that makes him lose control of his mind. If he was forcefully taken to the hospital, forcefully given medication, and recovered he would exclaim "Thank you for saving me! I had a disease in my brain that lead me to believe in crazy things: to be paranoid of police and even medical personnel. I spent 2 years on the streets suffering like this with no place I believed could help me, but you cured me." If I had a mental disorder that made me go crazy--so crazy that it doesn't even enter my mind that I need help--I would hope that my government would restore my sanity (as I am unable to do so).

Gatsky 11y ago

Institutionalisation can be avoided. Properly staffed and trained community mental health services could have intervened while he was still living in his apartment, and probably kept his lease going while getting his treatment back on track. It's a crying shame to let yet another mentally ill person end up in crisis. He could have easily died or been severely injured.

mattchew 11y ago

The kind that has prior experience with what forced institutionalization actually means. (Hint: it's not about "helping" people.)

vidarh 11y ago

Many other good answers, but here's an anecdote: In Oslo, near the university, there used by a "cave dweller". A by all accounts bright student who at 25 decided to stop washing himself. He was soon thrown out of his student accommodation because of the smell. He then decided to take up residence under a tarp in a makeshift "cave" in a hillside next to the university where he stayed for the following two and half decades. In 1987, he was refused the opportunity to take his astrophysics exam because of the smell, and later given a blanket restriction on participating in any exams unless he washed first. He was repeatedly institutionalised against his will, but in 1988 he won a supreme court decision that made it clear that his unorthodox lifestyle was insufficient grounds for forcing him into mental health institutions. He later sued the University of Oslo over lost income due to the exam ban, but lost. It may seem obvious that this guy had mental problems. The problem is that in court and during psychological examinations he was fully coherent and defended his choices with references to traditions of asceticism and spiritual beliefs. He understood what he was doing. (EDIT: This does not mean that he necessarily didn't have mental problems, but that he was coherent enough to be able to justify his decisions sufficiently that the court found he was competent to make his own decisions about whether or not he needed treatment) This poses a challenge, because it can be superficially extremely hard to distinguish actual mental illness from "crazy" lifestyle choices that the person making them are perfectly happy with. The guy mentioned above was very bright and able to get the resources he needed to protect what he saw as his own best interests in court (all the way to the supreme court 3 times, with one win), but most don't. Many of these people are mentally ill and need treatment, but we also need to protect those who aren't, and especially those who aren't yet are not resourceful enough to mount vigorous legal campaigns to protect their choices. At the same time setting the bar high means there are potential high costs and lots of resources involved in helping people that makes it harder to help those who need it out of a concern for e.g. distinguishing resistance and refusals grounded in mental illness from resistance and refusals from people who are mentally competent. Getting the balance right is hard.

chris_wot 11y ago
It is very hard for a mentally ill person to defend themselves. If they are in a mental institution, they can complain but even legitimate complaints get treated like a mentally ill person being difficult or delusional. That's sort of understandable - if you are around people all day who hear Satan, or have obsessive compulsions, complaining that you don't have enough bedclothes or the food is bad is just seen as part of your condition. If you get given the wrong medication, it's assumed you are wrong and you'll be ignored. If you get mad about being ignored, you can't just walk out as they wont let you. In all likelihood you'll be tranquillised to keep you quiet. How do I know this? Everything except the sedation happened to me!

giardini 11y ago

To answer your question in general "Every society!". But if you're talking about the USA and want to understand why so many are not institutionalized see the single-page summary: "A Brief History of Mental Illness and the U.S. Mental Health Care System": http://www.uniteforsight.org/mental-health/module2 http://www.uniteforsight.org/mental-health/module2 From that page: "...the deinstitutionalization movement has been widespread, dramatically changing the nature of modern psychiatric care.(7) The closure of state psychiatric hospitals in the United States was codified by the Community Mental Health Centers Act of 1963, and strict standards were passed so that only individuals “who posed an imminent danger to themselves or someone else” could be committed to state psychiatric hospitals."

harrumph 11y ago

>What kind of society lets a mentally ill man roam the streets, deteriorating, instead of institutionalising him and helping him recover? A society pathologically obsessed with markets, blind to the priceless.