5 ms·

Looking around at insane and drugged up street people (for instance) intuitively I say "Yes definitely, and it should be more widely practiced!". Then I rememb

Looking around at insane and drugged up street people (for instance) intuitively I say "Yes definitely, and it should be more widely practiced!". Then I remember how the definition of mental illness has changed over the years and think how it might change in the future, and now I'm not so sure.

TulliusCicero 4y ago
Seems like the threshold should probably be whether it's substantially interfering with their ability to interface with the rest of society, especially in terms of breaking laws. Many people in the situation you describe no longer seem capable of regulating their own behavior.
gernb 4y ago
There's a mentally ill person who lives outside my apartment. Every day/night she screams at the top of her voice about random things. I feel very sorry for her but at some point she needs to be moved and taken somewhere. She has no right to subject the entire neighborhood to her rants. All of our collective santity outweights her issues. It's not that different than a repeat criminal. Reguardless of reasons, at some point they're too much of a net negative to society. Dealing with them in some humane way is ideal but those 2 things are separate concerns IMO. Meaning there are 2 issues (1) Save everyone else from someone's distruptive behavior (2) Deal with the person in the best possible way You can solve (1) and not solve (2). Being not able to solve (2) perfectly does not invalidate the need to solve (1)
- horsawlarway 4y ago
  Yup - I think it's very important to point out that there are two different problems to solve here. 1) What sort of behaviors is a community willing to tolerate 2) What does that community do with people who are unable to stay within the confines of tolerated behavior The problem is that asymmetrical answers to the two questions can create a strange grey-zone, where problems linger. For example - if you murder someone, I don't think many people are going to argue against you spending some time in prison. The response is in line with the severity of the action. But... if you say, consistently piss in the elevators of your local metro (even though public bathrooms are available), most folks aren't sure prison is the right answer. Ideally - we'd just keep you out of the metro entirely - but setting up that system is very expensive when we're dealing with a very small number of bad actors. On the flip side - that small number of bad actors is doing considerable damage long term. They're making metro usage far less pleasant, driving down ridership, increasing cleaning costs, reducing public health, and requiring additional staff in attempts at monitoring. Each other member of society is only inconvenienced a relatively minor amount, but they're impacting a very large number of them by degrading a public and shared service. The same is true of those who camp/sleep outside of businesses, or scream & rant in public spaces, or do drugs in public spaces. They are actively harming the space they are using at large, and are unwilling to stop or unable regulate themselves. So what do we do with those people? What is a proportional action that we can take that prevents the damage this person is causing at scale? Prison/Jail rarely work - because the damage of each individual occurrence is small, they are usually out very quickly. Providing housing can resolve problems in some cases, but there are people who are actively unwilling to stay in publicly provided housing (for a variety of reasons - although the most common I see is consistent drug use, closely followed by serious mental illness). Meds can definitely help - but the category of people creating these disturbances generally have trouble consistently taking meds (again - for a variety of reasons including access to services and payment, but not the least is active, personal resistance) So... if we've ruled out (as in - tried and failed) self medication + housing + prison... where do we go? Because at that point - I'm not really convinced that forced treatment and care are really unreasonable responses. It is far more cost effective to gather these folks in a single place and confine them there than it is to allow them to roam and attempt to stop their problem behavior at the place it occurs. It's the difference between 10 guards, a large facility home, and medical staff - versus thousands of required staff spread over a city.
  - mlyle 4y ago
    > Providing housing can resolve problems in some cases, but there are people who are actively unwilling to stay in publicly provided housing (for a variety of reasons - although the most common I see is consistent drug use, closely followed by serious mental illness). Why don't we see what happens when we max out this intervention? Data seem to show that it would free up a lot of resources, and maybe some of those whom you're assuming will be recalcitrant won't be if housing options are ample. I think it's likely this would address 80% of the problem, and then we can see what the remaining 20% looks like qualitatively and quantitatively.
tracerbulletx 4y ago
We need to do the best we can with the information and morality we have, we've become paralyzed into inaction by fear of doing anything wrong and the ghosts of atrocities past.
Baeocystin 4y ago
I fully agree that this is a genuinely difficult, multi-factor problem with no easy answers. I also think that there are a lot of 'low-hanging fruit' level of options available, that seem to be disregarded in today's all-or-nothing environment. Specific example: During my short, ~10-block drive to the 101, I pass a good half-dozen regulars who are either screaming at the aether, wandering erratically through traffic, flinging things at passing people/cars, or in one case literally rolling around on the onramp between cars. This is not an exaggeration, or hyperbole. These people need to be in an institution. Maybe with treatment, they can recover. Maybe they will be there for the rest of their lives. Maybe some form of halfway-house works best. But I can't think of any good-faith argument that leads to the status quo being the best choice for either them or society at large. Surely we can come to a societal agreement about what to do for this level of dysfunction?
LexGray 4y ago
That question would be is forced denial of treatment for the mentally ill ever humane. I question how many mentally ill people on the street are there because they were given a choice to avoid treatment or if they were driven there by circumstances. The cognitive disruption of most mental health treatments would make most any sane person question their value versus quality of life. I do agree that mental illness definitions are a problem. Even forcing treatment on just those who are a danger to society makes me leery given that hostile social posts are now a social danger.

TulliusCicero 4y ago

Seems like the threshold should probably be whether it's substantially interfering with their ability to interface with the rest of society, especially in terms of breaking laws. Many people in the situation you describe no longer seem capable of regulating their own behavior.

gernb 4y ago

There's a mentally ill person who lives outside my apartment. Every day/night she screams at the top of her voice about random things. I feel very sorry for her but at some point she needs to be moved and taken somewhere. She has no right to subject the entire neighborhood to her rants. All of our collective santity outweights her issues. It's not that different than a repeat criminal. Reguardless of reasons, at some point they're too much of a net negative to society. Dealing with them in some humane way is ideal but those 2 things are separate concerns IMO. Meaning there are 2 issues (1) Save everyone else from someone's distruptive behavior (2) Deal with the person in the best possible way You can solve (1) and not solve (2). Being not able to solve (2) perfectly does not invalidate the need to solve (1)

horsawlarway 4y ago
Yup - I think it's very important to point out that there are two different problems to solve here. 1) What sort of behaviors is a community willing to tolerate 2) What does that community do with people who are unable to stay within the confines of tolerated behavior The problem is that asymmetrical answers to the two questions can create a strange grey-zone, where problems linger. For example - if you murder someone, I don't think many people are going to argue against you spending some time in prison. The response is in line with the severity of the action. But... if you say, consistently piss in the elevators of your local metro (even though public bathrooms are available), most folks aren't sure prison is the right answer. Ideally - we'd just keep you out of the metro entirely - but setting up that system is very expensive when we're dealing with a very small number of bad actors. On the flip side - that small number of bad actors is doing considerable damage long term. They're making metro usage far less pleasant, driving down ridership, increasing cleaning costs, reducing public health, and requiring additional staff in attempts at monitoring. Each other member of society is only inconvenienced a relatively minor amount, but they're impacting a very large number of them by degrading a public and shared service. The same is true of those who camp/sleep outside of businesses, or scream & rant in public spaces, or do drugs in public spaces. They are actively harming the space they are using at large, and are unwilling to stop or unable regulate themselves. So what do we do with those people? What is a proportional action that we can take that prevents the damage this person is causing at scale? Prison/Jail rarely work - because the damage of each individual occurrence is small, they are usually out very quickly. Providing housing can resolve problems in some cases, but there are people who are actively unwilling to stay in publicly provided housing (for a variety of reasons - although the most common I see is consistent drug use, closely followed by serious mental illness). Meds can definitely help - but the category of people creating these disturbances generally have trouble consistently taking meds (again - for a variety of reasons including access to services and payment, but not the least is active, personal resistance) So... if we've ruled out (as in - tried and failed) self medication + housing + prison... where do we go? Because at that point - I'm not really convinced that forced treatment and care are really unreasonable responses. It is far more cost effective to gather these folks in a single place and confine them there than it is to allow them to roam and attempt to stop their problem behavior at the place it occurs. It's the difference between 10 guards, a large facility home, and medical staff - versus thousands of required staff spread over a city.
- mlyle 4y ago
  > Providing housing can resolve problems in some cases, but there are people who are actively unwilling to stay in publicly provided housing (for a variety of reasons - although the most common I see is consistent drug use, closely followed by serious mental illness). Why don't we see what happens when we max out this intervention? Data seem to show that it would free up a lot of resources, and maybe some of those whom you're assuming will be recalcitrant won't be if housing options are ample. I think it's likely this would address 80% of the problem, and then we can see what the remaining 20% looks like qualitatively and quantitatively.

tracerbulletx 4y ago

We need to do the best we can with the information and morality we have, we've become paralyzed into inaction by fear of doing anything wrong and the ghosts of atrocities past.

Baeocystin 4y ago

I fully agree that this is a genuinely difficult, multi-factor problem with no easy answers. I also think that there are a lot of 'low-hanging fruit' level of options available, that seem to be disregarded in today's all-or-nothing environment. Specific example: During my short, ~10-block drive to the 101, I pass a good half-dozen regulars who are either screaming at the aether, wandering erratically through traffic, flinging things at passing people/cars, or in one case literally rolling around on the onramp between cars. This is not an exaggeration, or hyperbole. These people need to be in an institution. Maybe with treatment, they can recover. Maybe they will be there for the rest of their lives. Maybe some form of halfway-house works best. But I can't think of any good-faith argument that leads to the status quo being the best choice for either them or society at large. Surely we can come to a societal agreement about what to do for this level of dysfunction?

LexGray 4y ago

That question would be is forced denial of treatment for the mentally ill ever humane. I question how many mentally ill people on the street are there because they were given a choice to avoid treatment or if they were driven there by circumstances. The cognitive disruption of most mental health treatments would make most any sane person question their value versus quality of life. I do agree that mental illness definitions are a problem. Even forcing treatment on just those who are a danger to society makes me leery given that hostile social posts are now a social danger.