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> I figured it would be 200 pages of “and that’s a result of Reagan’s drive to shut down public mental health” Reagan hasn't been Governor of California for ne

> I figured it would be 200 pages of “and that’s a result of Reagan’s drive to shut down public mental health” Reagan hasn't been Governor of California for nearly 50 years.

red-iron-pine 3y ago
But he sure was president of the US, and that's where he pushed to repeal the Mental Health Systems Act of 1980. He certainly did try to crush it on state level, too, as a governor.
- Turing_Machine 3y ago
  And? 1980 was 43 years ago. I'm still not seeing why the present-day problems can reasonably be blamed on "Reagan". Why don't Bush I, Clinton, Bush II, Obama, Trump, and Biden bear any responsibility? Or, in California, Brown, Deukmejian, Wilson, Davis, Schwarzenegger, Brown (again), or Newsom? Why haven't any of those people undone what "Reagan" supposedly did?
  - fnordpiglet 3y ago
    Because of the act mentioned above. They presumably could have undone it, but the real damage was the dismantling of the public mental health infrastructure and the market economic approach to mental health via managed care that has turned out to be so disastrous. With the passage of the 1980 act the hospital networks were shut down and dismantled, and reimbursements via insurance for mental health were hobbled due to industry maneuvering despite many repeated attempts by congress to “fix” the loop holes exploited. The ACA actually did address the issues but by the point of the ACA decades of rot had set in - the hospital networks were long gone, mental health as a profession obliterated due to rapidly declining reimbursement rates (my father is a phd in clinical psychology with professorships and fellowships from Yale with an established private practice and hospital practice and saw his income go from upper middle class to upper lower class in 30 years, so he switched to doing evals for super secret government stuff). Even with the “fixes,” there’s no meaningful professional class in mental health - just a bunch of undergrads with a certificate, and even then not enough by a light year. But worse of all, there aren’t beds in facilities for the acute care people need today. Have bipolar and need inpatient care during a manic episode? It’s a multi month wait for a short term bed in Washington state, and the facilities are frightening and you’ll be co-habitating with criminally insane people. I know someone who was bunked with a serial rapist on trial - across the hall was two women who were gang affiliated schizophrenics on trial for murder and felony assault respectively). My friend was very well off with a well connected family. Doesn’t matter. Even then they could only house him for two weeks before sending him home deeply manic. They needed the bed for a criminally insane schizophrenic who had killed someone. That’s why it’s Reagan’s fault. He set up the stage so effectively it’s taken this long to turn around the basic issue of payment, and now we have no providers or services or infrastructure left to pay for.
    - Turing_Machine 3y ago
      Sorry, no. I'm willing to assume just for the sake of argument that Reagan messed things up. If things are still messed up 40-50 years later, it's not due to "Reagan". That's just an excuse. As for the idea that the mental health infrastructure was some kind of wondrous utopia before "Reagan", I draw your attention to this: https://en.wikipedia.org/wiki/Titicut_Follies https://en.wikipedia.org/wiki/Titicut_Follies Many other citations are available.
      - fnordpiglet 3y ago
        Would you say social security isn’t a part of FDR’s legacy because it passed through the hands of every president over the last 80+ years? Many have reviled it in that time but haven’t been able to dismantle it. It’s harder to build than destroy. The fact that it wasn’t until Obama we reversed coverage for mental health shows how enduring Reagan’s legacy is in mental health. But I would agree every president since carries a guilt for not driving redress, similarly every congress whose really at fault. I don’t hold it was a utopia. But if you want to see something worse than Bridgewater, look at the streets and see humans rotting in front of your eyes in the depths of untreated, yet easily treated, mental illness. It’s certainly morally convenient to do nothing, and morally wrong to try and get it wrong - but I think trying and failing in some cases and succeeding in others is better than failing in all cases by default. My father and great uncle were both clinical psychologists in the public mental health system, and there were many institutions that were high quality and served a population we let simply decompose on our streets now. If we traded a non utopia, we traded it for a total dystopia.

> I figured it would be 200 pages of “and that’s a result of Reagan’s drive to shut down public mental health” Reagan hasn't been Governor of California for nearly 50 years.

red-iron-pine 3y ago

But he sure was president of the US, and that's where he pushed to repeal the Mental Health Systems Act of 1980. He certainly did try to crush it on state level, too, as a governor.

Turing_Machine 3y ago
And? 1980 was 43 years ago. I'm still not seeing why the present-day problems can reasonably be blamed on "Reagan". Why don't Bush I, Clinton, Bush II, Obama, Trump, and Biden bear any responsibility? Or, in California, Brown, Deukmejian, Wilson, Davis, Schwarzenegger, Brown (again), or Newsom? Why haven't any of those people undone what "Reagan" supposedly did?
- fnordpiglet 3y ago
  Because of the act mentioned above. They presumably could have undone it, but the real damage was the dismantling of the public mental health infrastructure and the market economic approach to mental health via managed care that has turned out to be so disastrous. With the passage of the 1980 act the hospital networks were shut down and dismantled, and reimbursements via insurance for mental health were hobbled due to industry maneuvering despite many repeated attempts by congress to “fix” the loop holes exploited. The ACA actually did address the issues but by the point of the ACA decades of rot had set in - the hospital networks were long gone, mental health as a profession obliterated due to rapidly declining reimbursement rates (my father is a phd in clinical psychology with professorships and fellowships from Yale with an established private practice and hospital practice and saw his income go from upper middle class to upper lower class in 30 years, so he switched to doing evals for super secret government stuff). Even with the “fixes,” there’s no meaningful professional class in mental health - just a bunch of undergrads with a certificate, and even then not enough by a light year. But worse of all, there aren’t beds in facilities for the acute care people need today. Have bipolar and need inpatient care during a manic episode? It’s a multi month wait for a short term bed in Washington state, and the facilities are frightening and you’ll be co-habitating with criminally insane people. I know someone who was bunked with a serial rapist on trial - across the hall was two women who were gang affiliated schizophrenics on trial for murder and felony assault respectively). My friend was very well off with a well connected family. Doesn’t matter. Even then they could only house him for two weeks before sending him home deeply manic. They needed the bed for a criminally insane schizophrenic who had killed someone. That’s why it’s Reagan’s fault. He set up the stage so effectively it’s taken this long to turn around the basic issue of payment, and now we have no providers or services or infrastructure left to pay for.
  - Turing_Machine 3y ago
    Sorry, no. I'm willing to assume just for the sake of argument that Reagan messed things up. If things are still messed up 40-50 years later, it's not due to "Reagan". That's just an excuse. As for the idea that the mental health infrastructure was some kind of wondrous utopia before "Reagan", I draw your attention to this: https://en.wikipedia.org/wiki/Titicut_Follies https://en.wikipedia.org/wiki/Titicut_Follies Many other citations are available.
    - fnordpiglet 3y ago
      Would you say social security isn’t a part of FDR’s legacy because it passed through the hands of every president over the last 80+ years? Many have reviled it in that time but haven’t been able to dismantle it. It’s harder to build than destroy. The fact that it wasn’t until Obama we reversed coverage for mental health shows how enduring Reagan’s legacy is in mental health. But I would agree every president since carries a guilt for not driving redress, similarly every congress whose really at fault. I don’t hold it was a utopia. But if you want to see something worse than Bridgewater, look at the streets and see humans rotting in front of your eyes in the depths of untreated, yet easily treated, mental illness. It’s certainly morally convenient to do nothing, and morally wrong to try and get it wrong - but I think trying and failing in some cases and succeeding in others is better than failing in all cases by default. My father and great uncle were both clinical psychologists in the public mental health system, and there were many institutions that were high quality and served a population we let simply decompose on our streets now. If we traded a non utopia, we traded it for a total dystopia.