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On the flip side, we have thousands of obviously mentally ill people on the street homeless because we can't commit them because of that human autonomy that you

On the flip side, we have thousands of obviously mentally ill people on the street homeless because we can't commit them because of that human autonomy that you mention. It all points to public healthcare where there is governance at a political level and not profit level.

danharaj 8y ago
> we have thousands of obviously mentally ill people on the street homeless because we can't commit them because of that human autonomy that you mention. I think there's more to it than that, if we look at some graphs over time.
- ChuckMcM 8y ago
  It is always nuanced of course. The inability to lock people up in California as a result of the patients rights act[1] had its effects, but a general backing off of mental institutions from both the Federal and State governments was a big problem. The 55% number in [1] matches up with my experience with homeless in the Bay Area. The tricky bit is that survivor bias is an issue as well as mentally ill people are less likely to 'blend in' and keep a low profile so in street encounters it can seem like a higher percentage than it is. Similarly in food kitchen lines the mentally ill are at a disadvantage if they lack planning skills to get into the line. [1] 2015 In the San Francisco Homeless Count, 55 percent of people experiencing chronic homelessness report they have emotional or psychiatric conditions. -- https://www.kqed.org/news/11209729/did-the-emptying-of-mental-hospitals-contribute-to-homelessness-here https://www.kqed.org/news/11209729/did-the-emptying-of-menta...
lylecubed 8y ago
It's unconscionable to suggest that hospitals be allowed to legally kidnap people because of something as hand wavy as 'some homeless are mentally ill'.
- PiggySpeed 8y ago
  This is a complicated issue. I've seen this happen in practice. As long as the process remains conservative and respectful of the patient, it results in better outcomes for the patient and a more peaceful society. The cases where I have seen this happen: schizophrenia, drug-induced psychosis, acute mania, dementia. Patients come out far better in an institutionalized setting, as opposed to being on the streets and walking aimlessly in dangerous traffic.
  - lylecubed 8y ago
    There's a huge, gigantic, gaping chasm between a hospital patient with no history of mental illness with two parents, neither of which have a history of mental illness, and a schizophrenic homeless person. Saying one has anything to do with the other to justify a hospital kidnapping its own patients is seriously messed up.
    - PiggySpeed 8y ago
      I was referring to your reply to outside1234's comment. His answer was in the scope of the "obviously mentally ill" population. And I addressed your reply to that. It is incorrect to take my response outside of its intended context and attempt to attack it there.
      - lylecubed 8y ago
        The context of this conversation is the mayo clinic kidnapping a patient. If you want to talk about the homeless problem outside of that context, start another post.
        PiggySpeed 8y ago
        Context change was implied as soon as the respondent began with the words "on the flip side...". The topic in this sub-tree is now about that "flip side". Discussion has expanded into new areas.
grandmczeb 8y ago
> It all points to public healthcare where there is governance at a political level and not profit level. Because no-one has ever been kidnapped for political reasons?
ams6110 8y ago
> It all points to public healthcare where there is governance at a political level and not profit level. Might want to consider that political abuse of psychiatric diagnoses to get opponents or agitators involuntarily committed to asylums or hospitals is not exactly unheard of.
- lapinot 8y ago
  This is plain stupid. A for-profit hospital will benefit from abusing any patient while a political abuse only targets a small portion of opponents. And political abuse is an issue of the counter-powers in your political system, not of the way hospitals work: a functional political system will have functional public hospitals, but a functional economy will have private hospitals whose interests diverge substantially from the patients ones.
  - Gibbon1 8y ago
    > This is plain stupid. Not stupid you are just young and ill informed. > While on a phone call with Helen Thomas about the Watergate break-in, King pulled the phone cord from the wall. She was held against her will in a California hotel room and forcefully sedated by a psychiatrist after a physical struggle with five men that left her needing stitches. https://en.wikipedia.org/wiki/Martha_Mitchell https://en.wikipedia.org/wiki/Martha_Mitchell
    - lapinot 8y ago
      I'm not saying this does not exist, i'm pretty aware that this is a real problem. I'm just saying that this remark--even if true and on point--doesn't constitute a valid argument against public hospitals since (1) this problem of public hospitals has already a much more widespread cousin in the private sector and (2) it is not intrinsically a problem of the hospital but a governance issue (which is called power abuse and has a lot of other symptoms).
      - Gibbon1 8y ago
        The US got really leery of committing people to mental hospitals on little hard evidence because the power was being widely abused. The usual argument is there options in between living on the streets and being imprisoned in a mental hospital. My brother is mildly retarded and lives in a apartment complex where there very minimal supervision. He has a car and a job and can come and go as he pleases. 'Supervision' is there mostly to protect him from 'us' not the other way around.
mikestew 8y ago
obviously mentally ill people on the street homeless because we can't commit them because of that human autonomy that you mention. Obviously mentally ill, or politically out of favor? I see what you're getting at, and I'm sympathetic. OTOH, history has shown that slope to be unbelievably steep and not very grippy, IMO. I wish I had even the remotest hint where to start to find the happy medium.
throwaway080383 8y ago
We can't commit them because mental hospitals keep getting closed.
- crankylinuxuser 8y ago
  Justifiably so. When a "hospital" has more power over penal settings and indefinite imprisonment combined with no oversight, its time for them to go. I'm sure there is a good balance here, somewhere. But what we had and now have isn't it. A better balance feels like it should include a judge, 2 doctors with at least 2 hr patient time for each, and someone else that the patient knows.
  - throwaway080383 8y ago
    The hospitals aren't being closed due to some guilt over them bearing too many similarities to the prison-industrial complex. They're being closed to save money, and the patients are thrown out on the street. Quite the opposite direction of paying more doctors to help these people.
DoreenMichele 8y ago
Some people are on the street because it is the least worst option available to them. They changed the law in part because of the horrifying conditions under which people were living who had been committed. Having slept in a tent for nearly 6 years, I would take that over de facto imprisonment in an asylum any day. I did spend 10 days in an asylum in my teens. This is not an uninformed opinion by any stretch.
- DaiPlusPlus 8y ago
  What if “asylums” were much better funded and better equipped - closer to (if not exceeding) celebrity rehab facilities than today’s popular-culture impression of an archaic asylum?
  - DoreenMichele 8y ago
    My sister actually works for the CDC and she's had cancer multiple times. She was patient zero in a study in another state from the one she lived in. One of the times she had cancer, she flew regularly to a state of the art facility for about 18 months to not die from her very aggressive form of cancer. At that time, we were still close. When we talked on the phone, we would quote some Star Trek line about "Good God Jim, you can't leave him in the hands of 20th Century medicine!" (Not the quote, but the rescue scene where the good doctor describes chemo as "sounds like the Spanish Inquisition": https://www.youtube.com/watch?v=MMaGnpVaSGQ https://www.youtube.com/watch?v=MMaGnpVaSGQ) I was in a really nice facility. I was not crazy. I was just a teenager who had been molested and raped by a relative who was not old enough to legally advocate for myself. (it's a long story) You would need to do better than merely throwing money at the problem and upgrading our current cages to cushy gilded cages for me to feel that it had some hope of being better than sleeping in a tent in the woods on my own recognizance. "Bars do not a prison make". And gilded bars do not a civilized climate make by any stretch of the imagination.
fsloth 8y ago
"obviously mentally ill people on the street homeless" The problem with forced treatment is that while there is a category of people who can be said to be in need of help, there are others who are quite within their right to do with their lives whatever they please, as long as they are not explicitly breaking the law, but prefer non-conventional life choices. The main problem with enforced norms is that it pigeonholes everyone into "standard acceptable human" categorization, and if you don't fit into it, you become an outlaw. The western societies had great fun categorizing people into various abnormality groups, leading into practical eugenics (forced sterilizatin) and forced incarceration. See for example [0]. Germany's 1940's escapades brought this arbitrary categorization fad to an end with the holocaust, where it became explicitly clear what the logical end result is when you start mass categorizing people into first-grade and second-grade citizens. I have close relatives who would have benefitted from forced treatment, but I still prefer a society that does not do this. True, there is a difference between eugenics and declaring someone 'too sick', but not that great actually since we don't really have a reliable gauge for a persons mental health - hence, it becomes arbitrary categorization based on just not falling within subjective norms of the dominating culture within society. [0] https://www.nature.com/scitable/forums/genetics-generation/america-s-hidden-history-the-eugenics-movement-123919444 https://www.nature.com/scitable/forums/genetics-generation/a...
- maze-le 8y ago
  As you pointed out: " there is a category of people who can be said to be in need of help, there are others who are quite within their right to do with their lives whatever they please". But, if you only provide help to those who need it and are willing to accept it, there would be no forced-treatment-problem like described. I am convinced that quite a few of the "homeless, mentally ill" would be willing to accept help, that they are usually denied (because of the lack of a house, job and insurance).
TomMarius 8y ago
Reposting a comment I made in another thread here: But public healthcare service is much worse in my experience. I'm forced to be a part of a public system but I'd very much prefer to be able to pay private insurance and use private hospitals. We have private hospitals, but the government insurance isn't accepted there (because the law and the system doesn't allow it) and that makes it prohibitively expensive to me even though I'm a software developer for a USA company making nearly 6 figures - I'd have more than enough money for private services, but the government demands so much that I simply don't have enough left, and so I'm forced to take the "free" services (very huge quotes as I'm paying US$1500 per month for my government health insurance specifically - it's a separate line on my tax report). Anecdotal story: One time I've driven my girlfriend to a major hospital (in the capital city of the country) because she had acute abdomen pains and the ambulance wouldn't even get there within 20 minutes (again, I live in the capital city). We spent more than 4 hours waiting before somebody even looked at her even though I tried really hard to get someone to look at her immediately, it simply wasn't possible; during our journey from the main gate to the emergency room, we were met with extreme disinterest in anything regarding our well being or providing good services at all. They sent me to a wrong building THREE TIMES while I was carrying her in hands even though I asked VERY CLEARLY where the emergency service is. When we got there, I had to pay around 100 CZK (5 USD) to even get into a queue, but no one told us, with no signs or anything around - the problem is that I specifically asked THE GUY THAT I LATER PAID TO if we need to do something. He didn't even look at me and he didn't even know where is the emergency room in his building. And then I had to pay around 50 USD for parking there for so long. I have many first-hand experiences like that, e.g. you wouldn't believe the conditions and treatment that awaits you if you need to be hospitalized (5 and more people in one room, of course no AC, one shower and 2 toilets for ~10 rooms, one electrical socket for the whole room, of course no internet, TV always on at full volume, food that couldn't even be considered leftovers from neighboring low-tier restaurants, total disinterest of nurses and straight-up anger towards patients that need anything, people often need to have their beds in the hallway because there are not enough rooms, etc). If you're pregnant, tough luck, there are literally 5 year-long queues to get into a "good" hospital (very low quality by US standards) and if you want something that is at least of average quality by US standards, you have only two options: Corruption or private - I have a whole savings account for that, but I'm a high income individual (it costs around US$50k in a private "high quality" hospital that'd be considered below average in the US, and there is no way to insure yourself against expenses in private hospitals, and even if there was, it'd be on top of the US$1500 I'm already paying). My grandfather died because of these low quality services, but of course tough luck suing anyone or getting any compensation, that's simply not possible because "that's just how it is" is considered to be acceptable defense of the hospital and the system. Even if you're successful, the biggest compensation ever granted (and that happened just once) was around US$10k. The only thing that is "good" (average compared to the US) is what we call "high-intensive hospital care", but you don't get into that very often - that's a completely separate department for people with very severe illness or very severe other problems, and of course even if you really need it, qualifying for it is very hard because there are not enough places. Fuck public healthcare services. I'm completely okay with donating (even through taxes) some sum of money so everyone can have access to healthcare, but I want to buy my own healthcare services on a free market. I live in Central Europe, btw. I expect downvotes to flow, but it'd be nice to have a discussion, so please, reply instead of downvoting if possible.
TheCoelacanth 8y ago
Have these homeless people been offered housing and treatment in a setting that preserves their autonomy and turned that down? I highly doubt it. Commitment shouldn't even be under consideration except for people who have refused treatment without confinement.

danharaj 8y ago

> we have thousands of obviously mentally ill people on the street homeless because we can't commit them because of that human autonomy that you mention. I think there's more to it than that, if we look at some graphs over time.

ChuckMcM 8y ago
It is always nuanced of course. The inability to lock people up in California as a result of the patients rights act[1] had its effects, but a general backing off of mental institutions from both the Federal and State governments was a big problem. The 55% number in [1] matches up with my experience with homeless in the Bay Area. The tricky bit is that survivor bias is an issue as well as mentally ill people are less likely to 'blend in' and keep a low profile so in street encounters it can seem like a higher percentage than it is. Similarly in food kitchen lines the mentally ill are at a disadvantage if they lack planning skills to get into the line. [1] 2015 In the San Francisco Homeless Count, 55 percent of people experiencing chronic homelessness report they have emotional or psychiatric conditions. -- https://www.kqed.org/news/11209729/did-the-emptying-of-mental-hospitals-contribute-to-homelessness-here https://www.kqed.org/news/11209729/did-the-emptying-of-menta...

lylecubed 8y ago

It's unconscionable to suggest that hospitals be allowed to legally kidnap people because of something as hand wavy as 'some homeless are mentally ill'.

PiggySpeed 8y ago
This is a complicated issue. I've seen this happen in practice. As long as the process remains conservative and respectful of the patient, it results in better outcomes for the patient and a more peaceful society. The cases where I have seen this happen: schizophrenia, drug-induced psychosis, acute mania, dementia. Patients come out far better in an institutionalized setting, as opposed to being on the streets and walking aimlessly in dangerous traffic.
- lylecubed 8y ago
  There's a huge, gigantic, gaping chasm between a hospital patient with no history of mental illness with two parents, neither of which have a history of mental illness, and a schizophrenic homeless person. Saying one has anything to do with the other to justify a hospital kidnapping its own patients is seriously messed up.
  - PiggySpeed 8y ago
    I was referring to your reply to outside1234's comment. His answer was in the scope of the "obviously mentally ill" population. And I addressed your reply to that. It is incorrect to take my response outside of its intended context and attempt to attack it there.
    - lylecubed 8y ago
      The context of this conversation is the mayo clinic kidnapping a patient. If you want to talk about the homeless problem outside of that context, start another post.
      - PiggySpeed 8y ago
        Context change was implied as soon as the respondent began with the words "on the flip side...". The topic in this sub-tree is now about that "flip side". Discussion has expanded into new areas.

grandmczeb 8y ago

> It all points to public healthcare where there is governance at a political level and not profit level. Because no-one has ever been kidnapped for political reasons?

ams6110 8y ago

> It all points to public healthcare where there is governance at a political level and not profit level. Might want to consider that political abuse of psychiatric diagnoses to get opponents or agitators involuntarily committed to asylums or hospitals is not exactly unheard of.

lapinot 8y ago
This is plain stupid. A for-profit hospital will benefit from abusing any patient while a political abuse only targets a small portion of opponents. And political abuse is an issue of the counter-powers in your political system, not of the way hospitals work: a functional political system will have functional public hospitals, but a functional economy will have private hospitals whose interests diverge substantially from the patients ones.
- Gibbon1 8y ago
  > This is plain stupid. Not stupid you are just young and ill informed. > While on a phone call with Helen Thomas about the Watergate break-in, King pulled the phone cord from the wall. She was held against her will in a California hotel room and forcefully sedated by a psychiatrist after a physical struggle with five men that left her needing stitches. https://en.wikipedia.org/wiki/Martha_Mitchell https://en.wikipedia.org/wiki/Martha_Mitchell
  - lapinot 8y ago
    I'm not saying this does not exist, i'm pretty aware that this is a real problem. I'm just saying that this remark--even if true and on point--doesn't constitute a valid argument against public hospitals since (1) this problem of public hospitals has already a much more widespread cousin in the private sector and (2) it is not intrinsically a problem of the hospital but a governance issue (which is called power abuse and has a lot of other symptoms).
    - Gibbon1 8y ago
      The US got really leery of committing people to mental hospitals on little hard evidence because the power was being widely abused. The usual argument is there options in between living on the streets and being imprisoned in a mental hospital. My brother is mildly retarded and lives in a apartment complex where there very minimal supervision. He has a car and a job and can come and go as he pleases. 'Supervision' is there mostly to protect him from 'us' not the other way around.

mikestew 8y ago

obviously mentally ill people on the street homeless because we can't commit them because of that human autonomy that you mention. Obviously mentally ill, or politically out of favor? I see what you're getting at, and I'm sympathetic. OTOH, history has shown that slope to be unbelievably steep and not very grippy, IMO. I wish I had even the remotest hint where to start to find the happy medium.

throwaway080383 8y ago

We can't commit them because mental hospitals keep getting closed.

crankylinuxuser 8y ago
Justifiably so. When a "hospital" has more power over penal settings and indefinite imprisonment combined with no oversight, its time for them to go. I'm sure there is a good balance here, somewhere. But what we had and now have isn't it. A better balance feels like it should include a judge, 2 doctors with at least 2 hr patient time for each, and someone else that the patient knows.
- throwaway080383 8y ago
  The hospitals aren't being closed due to some guilt over them bearing too many similarities to the prison-industrial complex. They're being closed to save money, and the patients are thrown out on the street. Quite the opposite direction of paying more doctors to help these people.

DoreenMichele 8y ago

Some people are on the street because it is the least worst option available to them. They changed the law in part because of the horrifying conditions under which people were living who had been committed. Having slept in a tent for nearly 6 years, I would take that over de facto imprisonment in an asylum any day. I did spend 10 days in an asylum in my teens. This is not an uninformed opinion by any stretch.

DaiPlusPlus 8y ago
What if “asylums” were much better funded and better equipped - closer to (if not exceeding) celebrity rehab facilities than today’s popular-culture impression of an archaic asylum?
- DoreenMichele 8y ago
  My sister actually works for the CDC and she's had cancer multiple times. She was patient zero in a study in another state from the one she lived in. One of the times she had cancer, she flew regularly to a state of the art facility for about 18 months to not die from her very aggressive form of cancer. At that time, we were still close. When we talked on the phone, we would quote some Star Trek line about "Good God Jim, you can't leave him in the hands of 20th Century medicine!" (Not the quote, but the rescue scene where the good doctor describes chemo as "sounds like the Spanish Inquisition": https://www.youtube.com/watch?v=MMaGnpVaSGQ https://www.youtube.com/watch?v=MMaGnpVaSGQ) I was in a really nice facility. I was not crazy. I was just a teenager who had been molested and raped by a relative who was not old enough to legally advocate for myself. (it's a long story) You would need to do better than merely throwing money at the problem and upgrading our current cages to cushy gilded cages for me to feel that it had some hope of being better than sleeping in a tent in the woods on my own recognizance. "Bars do not a prison make". And gilded bars do not a civilized climate make by any stretch of the imagination.

fsloth 8y ago

"obviously mentally ill people on the street homeless" The problem with forced treatment is that while there is a category of people who can be said to be in need of help, there are others who are quite within their right to do with their lives whatever they please, as long as they are not explicitly breaking the law, but prefer non-conventional life choices. The main problem with enforced norms is that it pigeonholes everyone into "standard acceptable human" categorization, and if you don't fit into it, you become an outlaw. The western societies had great fun categorizing people into various abnormality groups, leading into practical eugenics (forced sterilizatin) and forced incarceration. See for example [0]. Germany's 1940's escapades brought this arbitrary categorization fad to an end with the holocaust, where it became explicitly clear what the logical end result is when you start mass categorizing people into first-grade and second-grade citizens. I have close relatives who would have benefitted from forced treatment, but I still prefer a society that does not do this. True, there is a difference between eugenics and declaring someone 'too sick', but not that great actually since we don't really have a reliable gauge for a persons mental health - hence, it becomes arbitrary categorization based on just not falling within subjective norms of the dominating culture within society. [0] https://www.nature.com/scitable/forums/genetics-generation/america-s-hidden-history-the-eugenics-movement-123919444 https://www.nature.com/scitable/forums/genetics-generation/a...

maze-le 8y ago
As you pointed out: " there is a category of people who can be said to be in need of help, there are others who are quite within their right to do with their lives whatever they please". But, if you only provide help to those who need it and are willing to accept it, there would be no forced-treatment-problem like described. I am convinced that quite a few of the "homeless, mentally ill" would be willing to accept help, that they are usually denied (because of the lack of a house, job and insurance).

TomMarius 8y ago

Reposting a comment I made in another thread here: But public healthcare service is much worse in my experience. I'm forced to be a part of a public system but I'd very much prefer to be able to pay private insurance and use private hospitals. We have private hospitals, but the government insurance isn't accepted there (because the law and the system doesn't allow it) and that makes it prohibitively expensive to me even though I'm a software developer for a USA company making nearly 6 figures - I'd have more than enough money for private services, but the government demands so much that I simply don't have enough left, and so I'm forced to take the "free" services (very huge quotes as I'm paying US$1500 per month for my government health insurance specifically - it's a separate line on my tax report). Anecdotal story: One time I've driven my girlfriend to a major hospital (in the capital city of the country) because she had acute abdomen pains and the ambulance wouldn't even get there within 20 minutes (again, I live in the capital city). We spent more than 4 hours waiting before somebody even looked at her even though I tried really hard to get someone to look at her immediately, it simply wasn't possible; during our journey from the main gate to the emergency room, we were met with extreme disinterest in anything regarding our well being or providing good services at all. They sent me to a wrong building THREE TIMES while I was carrying her in hands even though I asked VERY CLEARLY where the emergency service is. When we got there, I had to pay around 100 CZK (5 USD) to even get into a queue, but no one told us, with no signs or anything around - the problem is that I specifically asked THE GUY THAT I LATER PAID TO if we need to do something. He didn't even look at me and he didn't even know where is the emergency room in his building. And then I had to pay around 50 USD for parking there for so long. I have many first-hand experiences like that, e.g. you wouldn't believe the conditions and treatment that awaits you if you need to be hospitalized (5 and more people in one room, of course no AC, one shower and 2 toilets for ~10 rooms, one electrical socket for the whole room, of course no internet, TV always on at full volume, food that couldn't even be considered leftovers from neighboring low-tier restaurants, total disinterest of nurses and straight-up anger towards patients that need anything, people often need to have their beds in the hallway because there are not enough rooms, etc). If you're pregnant, tough luck, there are literally 5 year-long queues to get into a "good" hospital (very low quality by US standards) and if you want something that is at least of average quality by US standards, you have only two options: Corruption or private - I have a whole savings account for that, but I'm a high income individual (it costs around US$50k in a private "high quality" hospital that'd be considered below average in the US, and there is no way to insure yourself against expenses in private hospitals, and even if there was, it'd be on top of the US$1500 I'm already paying). My grandfather died because of these low quality services, but of course tough luck suing anyone or getting any compensation, that's simply not possible because "that's just how it is" is considered to be acceptable defense of the hospital and the system. Even if you're successful, the biggest compensation ever granted (and that happened just once) was around US$10k. The only thing that is "good" (average compared to the US) is what we call "high-intensive hospital care", but you don't get into that very often - that's a completely separate department for people with very severe illness or very severe other problems, and of course even if you really need it, qualifying for it is very hard because there are not enough places. Fuck public healthcare services. I'm completely okay with donating (even through taxes) some sum of money so everyone can have access to healthcare, but I want to buy my own healthcare services on a free market. I live in Central Europe, btw. I expect downvotes to flow, but it'd be nice to have a discussion, so please, reply instead of downvoting if possible.

TheCoelacanth 8y ago

Have these homeless people been offered housing and treatment in a setting that preserves their autonomy and turned that down? I highly doubt it. Commitment shouldn't even be under consideration except for people who have refused treatment without confinement.