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>I would like to hear what you propose, as an alternative for them. https://en.wikipedia.org/wiki/Assertive_community_treatment https://en.wikipedia.org/wiki/A

>I would like to hear what you propose, as an alternative for them. https://en.wikipedia.org/wiki/Assertive_community_treatment https://en.wikipedia.org/wiki/Assertive_community_treatment

vkou 8y ago
So, "Medical professionals should spend more time helping their patients." That's great. I fully endorse that. That's an improvement over them spending less time helping their patients. How does this help someone who refuses to be treated? What do you do until they are willing to be treated? Keep them on the streets?
- DanBC 8y ago
  If someone is a danger to themselves or others you can detain them and force them to take medication against their will. If they're not a danger to themselves or others you can't do either of this because they're both significant interferences with human rights. But it's important to recogise that forced hospitalisation doesn't always work, and that keeping someone banged up in hospital for two years is an expensive injustice. So you provide assertive outreach - teams that maintain contact with people who deny their illness, and who aim to work with the patient until they're ready to engage with services. https://www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2017/aug/21/assertive-outreach-team-community-care-mental-illness https://www.theguardian.com/healthcare-network/views-from-th...
  - vkou 8y ago
    > If someone is a danger to themselves or others you can detain them and force them to take medication against their will. It's possible to be someone who is not a danger to yourself, or others, and also be someone who is impossible to live next to. See: The 'harmless' guy who is screaming at invisible aliens at 3 am in the morning. Do you let that guy into the shelter? Or do you let him carry that behavior out on the street? What about the guy who is ODing over and over again? Can he be institutionalized? Or is he not being a danger to himself? When someone downs a bottle of sleeping pills once a week, we consider them suicidal, and we can mandate treatment - but shooting up heroin until you're passed out, barely breathing under an overpass isn't considered self-harm?
- jdietrich 8y ago
  >So, "Medical professionals should spend more time helping their patients." Assertive community treatment is about much more than conventional healthcare interventions. When delivered properly, it's an integrative and interdisciplinary approach that includes psychiatrists and psychiatric nurses, social workers, occupational therapists and peer mentors. People with severe mental illness need medical care, but they also need good housing, support in maintaining that housing, meaningful daily activity and a network of social support. Most of that support can be provided by non-medical practitioners. If someone is offered housing and doesn't want it, they are under no obligation to take it; they have the right to make choices about their own life, even if those choices don't seem rational. A lot of people genuinely do feel safer on the streets, which is in part a sad indictment of the standard of housing on offer to the very poorest. If someone doesn't want to work with a mental health practitioner, send a social worker. If they won't talk to a social worker, send a peer mentor. If they don't want to work with anyone, train the local police in mental health crisis management so that they can provide positive interactions. As is so often said in addiction treatment, you can't make someone want to get better. The idea that locking people up against their will consistently facilitates effective treatment is wishful thinking at best. Some people just need time, some need the right circumstances, some need a long and patient process of rapport-building. Some people are just very difficult to treat, but that doesn't mean we should either abandon them to fate or lock them up indefinitely to keep them out of sight and out of mind. There are a whole spectrum of useful, evidence-based interventions, many of which don't particularly resemble what we might think of as psychiatric care. With a bit of imagination and sufficient funding, we can deliver good outcomes for people who seem to have intractable problems.

>I would like to hear what you propose, as an alternative for them. https://en.wikipedia.org/wiki/Assertive_community_treatment https://en.wikipedia.org/wiki/Assertive_community_treatment

vkou 8y ago

So, "Medical professionals should spend more time helping their patients." That's great. I fully endorse that. That's an improvement over them spending less time helping their patients. How does this help someone who refuses to be treated? What do you do until they are willing to be treated? Keep them on the streets?

DanBC 8y ago
If someone is a danger to themselves or others you can detain them and force them to take medication against their will. If they're not a danger to themselves or others you can't do either of this because they're both significant interferences with human rights. But it's important to recogise that forced hospitalisation doesn't always work, and that keeping someone banged up in hospital for two years is an expensive injustice. So you provide assertive outreach - teams that maintain contact with people who deny their illness, and who aim to work with the patient until they're ready to engage with services. https://www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2017/aug/21/assertive-outreach-team-community-care-mental-illness https://www.theguardian.com/healthcare-network/views-from-th...
- vkou 8y ago
  > If someone is a danger to themselves or others you can detain them and force them to take medication against their will. It's possible to be someone who is not a danger to yourself, or others, and also be someone who is impossible to live next to. See: The 'harmless' guy who is screaming at invisible aliens at 3 am in the morning. Do you let that guy into the shelter? Or do you let him carry that behavior out on the street? What about the guy who is ODing over and over again? Can he be institutionalized? Or is he not being a danger to himself? When someone downs a bottle of sleeping pills once a week, we consider them suicidal, and we can mandate treatment - but shooting up heroin until you're passed out, barely breathing under an overpass isn't considered self-harm?
jdietrich 8y ago
>So, "Medical professionals should spend more time helping their patients." Assertive community treatment is about much more than conventional healthcare interventions. When delivered properly, it's an integrative and interdisciplinary approach that includes psychiatrists and psychiatric nurses, social workers, occupational therapists and peer mentors. People with severe mental illness need medical care, but they also need good housing, support in maintaining that housing, meaningful daily activity and a network of social support. Most of that support can be provided by non-medical practitioners. If someone is offered housing and doesn't want it, they are under no obligation to take it; they have the right to make choices about their own life, even if those choices don't seem rational. A lot of people genuinely do feel safer on the streets, which is in part a sad indictment of the standard of housing on offer to the very poorest. If someone doesn't want to work with a mental health practitioner, send a social worker. If they won't talk to a social worker, send a peer mentor. If they don't want to work with anyone, train the local police in mental health crisis management so that they can provide positive interactions. As is so often said in addiction treatment, you can't make someone want to get better. The idea that locking people up against their will consistently facilitates effective treatment is wishful thinking at best. Some people just need time, some need the right circumstances, some need a long and patient process of rapport-building. Some people are just very difficult to treat, but that doesn't mean we should either abandon them to fate or lock them up indefinitely to keep them out of sight and out of mind. There are a whole spectrum of useful, evidence-based interventions, many of which don't particularly resemble what we might think of as psychiatric care. With a bit of imagination and sufficient funding, we can deliver good outcomes for people who seem to have intractable problems.