8 ms·

Psychiatric detentions rise in first year of 988 hotline

62 points by VagueMag 3y ago

josh_fyi 3y ago
The people being involuntarily detained have to pay the hospital bill, and in the US that is expensive.
- amatecha 3y ago
  Rhetorical question, but why is there even a hospital bill for being hospitalized? Keeping your people healthy should just be a given. How many hundreds of years will it take before universal healthcare is finally accepted as the basic standard of a humane civilization?
  - blowski 3y ago
    Rhetorical and unfortunately polarising, with a lot of detailed and well-written responses from all perspectives.
  - LudwigNagasena 3y ago
    Who are “your people”?
    - yarg 3y ago
      Clearly he's referring to the citizens of a nation.
      - LudwigNagasena 3y ago
        Should every person consider people with the same citizenship as “their people” and treat them better than others? Is it really uncivilized and inhumane to not follow that norm?
        yarg 3y ago
        I think you're reading tribalism into an issue of logistics.
        LudwigNagasena 3y ago
        There are no logistics issues with residents and tourists.
        yarg 3y ago
        Bloody hell man, you really do like to read between imaginary lines.
        LudwigNagasena 3y ago
        I think you have imagined those imaginary lines. I have no idea what you mean.
        yarg 3y ago
        In every comment you made in the thread, you seem to have taken minor issues of phrasing and used them to wildly misinterpret comments in the least charitable way imaginable. > Who are “your people”? This seemed (to me at least, but it wasn't entirely clear) to be reading a comment to be race based when it obviously wasn't. > Should every person consider people with the same citizenship as “their people” and treat them better than others? Is it really uncivilized and inhumane to not follow that norm? Really? This just completely misinterprets the comment it replied to. > There are no logistics issues with residents and tourists. This assumes that a system aiming to provide universal healthcare to the citizens of a nation will refuse to help non-citizens within the nation.
        LudwigNagasena 3y ago
        > This seemed (to me at least, but it wasn't entirely clear) to be reading a comment to be race based when it obviously wasn't. It seemed so to you because you tried to read something imaginary between the lines. It is ironic that it is exactly what you accuse me of. > Really? This just completely misinterprets the comment it replied to. I don't think it misinterprets anything. If you think it does, provide a better interpretation. > This assumes that a system aiming to provide universal healthcare to the citizens of a nation will refuse to help non-citizens within the nation. No, I didn't assume anything. OP said "Keeping your people healthy should just be a given". Following basic language pragmatics, it means that keeping not your people healthy is not a given. I asked who are "your people" and was given an answer that it means citizens.
    - drekk 3y ago
      Presumably the voting-age population in the US that allows people to die untreated (or buried in medical debt)
    - amatecha 3y ago
      The term I used was intentionally vague, referring broadly to the people who make up a given community, society or civilization. Everyone living in a given country, for example. Everyone within a respective health authority's region of responsibility. The people who make up the society in which we live, and with whom we share some degree of dependence and implicit/explicit responsibility to help ensure the survival of.
      - LudwigNagasena 3y ago
        Do you think a civilization where healthcare is provided by mandatory extraction of wealth under a threat of violence is more humane compared to the one where people take care only of their close relatives without being compelled by any force?
  - hackernewds 3y ago
    They are in countries that also have high taxation. The US chooses to remain one of the lowest taxed countries in the developed world. The gap could be used to fund private insurance costs, would you rather have that as an option or be mandatory remit to the state?
    - nullsense 3y ago
      I dunno. I'll take my high tax rate and universal healthcare any day.
    - LadyCailin 3y ago
      So long as insurance providers are obligated to cover individuals that can’t afford the premiums, then sure, why not. But if you’re going to do that, you might as well cut out the rent seeking, handle it at a government level, and make it cheaper overall.
    - lifeonlars 3y ago
      You're actually asking, would you rather be forced to have all your health needs taken care of, or have the freedom to choose inadequate healthcare in order to save money?
    - drekk 3y ago
      I would rather the state be able to collectively bargain on behalf of 330+ million individuals, personally. It would dramatically reduce costs. I never understand this argument because the average American pays more in insurance premiums, deductibles, and out-of-pocket expenses than what the tax would be. Unless you're a (temporarily embarrassed) millionaire I don't get it. As a nation we spend 2x as much per capita on healthcare costs than any other developed nation, and for some of the worst outcomes! Cuba, a tiny island nation-state suffering from 60 years of embargo has lower child mortality rates (under 5 years, infants, and neonatal) compared to the US. How can that be justified? Life, liberty, and the pursuit of happiness—so long as you have a premium healthcare plan brought to you by Blue Aetna Cigna Humana Kaiser(tm)! https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims https://www.propublica.org/article/cigna-pxdx-medical-health...
    - 3y ago
  - yarg 3y ago
    It's not really rhetorical. People absolutely should not be subjected to bankruptcy in order to get adequate health care, but there's an aspect of personal responsibility that needs to be considered. In NZ we have ACC, ACC is a universal insurance plan that covers injuries only (we don't have universal healthcare) so some dickhead can shatter his knees jumping of the roof of a three story building and be fully covered, but my little cousin with a disintegrating hipbone got no help from the state. I think we should expand to universal healthcare (no chance), and failing that ACC should not be abolished (no need to throw ambulance chasers and insurance fraud into the mix) but I do think that the state should have the power to recoup the costs in the case of grossly negligent behaviour that leads to predictable outcomes. Beyond momentary acts of idiocy, there are also lifestyle choices that have a significant impact on the health - for example, my morbidly obese aunty has had damned near every one of her non essential organs removed - I firmly believe that tax payers should not be on the hook for her (or anyone else's) wilful self-neglect.
    - candiodari 3y ago
      I wonder where you get the idea that psychiatric detention is adequate health care, or that it helps patients. Regularly studies pop up pointing out that involuntary treatment in general does not lower the odds of suicide. https://www.madinamerica.com/2019/06/involuntary-hospitalization-increases-risk-suicide-study-finds/ https://www.madinamerica.com/2019/06/involuntary-hospitaliza... And before you ask, doing nothing does work, or at least it beats this option. Yes there are yet better options, actual interested attention from an actual human being, but literally leaving the person on the street works better than any mandatory treatment, and is a lot better than involuntary detention. https://pubmed.ncbi.nlm.nih.gov/1023455/ https://pubmed.ncbi.nlm.nih.gov/1023455/ And frankly, find a local Psychiatrist and ask them this question "Who is best of: a person committing suicide, or a person in involuntary detention NOT committing suicide for 6 months". They will illuminate what causes this problem. So why are we doing this? Well, this gets done to those people to give Police an option to deal with people who've done nothing wrong but are judged to be "at risk" and generally being a nuisance, or the police judges they're "at risk" of doing serious damage by killing themselves, slowly getting worse but not actually having done anything wrong. Lastly, some people are doing this because they see it as a form of euthanasia. They are ill, or have destroyed their lives (for example with medical bills) beyond repair and they just want out. It takes a long time for them to actually do something about this. Needless to say, any form of "treatment" for this will only (sometimes rapidly) make things worse. In fact most old people die not from old age but from starving or dehydrating themselves to death (this gets a lot easier once you're past 70 or so. Energy/calorie shortage causes cascading organ failure, which ironically feels good, and you fall asleep as your blood poisons itself. Obviously doctors do not make a habit out of telling next-of-kin this is what happened, nor do they try to prevent this by for example force-feeding them). But, there is sadly no age limit on this. For example, in one famous case a 15 year old kid relapsed into Cancer after a very intense and destructive cancer. She'd had chemo from 5 to 9 years old, which handicapped her phsysically and mentally, permanently. She caused a lot of damage killing herself by putting a certain person in a position where the police could indict her for murder, a hospital was involved, psychiatrists, she got people to cover up her earlier attempts at suicide, psychiatrists lied to her parents, her parents got divorced and partially remarried, youth services got involved because the parents did not agree on what to do ... Note that this is independent of the actual health care system. The same problems manifest in Europe with public systems. The problem is that psychiatric help ... well, somewhere between doesn't help and actually destroys people. Who pays for this is beside the point because mostly, of course, these people are homeless, very ill and/or (ex-)criminals. You can charge them all you want, but as the expression goes "you can't get blood from a stone". The sad part is that parents and children can be held liable if a suicide (attempt) does damage, which then causes more problems. This is done to "protect" society against psychiatric patients and to redirect as much of the cost of totally rejecting people to those people and their families as possible.
  - lynx23 3y ago
    You named it, humane civilization, which probably also excluded the death penalty. The USA still has quite a way to go. Racist police violence, death penalty, universal healthcare, did I miss something?
  - tivert 3y ago
    > why is there even a hospital bill for being hospitalized? Because hospitalization takes a lot of expensive resources. The bill has to go somewhere. > Keeping your people healthy should just be a given. For the entirety of human history, up to and including this point, it hasn't been. > How many hundreds of years will it take before universal healthcare is finally accepted as the basic standard of a humane civilization? Realistically? When they have AI doctors that can treat the plebs for very little cost. Until then, we're talking about at least 10-15% of GDP of a rich country, which is a massive amount of money. Even places with "universal healthcare" make tradeoffs (e.g. IIRC, healthcare waiting lists for many things are absurdly long in Canada compared to the US).
    - aaomidi 3y ago
      For the majority of human history, health care was done by village shamans etc (that did actually treat most ailments they could) for free. It was part of living in that village. So no, under modern less-personal systems this hasn’t been the case.
      - tivert 3y ago
        >>> Keeping your people healthy should just be a given. >> For the entirety of human history, up to and including this point, it hasn't been. > For the majority of human history, health care was done by village shamans etc (that did actually treat most ailments they could) for free. Would you be OK with universal shamanistic healthcare? Because I don't think that would count as succeeding at "keeping your people healthy" by any reasonable definition. My strong hunch is that village shamans could successfully treat far, far fewer aliments than you could with OTC medications and first aid supplies. Things start getting expensive once you try to be more effective than that. And the shamans almost certainly weren't doing it "for free," but a village like that almost certainly is primarily a non-market economy, so their compensation could be obscure to modern eyes (e.g. for a more modern example and easy-to-understand example, Jewish priests were compensated by being entitled to a portion of religious sacrifices).
        3y ago
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- vixen99 3y ago
  The Netflix film 'I care a lot' is a comedy based on a scam in which a care home provider gets a dodgy doctor to certify (with a court order) retirees with no dependents and significant assets who happen to have a few memory problems. It would be nice to think variations on this theme simply never happen in reality.
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htag 3y ago
I was a volunteer phone responder for a (smaller) state Suicide Prevention Hotline, but stopped because of the changes to the organization caused by the 988 transition. My primary complaint was in the organizational changes made by the non-profit. The amount of funding increased significantly, and while some of it was spent on non-volunteer responders the majority of the funding was spent on new bureaucrats. With the funding, the amount of external organizations we were answerable increased. I was suddenly scolded for behaviors I had been doing for years before. Things like calls taking longer than fifteen minutes (when we had lines open, and I am talking to a person in crisis), or me failing to collect enough demographic information from distressed individuals. I didn't want to adapt, and they were more than happy to pay someone $12/hr that will follow orders more closely. There were a lot of great things that came from the 988 transition. For one, cell phone calls are now routed based on the location of the cell phone, where previous they were routed by the area code of the cellphone number. Another thing, is it did lead to increased call volume. I bet the combination of increased calls, with all calls routing to centers familiar with local resources, drastically increased the amount of detentions coming from suicide hotlines.
- nkingsy 3y ago
  My wife has had the exact same experience. There was a core of highly skilled volunteers that is now entirely gone over the last 2 years. She still volunteers because she wants to be there if a teen calls. This is emotionally draining work when done right and it shouldn’t be done full time by 20 year olds.
  - startupsfail 3y ago
    Saving a life of a child, by volunteering to answer a phone call. That’s impressive.
    - soco 3y ago
      A friend of mine is doing this now, after being helped herself by an operator times ago. She's giving back now that she's in a better place and yeah I'm... impressed too.
Gimpei 3y ago
I don’t see what the problem is. If someone has just taken pills and is close to dying on the other end of the line, do you really think the optimal course of action is to just sit there and listen to them fade away?
- deleted 3y ago
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- NoZebra120vClip 3y ago
  That's almost never the case. And how can some stranger at a call center know this? Mentally ill people are unreliable narrators of their own circumstances. They're prone to exaggerations, delusion, rants, lies, subterfuge, concealment, verbal abuse. If someone called 998, then yes, please listen to them. Listen attentively, validate their feelings, but soothe and comfort and reassure them. There are systematic ways to do this and they can get results. But never ever call 998. Beware if someone offers to do so. Your hospital incarceration will be more traumatic, damaging, and expensive than any other alternative. Get help before it gets to that point. Seek out good therapists and support groups when you're sane and calm, and stick to your treatment. Do it in-person, face-to-face. There is no substitute.
  - nkingsy 3y ago
    988 is not 911. Authorities are only called in extreme circumstances. Please do call if you feel the need.
    - NoZebra120vClip 3y ago
      You called 998, you called the "authorities" already. Cat's out of the bag. Van's engine is running. They know where you live and they know how fast you're moving. They can't know how many doses you took or how many rounds are left. You'll wake up chained to a bed with screams and moaning in the hallway. Nurse Ratched is here with your pills.
      - 3y ago
tcj_phx 3y ago
The tragedy of modern psychiatry is that it's so close to knowing enough to be helpful to people whose symptoms are behavioral, but the psychiatric standard of care is a straight jacket that prevents progress. I've commented here about my efforts to extract my friend from her psychiatric misdiagnosis. tl/dr: she has the genetic condition where she can't turn the food fortification folic acid into a methylated form of Vitamin B-9 (MTHFR), which results in her being harmed by fortified food. Folate-deficiency is known to be behind problematic alcohol consumption. She told me about how adding L-Methyl-Folate to her routine was like flipping a switch from 'depressed' to 'not-depressed'. But the doctors had already decided her substance-associated psychosis required tranquilizers ('antipsychotics') in perpetuity, and only added the vitamin to their forced prescriptions. The latest news is that she escaped from her court-ordered guardian and involuntary mental health treatments, sometime in February 2023. The antipsychotics have worn off, and she's been able to stay sober. She sounds like she's doing well. Mad in America has published two of my blog posts. The second one was called Cargo Cult Psychiatry: https://www.madinamerica.com/2022/06/cargo-cult-psychiatry/ https://www.madinamerica.com/2022/06/cargo-cult-psychiatry/ SCOTUS dismissed my latest petition without comment, as if to say it's perfectly fine for the mental health industry to perpetrate fraud on the United States Court. Still thinking about how to proceed. A book - Brain Energy by Chris Palmer - was published in 2022. All the old approaches to forced psychiatric drugging have been obsolete for decades, now they're indefensible. There's nothing new in the book, Dr. Palmer just compiled 50+ years of research into his book.
- alvarezbjm-hn 3y ago
  "Still thinking about how to proceed" Try to find someone very powerful, or very rich, who has a son or a daughter with the same disease. Then convince that person to spend some energy in public awareness and lobbying. Other than that, drink a lot of patience. Making too much noise can get you in trouble.
  - tcj_phx 3y ago
    "Making too much noise can get you in trouble." Someone explained this to me once, in another way: "missionaries get eaten by cannibals." Thanks for the reminder.
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DiscourseFan 3y ago
So when I was at College, I went to my University's counseling service (which you should never do), and I told a bunch of people I was thinking about killing myself and I wanted to talk to someone about these feelings. I never said that I immanently was about to do it or anything and I needed someone to stop me, I just said I was having suicidal ideation. Now, at that point in time I was very mentally ill, I'd recently gone through a nasty breakup and I was thinking all sorts of terrible things. But the response from the university was severe. Little did I know, my school had its own psychiatric hospital, which I found myself in: the door locked behind me, I was never told that entering that building might lead to me being committed, I was only interested in outpatient programs. But I didn't get much choice in the matter: after telling my story, I was told that either I "voluntarily" committed, or they would go and get a court order and have me forced to come back within 72 hours. Now if I was at all intelligent, I would've told them to let me go, and I would've gtfo of the state for about a week and gotten a lawyer. But as a young college student I didn't know any better--and I also didn't realize how much money they made off of voluntary patients like myself (my insurance never paid for the say, by the way). Well a week later, after taking medication that didn't work but gave me terrible side-effects and me telling more than enough lies about how I was feeling better, they got me out of there (since its not there job to keep people there forever anyway), and I was on my way. It wasn't so terrible except for the forced medication, the constant threat of being moved essentially to jail in the form of involuntary commitment, and the basic dehumanization you experience. Though it wasn't so simple: my university decided that I needed to go into an outpatient program or else they wouldn't "approve" me going back to class. That is why I say you should never go to your schools counselors: they will always use it against you. I was forced into an outpatient program, which my insurance also wouldn't pay for (or else I wouldn't be able to go back to school), but thankfully I was able to convince someone in there to move me to a less intensive program. I'd also, by then, stopped taking my medication (and haven't taken a single psychiatric drug since). Well, long story short at this new program I was getting bullied by one of the members of the staff, but instead of taking my complaint seriously the head of the program (which was quite small) simply ejected me before I could talk to anyone higher up. And from the university's perspective, I was done with my treatment. You think that this would be the end of the story, but the school kept their eye on me for years after; the amount of run-ins I had with the police over supposed alarms about my "mental health" was both horrifying and shocking. Thankfully, I eventually learned just to tell them I wouldn't talk without a lawyer, and they stopped bothering me after. But its very scary feeling like you're being constantly surveilled all the time, and fearing that if you ever talk to the police they'll try to take you in to a psychiatric facility. Years later and I'm very happy: but not on account of any help from contemporary psychiatric institutions, modern psychology, therapy, or anything (though I did get a therapist who wasn't affiliated with my university), but from my readings. God you couldn't know how much Nietzsche and Freud can help someone like me, but they certainly put me through, and I'd have to guess that as their influence waned in American psychology, so did the quality of treatment--but what can you do when all their readers say that the system is the problem, and it just so happens the functionaries of power control the purses of psych programs! Everything radical, actually life-affirming and helpful was shunted from mental health and the whole thing was turned into some sort of pseudo-scientifical escapade for extracting as much money as possible from a socially dissatisfied population: they made a whole business out of ennui--what else is "positive psychology?" Anyway I'm on the other side of things and all I can say is this: stay the fuck away from mentally ill people, they will ruin your life and only make you feel worse. Also, get exercise, eat decently, and stay hydrated, that usually helps. And never, ever, trust your run of the mill, CBT practicing psych: they either didn't do very well in med-school and became a psychiatrist; or, they studied psychology because they didn't know what else to do and they ended up practicing. There are people out there that can help, who aren't scam artist or just mindless NPCs; but there aren't a whole lot of them, and its almost impossible to differentiate the good from the bad until you get to the other side of things. I would recommend just doing some reading on your own: read Nietzsche, read Camus, read Kierkegaard (I haven't read him but I hear he is good): there is freedom, joy, and affirmation of life to be discovered here--which is nothing that our current mode of organizing society wants for you!
janalsncm 3y ago
I’d like to know some other metrics that resulted from this service. Maybe they’re impossible to get but I’d like to know them. How many suicides were prevented? How many people were saved from harm by another person? Has general mental health improved? People involuntarily detained is a negative result, but it’s not the only important one.
- candiodari 3y ago
  > How many suicides were prevented? Given that involuntary detention increases the risk of suicide, this caused suicides rather than prevent them. Especially by using deception to involuntarily detain someone, which is known to have a devastating effect. So a negative number. https://www.madinamerica.com/2019/06/involuntary-hospitalization-increases-risk-suicide-study-finds/ https://www.madinamerica.com/2019/06/involuntary-hospitaliza... In general it is the amount of psychiatric help a person gets, not their problems, that predicts the odds of a successful suicide. This even applies to children. And yes, the corollary does apply: refusing help does reduce the risk significantly. https://pubmed.ncbi.nlm.nih.gov/1023455/ https://pubmed.ncbi.nlm.nih.gov/1023455/ Suicide prevention is about reducing the risk for others, specifically the psychiatry industry (but also school, work, government, ...). Not about reducing the risk for the victims or their families. It is about hiding the problem of suicide, not about actually preventing it or helping families. And sure, not because they don't want to help, but because they can't, due to a combination of not knowing how, not caring, and help needed (e.g. housing) not being available. > How many people were saved from harm by another person? This is not 911, is this even an option? I suppose I don't know. > Has general mental health improved? No it's gotten worse. https://www.psychiatry.org/news-room/news-releases/americans-anticipate-higher-stress-at-the-start-of https://www.psychiatry.org/news-room/news-releases/americans...
rob74 3y ago
The article certainly has a point, but OTOH the goal of a suicide prevention hotline is to, well, prevent suicides. If someone is close to commiting suicide out of their own free will, calls the hotline, but is obviously still unstable, maybe it is justified to detain them until they are no longer in danger? And of course the operators of the hotline will be cagey about admitting they may track users, out of fear that knowing about this might prevent people from calling the hotline and getting help.
- lynx23 3y ago
  All this story and your conclusion underlines for me is what I already knew: Never ever tell the system that you have a problem. Working on fixing it yourself always has less fallout then whatever the system might be thinking is best for you. Just dont trust em, they will detain you forever and take away your individual rights.
  - rob74 3y ago
    In the end it's a philosophical question: if you value individual freedom above all else, why even have a suicide prevention hotline? If you can agree that preventing suicides should be something society (sounds better than "the system") wants, and you create a suicide prevention hotline, how far should they be allowed to go to prevent suicides? The people working there will of course want to help people, and may even be made liable if they don't do everything in their power to help someone once they know of their situation. Or at the very least, limiting what they are allowed to do to help someone will lead to burn-out: imagine how traumatizing it is to know that someone you talked to then went through with their suicide because you weren't allowed to track their phone?
    - lll-o-lll 3y ago
      It’s not philosophical at all. It’s the boring practical reality that letting the government into your personal life is likely to completely screw said life over. Don’t ring the hotline, go to a priest. He will listen, offer some guidance that may help, and won’t put you in a system from which you may never escape. People need someone they can talk to knowing that they are still in some control of the outcome. Or they just won’t call.

62 points by VagueMag 3y ago

josh_fyi 3y ago

The people being involuntarily detained have to pay the hospital bill, and in the US that is expensive.

amatecha 3y ago
Rhetorical question, but why is there even a hospital bill for being hospitalized? Keeping your people healthy should just be a given. How many hundreds of years will it take before universal healthcare is finally accepted as the basic standard of a humane civilization?
- blowski 3y ago
  Rhetorical and unfortunately polarising, with a lot of detailed and well-written responses from all perspectives.
- LudwigNagasena 3y ago
  Who are “your people”?
  - yarg 3y ago
    Clearly he's referring to the citizens of a nation.
    - LudwigNagasena 3y ago
      Should every person consider people with the same citizenship as “their people” and treat them better than others? Is it really uncivilized and inhumane to not follow that norm?
      - yarg 3y ago
        I think you're reading tribalism into an issue of logistics.
        LudwigNagasena 3y ago
        There are no logistics issues with residents and tourists.
        yarg 3y ago
        Bloody hell man, you really do like to read between imaginary lines.
        LudwigNagasena 3y ago
        I think you have imagined those imaginary lines. I have no idea what you mean.
        yarg 3y ago
        In every comment you made in the thread, you seem to have taken minor issues of phrasing and used them to wildly misinterpret comments in the least charitable way imaginable. > Who are “your people”? This seemed (to me at least, but it wasn't entirely clear) to be reading a comment to be race based when it obviously wasn't. > Should every person consider people with the same citizenship as “their people” and treat them better than others? Is it really uncivilized and inhumane to not follow that norm? Really? This just completely misinterprets the comment it replied to. > There are no logistics issues with residents and tourists. This assumes that a system aiming to provide universal healthcare to the citizens of a nation will refuse to help non-citizens within the nation.
        LudwigNagasena 3y ago
        > This seemed (to me at least, but it wasn't entirely clear) to be reading a comment to be race based when it obviously wasn't. It seemed so to you because you tried to read something imaginary between the lines. It is ironic that it is exactly what you accuse me of. > Really? This just completely misinterprets the comment it replied to. I don't think it misinterprets anything. If you think it does, provide a better interpretation. > This assumes that a system aiming to provide universal healthcare to the citizens of a nation will refuse to help non-citizens within the nation. No, I didn't assume anything. OP said "Keeping your people healthy should just be a given". Following basic language pragmatics, it means that keeping not your people healthy is not a given. I asked who are "your people" and was given an answer that it means citizens.
  - drekk 3y ago
    Presumably the voting-age population in the US that allows people to die untreated (or buried in medical debt)
  - amatecha 3y ago
    The term I used was intentionally vague, referring broadly to the people who make up a given community, society or civilization. Everyone living in a given country, for example. Everyone within a respective health authority's region of responsibility. The people who make up the society in which we live, and with whom we share some degree of dependence and implicit/explicit responsibility to help ensure the survival of.
    - LudwigNagasena 3y ago
      Do you think a civilization where healthcare is provided by mandatory extraction of wealth under a threat of violence is more humane compared to the one where people take care only of their close relatives without being compelled by any force?
- hackernewds 3y ago
  They are in countries that also have high taxation. The US chooses to remain one of the lowest taxed countries in the developed world. The gap could be used to fund private insurance costs, would you rather have that as an option or be mandatory remit to the state?
  - nullsense 3y ago
    I dunno. I'll take my high tax rate and universal healthcare any day.
  - LadyCailin 3y ago
    So long as insurance providers are obligated to cover individuals that can’t afford the premiums, then sure, why not. But if you’re going to do that, you might as well cut out the rent seeking, handle it at a government level, and make it cheaper overall.
  - lifeonlars 3y ago
    You're actually asking, would you rather be forced to have all your health needs taken care of, or have the freedom to choose inadequate healthcare in order to save money?
  - drekk 3y ago
    I would rather the state be able to collectively bargain on behalf of 330+ million individuals, personally. It would dramatically reduce costs. I never understand this argument because the average American pays more in insurance premiums, deductibles, and out-of-pocket expenses than what the tax would be. Unless you're a (temporarily embarrassed) millionaire I don't get it. As a nation we spend 2x as much per capita on healthcare costs than any other developed nation, and for some of the worst outcomes! Cuba, a tiny island nation-state suffering from 60 years of embargo has lower child mortality rates (under 5 years, infants, and neonatal) compared to the US. How can that be justified? Life, liberty, and the pursuit of happiness—so long as you have a premium healthcare plan brought to you by Blue Aetna Cigna Humana Kaiser(tm)! https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims https://www.propublica.org/article/cigna-pxdx-medical-health...
  - 3y ago
- yarg 3y ago
  It's not really rhetorical. People absolutely should not be subjected to bankruptcy in order to get adequate health care, but there's an aspect of personal responsibility that needs to be considered. In NZ we have ACC, ACC is a universal insurance plan that covers injuries only (we don't have universal healthcare) so some dickhead can shatter his knees jumping of the roof of a three story building and be fully covered, but my little cousin with a disintegrating hipbone got no help from the state. I think we should expand to universal healthcare (no chance), and failing that ACC should not be abolished (no need to throw ambulance chasers and insurance fraud into the mix) but I do think that the state should have the power to recoup the costs in the case of grossly negligent behaviour that leads to predictable outcomes. Beyond momentary acts of idiocy, there are also lifestyle choices that have a significant impact on the health - for example, my morbidly obese aunty has had damned near every one of her non essential organs removed - I firmly believe that tax payers should not be on the hook for her (or anyone else's) wilful self-neglect.
  - candiodari 3y ago
    I wonder where you get the idea that psychiatric detention is adequate health care, or that it helps patients. Regularly studies pop up pointing out that involuntary treatment in general does not lower the odds of suicide. https://www.madinamerica.com/2019/06/involuntary-hospitalization-increases-risk-suicide-study-finds/ https://www.madinamerica.com/2019/06/involuntary-hospitaliza... And before you ask, doing nothing does work, or at least it beats this option. Yes there are yet better options, actual interested attention from an actual human being, but literally leaving the person on the street works better than any mandatory treatment, and is a lot better than involuntary detention. https://pubmed.ncbi.nlm.nih.gov/1023455/ https://pubmed.ncbi.nlm.nih.gov/1023455/ And frankly, find a local Psychiatrist and ask them this question "Who is best of: a person committing suicide, or a person in involuntary detention NOT committing suicide for 6 months". They will illuminate what causes this problem. So why are we doing this? Well, this gets done to those people to give Police an option to deal with people who've done nothing wrong but are judged to be "at risk" and generally being a nuisance, or the police judges they're "at risk" of doing serious damage by killing themselves, slowly getting worse but not actually having done anything wrong. Lastly, some people are doing this because they see it as a form of euthanasia. They are ill, or have destroyed their lives (for example with medical bills) beyond repair and they just want out. It takes a long time for them to actually do something about this. Needless to say, any form of "treatment" for this will only (sometimes rapidly) make things worse. In fact most old people die not from old age but from starving or dehydrating themselves to death (this gets a lot easier once you're past 70 or so. Energy/calorie shortage causes cascading organ failure, which ironically feels good, and you fall asleep as your blood poisons itself. Obviously doctors do not make a habit out of telling next-of-kin this is what happened, nor do they try to prevent this by for example force-feeding them). But, there is sadly no age limit on this. For example, in one famous case a 15 year old kid relapsed into Cancer after a very intense and destructive cancer. She'd had chemo from 5 to 9 years old, which handicapped her phsysically and mentally, permanently. She caused a lot of damage killing herself by putting a certain person in a position where the police could indict her for murder, a hospital was involved, psychiatrists, she got people to cover up her earlier attempts at suicide, psychiatrists lied to her parents, her parents got divorced and partially remarried, youth services got involved because the parents did not agree on what to do ... Note that this is independent of the actual health care system. The same problems manifest in Europe with public systems. The problem is that psychiatric help ... well, somewhere between doesn't help and actually destroys people. Who pays for this is beside the point because mostly, of course, these people are homeless, very ill and/or (ex-)criminals. You can charge them all you want, but as the expression goes "you can't get blood from a stone". The sad part is that parents and children can be held liable if a suicide (attempt) does damage, which then causes more problems. This is done to "protect" society against psychiatric patients and to redirect as much of the cost of totally rejecting people to those people and their families as possible.
- lynx23 3y ago
  You named it, humane civilization, which probably also excluded the death penalty. The USA still has quite a way to go. Racist police violence, death penalty, universal healthcare, did I miss something?
- tivert 3y ago
  > why is there even a hospital bill for being hospitalized? Because hospitalization takes a lot of expensive resources. The bill has to go somewhere. > Keeping your people healthy should just be a given. For the entirety of human history, up to and including this point, it hasn't been. > How many hundreds of years will it take before universal healthcare is finally accepted as the basic standard of a humane civilization? Realistically? When they have AI doctors that can treat the plebs for very little cost. Until then, we're talking about at least 10-15% of GDP of a rich country, which is a massive amount of money. Even places with "universal healthcare" make tradeoffs (e.g. IIRC, healthcare waiting lists for many things are absurdly long in Canada compared to the US).
  - aaomidi 3y ago
    For the majority of human history, health care was done by village shamans etc (that did actually treat most ailments they could) for free. It was part of living in that village. So no, under modern less-personal systems this hasn’t been the case.
    - tivert 3y ago
      >>> Keeping your people healthy should just be a given. >> For the entirety of human history, up to and including this point, it hasn't been. > For the majority of human history, health care was done by village shamans etc (that did actually treat most ailments they could) for free. Would you be OK with universal shamanistic healthcare? Because I don't think that would count as succeeding at "keeping your people healthy" by any reasonable definition. My strong hunch is that village shamans could successfully treat far, far fewer aliments than you could with OTC medications and first aid supplies. Things start getting expensive once you try to be more effective than that. And the shamans almost certainly weren't doing it "for free," but a village like that almost certainly is primarily a non-market economy, so their compensation could be obscure to modern eyes (e.g. for a more modern example and easy-to-understand example, Jewish priests were compensated by being entitled to a portion of religious sacrifices).
      - 3y ago
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vixen99 3y ago
The Netflix film 'I care a lot' is a comedy based on a scam in which a care home provider gets a dodgy doctor to certify (with a court order) retirees with no dependents and significant assets who happen to have a few memory problems. It would be nice to think variations on this theme simply never happen in reality.

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htag 3y ago

I was a volunteer phone responder for a (smaller) state Suicide Prevention Hotline, but stopped because of the changes to the organization caused by the 988 transition. My primary complaint was in the organizational changes made by the non-profit. The amount of funding increased significantly, and while some of it was spent on non-volunteer responders the majority of the funding was spent on new bureaucrats. With the funding, the amount of external organizations we were answerable increased. I was suddenly scolded for behaviors I had been doing for years before. Things like calls taking longer than fifteen minutes (when we had lines open, and I am talking to a person in crisis), or me failing to collect enough demographic information from distressed individuals. I didn't want to adapt, and they were more than happy to pay someone $12/hr that will follow orders more closely. There were a lot of great things that came from the 988 transition. For one, cell phone calls are now routed based on the location of the cell phone, where previous they were routed by the area code of the cellphone number. Another thing, is it did lead to increased call volume. I bet the combination of increased calls, with all calls routing to centers familiar with local resources, drastically increased the amount of detentions coming from suicide hotlines.

nkingsy 3y ago
My wife has had the exact same experience. There was a core of highly skilled volunteers that is now entirely gone over the last 2 years. She still volunteers because she wants to be there if a teen calls. This is emotionally draining work when done right and it shouldn’t be done full time by 20 year olds.
- startupsfail 3y ago
  Saving a life of a child, by volunteering to answer a phone call. That’s impressive.
  - soco 3y ago
    A friend of mine is doing this now, after being helped herself by an operator times ago. She's giving back now that she's in a better place and yeah I'm... impressed too.

Gimpei 3y ago

I don’t see what the problem is. If someone has just taken pills and is close to dying on the other end of the line, do you really think the optimal course of action is to just sit there and listen to them fade away?

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NoZebra120vClip 3y ago
That's almost never the case. And how can some stranger at a call center know this? Mentally ill people are unreliable narrators of their own circumstances. They're prone to exaggerations, delusion, rants, lies, subterfuge, concealment, verbal abuse. If someone called 998, then yes, please listen to them. Listen attentively, validate their feelings, but soothe and comfort and reassure them. There are systematic ways to do this and they can get results. But never ever call 998. Beware if someone offers to do so. Your hospital incarceration will be more traumatic, damaging, and expensive than any other alternative. Get help before it gets to that point. Seek out good therapists and support groups when you're sane and calm, and stick to your treatment. Do it in-person, face-to-face. There is no substitute.
- nkingsy 3y ago
  988 is not 911. Authorities are only called in extreme circumstances. Please do call if you feel the need.
  - NoZebra120vClip 3y ago
    You called 998, you called the "authorities" already. Cat's out of the bag. Van's engine is running. They know where you live and they know how fast you're moving. They can't know how many doses you took or how many rounds are left. You'll wake up chained to a bed with screams and moaning in the hallway. Nurse Ratched is here with your pills.
    - 3y ago

tcj_phx 3y ago

The tragedy of modern psychiatry is that it's so close to knowing enough to be helpful to people whose symptoms are behavioral, but the psychiatric standard of care is a straight jacket that prevents progress. I've commented here about my efforts to extract my friend from her psychiatric misdiagnosis. tl/dr: she has the genetic condition where she can't turn the food fortification folic acid into a methylated form of Vitamin B-9 (MTHFR), which results in her being harmed by fortified food. Folate-deficiency is known to be behind problematic alcohol consumption. She told me about how adding L-Methyl-Folate to her routine was like flipping a switch from 'depressed' to 'not-depressed'. But the doctors had already decided her substance-associated psychosis required tranquilizers ('antipsychotics') in perpetuity, and only added the vitamin to their forced prescriptions. The latest news is that she escaped from her court-ordered guardian and involuntary mental health treatments, sometime in February 2023. The antipsychotics have worn off, and she's been able to stay sober. She sounds like she's doing well. Mad in America has published two of my blog posts. The second one was called Cargo Cult Psychiatry: https://www.madinamerica.com/2022/06/cargo-cult-psychiatry/ https://www.madinamerica.com/2022/06/cargo-cult-psychiatry/ SCOTUS dismissed my latest petition without comment, as if to say it's perfectly fine for the mental health industry to perpetrate fraud on the United States Court. Still thinking about how to proceed. A book - Brain Energy by Chris Palmer - was published in 2022. All the old approaches to forced psychiatric drugging have been obsolete for decades, now they're indefensible. There's nothing new in the book, Dr. Palmer just compiled 50+ years of research into his book.

alvarezbjm-hn 3y ago
"Still thinking about how to proceed" Try to find someone very powerful, or very rich, who has a son or a daughter with the same disease. Then convince that person to spend some energy in public awareness and lobbying. Other than that, drink a lot of patience. Making too much noise can get you in trouble.
- tcj_phx 3y ago
  "Making too much noise can get you in trouble." Someone explained this to me once, in another way: "missionaries get eaten by cannibals." Thanks for the reminder.

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DiscourseFan 3y ago

So when I was at College, I went to my University's counseling service (which you should never do), and I told a bunch of people I was thinking about killing myself and I wanted to talk to someone about these feelings. I never said that I immanently was about to do it or anything and I needed someone to stop me, I just said I was having suicidal ideation. Now, at that point in time I was very mentally ill, I'd recently gone through a nasty breakup and I was thinking all sorts of terrible things. But the response from the university was severe. Little did I know, my school had its own psychiatric hospital, which I found myself in: the door locked behind me, I was never told that entering that building might lead to me being committed, I was only interested in outpatient programs. But I didn't get much choice in the matter: after telling my story, I was told that either I "voluntarily" committed, or they would go and get a court order and have me forced to come back within 72 hours. Now if I was at all intelligent, I would've told them to let me go, and I would've gtfo of the state for about a week and gotten a lawyer. But as a young college student I didn't know any better--and I also didn't realize how much money they made off of voluntary patients like myself (my insurance never paid for the say, by the way). Well a week later, after taking medication that didn't work but gave me terrible side-effects and me telling more than enough lies about how I was feeling better, they got me out of there (since its not there job to keep people there forever anyway), and I was on my way. It wasn't so terrible except for the forced medication, the constant threat of being moved essentially to jail in the form of involuntary commitment, and the basic dehumanization you experience. Though it wasn't so simple: my university decided that I needed to go into an outpatient program or else they wouldn't "approve" me going back to class. That is why I say you should never go to your schools counselors: they will always use it against you. I was forced into an outpatient program, which my insurance also wouldn't pay for (or else I wouldn't be able to go back to school), but thankfully I was able to convince someone in there to move me to a less intensive program. I'd also, by then, stopped taking my medication (and haven't taken a single psychiatric drug since). Well, long story short at this new program I was getting bullied by one of the members of the staff, but instead of taking my complaint seriously the head of the program (which was quite small) simply ejected me before I could talk to anyone higher up. And from the university's perspective, I was done with my treatment. You think that this would be the end of the story, but the school kept their eye on me for years after; the amount of run-ins I had with the police over supposed alarms about my "mental health" was both horrifying and shocking. Thankfully, I eventually learned just to tell them I wouldn't talk without a lawyer, and they stopped bothering me after. But its very scary feeling like you're being constantly surveilled all the time, and fearing that if you ever talk to the police they'll try to take you in to a psychiatric facility. Years later and I'm very happy: but not on account of any help from contemporary psychiatric institutions, modern psychology, therapy, or anything (though I did get a therapist who wasn't affiliated with my university), but from my readings. God you couldn't know how much Nietzsche and Freud can help someone like me, but they certainly put me through, and I'd have to guess that as their influence waned in American psychology, so did the quality of treatment--but what can you do when all their readers say that the system is the problem, and it just so happens the functionaries of power control the purses of psych programs! Everything radical, actually life-affirming and helpful was shunted from mental health and the whole thing was turned into some sort of pseudo-scientifical escapade for extracting as much money as possible from a socially dissatisfied population: they made a whole business out of ennui--what else is "positive psychology?" Anyway I'm on the other side of things and all I can say is this: stay the fuck away from mentally ill people, they will ruin your life and only make you feel worse. Also, get exercise, eat decently, and stay hydrated, that usually helps. And never, ever, trust your run of the mill, CBT practicing psych: they either didn't do very well in med-school and became a psychiatrist; or, they studied psychology because they didn't know what else to do and they ended up practicing. There are people out there that can help, who aren't scam artist or just mindless NPCs; but there aren't a whole lot of them, and its almost impossible to differentiate the good from the bad until you get to the other side of things. I would recommend just doing some reading on your own: read Nietzsche, read Camus, read Kierkegaard (I haven't read him but I hear he is good): there is freedom, joy, and affirmation of life to be discovered here--which is nothing that our current mode of organizing society wants for you!

janalsncm 3y ago

I’d like to know some other metrics that resulted from this service. Maybe they’re impossible to get but I’d like to know them. How many suicides were prevented? How many people were saved from harm by another person? Has general mental health improved? People involuntarily detained is a negative result, but it’s not the only important one.

candiodari 3y ago
> How many suicides were prevented? Given that involuntary detention increases the risk of suicide, this caused suicides rather than prevent them. Especially by using deception to involuntarily detain someone, which is known to have a devastating effect. So a negative number. https://www.madinamerica.com/2019/06/involuntary-hospitalization-increases-risk-suicide-study-finds/ https://www.madinamerica.com/2019/06/involuntary-hospitaliza... In general it is the amount of psychiatric help a person gets, not their problems, that predicts the odds of a successful suicide. This even applies to children. And yes, the corollary does apply: refusing help does reduce the risk significantly. https://pubmed.ncbi.nlm.nih.gov/1023455/ https://pubmed.ncbi.nlm.nih.gov/1023455/ Suicide prevention is about reducing the risk for others, specifically the psychiatry industry (but also school, work, government, ...). Not about reducing the risk for the victims or their families. It is about hiding the problem of suicide, not about actually preventing it or helping families. And sure, not because they don't want to help, but because they can't, due to a combination of not knowing how, not caring, and help needed (e.g. housing) not being available. > How many people were saved from harm by another person? This is not 911, is this even an option? I suppose I don't know. > Has general mental health improved? No it's gotten worse. https://www.psychiatry.org/news-room/news-releases/americans-anticipate-higher-stress-at-the-start-of https://www.psychiatry.org/news-room/news-releases/americans...

rob74 3y ago

The article certainly has a point, but OTOH the goal of a suicide prevention hotline is to, well, prevent suicides. If someone is close to commiting suicide out of their own free will, calls the hotline, but is obviously still unstable, maybe it is justified to detain them until they are no longer in danger? And of course the operators of the hotline will be cagey about admitting they may track users, out of fear that knowing about this might prevent people from calling the hotline and getting help.

lynx23 3y ago
All this story and your conclusion underlines for me is what I already knew: Never ever tell the system that you have a problem. Working on fixing it yourself always has less fallout then whatever the system might be thinking is best for you. Just dont trust em, they will detain you forever and take away your individual rights.
- rob74 3y ago
  In the end it's a philosophical question: if you value individual freedom above all else, why even have a suicide prevention hotline? If you can agree that preventing suicides should be something society (sounds better than "the system") wants, and you create a suicide prevention hotline, how far should they be allowed to go to prevent suicides? The people working there will of course want to help people, and may even be made liable if they don't do everything in their power to help someone once they know of their situation. Or at the very least, limiting what they are allowed to do to help someone will lead to burn-out: imagine how traumatizing it is to know that someone you talked to then went through with their suicide because you weren't allowed to track their phone?
  - lll-o-lll 3y ago
    It’s not philosophical at all. It’s the boring practical reality that letting the government into your personal life is likely to completely screw said life over. Don’t ring the hotline, go to a priest. He will listen, offer some guidance that may help, and won’t put you in a system from which you may never escape. People need someone they can talk to knowing that they are still in some control of the outcome. Or they just won’t call.