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This isn't changed by an arrest being the first step. As an EMT I frequently transported people to hospitals (or from hospitals to psychiatric facilities) follo

This isn't changed by an arrest being the first step. As an EMT I frequently transported people to hospitals (or from hospitals to psychiatric facilities) following their arrest. This just avoids the extraordinary cost to both society and the individual that comes along with an arrest being part of the process. The medical authoritarian system you're worried about already exists and frankly I saw no evidence of its abuse. Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released - which is a far cry from having healed or become functioning members of society.

Breza 6y ago
Very well said!
imperio59 6y ago
Psychiatry does not know how to cure mental illness. At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects. Investing more money into this doesn't solve the societal issues which come from drug addiction, lack of economic opportunity, a failing education system, etc I would rather see us focus on fixing schools and the economy than spend billions on these programs that have dubious outcomes
- Talanes 6y ago
  >I would rather see us focus on fixing schools and the economy than spend billions on these programs that have dubious outcomes I couldn't find an exact number in the five minutes of searching I was willing to put in, but the budget seems to be in the single digit millions, a far cry from billions.
  - vidarh 6y ago
    And it also ignores that the alternative here is not "do nothing" but "send police instead", which also costs. And if it leads to arrests it costs even more. And if people end up getting a criminal record, it tends to reduce their long term employment prospect, and as a result reduce tax revenue/increase welfare costs. There seems to be plenty of potential for this to save money over time.
- pm90 6y ago
  You can do both, and indeed they are both required. Fixing schools and the economy are the long term solution but we can’t let people be subjected to the inhumanity of our criminal justice system that exists today (especially if they’re part of a minority).
  - dkdk8283 6y ago
    Being a minority has no bearing here: it’s just as tough on all humans.
    - triceratops 6y ago
      That's not true, actually. Statistically minorities fare worse in their encounters with the justice system.
      - dkdk8283 6y ago
        Citation please.
        cycomanic 6y ago
        Not sure if you are genuine this was discussed at lot in the last year, below are two. https://www.washingtonpost.com/news/wonk/wp/2017/11/16/black-men-sentenced-to-more-time-for-committing-the-exact-same-crime-as-a-white-person-study-finds/ https://www.washingtonpost.com/news/wonk/wp/2017/11/16/black... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614457/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614457/
        cycomanic 6y ago
        So people are downvoting this because I provided citations that the GP asked for, seriously?!
        CryptoPunk 6y ago
        Counter-evidence from a controlled experiment: https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=267470 https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=2674... tl;dr police were 25 times less likely to shoot an unarmed suspect in a simulation, if that suspect was black instead of white. A little bit of common sense explains why. It would simply be inconceivable that the officer who shot Daniel Shaver to death would have been acquitted had Shaver been black instead of white. The kind of social backlash that an acquittal in such a case would elicit would ensure the political and judicial system punish the officer.
- GavinMcG 6y ago
  Fine. In the meantime, any objection to taking billions from a program that has dubious outcomes and involves violence and a permanent criminal record, and shifting it toward one that has dubious outcomes but doesn't?
  - deleted 6y ago
    [deleted]
  - artificialLimbs 6y ago
    Most 'permanent' criminal records can be expunged. When you are incarcerated against your will in a mental institute, you lose firearm privileges permanently (for real), deservedly or not. Seems like a great avenue for disarming the populace if the government needed to turn dictatorship.
    - hattar 6y ago
      Consider how many people would need to be incarcerated against their will to make this work. Disarming the American populace would be nearly impossible by far more effective means. Taking this approach would be incredibly ineffective.
    - asdfasgasdgasdg 6y ago
      You still seem to be missing the fact that there is no additionality here. If the current system would put you in a psych ward, the prior system would arrest you then put you in a psych ward, which most folks would agree is strictly worse.
    - danShumway 6y ago
      And what are the actual stats on that? I'm willing to make a pretty safe bet that there are far more people in the US who have criminal records than have been committed to institutions against their will. I doubt it's even a contest, I'm seeing rough estimations online as high as 1/4 of the entire adult male population in the US. And I'm also willing to make a pretty safe bet that the proportion of those criminal records that actually get expunged is a lot lower than you're making it sound like. And lastly, I'm willing to make a bet that overall, the long-term effects of even a short criminal record are roughly comparable to the long-term effects of involuntary commitment. Yes, we can have a conversation about firearm privileges, that's worth talking about. But let's also not forget that the most immediate effects of a criminal record are things like loss of income, housing, and the ability to find employment, which can have an extremely significant effect on your entire future. In comparison, most employers will not ask you questions about your mental history. And again -- you can still get involuntarily committed to an institution after you're arrested. The only difference is that now you have two problems instead of one, both a mental health record and a criminal record.
- scythe 6y ago
  >Psychiatry does not know how to cure mental illness Psychiatry doesn't know how to cure mental illness and oncology doesn't know how to cure cancer, but they both work a lot better than the supplement aisle.
  - imperio59 6y ago
    Agree for the case of oncology. Disagree for psychiatry. The evidence is mounting that vitamins may actually be just as good a treatment for most people with mild depression or other similar ailments vs SSRIs and other psychiatric drugs. Sources: SSRIs don't work better than placebos for mild to moderate depression Study https://www.ncbi.nlm.nih.gov/pubmed/18303940 https://www.ncbi.nlm.nih.gov/pubmed/18303940 Low B12 and Folic Acid are associated with Depression Study https://journals.sagepub.com/doi/abs/10.1177/0269881105048899 https://journals.sagepub.com/doi/abs/10.1177/026988110504889... Vitamin D can treat seasonal depression Study https://europepmc.org/abstract/med/10888476 https://europepmc.org/abstract/med/10888476 B-12 levels are associated with ability to recover from depression Study https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-3-17 https://bmcpsychiatry.biomedcentral.com/articles/10.1186/147... Magnesium helps to handle depression Study https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0180067 https://journals.plos.org/plosone/article?id=10.1371/journal...
    - adgjlsfhk1 6y ago
      While this is partially true, it is important to realize that most of these papers are talking about mild to moderate depression (not severe depression or any other mental illness). There is a ton of evidence that medication helps in more severe cases (https://www.psychiatrist.com/JCP/article/Pages/efficacy-ssris-newer-antidepressants-severe-depression.aspx https://www.psychiatrist.com/JCP/article/Pages/efficacy-ssri...) the main debate is whether depression meds are being over-prescribed in mild cases.
  - deleted 6y ago
    [deleted]
- danShumway 6y ago
  > Psychiatry does not know how to cure mental illness. At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects. I realize this is just a sidenote, but I just want to address this point for anyone who's struggling with problems like depression or other serious mental issues. Getting help can be a lifesaver, and sometimes medication is part of it. Properly prescribed by a professional who knows what they're doing, medication to treat depression can in some cases literally change your life. It's not the only way to address mental issues, you absolutely should couple it with therapy. It's not for everyone. That's why a professional is involved. But stigmatizing people who take medication to help manage their problems is incredibly harmful.
  - Daho0n 6y ago
    Absolutely correct, it can be a life-saver, but patients should also be aware that many people get permanently ruined by the medication prescribed by so-called professionals - especially antipsychotics and antidepressants - so to try it is to take a big gamble. Medicine should be the very last thing tried to help people with mental problems. Not the first as it is today and likely not the second either. It is, in many many cases, incredibly harmful or totally superfluous. I'd go so far as to say that IMO at least 9 out of 10 in the psychiatric system is over-medicated and/or misdiagnosed. Most people I have seen that get medication end up in one of three situations being either life-long medicinal dependency, polypharmacy or misdiagnosis. All could be prevented by a working psychiatric system without close ties to Big Pharma. Most people that get antidepressive medicine isn't heavily depressed and shouldn't get medicine at all: >Conclusions: The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial. https://jamanetwork.com/journals/jama/article-abstract/185157?redirect=true https://jamanetwork.com/journals/jama/article-abstract/18515... >My guess is that future generations of psychologists will look back at our over-prescribing of psychotropic drugs with incredulity too, amazed at our blind enthusiasm for largely ineffective and damaging treatments, and at how such barbaric methods could become so widespread. https://www.psychologytoday.com/us/blog/out-the-darkness/201603/chemical-lobotomy https://www.psychologytoday.com/us/blog/out-the-darkness/201...
- johncena33 6y ago
  > Psychiatry does not know how to cure mental illness. At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects. I whole-heartedly agree with this. I was on anti-depressants at some point of my life. At that time I did something very stupid that jeopardized my life. I was lucky enough to get out of it unscathed. Although I am still traumatized by the incident. Please be very careful taking anti-depressants.
  - nvrspyx 6y ago
    It is well known that antidepressants, especially SSRIs and SNRIs, will often make the depression symptoms worse during the onboarding period (~2-6 weeks) before the symptoms become alleviated. I'd say this was a failure on your doctor's part for not indicating and emphasizing that. It also depends on the medication as people have different reactions to different medications, even if they're in the same family of drugs (e.g. SSRI, SNRI, etc.). Some people will have the side effect you mentioned (e.g. suicidal ideation), but feel much better than before the medication after a few weeks. Those same people may not feel any difference on a different medication, even on the highest dosage, and never feel any improvements. Then there's a wide range of reactions in between. Unfortunately, it often takes a while to find the right medication for someone and the journey to do so is rarely pleasant. This is one of the hardest things about psychiatric pharmacology. There's no go-to medication because you're trying to alleviate symptoms for something that you don't know the exact mechanisms involved (i.e. everyone's brain is different and a "chemical imbalance" or the cause of it in one person isn't the same as another's, even if their symptoms are the same). With all of that said, I'd definitely recommend attempting cognitive-behavioral therapy before going to medication as a supplement or alternative to CBT, especially if the depression is mild/moderate. For those with severe depression (like me), however, they may not have the motivation/drive/confidence to consistently see a therapist. In those cases, medication might alleviate the symptoms enough for them to do so, which is what happened in my case. Although I don't continue CBT, mostly due to time constraints, I still take anti-depressants to maintain what I've climbed out of so far. None of this even mentions those with severe, treatment-resistant depression in which the only relief they get is maybe from electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS). The former sometimes doesn't work and the latter's effectiveness tends to range from months to weeks and dependent on specific pulse train protocols for those cases.
- justusw 6y ago
  > Psychiatry does not know how to cure mental illness. Source on this? Keep in mind that psychiatry doesn't only deal with mild to moderate depression, but some really severe disorders.
  - gillytech 6y ago
    There are a forest of sources. Psychiatrists and psychologists have made statements to this effect at their conventions. In my opinion, where you can't definitively diagnose, you are already set for failure in the cure. Here is some context: http://wayneramsay.com/diagnosis.htm http://wayneramsay.com/diagnosis.htm
- fredophile 6y ago
  There are many physical illnesses that we can't cure. That doesn't stop people from going to the doctor for treatment for them. Just because the illness will be there doesn't mean we can't significantly improve someone's quality of life.
  - Aerroon 6y ago
    But we can usually objectively tell what is wrong. A test can be administered by different doctors and they're almost certainly going to arrive at the same conclusion. Mental illness has so much overlap and comorbidity that we can't really do that. Even for something like ADHD we don't really have an objective test for.
    - Broken_Hippo 6y ago
      We can tell folks what is wrong if you have a common and fairly well understood disease that has indicators that we can test for. People sometimes wait years to be diagnosed with an autoimmune disorder, though, and these have medicines that can significantly improve life. We find cancer, but sometimes treat everything as aggressive (though it is starting to change). And so on. Heck, we are still slowly discovering body parts. The brain is one of those things we still don't know a lot about despite the seemingly broad knowledge we have. Some of the knowledge we have is fairly recent and can be thanked, in part, to modern scanning. I don't know how we can expect folks to have a definite test for this when there is so much we don't know.
- dragonwriter 6y ago
  > Psychiatry does not know how to cure mental illness Law enforcement doesn't know how to cure criminality, either. And it's much worse when it comes to mental illness. > At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects. Law enforcement isn't even that effective, at criminality or mental illness. > Investing more money into this doesn't solve the societal issues which come from drug addiction, lack of economic opportunity, a failing education system, etc Shifting resources into this from law enforcement responses to mental health issues does solve the societal issues that come from law enforcement’s egregious mishandling of mental health issues, plus saves money that can be used to deal with those other problems because it's cheaper per call handled. Also, alleviating mental health symptoms does mitigate many of those problems, which are, in many cases, direct consequences of mental health symptoms. > I would rather see us focus on fixing schools As if anyone knows how to do that. > and the economy Wasting less money on sending police to encounters where police presence is actively harmful is, among other things, fixing the economy.
  - collyw 6y ago
    > Law enforcement doesn't know how to cure criminality No but I am sure places with more law enforcement are more lawful than places without it.
    - circlefavshape 6y ago
      A quick google suggests that evidence for a relationship between police numbers and crime rates is rather weak
    - Broken_Hippo 6y ago
      That isn't true: We don't police rich neighborhoods like we do poor ones, so there isn't as much opportunity to catch people doing crime, not to mention that crimes of poverty or opportunity are less when folks aren't needing to steal things. (yes, I realize that not everything people steal are things like food, but mental health is important, and things often fill these needs). In addition, poor people are more likely to get caught for some things simply because of living conditions. A decently middle class person can find a private place to smoke a joint or do drugs. Just go camping, for instance, or out in the backyard. City living plus lack of resources means you can't just go out in the courtyard of the apartments. I'll also mention that rural places tend to have fewer cops and are seen as having a generally lower crime rate. (I didn't look up the numbers, but this is the stereotype).
- vidarh 6y ago
  It does however start to solve the issue of having people who don't belong in prison being sent to prison. A part of a complex set of issues that have led to the US having the largest prison population in the world despite being nowhere near the most populated country. In the US in particular it seems bizarre that this discussion has descended into worry over being locked up in mental health facilities given a prison population so large it compares unfavourably to most authoritarian dictatorships.
- imtringued 6y ago
  The service you are complaining about provides optional food and shelter instead of arresting homeless people. What's wrong with that?
- programmertote 6y ago
  My late father is a psychiatrist. My wife is a medical resident. What you said is fairly accurate. Both my wife and late father say if someone shows up with acute mental problem, you prescribe lithium-based meds, sleep-inducing meds and/or in extreme scenarios, shock (ECT) therapy. For mild forms, it's one-on-one therapy (most listening what the patient says). Psychiatry, as it is now, is more of an experimentation than it is a science.
walleeee 6y ago
It's not that avoiding an arrest or other police involvement isn't an improvement. It is. But it's easy to assume anyone committed to a psychiatric facility ought to be rehabilitated to society. Often you could just as justifiably argue the other way around.
- enkid 6y ago
  What's the other way around? I'm having difficulty parsing what you mean.
  - walleeee 6y ago
    That the social body might learn to accommodate some ways of being which defy initial expectations, rather than altering individuals to conform to rigid norms. When certain behaviors are thought worthy of institutionalization, it may reflect a narrowness of heart and mind in the majority rather than a social danger.
  - bigwavedave 6y ago
    I could be wrong, but I believe this is what the parent is saying: a) that people assume anyone committed to a mental institution should be rehabilitated and b) one could argue that this assumption is often false and that they shouldn't be rehabilitated. It sounds like they're saying that if someone is committed to a mental institution, rehabilitation could be a bad idea because it's just as likely that they're not fit for society. note: not agreeing with the above points, simply trying to interpret them.
    - XorNot 6y ago
      Except then they're not going to be released on account of demonstratably being an ongoing risk to society. Of course this concern runs exactly contra to the "medical authoritarian" one further up. Frankly, which is it that means a successful program as the article notes shouldn't be continued?
    - walleeee 6y ago
      > It sounds like they're saying that if someone is committed to a mental institution, rehabilitation could be a bad idea because it's just as likely that they're not fit for society. I'm saying if we make unexamined assumptions about who's "fit for society" it's easy to sacrifice non-normative people on the alter of social harmony. What is viewed as requiring rehabilitation can reflect neuroses endemic to the broader cultural context, not merely or necessarily the dysfunction of the institutionalized individual. It's a two-way mirror.
artificialLimbs 6y ago
> Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released. Having personally had family members and friends in such places, I can tell you this is false. It has often been the case they are 'magically' healed and capable when the insurance money runs dry.
- kelnos 6y ago
  While your anecdote is incredibly sad and messed up, it does not invalidate the parent's belief that most psych facilities are not like that.
  - judahmeek 6y ago
    You mean that one anecdote does not invalidate another?
    - bryanrasmussen 6y ago
      it's true that one anecdote does not invalidate another, but assuming truthfulness of both anecdotes the first anecdote seems more wide ranging and likely to give a better view of problems in the system.
      - nojster 6y ago
        Then I could counter argue with another anecdote that I visited thousands of such facilities and in all of them cases of magic healing once the insurance money dried up happened. Merely extending the scope of an anecdote does not change the fact that it is an anecdote and does not provide greater power to convince.
        tmpz22 6y ago
        The original comment claimed to be an EMT. That makes their comment a professional experience or professional opinion where as yours is an anecdote.
gillytech 6y ago
> Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released - which is a far cry from having healed or become functioning members of society. The problem of wrongful involuntary commitment (especially for insurance fraud reasons) is more rampant and widespread than one might initially guess. Here is a good paper on it: http://wayneramsay.com/unjustified.htm http://wayneramsay.com/unjustified.htm
- Talanes 6y ago
  I've only skimmed the paper at present, but are all of their examples based around minors being involuntarily committed by their parents? Because that seems like a separate, if related, issue.
  - imperio59 6y ago
    See the article at the bottom of my original comment for the Buzzfeed investigation into UnitedHealthCare psych wards. That was targeting adults, not children. However, involuntary commitment of children (and subsequent rape too many of the girls who end up there, tragically) is a huge problem. Look up abuses of the "Baker Act" in Florida for example.
    - MertsA 6y ago
      >Look up abuses of the "Baker Act" in Florida for example. I have a friend who was involuntarily committed under the Baker act when she was in 9th grade. She was never suicidal, never threatened anyone, and was held for 2 days to evaluate her. A bully lied and claimed my friend made suicidal statements and thought it would be hilarious to tell the school administration that they were "concerned for another student". Rather than just a call to her parents and a long chat with a guidance counselor the school administration decided that clearly she was just lying and even though she denied everything and never showed any indication to any of them that she was a risk to herself or others they had her committed. The bully that lied to the school administration even went on to brag about doing it. I think the real travesty here is that misuse is completely unchecked and the timeframe is absurd. If someone is being held against their will, without commiting a crime, why on earth is it considered fine to just hold them for days at a time before even being evaluated by a mental health professional? They already have to transport them to a mental health treatment center so why can't hospitals figure out an on call schedule for psychiatrists? It's a farce that the standard of proof is so low supposedly in the name of safety and urgency and yet even while the situation is urgent enough to hold someone against their will it's not urgent enough to get a psychiatrist on the phone on a Sunday.
crb002 6y ago
I was detained 3x last summer in political retaliation under Iowa Code 229. Sheriff deputy takes you to the designated facility. County hospitals are rife with abuse. Unjust detainments get billed to Medicaid for $$$.
- TimTheTinker 6y ago
  Wow. Is there any place you’ve written about your experiences in detail? Sounds like you have a story that needs to be told.
mlang23 6y ago
https://en.wikipedia.org/wiki/One_Flew_Over_the_Cuckoo%27s_Nest_(film)#Plot https://en.wikipedia.org/wiki/One_Flew_Over_the_Cuckoo%27s_N...
- bluGill 6y ago
  That is fiction. I recall my psychology 101 professor hating it because it makes it harder to use electro-shock treatment even though it works... I'm not able to evaluate either side of it, but one side has a phd in the area.
andrey_utkin 6y ago
> Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released Penitentiary system is overburdened and has no interest in keeping people around once they're safe enough to be released. Makes equal amount of sense to me. In USSR, punitive psychiatry was the tool of choice for the government in the times of wide international information dissemination. I don't mean to ridicule the American struggle for fixing community policing - I understand that defunding and disbanding the police comes out of a desperate situation, and I admire this kind of courage for radical changes. But it's a mistake to think that one step is a complete solution.
- varjag 6y ago
  In USSR, booking you into the ward for political reasons did involve an arrest and a trial.
  - TimTheTinker 6y ago
    I’m curious if you have any citations. (I’m reading The Gulag Archipelago, and I haven’t gotten far enough yet to find out the exact procedures that were used for dealing with political dissidents via mental health charges.)
    - varjag 6y ago
      https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_in_the_Soviet_Union#Examination_and_hospitalization https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_...
pdkl95 6y ago
> As an EMT I frequently transported people to hospitals (or from hospitals to psychiatric facilities) following their arrest. > I saw no evidence of its abuse. Unless your EMT services is responsible for 100% of the patients that enter the psych facility, the set of patients you see is probably affected by survivorship bias[1]. The people you see may be biased towards people with a legitimate problem severe enough for someone to call an EMT. > Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released About 8 years ago had an experience with a facility (in the SF Bay Area). A psych I had seen once for <5 min had me arrested and sent for a 3 day hold. The justification fabricated; a few sentences of vague nonsense. After finally seeing a doctor on day 2 for about 1 minute, he upgraded the 3 day hold into a 2 week hold at a psych facility (supposedly on the suggestion of the original psych). The facility was over-enrolled; the staff often complained about having to deny admission due to lack of room. Everyone at the facility that wasn't a doctor thought I obviously should be released immediately. I didn't see a doctor again until day 5 (I explained the situation for q few minutes, meeting over, nothing happened), while the facility was somehow able to justify to Medi-Cal why they should pay several thousand dollars to keep me there for another day. On day 10, I guess Medi-Cal stopped paying. The doctor showed up for a 2nd meeting, insisted I take a shitty SRNI and finally let me leave. [1] https://en.wikipedia.org/wiki/Survivorship_bias https://en.wikipedia.org/wiki/Survivorship_bias
- gillytech 6y ago
  Thank you for sharing your story. Involuntary commitment is a vastly underreported human rights abuse which needs to be seriously addressed.
sokoloff 6y ago
Arguing that psych facilities aren’t confining people who shouldn’t be because they’re over-full seems to be a contradiction. Perhaps they’re over-full because...
j_m_b 6y ago
To throw on the anecdote pile... my brother was committed due to overreaction of an LSD trip. He had been up for days and was almost incoherent after being brought in to the emergency room by the police. They said it would be 2 days, then 5 days, then another week. I called and told them that his insurance had contacted me and said they weren't going to be paying for any additional time. He was released the same day.
- woko 6y ago
  I was about to comment with a similar anecdote. Situations will be different depending on the psychiatric facilities, but there are some, usually the most expensive ones (and being expensive is not at all an indicator of being a good one), in which some physicians have no issue keeping people in there as long as there is money to be drained from the family. Worse, the psychiatric state of the patient has not necessarily improved during that costly stay.
- ogre_codes 6y ago
  I feel like this conversation has gone entirely sideways based on someones' random unrelated anecdote. What does this have to do with the police showing up when you call 911 instead of a few social workers (who can't actually commit anyone)? This program is far far more likely to deal with homeless people than people with insurance that can cover multiple days in a facility.
cutemonster 6y ago
> Most psych facilities are over-enrolled and have no interest in keeping people around Seems you didn't read the linked buzzfeednews article. If you read it you'll notice that many hospitals work fine -- but there's one particular psych facility company that abuses the system, Universal Health Services, or UHS.
- GavinMcG 6y ago
  No need to make accusations. It's just that the problem the article describes is with UHS, not with taking police out of the response to mental health issues and homelessness.
  - cutemonster 6y ago
    Observation != Accusation ? Anyway yes I think / agree with you that the buzzfeednews article is ... off topic? Maybe it'd been better in its own discussion. And sounds like a really good thing they're doing, sending health care workers instead of police

Breza 6y ago

Very well said!

imperio59 6y ago

Psychiatry does not know how to cure mental illness. At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects. Investing more money into this doesn't solve the societal issues which come from drug addiction, lack of economic opportunity, a failing education system, etc I would rather see us focus on fixing schools and the economy than spend billions on these programs that have dubious outcomes

Talanes 6y ago
>I would rather see us focus on fixing schools and the economy than spend billions on these programs that have dubious outcomes I couldn't find an exact number in the five minutes of searching I was willing to put in, but the budget seems to be in the single digit millions, a far cry from billions.
- vidarh 6y ago
  And it also ignores that the alternative here is not "do nothing" but "send police instead", which also costs. And if it leads to arrests it costs even more. And if people end up getting a criminal record, it tends to reduce their long term employment prospect, and as a result reduce tax revenue/increase welfare costs. There seems to be plenty of potential for this to save money over time.
pm90 6y ago
You can do both, and indeed they are both required. Fixing schools and the economy are the long term solution but we can’t let people be subjected to the inhumanity of our criminal justice system that exists today (especially if they’re part of a minority).
- dkdk8283 6y ago
  Being a minority has no bearing here: it’s just as tough on all humans.
  - triceratops 6y ago
    That's not true, actually. Statistically minorities fare worse in their encounters with the justice system.
    - dkdk8283 6y ago
      Citation please.
      - cycomanic 6y ago
        Not sure if you are genuine this was discussed at lot in the last year, below are two. https://www.washingtonpost.com/news/wonk/wp/2017/11/16/black-men-sentenced-to-more-time-for-committing-the-exact-same-crime-as-a-white-person-study-finds/ https://www.washingtonpost.com/news/wonk/wp/2017/11/16/black... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614457/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614457/
        cycomanic 6y ago
        So people are downvoting this because I provided citations that the GP asked for, seriously?!
        CryptoPunk 6y ago
        Counter-evidence from a controlled experiment: https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=267470 https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=2674... tl;dr police were 25 times less likely to shoot an unarmed suspect in a simulation, if that suspect was black instead of white. A little bit of common sense explains why. It would simply be inconceivable that the officer who shot Daniel Shaver to death would have been acquitted had Shaver been black instead of white. The kind of social backlash that an acquittal in such a case would elicit would ensure the political and judicial system punish the officer.
GavinMcG 6y ago
Fine. In the meantime, any objection to taking billions from a program that has dubious outcomes and involves violence and a permanent criminal record, and shifting it toward one that has dubious outcomes but doesn't?
- deleted 6y ago
  [deleted]
- artificialLimbs 6y ago
  Most 'permanent' criminal records can be expunged. When you are incarcerated against your will in a mental institute, you lose firearm privileges permanently (for real), deservedly or not. Seems like a great avenue for disarming the populace if the government needed to turn dictatorship.
  - hattar 6y ago
    Consider how many people would need to be incarcerated against their will to make this work. Disarming the American populace would be nearly impossible by far more effective means. Taking this approach would be incredibly ineffective.
  - asdfasgasdgasdg 6y ago
    You still seem to be missing the fact that there is no additionality here. If the current system would put you in a psych ward, the prior system would arrest you then put you in a psych ward, which most folks would agree is strictly worse.
  - danShumway 6y ago
    And what are the actual stats on that? I'm willing to make a pretty safe bet that there are far more people in the US who have criminal records than have been committed to institutions against their will. I doubt it's even a contest, I'm seeing rough estimations online as high as 1/4 of the entire adult male population in the US. And I'm also willing to make a pretty safe bet that the proportion of those criminal records that actually get expunged is a lot lower than you're making it sound like. And lastly, I'm willing to make a bet that overall, the long-term effects of even a short criminal record are roughly comparable to the long-term effects of involuntary commitment. Yes, we can have a conversation about firearm privileges, that's worth talking about. But let's also not forget that the most immediate effects of a criminal record are things like loss of income, housing, and the ability to find employment, which can have an extremely significant effect on your entire future. In comparison, most employers will not ask you questions about your mental history. And again -- you can still get involuntarily committed to an institution after you're arrested. The only difference is that now you have two problems instead of one, both a mental health record and a criminal record.
scythe 6y ago
>Psychiatry does not know how to cure mental illness Psychiatry doesn't know how to cure mental illness and oncology doesn't know how to cure cancer, but they both work a lot better than the supplement aisle.
- imperio59 6y ago
  Agree for the case of oncology. Disagree for psychiatry. The evidence is mounting that vitamins may actually be just as good a treatment for most people with mild depression or other similar ailments vs SSRIs and other psychiatric drugs. Sources: SSRIs don't work better than placebos for mild to moderate depression Study https://www.ncbi.nlm.nih.gov/pubmed/18303940 https://www.ncbi.nlm.nih.gov/pubmed/18303940 Low B12 and Folic Acid are associated with Depression Study https://journals.sagepub.com/doi/abs/10.1177/0269881105048899 https://journals.sagepub.com/doi/abs/10.1177/026988110504889... Vitamin D can treat seasonal depression Study https://europepmc.org/abstract/med/10888476 https://europepmc.org/abstract/med/10888476 B-12 levels are associated with ability to recover from depression Study https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-3-17 https://bmcpsychiatry.biomedcentral.com/articles/10.1186/147... Magnesium helps to handle depression Study https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0180067 https://journals.plos.org/plosone/article?id=10.1371/journal...
  - adgjlsfhk1 6y ago
    While this is partially true, it is important to realize that most of these papers are talking about mild to moderate depression (not severe depression or any other mental illness). There is a ton of evidence that medication helps in more severe cases (https://www.psychiatrist.com/JCP/article/Pages/efficacy-ssris-newer-antidepressants-severe-depression.aspx https://www.psychiatrist.com/JCP/article/Pages/efficacy-ssri...) the main debate is whether depression meds are being over-prescribed in mild cases.
- deleted 6y ago
  [deleted]
danShumway 6y ago
> Psychiatry does not know how to cure mental illness. At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects. I realize this is just a sidenote, but I just want to address this point for anyone who's struggling with problems like depression or other serious mental issues. Getting help can be a lifesaver, and sometimes medication is part of it. Properly prescribed by a professional who knows what they're doing, medication to treat depression can in some cases literally change your life. It's not the only way to address mental issues, you absolutely should couple it with therapy. It's not for everyone. That's why a professional is involved. But stigmatizing people who take medication to help manage their problems is incredibly harmful.
- Daho0n 6y ago
  Absolutely correct, it can be a life-saver, but patients should also be aware that many people get permanently ruined by the medication prescribed by so-called professionals - especially antipsychotics and antidepressants - so to try it is to take a big gamble. Medicine should be the very last thing tried to help people with mental problems. Not the first as it is today and likely not the second either. It is, in many many cases, incredibly harmful or totally superfluous. I'd go so far as to say that IMO at least 9 out of 10 in the psychiatric system is over-medicated and/or misdiagnosed. Most people I have seen that get medication end up in one of three situations being either life-long medicinal dependency, polypharmacy or misdiagnosis. All could be prevented by a working psychiatric system without close ties to Big Pharma. Most people that get antidepressive medicine isn't heavily depressed and shouldn't get medicine at all: >Conclusions: The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial. https://jamanetwork.com/journals/jama/article-abstract/185157?redirect=true https://jamanetwork.com/journals/jama/article-abstract/18515... >My guess is that future generations of psychologists will look back at our over-prescribing of psychotropic drugs with incredulity too, amazed at our blind enthusiasm for largely ineffective and damaging treatments, and at how such barbaric methods could become so widespread. https://www.psychologytoday.com/us/blog/out-the-darkness/201603/chemical-lobotomy https://www.psychologytoday.com/us/blog/out-the-darkness/201...
johncena33 6y ago
> Psychiatry does not know how to cure mental illness. At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects. I whole-heartedly agree with this. I was on anti-depressants at some point of my life. At that time I did something very stupid that jeopardized my life. I was lucky enough to get out of it unscathed. Although I am still traumatized by the incident. Please be very careful taking anti-depressants.
- nvrspyx 6y ago
  It is well known that antidepressants, especially SSRIs and SNRIs, will often make the depression symptoms worse during the onboarding period (~2-6 weeks) before the symptoms become alleviated. I'd say this was a failure on your doctor's part for not indicating and emphasizing that. It also depends on the medication as people have different reactions to different medications, even if they're in the same family of drugs (e.g. SSRI, SNRI, etc.). Some people will have the side effect you mentioned (e.g. suicidal ideation), but feel much better than before the medication after a few weeks. Those same people may not feel any difference on a different medication, even on the highest dosage, and never feel any improvements. Then there's a wide range of reactions in between. Unfortunately, it often takes a while to find the right medication for someone and the journey to do so is rarely pleasant. This is one of the hardest things about psychiatric pharmacology. There's no go-to medication because you're trying to alleviate symptoms for something that you don't know the exact mechanisms involved (i.e. everyone's brain is different and a "chemical imbalance" or the cause of it in one person isn't the same as another's, even if their symptoms are the same). With all of that said, I'd definitely recommend attempting cognitive-behavioral therapy before going to medication as a supplement or alternative to CBT, especially if the depression is mild/moderate. For those with severe depression (like me), however, they may not have the motivation/drive/confidence to consistently see a therapist. In those cases, medication might alleviate the symptoms enough for them to do so, which is what happened in my case. Although I don't continue CBT, mostly due to time constraints, I still take anti-depressants to maintain what I've climbed out of so far. None of this even mentions those with severe, treatment-resistant depression in which the only relief they get is maybe from electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS). The former sometimes doesn't work and the latter's effectiveness tends to range from months to weeks and dependent on specific pulse train protocols for those cases.
justusw 6y ago
> Psychiatry does not know how to cure mental illness. Source on this? Keep in mind that psychiatry doesn't only deal with mild to moderate depression, but some really severe disorders.
- gillytech 6y ago
  There are a forest of sources. Psychiatrists and psychologists have made statements to this effect at their conventions. In my opinion, where you can't definitively diagnose, you are already set for failure in the cure. Here is some context: http://wayneramsay.com/diagnosis.htm http://wayneramsay.com/diagnosis.htm
fredophile 6y ago
There are many physical illnesses that we can't cure. That doesn't stop people from going to the doctor for treatment for them. Just because the illness will be there doesn't mean we can't significantly improve someone's quality of life.
- Aerroon 6y ago
  But we can usually objectively tell what is wrong. A test can be administered by different doctors and they're almost certainly going to arrive at the same conclusion. Mental illness has so much overlap and comorbidity that we can't really do that. Even for something like ADHD we don't really have an objective test for.
  - Broken_Hippo 6y ago
    We can tell folks what is wrong if you have a common and fairly well understood disease that has indicators that we can test for. People sometimes wait years to be diagnosed with an autoimmune disorder, though, and these have medicines that can significantly improve life. We find cancer, but sometimes treat everything as aggressive (though it is starting to change). And so on. Heck, we are still slowly discovering body parts. The brain is one of those things we still don't know a lot about despite the seemingly broad knowledge we have. Some of the knowledge we have is fairly recent and can be thanked, in part, to modern scanning. I don't know how we can expect folks to have a definite test for this when there is so much we don't know.
dragonwriter 6y ago
> Psychiatry does not know how to cure mental illness Law enforcement doesn't know how to cure criminality, either. And it's much worse when it comes to mental illness. > At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects. Law enforcement isn't even that effective, at criminality or mental illness. > Investing more money into this doesn't solve the societal issues which come from drug addiction, lack of economic opportunity, a failing education system, etc Shifting resources into this from law enforcement responses to mental health issues does solve the societal issues that come from law enforcement’s egregious mishandling of mental health issues, plus saves money that can be used to deal with those other problems because it's cheaper per call handled. Also, alleviating mental health symptoms does mitigate many of those problems, which are, in many cases, direct consequences of mental health symptoms. > I would rather see us focus on fixing schools As if anyone knows how to do that. > and the economy Wasting less money on sending police to encounters where police presence is actively harmful is, among other things, fixing the economy.
- collyw 6y ago
  > Law enforcement doesn't know how to cure criminality No but I am sure places with more law enforcement are more lawful than places without it.
  - circlefavshape 6y ago
    A quick google suggests that evidence for a relationship between police numbers and crime rates is rather weak
  - Broken_Hippo 6y ago
    That isn't true: We don't police rich neighborhoods like we do poor ones, so there isn't as much opportunity to catch people doing crime, not to mention that crimes of poverty or opportunity are less when folks aren't needing to steal things. (yes, I realize that not everything people steal are things like food, but mental health is important, and things often fill these needs). In addition, poor people are more likely to get caught for some things simply because of living conditions. A decently middle class person can find a private place to smoke a joint or do drugs. Just go camping, for instance, or out in the backyard. City living plus lack of resources means you can't just go out in the courtyard of the apartments. I'll also mention that rural places tend to have fewer cops and are seen as having a generally lower crime rate. (I didn't look up the numbers, but this is the stereotype).
vidarh 6y ago
It does however start to solve the issue of having people who don't belong in prison being sent to prison. A part of a complex set of issues that have led to the US having the largest prison population in the world despite being nowhere near the most populated country. In the US in particular it seems bizarre that this discussion has descended into worry over being locked up in mental health facilities given a prison population so large it compares unfavourably to most authoritarian dictatorships.
imtringued 6y ago
The service you are complaining about provides optional food and shelter instead of arresting homeless people. What's wrong with that?
programmertote 6y ago
My late father is a psychiatrist. My wife is a medical resident. What you said is fairly accurate. Both my wife and late father say if someone shows up with acute mental problem, you prescribe lithium-based meds, sleep-inducing meds and/or in extreme scenarios, shock (ECT) therapy. For mild forms, it's one-on-one therapy (most listening what the patient says). Psychiatry, as it is now, is more of an experimentation than it is a science.

walleeee 6y ago

It's not that avoiding an arrest or other police involvement isn't an improvement. It is. But it's easy to assume anyone committed to a psychiatric facility ought to be rehabilitated to society. Often you could just as justifiably argue the other way around.

enkid 6y ago
What's the other way around? I'm having difficulty parsing what you mean.
- walleeee 6y ago
  That the social body might learn to accommodate some ways of being which defy initial expectations, rather than altering individuals to conform to rigid norms. When certain behaviors are thought worthy of institutionalization, it may reflect a narrowness of heart and mind in the majority rather than a social danger.
- bigwavedave 6y ago
  I could be wrong, but I believe this is what the parent is saying: a) that people assume anyone committed to a mental institution should be rehabilitated and b) one could argue that this assumption is often false and that they shouldn't be rehabilitated. It sounds like they're saying that if someone is committed to a mental institution, rehabilitation could be a bad idea because it's just as likely that they're not fit for society. note: not agreeing with the above points, simply trying to interpret them.
  - XorNot 6y ago
    Except then they're not going to be released on account of demonstratably being an ongoing risk to society. Of course this concern runs exactly contra to the "medical authoritarian" one further up. Frankly, which is it that means a successful program as the article notes shouldn't be continued?
  - walleeee 6y ago
    > It sounds like they're saying that if someone is committed to a mental institution, rehabilitation could be a bad idea because it's just as likely that they're not fit for society. I'm saying if we make unexamined assumptions about who's "fit for society" it's easy to sacrifice non-normative people on the alter of social harmony. What is viewed as requiring rehabilitation can reflect neuroses endemic to the broader cultural context, not merely or necessarily the dysfunction of the institutionalized individual. It's a two-way mirror.

artificialLimbs 6y ago

> Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released. Having personally had family members and friends in such places, I can tell you this is false. It has often been the case they are 'magically' healed and capable when the insurance money runs dry.

kelnos 6y ago
While your anecdote is incredibly sad and messed up, it does not invalidate the parent's belief that most psych facilities are not like that.
- judahmeek 6y ago
  You mean that one anecdote does not invalidate another?
  - bryanrasmussen 6y ago
    it's true that one anecdote does not invalidate another, but assuming truthfulness of both anecdotes the first anecdote seems more wide ranging and likely to give a better view of problems in the system.
    - nojster 6y ago
      Then I could counter argue with another anecdote that I visited thousands of such facilities and in all of them cases of magic healing once the insurance money dried up happened. Merely extending the scope of an anecdote does not change the fact that it is an anecdote and does not provide greater power to convince.
      - tmpz22 6y ago
        The original comment claimed to be an EMT. That makes their comment a professional experience or professional opinion where as yours is an anecdote.

gillytech 6y ago

> Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released - which is a far cry from having healed or become functioning members of society. The problem of wrongful involuntary commitment (especially for insurance fraud reasons) is more rampant and widespread than one might initially guess. Here is a good paper on it: http://wayneramsay.com/unjustified.htm http://wayneramsay.com/unjustified.htm

Talanes 6y ago
I've only skimmed the paper at present, but are all of their examples based around minors being involuntarily committed by their parents? Because that seems like a separate, if related, issue.
- imperio59 6y ago
  See the article at the bottom of my original comment for the Buzzfeed investigation into UnitedHealthCare psych wards. That was targeting adults, not children. However, involuntary commitment of children (and subsequent rape too many of the girls who end up there, tragically) is a huge problem. Look up abuses of the "Baker Act" in Florida for example.
  - MertsA 6y ago
    >Look up abuses of the "Baker Act" in Florida for example. I have a friend who was involuntarily committed under the Baker act when she was in 9th grade. She was never suicidal, never threatened anyone, and was held for 2 days to evaluate her. A bully lied and claimed my friend made suicidal statements and thought it would be hilarious to tell the school administration that they were "concerned for another student". Rather than just a call to her parents and a long chat with a guidance counselor the school administration decided that clearly she was just lying and even though she denied everything and never showed any indication to any of them that she was a risk to herself or others they had her committed. The bully that lied to the school administration even went on to brag about doing it. I think the real travesty here is that misuse is completely unchecked and the timeframe is absurd. If someone is being held against their will, without commiting a crime, why on earth is it considered fine to just hold them for days at a time before even being evaluated by a mental health professional? They already have to transport them to a mental health treatment center so why can't hospitals figure out an on call schedule for psychiatrists? It's a farce that the standard of proof is so low supposedly in the name of safety and urgency and yet even while the situation is urgent enough to hold someone against their will it's not urgent enough to get a psychiatrist on the phone on a Sunday.

crb002 6y ago

I was detained 3x last summer in political retaliation under Iowa Code 229. Sheriff deputy takes you to the designated facility. County hospitals are rife with abuse. Unjust detainments get billed to Medicaid for $$$.

TimTheTinker 6y ago
Wow. Is there any place you’ve written about your experiences in detail? Sounds like you have a story that needs to be told.

mlang23 6y ago

https://en.wikipedia.org/wiki/One_Flew_Over_the_Cuckoo%27s_Nest_(film)#Plot https://en.wikipedia.org/wiki/One_Flew_Over_the_Cuckoo%27s_N...

bluGill 6y ago
That is fiction. I recall my psychology 101 professor hating it because it makes it harder to use electro-shock treatment even though it works... I'm not able to evaluate either side of it, but one side has a phd in the area.

andrey_utkin 6y ago

> Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released Penitentiary system is overburdened and has no interest in keeping people around once they're safe enough to be released. Makes equal amount of sense to me. In USSR, punitive psychiatry was the tool of choice for the government in the times of wide international information dissemination. I don't mean to ridicule the American struggle for fixing community policing - I understand that defunding and disbanding the police comes out of a desperate situation, and I admire this kind of courage for radical changes. But it's a mistake to think that one step is a complete solution.

varjag 6y ago
In USSR, booking you into the ward for political reasons did involve an arrest and a trial.
- TimTheTinker 6y ago
  I’m curious if you have any citations. (I’m reading The Gulag Archipelago, and I haven’t gotten far enough yet to find out the exact procedures that were used for dealing with political dissidents via mental health charges.)
  - varjag 6y ago
    https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_in_the_Soviet_Union#Examination_and_hospitalization https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_...

pdkl95 6y ago

> As an EMT I frequently transported people to hospitals (or from hospitals to psychiatric facilities) following their arrest. > I saw no evidence of its abuse. Unless your EMT services is responsible for 100% of the patients that enter the psych facility, the set of patients you see is probably affected by survivorship bias[1]. The people you see may be biased towards people with a legitimate problem severe enough for someone to call an EMT. > Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released About 8 years ago had an experience with a facility (in the SF Bay Area). A psych I had seen once for <5 min had me arrested and sent for a 3 day hold. The justification fabricated; a few sentences of vague nonsense. After finally seeing a doctor on day 2 for about 1 minute, he upgraded the 3 day hold into a 2 week hold at a psych facility (supposedly on the suggestion of the original psych). The facility was over-enrolled; the staff often complained about having to deny admission due to lack of room. Everyone at the facility that wasn't a doctor thought I obviously should be released immediately. I didn't see a doctor again until day 5 (I explained the situation for q few minutes, meeting over, nothing happened), while the facility was somehow able to justify to Medi-Cal why they should pay several thousand dollars to keep me there for another day. On day 10, I guess Medi-Cal stopped paying. The doctor showed up for a 2nd meeting, insisted I take a shitty SRNI and finally let me leave. [1] https://en.wikipedia.org/wiki/Survivorship_bias https://en.wikipedia.org/wiki/Survivorship_bias

gillytech 6y ago
Thank you for sharing your story. Involuntary commitment is a vastly underreported human rights abuse which needs to be seriously addressed.

sokoloff 6y ago

Arguing that psych facilities aren’t confining people who shouldn’t be because they’re over-full seems to be a contradiction. Perhaps they’re over-full because...

j_m_b 6y ago

To throw on the anecdote pile... my brother was committed due to overreaction of an LSD trip. He had been up for days and was almost incoherent after being brought in to the emergency room by the police. They said it would be 2 days, then 5 days, then another week. I called and told them that his insurance had contacted me and said they weren't going to be paying for any additional time. He was released the same day.

woko 6y ago
I was about to comment with a similar anecdote. Situations will be different depending on the psychiatric facilities, but there are some, usually the most expensive ones (and being expensive is not at all an indicator of being a good one), in which some physicians have no issue keeping people in there as long as there is money to be drained from the family. Worse, the psychiatric state of the patient has not necessarily improved during that costly stay.
ogre_codes 6y ago
I feel like this conversation has gone entirely sideways based on someones' random unrelated anecdote. What does this have to do with the police showing up when you call 911 instead of a few social workers (who can't actually commit anyone)? This program is far far more likely to deal with homeless people than people with insurance that can cover multiple days in a facility.

cutemonster 6y ago

> Most psych facilities are over-enrolled and have no interest in keeping people around Seems you didn't read the linked buzzfeednews article. If you read it you'll notice that many hospitals work fine -- but there's one particular psych facility company that abuses the system, Universal Health Services, or UHS.

GavinMcG 6y ago
No need to make accusations. It's just that the problem the article describes is with UHS, not with taking police out of the response to mental health issues and homelessness.
- cutemonster 6y ago
  Observation != Accusation ? Anyway yes I think / agree with you that the buzzfeednews article is ... off topic? Maybe it'd been better in its own discussion. And sounds like a really good thing they're doing, sending health care workers instead of police