5 ms·

> Most of these people aren't "incompatible with peaceful society", they just need help and can't get it Do you have any source that most of these people can't

by ascar 8y ago

> Most of these people aren't "incompatible with peaceful society", they just need help and can't get it Do you have any source that most of these people can't get it? With a father who outright refused any medical help unless basically forced on him, in a country where it's completely free, I can absolutely relate to the argument that not having involuntary psychatric treatment plays a big part here. And his mental state was only a minor part of his health issues. It's not nice to be in stationary psychatric treatment. These are horrible places you want to leave as soon as possible. But it sometimes can't be helped. I can even relate to the point that it's better for (some/most of) these people to live on the streets than in a psychatric facility, while it's probably worse for society as a whole.

jdietrich 8y ago
There's a world of difference between "having access to medical care" and "having access to appropriate care for a disorder that presents particular obstacles in accessing conventional care pathways". Access to care in the US is highly inconsistent, because there's a patchwork of providers and funders. Effective care for people with severe and enduring mental illness needs to be patient-led but assertive - we're not going to lock you up unless it's genuinely in your best interests, but we're not going to let you slip through the cracks either. Compulsory inpatient treatment is a necessary last resort where people pose a clear and immediate risk, but it should not be the basis of care for severe and enduring mental illness. The issues regarding involuntary treatment in the US are highly complex, but the evidence indicates that involuntary community treatment does not make a significant difference in clinical outcomes. Forcing people to attend appointments or take medication doesn't seem to result in any long-term benefit on aggregate. Some people do benefit (at least in the short term) from being treated against their will, but compulsion undermines the relationship of trust between care providers and service users and discourages people from engaging with care. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8182.pdf https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8... https://en.wikipedia.org/wiki/Assertive_community_treatment https://en.wikipedia.org/wiki/Assertive_community_treatment https://www.cochrane.org/CD004408/SCHIZ_compulsory-community-and-involuntary-outpatient-treatment-people-severe-mental-disorders https://www.cochrane.org/CD004408/SCHIZ_compulsory-community...
- tathougies 8y ago
  > significant difference in clinical outcomes But by removing these peiple from the streets nd the libraries, even if they are not cured themselves, we avoid a librarian -- a productive member of society -- from developing PTSD.
  - scruple 8y ago
    My (controversial?) opinion is that the civil commitment laws aren't good enough. A (mentally ill) person shouldn't have to become a danger to others or themselves before a serious conversation about involuntary commitment can be had. And I acknowledge and fully accept that this is a very rough position to hold today. But, it is born out of over a decade of direct personal experience. It's come from watching the state of California continually fail to provide adequate support to my clinically diagnosed family member, to our family as people who care about this person, as well as failing to protect to public from him time and time again.
  - mercer 8y ago
    but we're also conveniently shielded from having to come up with actual good and humane solutions to the problems these people have. I don't think the benefits are worth the cost. We have a long history of simply 'hiding' people who were inconvenient and/or problematic, where in many cases various forms of treatment have essentially solved the problem. I personally remember a time where kids with AD(H)D were sent to 'special schools', lumped together with others who often had more severe problems, for example. I definitely think things got a bit better now that we found ways to keep these kids integrated in society.
PaulHoule 8y ago
I've known quite a few people who were suicidal who had a hard time getting care. One 30-something women who was on medicaid, suicidal, history of opioid addiction and (I believe, based on her living with us for 1.5 years and my reading everything I could about psychiatric diagnosis) schizoaffective showed up at the hospital and got discharged 48 hours later. She killed herself a month after that. She was unable to work, even unable to get up in the morning and smoke a cig sometimes even though she was addicted to tobacco. A 50-something man I knew drank antifreeze, presented at the ER. Was discharged 48 hours later. His family wondered where he was in that time. People in the ER don't take suicide attempts seriously because they have a few "frequent fliers" who take a handful of pills every week. He gets a referral to a psychiatrist two weeks later. Has to fill out his name and birthday 20 times, gets asked questions like that over and over again, has an argument with a nurse, is underwhelmed with the doctor... That night we get a call from his wife and they don't know where he is. We told her to call the police, she did, they kicked down the door to the garage and found he was hanging.
deleted 8y ago
[deleted]
DoreenMichele 8y ago
There are a lot of conditions for which we don't have good answers. If you have something the world doesn't know how to fix, the reality is you aren't getting the help you need even in a good system. In the US, this gets compounded by systemic issues.

by ascar 8y ago

jdietrich 8y ago

There's a world of difference between "having access to medical care" and "having access to appropriate care for a disorder that presents particular obstacles in accessing conventional care pathways". Access to care in the US is highly inconsistent, because there's a patchwork of providers and funders. Effective care for people with severe and enduring mental illness needs to be patient-led but assertive - we're not going to lock you up unless it's genuinely in your best interests, but we're not going to let you slip through the cracks either. Compulsory inpatient treatment is a necessary last resort where people pose a clear and immediate risk, but it should not be the basis of care for severe and enduring mental illness. The issues regarding involuntary treatment in the US are highly complex, but the evidence indicates that involuntary community treatment does not make a significant difference in clinical outcomes. Forcing people to attend appointments or take medication doesn't seem to result in any long-term benefit on aggregate. Some people do benefit (at least in the short term) from being treated against their will, but compulsion undermines the relationship of trust between care providers and service users and discourages people from engaging with care. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8182.pdf https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8... https://en.wikipedia.org/wiki/Assertive_community_treatment https://en.wikipedia.org/wiki/Assertive_community_treatment https://www.cochrane.org/CD004408/SCHIZ_compulsory-community-and-involuntary-outpatient-treatment-people-severe-mental-disorders https://www.cochrane.org/CD004408/SCHIZ_compulsory-community...

tathougies 8y ago
> significant difference in clinical outcomes But by removing these peiple from the streets nd the libraries, even if they are not cured themselves, we avoid a librarian -- a productive member of society -- from developing PTSD.
- scruple 8y ago
  My (controversial?) opinion is that the civil commitment laws aren't good enough. A (mentally ill) person shouldn't have to become a danger to others or themselves before a serious conversation about involuntary commitment can be had. And I acknowledge and fully accept that this is a very rough position to hold today. But, it is born out of over a decade of direct personal experience. It's come from watching the state of California continually fail to provide adequate support to my clinically diagnosed family member, to our family as people who care about this person, as well as failing to protect to public from him time and time again.
- mercer 8y ago
  but we're also conveniently shielded from having to come up with actual good and humane solutions to the problems these people have. I don't think the benefits are worth the cost. We have a long history of simply 'hiding' people who were inconvenient and/or problematic, where in many cases various forms of treatment have essentially solved the problem. I personally remember a time where kids with AD(H)D were sent to 'special schools', lumped together with others who often had more severe problems, for example. I definitely think things got a bit better now that we found ways to keep these kids integrated in society.

PaulHoule 8y ago

I've known quite a few people who were suicidal who had a hard time getting care. One 30-something women who was on medicaid, suicidal, history of opioid addiction and (I believe, based on her living with us for 1.5 years and my reading everything I could about psychiatric diagnosis) schizoaffective showed up at the hospital and got discharged 48 hours later. She killed herself a month after that. She was unable to work, even unable to get up in the morning and smoke a cig sometimes even though she was addicted to tobacco. A 50-something man I knew drank antifreeze, presented at the ER. Was discharged 48 hours later. His family wondered where he was in that time. People in the ER don't take suicide attempts seriously because they have a few "frequent fliers" who take a handful of pills every week. He gets a referral to a psychiatrist two weeks later. Has to fill out his name and birthday 20 times, gets asked questions like that over and over again, has an argument with a nurse, is underwhelmed with the doctor... That night we get a call from his wife and they don't know where he is. We told her to call the police, she did, they kicked down the door to the garage and found he was hanging.

deleted 8y ago

[deleted]

DoreenMichele 8y ago

There are a lot of conditions for which we don't have good answers. If you have something the world doesn't know how to fix, the reality is you aren't getting the help you need even in a good system. In the US, this gets compounded by systemic issues.