4 ms·

That was part of the problem. The other part is that "One Who Flew Over the Cuckoo's Nest" inspired the left to change laws so that it became hard for Psychs to

by cjensen 10y ago

That was part of the problem. The other part is that "One Who Flew Over the Cuckoo's Nest" inspired the left to change laws so that it became hard for Psychs to institutionalize people who need help. Both parts need to change. The "they aren't hurting anybody so leave them alone" people need to understand that they are hurting themselves and need to have their freedom of choice taken away. There needs to be strong oversight to prevent abuse. There needs to be sufficient funding to humanely take care of the mentally ill and, when possible, make them better. Addiction needs to be treated as a mental illness since, once the individual becomes addicted, it literally is a chemical abnormality in the physical brain mostly beyond the ability of the individual to address without medical help.

m_mueller 10y ago
Before expanding the process to lock up people I'd have a good look at the current state of me tal health services - see the recent article about UHS about how they're abusing the system and their patient just to milk a bit more profit. Locked wards are fine IMO, but please don't allow this to for-profit institutions - same wrong incentives as for-profit prisons, i.e. current day slavery in the US.
maxerickson 10y ago
What legislation do you think most contributed to deinstitutionalization?
thraway2016 10y ago
it became hard for Psychs to institutionalize people who need help. The prospect of a society in which any psychologist can, on a whim, circumvent due process and imprison anyone against their will indefinitely, is terrifying. It's much, much better this way.
- kolbe 10y ago
  i agree that liberty is more important in this case, but it is important to acknowledge that the cost of liberty is the well-being of thousands (maybe millions) of mentally-ill would would otherwise be treatable.
- DanBC 10y ago
  >> it became hard for Psychs to institutionalize people who need help. > The prospect of a society in which any psychologist can, You've mixed up psychologist and psychiatrist. It's easy to find ways that psychiatrists can detain people against their will, and force them to undergo medical treatment against their will, that don't rely on a single doctor and that have strong protections against abuse. Something like two doctors - one of which knows the patient, plus an approved MH professional who's role is to protect the legal rights of the patient, plus free advocacy during all stages of detention to protect the legal rights, with powers of a close relative to ask for the detained person to be released; with a default position that people have capacity to make decisions about themselves, and that any limitations of capacity are limited to a single domain (I might not be able to say what happens to my money, but you should not use that to assume my capacity chose my medication is limited); with a recognition from all involved that this is a significant interference with my human rights and that we only tolerate this because it's in my best interests.
  - tptacek 10y ago
    Same problem with psychiatrists. The psychiatrists associated with large-scale direct intake at hospitals are also extremely overworked and often not particularly sophisticated (psychiatrists who keep up with research and are effective practitioners can make more money outside the hospital system). In the very worst case, which is unfortunately common, you have chains like UHS operating mental health hospitals in numerous states with what appear to be quotas. You don't have to drive yourself to a UHS hospital to end up in one. Most hospitals, even the very good ones, don't do on-site psych; in many of them, if you show up for any psych reason, you'll be held and then transported to an affiliated mental health hospital. So, yes, there are very significant due process concerns with acute mental health care.
- CalChris 10y ago
  Psychologist no. But psychiatrist yes. Actually there's a few others who have that authority as well. Involuntary commitment, 72 hour hold. Police can do this and some mental health professionals. http://www.disabilityrightsca.org/pubs/502401.pdf http://www.disabilityrightsca.org/pubs/502401.pdf
- anigbrowl 10y ago
  I feel you're committing the fallacy of the excluded middle here. The current standard in which a person needs to present a danger to themselves or others also results in everyone within the mental health system being treated like they're one step away from being violent criminals, resulting in significant additional stigmatization. My best friend went through a mental health crisis earlier this spring and was involuntarily hospitalized for several weeks in virtually carceral conditions.
- cjensen 10y ago
  Like I said above "There needs to be strong oversight to prevent abuse". That pretty much rules out whims. We have people who talk to themselves and freeze to death in the Winter. I disagree when you say "it is better this way." There are real risks in allowing institutionalization; on the other hand, innocent people are dying from treatable mental health issues. Surely there is some middle position to be had?
millzlane 10y ago
>The "they aren't hurting anybody so leave them alone" people need to understand that they are hurting themselves and need to have their freedom of choice taken away. You bring up an interesting point. I wonder who becomes in charge of diagnosing, which ones do we choose, for how long do we lock them away? Did we use shock therapy here in the US?
- DanBC 10y ago
  > Did we use shock therapy here in the US? You still do! It's a useful treatment for some people with treatment resistant and severe, life threatening, depression. It's used much less often, and there are some extra bits of bureaucracy around it. And it's safer than conventional treatment for some people - pregnant women, for example.
  - openasocket 10y ago
    To add to this: it's nothing at all today like it was in the 50s. Patients are not strapped down and thrashing: they are sedated and given muscle relaxants so that they don't thrash. The most common side effect is memory loss.
sedachv 10y ago
> Both parts need to change. The "they aren't hurting anybody so leave them alone" people need to understand that they are hurting themselves and need to have their freedom of choice taken away. One of the big functions of involuntary commitment to mental hospitals in pre-1950s America was for parents to put away their "troubled daughters" because of social behavior they did not approve of (promiscuity, friend circle, etc). You get glimpses of this in memoirs from the era (the most recent one I have read that comes to mind is Herbert Huncke's autobiography). This continues today for rich parents who send their children to be involuntarily committed to "residential centers," "boot camps," and certain rehab programs. This is a slippery slope that social reformers, busybodies, religious fundamentalists, etc have used to label any behavior they do not approve of, but cannot convince legislators to make against the law, as "hurting yourself" and grounds for taking freedom away. You are already most of the way down the slope by advocating for locking away drug addicts. Don't forget that Nixon's administration ramped up the drug prohibition as a way to break the civil rights and anti-war movements: https://harpers.org/archive/2016/04/legalize-it-all/ https://harpers.org/archive/2016/04/legalize-it-all/. Today a similar policy will just be used to target leftist collectives and human rights groups, anarchists, the groups that sprang out of the Occupy movement, left-wing hackers, etc. Involuntary institutionalization starts as a way to help the mentally ill, progresses through to oppression of women, and ends up as a tool of political repression (as it did in the USSR, and currently still does in Belarus).
anigbrowl 10y ago
need to have their freedom of choice taken away A lot of people undergoing mental health issues also have severe financial stress and the related economic insecurities, which end up in a vicious cycle of poverty and worsening mental health - a situation of which I have first-hand experience. It's depressing that your go-to strategy is to reduce their freedom of choice (and inevitably, their dignity and autonomy) instead of considering whether their functional needs are adequately met. It's as if you're arguing that people who are not able to participate and compete fully in the market can't be allowed any choices whatsoever.

by cjensen 10y ago

m_mueller 10y ago

Before expanding the process to lock up people I'd have a good look at the current state of me tal health services - see the recent article about UHS about how they're abusing the system and their patient just to milk a bit more profit. Locked wards are fine IMO, but please don't allow this to for-profit institutions - same wrong incentives as for-profit prisons, i.e. current day slavery in the US.

maxerickson 10y ago

What legislation do you think most contributed to deinstitutionalization?

thraway2016 10y ago

it became hard for Psychs to institutionalize people who need help. The prospect of a society in which any psychologist can, on a whim, circumvent due process and imprison anyone against their will indefinitely, is terrifying. It's much, much better this way.

kolbe 10y ago
i agree that liberty is more important in this case, but it is important to acknowledge that the cost of liberty is the well-being of thousands (maybe millions) of mentally-ill would would otherwise be treatable.
DanBC 10y ago
>> it became hard for Psychs to institutionalize people who need help. > The prospect of a society in which any psychologist can, You've mixed up psychologist and psychiatrist. It's easy to find ways that psychiatrists can detain people against their will, and force them to undergo medical treatment against their will, that don't rely on a single doctor and that have strong protections against abuse. Something like two doctors - one of which knows the patient, plus an approved MH professional who's role is to protect the legal rights of the patient, plus free advocacy during all stages of detention to protect the legal rights, with powers of a close relative to ask for the detained person to be released; with a default position that people have capacity to make decisions about themselves, and that any limitations of capacity are limited to a single domain (I might not be able to say what happens to my money, but you should not use that to assume my capacity chose my medication is limited); with a recognition from all involved that this is a significant interference with my human rights and that we only tolerate this because it's in my best interests.
- tptacek 10y ago
  Same problem with psychiatrists. The psychiatrists associated with large-scale direct intake at hospitals are also extremely overworked and often not particularly sophisticated (psychiatrists who keep up with research and are effective practitioners can make more money outside the hospital system). In the very worst case, which is unfortunately common, you have chains like UHS operating mental health hospitals in numerous states with what appear to be quotas. You don't have to drive yourself to a UHS hospital to end up in one. Most hospitals, even the very good ones, don't do on-site psych; in many of them, if you show up for any psych reason, you'll be held and then transported to an affiliated mental health hospital. So, yes, there are very significant due process concerns with acute mental health care.
CalChris 10y ago
Psychologist no. But psychiatrist yes. Actually there's a few others who have that authority as well. Involuntary commitment, 72 hour hold. Police can do this and some mental health professionals. http://www.disabilityrightsca.org/pubs/502401.pdf http://www.disabilityrightsca.org/pubs/502401.pdf
anigbrowl 10y ago
I feel you're committing the fallacy of the excluded middle here. The current standard in which a person needs to present a danger to themselves or others also results in everyone within the mental health system being treated like they're one step away from being violent criminals, resulting in significant additional stigmatization. My best friend went through a mental health crisis earlier this spring and was involuntarily hospitalized for several weeks in virtually carceral conditions.
cjensen 10y ago
Like I said above "There needs to be strong oversight to prevent abuse". That pretty much rules out whims. We have people who talk to themselves and freeze to death in the Winter. I disagree when you say "it is better this way." There are real risks in allowing institutionalization; on the other hand, innocent people are dying from treatable mental health issues. Surely there is some middle position to be had?

millzlane 10y ago

>The "they aren't hurting anybody so leave them alone" people need to understand that they are hurting themselves and need to have their freedom of choice taken away. You bring up an interesting point. I wonder who becomes in charge of diagnosing, which ones do we choose, for how long do we lock them away? Did we use shock therapy here in the US?

DanBC 10y ago
> Did we use shock therapy here in the US? You still do! It's a useful treatment for some people with treatment resistant and severe, life threatening, depression. It's used much less often, and there are some extra bits of bureaucracy around it. And it's safer than conventional treatment for some people - pregnant women, for example.
- openasocket 10y ago
  To add to this: it's nothing at all today like it was in the 50s. Patients are not strapped down and thrashing: they are sedated and given muscle relaxants so that they don't thrash. The most common side effect is memory loss.

sedachv 10y ago

> Both parts need to change. The "they aren't hurting anybody so leave them alone" people need to understand that they are hurting themselves and need to have their freedom of choice taken away. One of the big functions of involuntary commitment to mental hospitals in pre-1950s America was for parents to put away their "troubled daughters" because of social behavior they did not approve of (promiscuity, friend circle, etc). You get glimpses of this in memoirs from the era (the most recent one I have read that comes to mind is Herbert Huncke's autobiography). This continues today for rich parents who send their children to be involuntarily committed to "residential centers," "boot camps," and certain rehab programs. This is a slippery slope that social reformers, busybodies, religious fundamentalists, etc have used to label any behavior they do not approve of, but cannot convince legislators to make against the law, as "hurting yourself" and grounds for taking freedom away. You are already most of the way down the slope by advocating for locking away drug addicts. Don't forget that Nixon's administration ramped up the drug prohibition as a way to break the civil rights and anti-war movements: https://harpers.org/archive/2016/04/legalize-it-all/ https://harpers.org/archive/2016/04/legalize-it-all/. Today a similar policy will just be used to target leftist collectives and human rights groups, anarchists, the groups that sprang out of the Occupy movement, left-wing hackers, etc. Involuntary institutionalization starts as a way to help the mentally ill, progresses through to oppression of women, and ends up as a tool of political repression (as it did in the USSR, and currently still does in Belarus).

anigbrowl 10y ago

need to have their freedom of choice taken away A lot of people undergoing mental health issues also have severe financial stress and the related economic insecurities, which end up in a vicious cycle of poverty and worsening mental health - a situation of which I have first-hand experience. It's depressing that your go-to strategy is to reduce their freedom of choice (and inevitably, their dignity and autonomy) instead of considering whether their functional needs are adequately met. It's as if you're arguing that people who are not able to participate and compete fully in the market can't be allowed any choices whatsoever.