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American Emergency Rooms Confront a Crisis of Violence
- booleandilemma 7y ago“I have seen a colleague kicked in the face; I’ve seen a nurse kicked in the chest and have to get medical treatment. I’ve seen patients spit on people and throw urine across the room,” he added Why is our society so tolerant of this? Why should anyone, let alone an educated, working professional have to put up with this?
- tristanstcyr 7y agoWhat solution do you propose?
- oh_sigh 7y agoInvoluntary mental health treatment.
- henryfjordan 7y agoUnder the UN Declaration on the Rights of Disabled Persons, that's unethical. Also historically "Involuntary mental health treatment" in the US has not been humane. We should strive to have compassion for the homeless and ill, not imprison them.
- sincerely 7y agoSomething something your right to compassion ends where your fist hits my face something something
- throwaway-hn123 7y agosomething something you're an ignorant dickhead who is probably a snivelling coward something something
- GhostVII 7y agoYou can give people a choice between either being prosecuted as a mentally healthy person, or getting mental health treatment. It's not involuntary but gives mentally disabled people a way to get help.
- zdragnar 7y ago> a choice It's a nice thought, and should probably be an option, but it won't be sufficient on its own, I don't think. Would it surprise you to learn that many with severe mental illnesses do not voluntarily undergo treatment? A friend worked in a job training and support program, first with chronically homeless, and then with mentally disabled specifically. The single biggest obstacle most faced was their own unwillingness to accept or stick with treatment. The homeless in particular that this friend worked with were untrusting of any program that might potentially hinder their autonomy- so they would show up for the free bus cards, food and job training, but any hint of medical support and they would disappear for fear of being taken off the street and locked up. Most, given the choice between jail or treatment, would choose jail, simply because there was a defined time period that they would get their freedom back, plus no pills.
- oh_sigh 7y agoYou're not giving them involuntary mental health treatment because you deem them ill - you do it because they are mentally ill AND have kicked a nurse in the chest and threw feces at others.
- closeparen 7y agoIs carte blanche to wander the streets of San Francisco and menace pedestrians really more humane or compassionate?
- nikanj 7y agoHow about some compassion for the victims, too? They get spit at, insulted, their belongings stolen, and their property vandalized. And we mostly guilt them for not turning the other cheek more gracefully.
- nickles 7y ago> Involuntary mental health treatment. It can be dangerous to give governments carte blanche to do this... > Sluggish schizophrenia or slow progressive schizophrenia was a diagnostic category used in the Soviet Union to describe what was claimed to be a form of schizophrenia characterized by a slowly progressive course; it was diagnosed even in patients who showed no symptoms of schizophrenia or other psychotic disorders, on the assumption that these symptoms would appear later. The diagnosis has long been discredited because of its scientific inadequacy and its use as a means of confining dissenters. It is considered a prime example of the political abuse of psychiatry in the Soviet Union. [0] https://en.m.wikipedia.org/wiki/Sluggish_schizophrenia https://en.m.wikipedia.org/wiki/Sluggish_schizophrenia
- oh_sigh 7y agoI'm talking about after they've already broken the law - not just when some doctor declares they are ill. I assumed intentionally, violently kicking a person in the chest to the point where they medical intervention is illegal.
- tomcam 7y agoHow about being prosecuted for assault and battery?
- fzeroracer 7y agoThink about this for a moment. You prosecute someone that's mentally ill and send them to jail. Now the jail has to deal with violent outbursts and is generally not equipped to handle people on a medical level like that. Our prison system is designed to punish people, so those people if they get out of jail fall back into the same issues. The answer to solve these problems is better preventative care. Meaning better healthcare for vulnerable populations, better solutions to housing for the homeless and so forth. Unfortunately solutions like this require things like increased taxes or recognizing the problem exists and many would prefer to just sweep it under the rug for people in emergency rooms and jails to deal with.
- creato 7y agoOnce someone commits a serious crime like battery, they need to either go to jail, or be involuntarily committed to some other kind of institution.
- fzeroracer 7y agoExcept, again, that doesn't solve the problem. They go to jail for a year or two, become a handful for people in prison to handle (whom are not equipped to handle people with severe mental illness), are released and then the cycle continues. Or even then, those inmates are admitted to those same hospitals because where else do you think people get proper treatment? None of this discussion solves the actual problem at hand, it just deals with the symptoms. Eventually the problem will become uncontrollable if you just ignore the actual damn reasons why people with said issues end up becoming homeless or violent in the first place.
- closeparen 7y agoWhen the symptoms include unacceptable impacts on other people, they still have to be dealt with. We can and should chip away at risk factors, but the human brain is wickedly complex and we're never going to get 100% health and behavior within norms. Just like we can and should encourage exercise and healthy diets, but we're still going to need the medical system.
- GhettoMaestro 7y agoLocking up crazy fuckers. Shocking idea I know.
- ars 7y agoHow do you know in advance who they are?
- timbit42 7y agoDon't need to.
- GhettoMaestro 7y agoYou don't. But after a certain number of violent interactions that point to a mental health, I wager to say it does not take a rocket scientist to draw a conclusion.
- jacobwilliamroy 7y agoYou really shouldn't incarcerate an animal unless you're prepared to accept the responsibility of taking care of that animal. A human needs food, water, shelter, clothing, medical services. If you're holding a bunch of humans in one place, against their will, you're gonna need to use force which means you're also buying weapons, guards, training for the guards, facilities for the guards. In order to coordinate all this spending you need computers, administrators, office spaces. Because insanity is usually incurable, you would be taking care of these people from the date of their incarceration, for the rest of their natural lives. Are you ready for that responsibility? Is anybody? My community has been routinely fucking this up for decades and they have a couple hundred-million dollars to play with. What about yours?
- thrower123 7y agoIf an animal is violent and a threat to others, you put it down, you don't keep it in a cage forever. Generally, people get uncomfortable with that idea when it is extrapolated to people.
- wisty 7y agoThere's 3 main factors talked about in deterrence theory - severity, certainty, and speed. The US generally has severe enough punishments, and increases do little to add deterrence (and the downsides then take over). Certainty and speed are weak though. People drive in a civilised manner because if you don't, a cop will write you out a ticket. But if people behave in an uncivilised manner in a more criminal way, it's actually unconstitutional to have swift and certain penalties. People are fine arguing that the 2nd amendment was more appropriate for the era of muskets. Maybe the 5th is more appropriate for an era where overly harsh sentences were applied to political prisoners through the use of torture.
- nordsieck 7y ago> What solution do you propose? Ban those people from emergency services.
- TheGallopedHigh 7y agoThis would not be a good measure of society.
- austincheney 7y agoThe best measure of society is compromise and social valor. Those who have neither deserve none.
- happytoexplain 7y agoI can't tolerate the concept that people don't "deserve" basic things like health treatment based on their behavior. It's sick to me, and a hallmark of a sick society.
- thrower123 7y agoHealth treatment isn't really a basic thing. I find it really bizarre how people keep trying to write in more and more luxury goods as god-given rights. Whenever I think of rights, it is things that society and other people must not do, rather than something that other people must provide for me.
- kwhitefoot 7y agoThink of it as a duty. Love thy neighbour and all that.
- austincheney 7y agoYou are saying people deserve a certain level of care regardless of their harassing behavior while waiting for such care and that you are utterly intolerant of any disagreement. A sick society is one that cannot handle minor disagreements.
- brightball 7y agoSecurity personnel at hospitals who have the right to restrain violent patients until police arrive, while continuing to treat them if necessary. If nothing else, it should be clear that the behavior will result in immediate corrective action. If it’s not, then there’s no deterrent at all.
- sandworm101 7y agoThe mentally ill do not respond to rationality. The threat of police violence means nothing to someone in crisis sever enough to be in an ER.
- brightball 7y agoBut the ability of hospital staff to feel protected is still a lot better than the alternative.
- candiodari 7y agoCome on. Let's take the definition of mental illness in this article: "declining communities must respond to drug abuse, homelessness, and antisocial behavior" A significant cause of drug abuse is chronic untreated pain, another significant cause is addiction CAUSED by medical treatment (the so-called opioid crisis), and of course neither homelessness nor antisocial behavior are even remotely mental problems. In short, VERY few of these people have mental illnesses other than being poor. In other words what this article is complaining about are ... economic problems that cause people to become more desperate, less willing to compromise and all of those economic problems must of course be mental illnesses. Futurama put it best: https://getyarn.io/yarn-clip/ec2178ed-acf0-4aab-9141-2c17d11b4a4e https://getyarn.io/yarn-clip/ec2178ed-acf0-4aab-9141-2c17d11... All of this of course means that the vast majority of "mentally ill" do not have any problem responding rationally. Their rational responses are simply not what the clinic and/or other people want to see. For example panicked responses to not receiving treatment for a child because they have no alternative. The article reports that ERs let some people wait for weeks before any actual medical care was provided, then complain these people protest, and at some point protest strongly, even violently.
- thrower123 7y agoGetting the big guys in the white suits with butterfly nets back on staff would seem to be a good step. It's sad that we need bouncers for the ER, but here we are.
- deleted 7y ago[deleted]
- gowld 7y agoWhy do uneducated, unworking, or nonprofessionals deserve it more? That's sick.
- deleted 7y ago[deleted]
- Animats 7y agoThe US used to have places to send those people. Santa Clara, CA had "The Great Asylum for the Insane".[1] Later "Agnews State Mental Hospital", then "Agnews Developmental Center", and finally demolished for a Sun Microsystems facility. It was the classic "funny farm" in a rural area, with impressive architecture. This was the early 20th century solution to homeless crazies. Was it better than what we have now? [1] https://en.wikipedia.org/wiki/Agnews_Developmental_Center https://en.wikipedia.org/wiki/Agnews_Developmental_Center
- gowld 7y agoFrankly, I don't trust healthcare leadership to people who call a suffering human "a crazy", and that's why those places were shut down. Society reaps what it sows.
- cmiles74 7y agoThe "state hospital" in my area was shut down in the eighties. It turns out that many of their treatments were ineffective and inhumane. I believe there is still a support group for former patients that is active.
- randogogogo 7y agoI don't know how much truth there is to it, but people I've known that worked in metal health institutions have complained that they're systemically being shut down with no where for the patients to go. They say that often patients end up being handled by police, EMTs, and medical workers. None of which are particularly expert in dealing with mental health issues.
- agumonkey 7y agoSimilar issues in France right now
- cm2187 7y agoWas about to make that very comment. I think it probably has more to do with the drop in civility in western societies than anything US centric.
- epiphanitus 7y agoIs France also dealing with an opiod crisis? That might explain it
- agumonkey 7y agoNo the underlying causes are different. Social tensions, budget cuts, inadequate management... all these leads to delays and mishaps in emergency rooms. To a level we've never seen before (forgotten elder died after too many hours unattended).
- patientplatypus 7y agoWell...doctors and nurses are some of the highest paid people in the US and these problems are directly caused by a lack of a social safety net and mental health care. It's like they took the Hippocratic oath and didn't think it applied to not bankrupting people for getting sick. Color me completely unsympathetic.
- el_dev_hell 7y agoYou're "completely unsympathetic" that ER nurses (making a little over minimum wage in some cases) and on-call doctors are getting assaulted at work?
- HarryHirsch 7y agoA few years back, my wife had to go to the ER due to sudden life-threatening illness. They were getting ready to stabilize her (barely) and turf her out because of an issue with health insurance (my employer was happy enough to take the premium out of the paycheck but never informed the insurance). It took a lot of pleading to keep her that night. A young black guy might well have been arrested. Right now I am dealing with fantasy bills from an ER visit a few months ago. The whole medical-industrial complex can die right now. I have no sympathies for anyone in it. If they get assaulted in the course of work, they earned it many times over.
- mikeash 7y agoI can totally see being upset with the people in administration and billing. But how can you be that upset with the doctors and nurses, when your whole complaint is that you wanted more of their attention?
- HarryHirsch 7y agoThe physicians and nurses are the public face of the healthcare mess. It's only natural that they would attract ire. You go to the physician and you know they'll overbill you. It's sickening. You get angry the moment you walk through the door.
- olivermarks 7y agoIt's not just emergency rooms, example of a food store in San Francisco: '...When I sit down with Desaulniers, he's tired and stressed and the deep creases between his brow are furrowed. In our brief meeting, I get an up-close look at how much he's juggling by the number of people who approach him as we're talking at one of the tables in the grocery store's cafe. For starters, there's the worker who has arrived to fix the $4,000 broken window due to a robbery early that morning. There's also an investigator from the District Attorney's office who drops by to share that a customer who bit Desaulniers in the arm is being subpoenaed (This is the second customer who bit him). And there's the employee who asks him to deal with an uncontrollable customer who is shoplifting and hollering that he needs to use the bathroom'. https://www.sfgate.com/bayarea/article/SoMa-San-Francisco-Harvest-Urban-Market-drugs-14450121.php https://www.sfgate.com/bayarea/article/SoMa-San-Francisco-Ha...
- omfgwhat 7y agoThis isn't limited to ERs. I have a close friend that works as a nurse at Stanford (not in the ER) and the treatment they have to endure there is insane. Patients have punched her, spit on her, asked her for sexual favors, massages, and the list goes on. Worse, Stanford wants their nurses to treat patients like hotel guests which makes matters worse. The staff has no recourse when patients act this way. Seeing all of the sexual harassment backlash in Silicon Valley makes me wonder why it hasn't applied to places like hospitals - it's as if this treatment is expected and hospitals are immune because they're seen as a last resort for sick people. Where else do you send them?
- golemiprague 7y agoThere was no sexual harassment backlash in silicon valley because there was no a particular sexual harassment issue in silicon valley which probably the safest industry for women to work. What happened in silicon valley was that women didn't want to put the time and effort to become good programmers, partly because of lack of interest and partly because they didn't deem the geeks as a cool group to hang up with. But then they realised those geeks are making a lot of money and on the way changing the world so they tried to jump on the bandwagon in the only way they know, shaming. The funny thing, it still doesn't work for them because you still need to put the time and effort and to take the risks and to build companies from the ground, so they prefer to be nurses or doctors where there is much more sexual harassment but they couldn't care less because that's not what it was all about in the first place.
- cm2187 7y agoPresumably the people making those offenses aren’t educated computer science students (referring to the parallel with the Sillicon Valley).
- cyberferret 7y agoThe one thing that I find hard to believe in our society these days is the amount of violence shown to medical teams in hospital emergency rooms and also first responders and paramedics who are trying to save lives in the field. It is endemic here in Australia too, not just the US. I grew up in South East Asia, where I and my friends were taught to pretty much revere the people in this line of work. I guess it is still that way in those countries too, highlighted by a recent video of the protests in Hong Kong where huge crowds of protesters would willingly make way for ambulances to get to casualties in the crowd. Is it something that we need to ingrain to our kids as they are growing up, so that they have more empathy? It astounds me that a paramedic friend of mine was recently kicked and punched by 2 "friends" of an unconscious person as she tried to save his life on the street. She says it is a really common thing nowadays. Where is your mindset at when you try to prevent someone from saving your friend's life?
- cmiles74 7y agoThis article fails to mention that ER departments tend to be underfunded; hospitals typically do not generate much revenue through ER departments and they are often blamed for losing money. There are many articles out there, this is just the first one I grabbed. https://www.beckershospitalreview.com/finance/7-things-to-know-about-emergency-department-profitability.html https://www.beckershospitalreview.com/finance/7-things-to-kn... https://www.commonwealthfund.org/publications/newsletter-article/emergency-rooms-labeled-biggest-crisis-american-health-care https://www.commonwealthfund.org/publications/newsletter-art... With little motivation to staff up, this seems like the predictable outcome.
- creato 7y agoWhy is this relevant at all? Why is violence in an ER a predictable outcome of understaffing? That makes no sense.
- cmiles74 7y agoLess staff means higher wait times, long wait times lead to frustrated and angry patients. People with mental health issues might be less able to manage a longer and more stressful visit. Exhausted providers might me less effective managing upset patients. And so on. This article calls out people with mental health or drug addiciton specifically. "As doctors and nurses administer care, they risk physical assaults from drug-addicted or emotionally disturbed persons"
- brippalcharrid 7y agoMental illness exacerbated by drug use that leads to ER visits is a pretty disordered state of affairs to begin with. There are plenty of legitimate reasons that would make sense for a person to wait an hour or so in an ER once they have been stablised/triaged, such a for observation, further diagnostic tests, or the attention of a particular specialist. An otherwise-healthy person can generally deal with this without getting violent, even if they're feeling a bit stressed, but if someone's tripping balls and being chased by robotic dinosaurs, then it's no wonder that people are acting out and behaving in ways that transgress social norms.