5 ms·

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 i

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.

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.