23 ms·

Time to bring back asylums?

181 points by sam345 3y ago

jon_richards 3y ago
If we stopped arguing about the abuse cases of involuntary commitment and introduced better voluntary mental care, there would be a lot less people that "needed" to be involuntarily committed.
sam345 3y ago
No paywall: https://archive.is/RK7dH https://archive.is/RK7dH Author David M. Oshinsky is per Wikipedia an American historian, director of the Division of Medical Humanities at NYU School of Medicine[1] and a professor in the Department of History at New York University.
hotpotamus 3y ago
I wonder how much of an increase in taxes the folks at the WSJ would be willing to pay to bring back asylums? The longer I live, the more the quote "the past is a foreign country: they do things differently there" comes to mind. I don't really understand what the asylums were like, but I see that old America that they resided in as a very different place that believed more in public investment. These days, the idea of compelled vaccination is pretty controversial, so the idea that we are going to take away peoples' liberty and force them to take psychotropic drugs after we've imprisoned them seems beyond belief. None of that is to say I don't think it's probably the right answer, rather that I just don't see it happening in modern America.
- amadeuspagel 3y ago
  This old america did not believe in public investment enough to ensure humane conditions in asylums.
Spooky23 3y ago
It’s time to bring back a credible editorial board to the Wall St Journal.
- sam345 3y ago
  Explain ? Not a WSJ editorial board opinion. Also interested in when you think the WSJ board was credible and at what point it lost its credibility ?
  - Spooky23 3y ago
    It’s become a joke post Fox acquisition.
monkmartinez 3y ago
> These days, the idea of compelled vaccination is pretty controversial, so the idea that we are going to take away peoples' liberty and force them to take psychotropic drugs after we've imprisoned them seems beyond belief. This is already happening. Compelled vaccination is completely different than a mentally disturbed member of our society roaming the streets unhinged. I have been party to several title 36[1] cases and it's very, very difficult to get dangerous people "petitioned". It requires coordination between disparate agencies like hospitals, Fire/EMS, Police, community mental health orgs, etc. None of them share a database. Once they are found to be incapable of living on their own, what do we do with them? Jail? Hospital? Half-way house/Assisted Living? I will tell you... They end up back on the streets and it isn't pretty. The underbelly of every American city is a nasty, grimy, horrific place. I need to retire. [1] https://www.azleg.gov/arsDetail/?title=36 https://www.azleg.gov/arsDetail/?title=36
- sbuccini 3y ago
  You should write more on this topic.
  - devilbunny 3y ago
    There is no shortage of writing on this. The Supreme Court decisions of the early 1970s on mental health were well-intentioned but disastrous.
    - sbuccini 3y ago
      I am very curious to hear the personal experiences of a frontline firefighter/EMT in Phoenix
    - wahern 3y ago
      > The Supreme Court decisions of the early 1970s on mental health were well intentioned but disastrous. Those decisions still left much room for coerced treatment, so it's not clear how disastrous they were. Most if not all states and cities ended up with additional legislation, caselaw, and normative policies that made coerced treatment (including outpatient treatment) much more difficult.
amanaplanacanal 3y ago
It’s time to make money appear out of nowhere, ignore the long history of abuses in such places, and pretend the courts are going to do a 180 and suddenly allow what was unconstitutional before.
- phatskat 3y ago
  Right? We should stop at allocating money and then pivot to actually making meaningful impact. This article is just a megaphone for people who don’t like seeing how society treats those less fortunate.
- sgath92 3y ago
  > and suddenly allow what was unconstitutional before. To be fair, this isn't as much of an obstacle as the rest is.
- bobsmooth 3y ago
  https://www.gov.ca.gov/2023/03/16/governor-newsom-announces-1-billion-in-homelessness-funding-launches-states-largest-mobilization-of-small-homes/ https://www.gov.ca.gov/2023/03/16/governor-newsom-announces-... Instead of throwing away money how about we treat the underlying mental illness?
_8j50 3y ago
A person does not belong to society or to the government. Sane or not, a person who chooses to not get mental, physical or preventive treatment (like vaccines) or other social manadates should not be compelled because humans lack the authority to do so. What should happen is they should be expelled from society. Expulsion was very common in historical societies. The famous version of this is leper colonies. The land of thr country belongs to them, so designate a place for them to live in isolation except for volunteers that wish to visit them and offer aid/help. People should be asked that in the event they are deemed by professionals to be incapable of making their own decisions that they delegate the power of decision making on their behalf to the courts or society. This is a pervasive issue, even things like not wanting to be dependent on tech for day to day survival is a person's right. Compelling a person to do anything means you have deprived them of liberty and subjugated them, and to do that, having a good and legitimate reason is not enough, you also need authority. In communist governments for example, people are subjucts of the state and the state assumes authority even over what people belief. But in the US at least, the government that derives all its power and authority from the governed has not been granted such unlimited authority over law abiding citizens, or authority to pass laws to manipulate peoples bodies, regulate their beliefs and convictions or imprison them when they have not broken a law "for their own well being and without their prior consent. The people did not consent to have their wellbeing and safety taken care of against their will. If insane people, unvaccinated people, naked people and other people are considered to place a burden to society or to cause harm in the future, simply forbid them from coming into contact with society and only enforce complelled measures when they persistently refuse to comply.
- veave 3y ago
  There isn't much difference between expulsion and putting them in an asylum, no?
  - _8j50 3y ago
    There is, more space and freedom to do whatever they want there.
    - 3y ago
amadeuspagel 3y ago
Asylums still exist. What this person wants to bring back is the ability to lock people up and keep people locked up there with little recourse. A typical case from this time[1]: > [Cramer] frankly discusses the “regimented, often hopeless conditions of state mental hospitals”, talks about a hospital in Alabama where “care was worse than simply inadequate: one psychiatrist for 5000 patients; astonishingly low funding for clothing, food and upkeep of the buildings”, studies showing that institutions never actually got patients’ signatures on the forms that were supposed to waive their rights to court hearings. > [He] describes the case of Edna Long, who was hospitalized for “public drunkenness” and “permanently hospitalized in 1952. As Ennis tells the tale, Long received no treatment during the next fifteen years, but was kept busy working at menial jobs in the hospital. After the death of her husband in 1960, the state hospital had her declared incompetent, and seized her assets to pay for her care. Then, they put what assets remained under the management of an attorney, who made a bit of money from reducing the value of her estate by 86% (according to Ennis, a common practice at the time in New York). Once Long had become too physically ill to continue working, the hospital suddenly found her “competent to manage her own affairs” and released her, to a life of elderly poverty. Most of the money that she and her husband had accumulated had been consumed by attorneys supposedly protecting her assets.” [1]: https://astralcodexten.substack.com/p/book-review-san-fransicko https://astralcodexten.substack.com/p/book-review-san-fransi...
- bitwize 3y ago
  This sounds like that movie I Care a Lot, which is about a woman who runs a scam getting old folks locked away in care homes while acquiring power of attorney and cleaning out their assets.
  - ec109685 3y ago
    That movie was a rollercoaster.
- pjlegato 3y ago
  Non sequitur fallacy; mismanaged and abusive hospitals are not an inevitable consequence of involuntary committment for people with severe mental illnesses who are unable to take care of themselves. There are also many cases of mismanaged and abusive conventional hospitals for purely physical ailments. Should we shut down all ERs and stop putting casts on broken bones because of that?
mplewis 3y ago
Uh, what the hell?
- klyrs 3y ago
  This is pretty normal for Wall Street Journal. When they suggest anything that looks like socialized health care, it's gonna be the bizzaro version that does more harm than good to the patients, but gets the homeless off the streets they want to make money on. I haven't bothered to read the article, but there's good money to be made if these institutions are privatized.
  - sam345 3y ago
    ? Author not editorial board: David Oshinsky directs the Division of Medical Humanities at NYU Langone Health. His books include “Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital” and “Polio: An American Story,” which won the 2006 Pulitzer Prize for history. Wikipedia: https://en.wikipedia.org/wiki/David_Oshinsky https://en.wikipedia.org/wiki/David_Oshinsky
    - klyrs 3y ago
      Are you saying that the editorial board doesn't choose who, and what, to publish? Because I didn't say "this article was written by the editorial board" which is what you seem to be arguing against. I said that this article is consistent with WSJ's agenda.
- tacocataco 3y ago
  Nothing would please Jeff bozos more then being able to declare anyone trying to form a union insane and lock them away.
  - rsynnott 3y ago
    WSJ is Murdoch, not Bezos.
uejfiweun 3y ago
Clearly HN does not seem to like this idea so much. But I do have to ask, what exactly do you propose as a solution to the massive, growing hordes of drug addicted zombies in west coast cities? You can't tell me that this problem doesn't exist, anyone who's been to a west coast city knows it's very real. The past 20 years of the "compassion" approach or whatever is clearly a total disaster. At what point do we just say "these people are a danger to society and they need to be off the damn streets?" Because that strikes me as the most realistic solution. We're not gonna be able to stop the illicit flow of fentanyl into our society.
- Danjoe4 3y ago
  Jail. Asylums circumvent due process as other commentators have pointed out. Jails should be staffed with a physician who has the discretion to transfer inmates to treatment centers.
  - AequitasOmnibus 3y ago
    Leave it to an HN commenter to suggest that a marginalized group face the most draconian, outlandish, unrealistic proposition as a viable solution. Might as well propose that we eat the homeless and mentally ill. Then we can complete the Jonathan Swift proposal and go back to the real world.
    - code_biologist 3y ago
      Let me steelman the suggestion then. Our western answer for when society is allowed to intervene against the will of an individual is when a law is broken. I agree that we shouldn't involuntarily commit people arbitrarily, but if you break the rules of society and engage in trespassing, theft, assault or sexual assault, etc then yes society should be allowed to intervene against your will. It then becomes a question of preventing harm. Releasing the individual back onto the street seems like a recipe to have the same harm occur again. Putting a crazy person in jail seems harmful as well. Which is where your parent commenter's suggestion comes in...
aschearer 3y ago
[flagged]
- backtoyoujim 3y ago
  And why do the rich US Americans keep profiting from it ?
  - aschearer 3y ago
    You tell me.
- wolverine876 3y ago
  The rhetorical tactic keeps winning. It works so well that, even though they've been doing in much of the rich world (Murdoch in the English-speaking portion) for decades, you still can't even describe the tactic and don't know why they use it. Why would they stop unless they start losing with it?
  - aschearer 3y ago
    Well don't keep it all to yourself. Break it down for me so I can understand.
    - wolverine876 3y ago
      The point is, you need to think about it for yourself.
      - deleted 3y ago
        [deleted]
- calderwoodra 3y ago
  Your sarcasm/examples are false equivalencies. US cities were at one point far less car centric than they are now. Do you think we should maintain the status quo there as well?
creer 3y ago
Mental health doesn't have to be done in the most stupid way possible. And yet could be much more present, available, temporary. An institutional system can be built with cross-checks, inspections, corruption fighting mechanisms, etc. By this I mean actual, independent, not powerless, not perfunctory, corruption-fighting, enforceable, etc. As opposed to the usual such cross-checks around here. This is a far broader issue that just mental health but simply (not) doing mental health on the street isn't a great solution.
- phatskat 3y ago
  > An institutional system can be built with cross-checks, inspections, corruption fighting mechanisms, etc. By this I mean actual, independent, not powerless, not perfunctory, corruption-fighting, enforceable, etc. It can be but not within capitalism. Even if it’s the Best Government Program Ever, eventually it will become public/private, and eventually private. And it will get worse and worse the entire time. Once it’s fully private then it will be incentivized to put people there (if it wasn’t already), and those interred will be used for labor in the worst and likely most potential ways. It’s reinventing prisons.
  - creer 3y ago
    Okay, let's take that comment as an opportunity: Which institutional system out there, worldwide, is a model of cross-checks, effective powerful independent oversight, corruption fighting, etc - enforcing not just lack of corruption (not just financial) but also efficiency in accomplishing its mission? Anyone? Anyone? Some institutions used to have great reputation but I don't know that they were all that efficient. (UK Police, French electricity company). But for both of these I don't feel that it was because of good independent oversight anyway.
  - DropInIn 3y ago
    Also: kids for cash scandal https://en.m.wikipedia.org/wiki/Kids_for_cash_scandal https://en.m.wikipedia.org/wiki/Kids_for_cash_scandal
    - 3y ago
spondylosaurus 3y ago
Meanwhile I've been reading this New Yorker piece this morning: https://www.newyorker.com/science/annals-of-medicine/reinventing-the-er-for-americas-mental-health-crisis https://www.newyorker.com/science/annals-of-medicine/reinven... Reinventing the E.R. For America's Mental Health Crisis (subtitle: EmPATH units are advancing a radically new approach to psychiatric emergencies. It seems to be working.)
- tudorw 3y ago
  I'm all for re-inventing psychiatric care, however, this part of the article seems to cast doubt on the true efficacy of the approach; '2009 Alameda placed 11.0 involuntary holds per 1,000 population, while the next highest county in California only placed 6.4 per 1,000 population'
iancmceachern 3y ago
I've had this conversation with many friends. Totally agree. They need to be good, well run with compassion and care of course. But we indeed need them.
- orwin 3y ago
  But they already exist, no?
  - iancmceachern 3y ago
    They've been systematically dismantled over the last 70 years. Not much remains. https://en.m.wikipedia.org/wiki/Deinstitutionalization_in_the_United_States https://en.m.wikipedia.org/wiki/Deinstitutionalization_in_th...
- michaelmrose 3y ago
  What if most of the people you wish were interred there are competent enough to decide they don't want to be there but not competent enough to meaningfully integrate with society. This can even be true of some who definitely not competent now but would become sufficiently lucid to disinter themselves before discontinuing medication and resuming drinking and drugging.
  - baremetal 3y ago
    You need to give them a purpose. The trades come to mind.
    - weard_beard 3y ago
      Roofers are where they get their drugs.
  - sbuttgereit 3y ago
    ".. competent enough to decide they don't want to be there but not competent enough to meaningfully integrate with society..." At some level these should be mutually exclusive conditions; one (unable to integrate) is the major fact that disproves the other (competent enough for self-determination). "but would become sufficiently lucid to disinter themselves before discontinuing medication and resuming drinking and drugging." If someone is forcibly committed to an institution, there would almost certainly need to be a set of steps to transition to a non-institutionalized way of living. For example, a probation-like system to monitor progress and look for signs of relapse and non-compliance would almost need to exist. Halfway house stays may also make the transition more likely to stick. probably some combination of those. Much of this sounds like the kind of things you do in criminal matters. It's not surprising that it would. The resemblance is only because both deal with behavioral issues requiring the denial of personal liberties. However, we mustn't view this kind of thing like its about criminality, someone that isn't sufficiently mentally sound enough to support themselves isn't a criminal: almost certainly not from a moral point of view. But at some point, the impacts on society by the extremely mentally ill can be just as negative as someone acting with criminal intent. So appropriate responses may look similar, but for the mentally ill they should not be punitive.
neonate 3y ago
https://archive.ph/d948j https://archive.ph/d948j
pengaru 3y ago
https://en.wikipedia.org/wiki/One_Flew_Over_the_Cuckoo%27s_Nest_(novel) https://en.wikipedia.org/wiki/One_Flew_Over_the_Cuckoo%27s_N...
- scythe 3y ago
  Mentioned in the article.
Avshalom 3y ago
https://broadview.org/geel-belgium-mental-health/ https://broadview.org/geel-belgium-mental-health/
wolverine876 3y ago
A step like this one establishes the precedent. In a few years, the WSJ will be advocating locking up people they don't like, making they case that they are ipso facto mentally unstable, a threat to society, etc. How about protesters? Left-wing ones, of course. Many people in business arguably belong in an asylum - how about the wealthiest person in the world? how about some WSJ op-ed writers? crypto bros? some SV VCs? - and mentally unstable people with power are far more threat than the person on the subway.
- moose_man 3y ago
  How often do you ride public transit? Experiences in the past month include being threatened with horrific assault for just saying I didn't have cash on me and a bus ride where a guy talked to me the whole ride about how he was about to murder the bus driver. That's just recent.
  - wolverine876 3y ago
    Often for many years, in major cities, including in poorer neighborhoods. I've never had one experience like that. It's so placid I can sleep; I see people helping each other, etc. I also see people commonly keeping to themselves - it's not all rainbows and unicorns. I don't believe that so many have had so many extreme experiences as they report, though of course I don't know you personally.
- phendrenad2 3y ago
  > In a few years, the WSJ will be advocating locking up people they don't like Okay but if we need to fear the opinion of the WSJ, we're already screwed. What's stopping them from advocating for locking up people they don't like right now? How does the existence of asylums suddenly turn this frightening power of mind-control that you seem to imply that the WSJ has into a real threat?
  - wolverine876 3y ago
    I'm not sure what you mean. Obviously the WSJ is influential but not to the extreme of mind control. Also, advocating a half-step forward is easier than advocating 2 or 3 steps forward. I think you know those things, but I'm not sure what you are saying.
BasedAnon 3y ago
ah yes another way to shut down people you find inconvenient
peter303 3y ago
Congress
EatingWithForks 3y ago
For anyone who wants to bring back asylums: first and foremost, you must imagine that you will be subjected to asylums as they existed. You could simply be protesting while black or female, considered insane for protesting and forcibly detained-- for which you can be raped and assaulted, and any reporting to the police of your trauma isn't taken seriously because you're considered insane. It's nonsensical to say we should bring back asylums and then not seriously consider what asylums were at the time. Women who tried to fight for their right to vote were put in asylums and raped.
- imgabe 3y ago
  > you must imagine that you will be subjected to asylums as they existed. No you don't. Nobody is advocating for that. Nobody is saying we should follow the same broken standards that led to locking up people for protesting, or that we should allow abuse and rape. Do you not think there is any middle ground between raping protestors and letting people with violent schizophrenia live in a tent on the street?
  - pierat 3y ago
    If they can be used as a punishment, they WILL be used as a punishment. Not too long ago, BDSM was considered a mental illness. We'not talking the 1960s either.. this was 2010 when the DSM-4 had BDSM and similar removed. Prior to 1980, homosexuality was also in the DSM-4. The trend is obvious and troublesome: this is mainly a list of consensual actions that were listed as "mental health problems" and therefore could be treated against the will of the person. And it's easier to dismiss a 'sick' person since they're obviously out of their mind. So yes, this is something you definitely will have if the asylum system is recreated and/or reformed. Person making different lifestyle choices others don't like? Committed, with no real say or due process.
    - imgabe 3y ago
      Do you think they're suddenly going to put homosexuality and BDSM back in the DSM-4 and lock people up for it? I mean, you look at the current political climate and you believe that is a thing that could actually happen when the White House is hosting a Pride parade? There are real people getting assaulted and murdered by the mentally ill right now. Not to mention the mentally ill themselves who are subject to violence on the streets and living in squalor. These are actual problems that are really happening and you're saying we shouldn't do anything to address them because of hypothetical problems you that you think might happen and that we could easily be aware of and prevent?
tacocataco 3y ago
Will the 1% also be institutionalized against their will to treat their undiagnosed hoarding mental illness?
bespokedevelopr 3y ago
I see a lot of misinformed takes in here and this is a very nuanced topic. However unless you actually work in services interacting with mentally ill and homeless people you likely have a very skewed idea of how things work. I know I certainly did before I became involved. Washington state has what is called ITA (involuntary treatment act) which is used for holding people in mental health facilities temporarily. These people are placed there after a DCR (designated crisis responder) performs an evaluation on the person. I work in an ED in a busy city hospital. We have a constant stream of psych patients coming in. Not all of them end up on ITA. Some times they just need to go through a 72 hr hold in the ED and detox and are fine to be released. Other pts coming in every week , they’re too unstable to live in a shelter but not enough of a danger to themselves or others to be sent to a mental health facility. The social workers at the hospital are the ones who make these decisions to place pts on holds. They are not tyrants with power trips. These are people who have Masters in psychology and licensed in the state. They’re incredibly empathetic people working a job that is massively underpaid compared to their private sector colleagues. Some of these pts are absolutely unable to care for themselves but again can’t get into shelters because they are behaviorally nondirectable so their only recourse is to live on the streets. Pts get ITA and sent off to facilities but after 30 days they’re released back on to the street only to end up in crisis again and back in the ED to start the process again. We have one regular pt who cuts himself every time he gets released. His legs and arms are covered in scars. He isn’t capable of taking care of himself but he doesn’t stay sober enough to live in a shelter so he’s in the ED every week until something bad enough happens that he gets ITA and sent to a facility again, rinse repeat. There’s no where for most of these people. There is no long term facility for people who are not able to care for themselves and function in society. When I worked at homeless shelters before the hospital I’m at it was a mess. There’s no help for people who want to get sober. You’re thrown into a barracks style room mixed in with sex offenders, users, elderly, mentally ill, there’s no separation and there’s no services to help people so you see them relapsing constantly. There’s usually encampments outside the shelters so those trying to get clean can’t even go outside without being triggered by the surrounding people using openly and selling to those living in the shelters. It’s really hard to be sober and get your shit together living in a shelter. This is just a scratch of the surface. It’s so much more complex and nuanced than what you think.
isykt 3y ago
This article doesn’t mention what other countries do about this problem. As far as I know, the UK has a series of “sections” that allow voluntary and involuntary commitment. Do these “work”? Can anyone with some background knowledge of this or another country’s system weigh in?
qwery 3y ago
It's interesting how the writer avoids the issue of homelessness, as if that's an unshakeable pillar of reality. They even touch on the prison population in the U.S. -- comparing a figure from their childhood (when times were good) to today: "The number of inmates in the U.S. in 1955 was 185,000; today, that figure is 1,900,000." -- while gliding easily over any further details or uncomfortable truths about that, presumably that increase is entirely people who would/should be locked up in asylums instead. The term 'asylum' implies refuge, yes. It also refers to actual places that "were popular because they [... relieved] families of their most burdensome members." Places that largely ended with a legacy of being "torture chambers where icepick lobotomies, electric shock, sterilization and solitary confinement turned humans into zombies." The presented model of success (the Worcester Recovery Center in Massachusetts) is described as something completely unlike the article's own description of asylums. Note: the title on the article is the assertive 'It’s Time to Bring Back Asylums', not phrased as the question it is on HN ('Time to Bring Back Asylums?').
EGreg 3y ago
Interesting, when Andrew Yang was saying it, people lost their stuff: https://www.teenvogue.com/story/andrew-yang-mental-health-comments https://www.teenvogue.com/story/andrew-yang-mental-health-co...
colechristensen 3y ago
States need to start doing better taking care of the people they’ve made themselves responsible for. We can talk about expanding that when they’re doing a better job of what they are responsible for now. Jails need to be supportive places where a person actually has the opportunity to grow and experience some dignity. Facilities for the profoundly disabled need to be appropriately funded and there needs to be more room to those need. Facilities for those experiencing mental health crises need more space and resources so they can actually get in in a timely manner and spend the time they need. Quality of care needs to be improved across the board. Then you can start talking about expanding to people who are having lots of trouble taking care of basic life necessities either temporarily or long term. A lot of people really do just need a time when their basic needs are met with some good life advice provided to reset and rebuild themselves. But the state doing it in the past has turned into minimizing costs and incredibly inhumane treatment of people least capable of advocating for themselves.
pineapple_guy 3y ago
We have to do something with our politicians
advisedwang 3y ago
The issues with mental health care are largely a lack of funding (including via insurance). If you are going to fund an asylum system well enough to be effective, you could fund our current system. If you are not going to fund it, you are literally reproducing the cycle that resulted in underfunded, abusive and hidden asylums of the 19th and 20th centuries.
- 01100011 3y ago
  I'll assert that, in the current economic environment, you can't staff it even if you reasonably fund it. i.e. you will not find enough applicants who will stick with the job even at insane and unsustainable wages.
tudorw 3y ago
I think it might be worth digging a little deeper into the causes, from this article, https://www.whitehouse.gov/cea/written-materials/2022/05/31/reducing-the-economic-burden-of-unmet-mental-health-needs/ https://www.whitehouse.gov/cea/written-materials/2022/05/31/... "Between 2008 and 2019, the percentage of adolescents (ages 12 to 17) that reported having experienced at least one major depressive episode in the past year increased nearly 90 percent, from 8.3 percent in 2008 to 15.7 percent in 2019" As m463 highlights, 'But later state mental illness funding was cut.' Does the cut in funding correlate with the rise in problems?
SamReidHughes 3y ago
If I were to make a system for taking homeless off the street, my idea would be: 1) Outlaw vagrancy, and arrest people for vagrancy, the crime specifically being living on the street instead of paying for their own upkeep, but the important part is... 2) They can get their freedom quickly by working some minimum wage job, provided by the city, like cleaning the highways or picking up trash, for a week. Then when they're released, they can still work that job, or they can get out of dodge. This is a clumsy proposal and not fully thought through -- but there can be some mechanism that lets people who aren't totally deranged get themselves quickly released while directing the others to treatment. An obvious criticism of this is, it's not hard to come up with counterfactuals. What if somebody is homeless with their family, and they get arrested for vagrancy. Now their kids are separated from them. Then what? What if they have a dog?
- mixmastamyk 3y ago
  I think that's starting at the wrong end. Need to get sick people help, addicts support, halfway housing available. Only much later would you start thinking about arresting folks who refuse.
  - SamReidHughes 3y ago
    I agree, maybe not the same way because instead of "helping" people, you could target much of addiction by arresting and hanging drug dealers. But aside from that, getting these people help apparently requires forcing them into custody. I don't want the more functional people, or people parking their RVs in the wrong place, to get swept up in that.
    - mixmastamyk 3y ago
      Focus on vengeance is a mental illness in itself; I’ll make sure you get on the list. ;-)
- vore 3y ago
  This doesn't really solve any kind of housing supply problem. If you're forced to live on the street because you can't afford any kind of housing, you're just going to get arrested and forced into a minimum wage job where you still can't afford housing. Then you're still not affording housing, aren't you now basically enslaved if you're just going to get arrested again and forced to work a minimum wage job?
01100011 3y ago
One problem with this line of thought: no one wants to fill the jobs needed to warehouse the mentally ill and socially incompetent. As it is, we can't seem to staff health care jobs adequately and we think we can just magic up the workers who would take these demanding jobs. It's not even about funding. You can pay people insane wages but if they burn out quickly or just flat out refuse the working conditions you're stuck.
whyenot 3y ago
Santa Clara county, one of the wealthiest locations in California, has only 211 inpatient psychiatric care beds. Soon, the number will be reduced to 193. Based on population, it should have 960 beds{1]. Is it really any wonder that the current system doesn’t work all that well? 1. https://www.mercurynews.com/2023/07/02/this-should-be-a-wakeup-call-mission-oaks-inpatient-psychiatric-care-unit-to-close/ https://www.mercurynews.com/2023/07/02/this-should-be-a-wake...
ThinkBeat 3y ago
Hell no and yes. Asylums in the post were often horrid places of torture and severe lack of productive treatment. (Here I define productive treatment, as treatment tailored for the patient with an aim of improving their quality fo life and their ability to cope. It might very well not be able to make the patient able to function in society but it can help give them a better life) We have this in a different form now in prisons. Due to lack of universal healthcare and for-profit prisons and "what the hell todo" Prisons are today's asylums, and it has a severe lack of productive treatment. Good, appropriate care in a safe environment, for both the patient, health workers and society. This works for the majority of cases. Then you have a small group of patients who are downright dangerous for all. They can either be kept in a mental health hospital and drugged into a calmer state (not ideal), or be kept in prison or prison like surroundings (not ideal). For them we do not yet have an ideal model of treatment that does not impose a severe treath to personell.
noelwelsh 3y ago
"A much higher percentage of the population suffer from mental illness in more unequal countries; differences in inequality tally with more than triple the differences in the percentage of people with mental illness in different countries. Rates of depression in US states are associated with income inequality (after adjusting for income, proportion of population with a college degree and proportion over 65). The more unequal the state, the higher the prevalence of depression." (https://equalitytrust.org.uk/health https://equalitytrust.org.uk/health) If you want to actually address the problem you'd look at inequality, and all the many problems that stem from it. But this is the WSJ, so I guess they prefer to throw poor people into jail, err, asylums, when they been broken by the current system and have no economic value.
black_13 3y ago
[dead]
RecycledEle 3y ago
This has been a used in the past to steal wealth from people, and it will be used to steal wealth in the future. This has been used in the past to silence rape victims, and it will be used again to silence rape victims. The State should not have this power.
ygmelnikova 3y ago
[dead]

181 points by sam345 3y ago

If we stopped arguing about the abuse cases of involuntary commitment and introduced better voluntary mental care, there would be a lot less people that "needed" to be involuntarily committed.

sam345 3y ago

No paywall: https://archive.is/RK7dH https://archive.is/RK7dH Author David M. Oshinsky is per Wikipedia an American historian, director of the Division of Medical Humanities at NYU School of Medicine[1] and a professor in the Department of History at New York University.

hotpotamus 3y ago

I wonder how much of an increase in taxes the folks at the WSJ would be willing to pay to bring back asylums? The longer I live, the more the quote "the past is a foreign country: they do things differently there" comes to mind. I don't really understand what the asylums were like, but I see that old America that they resided in as a very different place that believed more in public investment. These days, the idea of compelled vaccination is pretty controversial, so the idea that we are going to take away peoples' liberty and force them to take psychotropic drugs after we've imprisoned them seems beyond belief. None of that is to say I don't think it's probably the right answer, rather that I just don't see it happening in modern America.

amadeuspagel 3y ago
This old america did not believe in public investment enough to ensure humane conditions in asylums.

Spooky23 3y ago

It’s time to bring back a credible editorial board to the Wall St Journal.

sam345 3y ago
Explain ? Not a WSJ editorial board opinion. Also interested in when you think the WSJ board was credible and at what point it lost its credibility ?
- Spooky23 3y ago
  It’s become a joke post Fox acquisition.

monkmartinez 3y ago

> These days, the idea of compelled vaccination is pretty controversial, so the idea that we are going to take away peoples' liberty and force them to take psychotropic drugs after we've imprisoned them seems beyond belief. This is already happening. Compelled vaccination is completely different than a mentally disturbed member of our society roaming the streets unhinged. I have been party to several title 36[1] cases and it's very, very difficult to get dangerous people "petitioned". It requires coordination between disparate agencies like hospitals, Fire/EMS, Police, community mental health orgs, etc. None of them share a database. Once they are found to be incapable of living on their own, what do we do with them? Jail? Hospital? Half-way house/Assisted Living? I will tell you... They end up back on the streets and it isn't pretty. The underbelly of every American city is a nasty, grimy, horrific place. I need to retire. [1] https://www.azleg.gov/arsDetail/?title=36 https://www.azleg.gov/arsDetail/?title=36

sbuccini 3y ago
You should write more on this topic.
- devilbunny 3y ago
  There is no shortage of writing on this. The Supreme Court decisions of the early 1970s on mental health were well-intentioned but disastrous.
  - sbuccini 3y ago
    I am very curious to hear the personal experiences of a frontline firefighter/EMT in Phoenix
  - wahern 3y ago
    > The Supreme Court decisions of the early 1970s on mental health were well intentioned but disastrous. Those decisions still left much room for coerced treatment, so it's not clear how disastrous they were. Most if not all states and cities ended up with additional legislation, caselaw, and normative policies that made coerced treatment (including outpatient treatment) much more difficult.

amanaplanacanal 3y ago

It’s time to make money appear out of nowhere, ignore the long history of abuses in such places, and pretend the courts are going to do a 180 and suddenly allow what was unconstitutional before.

phatskat 3y ago
Right? We should stop at allocating money and then pivot to actually making meaningful impact. This article is just a megaphone for people who don’t like seeing how society treats those less fortunate.
sgath92 3y ago
> and suddenly allow what was unconstitutional before. To be fair, this isn't as much of an obstacle as the rest is.
bobsmooth 3y ago
https://www.gov.ca.gov/2023/03/16/governor-newsom-announces-1-billion-in-homelessness-funding-launches-states-largest-mobilization-of-small-homes/ https://www.gov.ca.gov/2023/03/16/governor-newsom-announces-... Instead of throwing away money how about we treat the underlying mental illness?

_8j50 3y ago

A person does not belong to society or to the government. Sane or not, a person who chooses to not get mental, physical or preventive treatment (like vaccines) or other social manadates should not be compelled because humans lack the authority to do so. What should happen is they should be expelled from society. Expulsion was very common in historical societies. The famous version of this is leper colonies. The land of thr country belongs to them, so designate a place for them to live in isolation except for volunteers that wish to visit them and offer aid/help. People should be asked that in the event they are deemed by professionals to be incapable of making their own decisions that they delegate the power of decision making on their behalf to the courts or society. This is a pervasive issue, even things like not wanting to be dependent on tech for day to day survival is a person's right. Compelling a person to do anything means you have deprived them of liberty and subjugated them, and to do that, having a good and legitimate reason is not enough, you also need authority. In communist governments for example, people are subjucts of the state and the state assumes authority even over what people belief. But in the US at least, the government that derives all its power and authority from the governed has not been granted such unlimited authority over law abiding citizens, or authority to pass laws to manipulate peoples bodies, regulate their beliefs and convictions or imprison them when they have not broken a law "for their own well being and without their prior consent. The people did not consent to have their wellbeing and safety taken care of against their will. If insane people, unvaccinated people, naked people and other people are considered to place a burden to society or to cause harm in the future, simply forbid them from coming into contact with society and only enforce complelled measures when they persistently refuse to comply.

veave 3y ago
There isn't much difference between expulsion and putting them in an asylum, no?
- _8j50 3y ago
  There is, more space and freedom to do whatever they want there.
  - 3y ago

amadeuspagel 3y ago

Asylums still exist. What this person wants to bring back is the ability to lock people up and keep people locked up there with little recourse. A typical case from this time[1]: > [Cramer] frankly discusses the “regimented, often hopeless conditions of state mental hospitals”, talks about a hospital in Alabama where “care was worse than simply inadequate: one psychiatrist for 5000 patients; astonishingly low funding for clothing, food and upkeep of the buildings”, studies showing that institutions never actually got patients’ signatures on the forms that were supposed to waive their rights to court hearings. > [He] describes the case of Edna Long, who was hospitalized for “public drunkenness” and “permanently hospitalized in 1952. As Ennis tells the tale, Long received no treatment during the next fifteen years, but was kept busy working at menial jobs in the hospital. After the death of her husband in 1960, the state hospital had her declared incompetent, and seized her assets to pay for her care. Then, they put what assets remained under the management of an attorney, who made a bit of money from reducing the value of her estate by 86% (according to Ennis, a common practice at the time in New York). Once Long had become too physically ill to continue working, the hospital suddenly found her “competent to manage her own affairs” and released her, to a life of elderly poverty. Most of the money that she and her husband had accumulated had been consumed by attorneys supposedly protecting her assets.” [1]: https://astralcodexten.substack.com/p/book-review-san-fransicko https://astralcodexten.substack.com/p/book-review-san-fransi...

bitwize 3y ago
This sounds like that movie I Care a Lot, which is about a woman who runs a scam getting old folks locked away in care homes while acquiring power of attorney and cleaning out their assets.
- ec109685 3y ago
  That movie was a rollercoaster.
pjlegato 3y ago
Non sequitur fallacy; mismanaged and abusive hospitals are not an inevitable consequence of involuntary committment for people with severe mental illnesses who are unable to take care of themselves. There are also many cases of mismanaged and abusive conventional hospitals for purely physical ailments. Should we shut down all ERs and stop putting casts on broken bones because of that?

mplewis 3y ago

Uh, what the hell?

klyrs 3y ago
This is pretty normal for Wall Street Journal. When they suggest anything that looks like socialized health care, it's gonna be the bizzaro version that does more harm than good to the patients, but gets the homeless off the streets they want to make money on. I haven't bothered to read the article, but there's good money to be made if these institutions are privatized.
- sam345 3y ago
  ? Author not editorial board: David Oshinsky directs the Division of Medical Humanities at NYU Langone Health. His books include “Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital” and “Polio: An American Story,” which won the 2006 Pulitzer Prize for history. Wikipedia: https://en.wikipedia.org/wiki/David_Oshinsky https://en.wikipedia.org/wiki/David_Oshinsky
  - klyrs 3y ago
    Are you saying that the editorial board doesn't choose who, and what, to publish? Because I didn't say "this article was written by the editorial board" which is what you seem to be arguing against. I said that this article is consistent with WSJ's agenda.
tacocataco 3y ago
Nothing would please Jeff bozos more then being able to declare anyone trying to form a union insane and lock them away.
- rsynnott 3y ago
  WSJ is Murdoch, not Bezos.

uejfiweun 3y ago

Clearly HN does not seem to like this idea so much. But I do have to ask, what exactly do you propose as a solution to the massive, growing hordes of drug addicted zombies in west coast cities? You can't tell me that this problem doesn't exist, anyone who's been to a west coast city knows it's very real. The past 20 years of the "compassion" approach or whatever is clearly a total disaster. At what point do we just say "these people are a danger to society and they need to be off the damn streets?" Because that strikes me as the most realistic solution. We're not gonna be able to stop the illicit flow of fentanyl into our society.

Danjoe4 3y ago
Jail. Asylums circumvent due process as other commentators have pointed out. Jails should be staffed with a physician who has the discretion to transfer inmates to treatment centers.
- AequitasOmnibus 3y ago
  Leave it to an HN commenter to suggest that a marginalized group face the most draconian, outlandish, unrealistic proposition as a viable solution. Might as well propose that we eat the homeless and mentally ill. Then we can complete the Jonathan Swift proposal and go back to the real world.
  - code_biologist 3y ago
    Let me steelman the suggestion then. Our western answer for when society is allowed to intervene against the will of an individual is when a law is broken. I agree that we shouldn't involuntarily commit people arbitrarily, but if you break the rules of society and engage in trespassing, theft, assault or sexual assault, etc then yes society should be allowed to intervene against your will. It then becomes a question of preventing harm. Releasing the individual back onto the street seems like a recipe to have the same harm occur again. Putting a crazy person in jail seems harmful as well. Which is where your parent commenter's suggestion comes in...

aschearer 3y ago

[flagged]

backtoyoujim 3y ago
And why do the rich US Americans keep profiting from it ?
- aschearer 3y ago
  You tell me.
wolverine876 3y ago
The rhetorical tactic keeps winning. It works so well that, even though they've been doing in much of the rich world (Murdoch in the English-speaking portion) for decades, you still can't even describe the tactic and don't know why they use it. Why would they stop unless they start losing with it?
- aschearer 3y ago
  Well don't keep it all to yourself. Break it down for me so I can understand.
  - wolverine876 3y ago
    The point is, you need to think about it for yourself.
    - deleted 3y ago
      [deleted]
calderwoodra 3y ago
Your sarcasm/examples are false equivalencies. US cities were at one point far less car centric than they are now. Do you think we should maintain the status quo there as well?

creer 3y ago

Mental health doesn't have to be done in the most stupid way possible. And yet could be much more present, available, temporary. An institutional system can be built with cross-checks, inspections, corruption fighting mechanisms, etc. By this I mean actual, independent, not powerless, not perfunctory, corruption-fighting, enforceable, etc. As opposed to the usual such cross-checks around here. This is a far broader issue that just mental health but simply (not) doing mental health on the street isn't a great solution.

phatskat 3y ago
> An institutional system can be built with cross-checks, inspections, corruption fighting mechanisms, etc. By this I mean actual, independent, not powerless, not perfunctory, corruption-fighting, enforceable, etc. It can be but not within capitalism. Even if it’s the Best Government Program Ever, eventually it will become public/private, and eventually private. And it will get worse and worse the entire time. Once it’s fully private then it will be incentivized to put people there (if it wasn’t already), and those interred will be used for labor in the worst and likely most potential ways. It’s reinventing prisons.
- creer 3y ago
  Okay, let's take that comment as an opportunity: Which institutional system out there, worldwide, is a model of cross-checks, effective powerful independent oversight, corruption fighting, etc - enforcing not just lack of corruption (not just financial) but also efficiency in accomplishing its mission? Anyone? Anyone? Some institutions used to have great reputation but I don't know that they were all that efficient. (UK Police, French electricity company). But for both of these I don't feel that it was because of good independent oversight anyway.
- DropInIn 3y ago
  Also: kids for cash scandal https://en.m.wikipedia.org/wiki/Kids_for_cash_scandal https://en.m.wikipedia.org/wiki/Kids_for_cash_scandal
  - 3y ago

spondylosaurus 3y ago

Meanwhile I've been reading this New Yorker piece this morning: https://www.newyorker.com/science/annals-of-medicine/reinventing-the-er-for-americas-mental-health-crisis https://www.newyorker.com/science/annals-of-medicine/reinven... Reinventing the E.R. For America's Mental Health Crisis (subtitle: EmPATH units are advancing a radically new approach to psychiatric emergencies. It seems to be working.)

tudorw 3y ago
I'm all for re-inventing psychiatric care, however, this part of the article seems to cast doubt on the true efficacy of the approach; '2009 Alameda placed 11.0 involuntary holds per 1,000 population, while the next highest county in California only placed 6.4 per 1,000 population'

iancmceachern 3y ago

I've had this conversation with many friends. Totally agree. They need to be good, well run with compassion and care of course. But we indeed need them.

orwin 3y ago
But they already exist, no?
- iancmceachern 3y ago
  They've been systematically dismantled over the last 70 years. Not much remains. https://en.m.wikipedia.org/wiki/Deinstitutionalization_in_the_United_States https://en.m.wikipedia.org/wiki/Deinstitutionalization_in_th...
michaelmrose 3y ago
What if most of the people you wish were interred there are competent enough to decide they don't want to be there but not competent enough to meaningfully integrate with society. This can even be true of some who definitely not competent now but would become sufficiently lucid to disinter themselves before discontinuing medication and resuming drinking and drugging.
- baremetal 3y ago
  You need to give them a purpose. The trades come to mind.
  - weard_beard 3y ago
    Roofers are where they get their drugs.
- sbuttgereit 3y ago
  ".. competent enough to decide they don't want to be there but not competent enough to meaningfully integrate with society..." At some level these should be mutually exclusive conditions; one (unable to integrate) is the major fact that disproves the other (competent enough for self-determination). "but would become sufficiently lucid to disinter themselves before discontinuing medication and resuming drinking and drugging." If someone is forcibly committed to an institution, there would almost certainly need to be a set of steps to transition to a non-institutionalized way of living. For example, a probation-like system to monitor progress and look for signs of relapse and non-compliance would almost need to exist. Halfway house stays may also make the transition more likely to stick. probably some combination of those. Much of this sounds like the kind of things you do in criminal matters. It's not surprising that it would. The resemblance is only because both deal with behavioral issues requiring the denial of personal liberties. However, we mustn't view this kind of thing like its about criminality, someone that isn't sufficiently mentally sound enough to support themselves isn't a criminal: almost certainly not from a moral point of view. But at some point, the impacts on society by the extremely mentally ill can be just as negative as someone acting with criminal intent. So appropriate responses may look similar, but for the mentally ill they should not be punitive.

neonate 3y ago

https://archive.ph/d948j https://archive.ph/d948j

pengaru 3y ago

https://en.wikipedia.org/wiki/One_Flew_Over_the_Cuckoo%27s_Nest_(novel) https://en.wikipedia.org/wiki/One_Flew_Over_the_Cuckoo%27s_N...

scythe 3y ago
Mentioned in the article.

Avshalom 3y ago

https://broadview.org/geel-belgium-mental-health/ https://broadview.org/geel-belgium-mental-health/

wolverine876 3y ago

A step like this one establishes the precedent. In a few years, the WSJ will be advocating locking up people they don't like, making they case that they are ipso facto mentally unstable, a threat to society, etc. How about protesters? Left-wing ones, of course. Many people in business arguably belong in an asylum - how about the wealthiest person in the world? how about some WSJ op-ed writers? crypto bros? some SV VCs? - and mentally unstable people with power are far more threat than the person on the subway.

moose_man 3y ago
How often do you ride public transit? Experiences in the past month include being threatened with horrific assault for just saying I didn't have cash on me and a bus ride where a guy talked to me the whole ride about how he was about to murder the bus driver. That's just recent.
- wolverine876 3y ago
  Often for many years, in major cities, including in poorer neighborhoods. I've never had one experience like that. It's so placid I can sleep; I see people helping each other, etc. I also see people commonly keeping to themselves - it's not all rainbows and unicorns. I don't believe that so many have had so many extreme experiences as they report, though of course I don't know you personally.
phendrenad2 3y ago
> In a few years, the WSJ will be advocating locking up people they don't like Okay but if we need to fear the opinion of the WSJ, we're already screwed. What's stopping them from advocating for locking up people they don't like right now? How does the existence of asylums suddenly turn this frightening power of mind-control that you seem to imply that the WSJ has into a real threat?
- wolverine876 3y ago
  I'm not sure what you mean. Obviously the WSJ is influential but not to the extreme of mind control. Also, advocating a half-step forward is easier than advocating 2 or 3 steps forward. I think you know those things, but I'm not sure what you are saying.

BasedAnon 3y ago

ah yes another way to shut down people you find inconvenient

peter303 3y ago

Congress

EatingWithForks 3y ago

For anyone who wants to bring back asylums: first and foremost, you must imagine that you will be subjected to asylums as they existed. You could simply be protesting while black or female, considered insane for protesting and forcibly detained-- for which you can be raped and assaulted, and any reporting to the police of your trauma isn't taken seriously because you're considered insane. It's nonsensical to say we should bring back asylums and then not seriously consider what asylums were at the time. Women who tried to fight for their right to vote were put in asylums and raped.

imgabe 3y ago
> you must imagine that you will be subjected to asylums as they existed. No you don't. Nobody is advocating for that. Nobody is saying we should follow the same broken standards that led to locking up people for protesting, or that we should allow abuse and rape. Do you not think there is any middle ground between raping protestors and letting people with violent schizophrenia live in a tent on the street?
- pierat 3y ago
  If they can be used as a punishment, they WILL be used as a punishment. Not too long ago, BDSM was considered a mental illness. We'not talking the 1960s either.. this was 2010 when the DSM-4 had BDSM and similar removed. Prior to 1980, homosexuality was also in the DSM-4. The trend is obvious and troublesome: this is mainly a list of consensual actions that were listed as "mental health problems" and therefore could be treated against the will of the person. And it's easier to dismiss a 'sick' person since they're obviously out of their mind. So yes, this is something you definitely will have if the asylum system is recreated and/or reformed. Person making different lifestyle choices others don't like? Committed, with no real say or due process.
  - imgabe 3y ago
    Do you think they're suddenly going to put homosexuality and BDSM back in the DSM-4 and lock people up for it? I mean, you look at the current political climate and you believe that is a thing that could actually happen when the White House is hosting a Pride parade? There are real people getting assaulted and murdered by the mentally ill right now. Not to mention the mentally ill themselves who are subject to violence on the streets and living in squalor. These are actual problems that are really happening and you're saying we shouldn't do anything to address them because of hypothetical problems you that you think might happen and that we could easily be aware of and prevent?

tacocataco 3y ago

Will the 1% also be institutionalized against their will to treat their undiagnosed hoarding mental illness?

bespokedevelopr 3y ago

I see a lot of misinformed takes in here and this is a very nuanced topic. However unless you actually work in services interacting with mentally ill and homeless people you likely have a very skewed idea of how things work. I know I certainly did before I became involved. Washington state has what is called ITA (involuntary treatment act) which is used for holding people in mental health facilities temporarily. These people are placed there after a DCR (designated crisis responder) performs an evaluation on the person. I work in an ED in a busy city hospital. We have a constant stream of psych patients coming in. Not all of them end up on ITA. Some times they just need to go through a 72 hr hold in the ED and detox and are fine to be released. Other pts coming in every week , they’re too unstable to live in a shelter but not enough of a danger to themselves or others to be sent to a mental health facility. The social workers at the hospital are the ones who make these decisions to place pts on holds. They are not tyrants with power trips. These are people who have Masters in psychology and licensed in the state. They’re incredibly empathetic people working a job that is massively underpaid compared to their private sector colleagues. Some of these pts are absolutely unable to care for themselves but again can’t get into shelters because they are behaviorally nondirectable so their only recourse is to live on the streets. Pts get ITA and sent off to facilities but after 30 days they’re released back on to the street only to end up in crisis again and back in the ED to start the process again. We have one regular pt who cuts himself every time he gets released. His legs and arms are covered in scars. He isn’t capable of taking care of himself but he doesn’t stay sober enough to live in a shelter so he’s in the ED every week until something bad enough happens that he gets ITA and sent to a facility again, rinse repeat. There’s no where for most of these people. There is no long term facility for people who are not able to care for themselves and function in society. When I worked at homeless shelters before the hospital I’m at it was a mess. There’s no help for people who want to get sober. You’re thrown into a barracks style room mixed in with sex offenders, users, elderly, mentally ill, there’s no separation and there’s no services to help people so you see them relapsing constantly. There’s usually encampments outside the shelters so those trying to get clean can’t even go outside without being triggered by the surrounding people using openly and selling to those living in the shelters. It’s really hard to be sober and get your shit together living in a shelter. This is just a scratch of the surface. It’s so much more complex and nuanced than what you think.

isykt 3y ago

This article doesn’t mention what other countries do about this problem. As far as I know, the UK has a series of “sections” that allow voluntary and involuntary commitment. Do these “work”? Can anyone with some background knowledge of this or another country’s system weigh in?

qwery 3y ago

It's interesting how the writer avoids the issue of homelessness, as if that's an unshakeable pillar of reality. They even touch on the prison population in the U.S. -- comparing a figure from their childhood (when times were good) to today: "The number of inmates in the U.S. in 1955 was 185,000; today, that figure is 1,900,000." -- while gliding easily over any further details or uncomfortable truths about that, presumably that increase is entirely people who would/should be locked up in asylums instead. The term 'asylum' implies refuge, yes. It also refers to actual places that "were popular because they [... relieved] families of their most burdensome members." Places that largely ended with a legacy of being "torture chambers where icepick lobotomies, electric shock, sterilization and solitary confinement turned humans into zombies." The presented model of success (the Worcester Recovery Center in Massachusetts) is described as something completely unlike the article's own description of asylums. Note: the title on the article is the assertive 'It’s Time to Bring Back Asylums', not phrased as the question it is on HN ('Time to Bring Back Asylums?').

EGreg 3y ago

Interesting, when Andrew Yang was saying it, people lost their stuff: https://www.teenvogue.com/story/andrew-yang-mental-health-comments https://www.teenvogue.com/story/andrew-yang-mental-health-co...

colechristensen 3y ago

States need to start doing better taking care of the people they’ve made themselves responsible for. We can talk about expanding that when they’re doing a better job of what they are responsible for now. Jails need to be supportive places where a person actually has the opportunity to grow and experience some dignity. Facilities for the profoundly disabled need to be appropriately funded and there needs to be more room to those need. Facilities for those experiencing mental health crises need more space and resources so they can actually get in in a timely manner and spend the time they need. Quality of care needs to be improved across the board. Then you can start talking about expanding to people who are having lots of trouble taking care of basic life necessities either temporarily or long term. A lot of people really do just need a time when their basic needs are met with some good life advice provided to reset and rebuild themselves. But the state doing it in the past has turned into minimizing costs and incredibly inhumane treatment of people least capable of advocating for themselves.

pineapple_guy 3y ago

We have to do something with our politicians

advisedwang 3y ago

The issues with mental health care are largely a lack of funding (including via insurance). If you are going to fund an asylum system well enough to be effective, you could fund our current system. If you are not going to fund it, you are literally reproducing the cycle that resulted in underfunded, abusive and hidden asylums of the 19th and 20th centuries.

01100011 3y ago
I'll assert that, in the current economic environment, you can't staff it even if you reasonably fund it. i.e. you will not find enough applicants who will stick with the job even at insane and unsustainable wages.

tudorw 3y ago

I think it might be worth digging a little deeper into the causes, from this article, https://www.whitehouse.gov/cea/written-materials/2022/05/31/reducing-the-economic-burden-of-unmet-mental-health-needs/ https://www.whitehouse.gov/cea/written-materials/2022/05/31/... "Between 2008 and 2019, the percentage of adolescents (ages 12 to 17) that reported having experienced at least one major depressive episode in the past year increased nearly 90 percent, from 8.3 percent in 2008 to 15.7 percent in 2019" As m463 highlights, 'But later state mental illness funding was cut.' Does the cut in funding correlate with the rise in problems?

SamReidHughes 3y ago

If I were to make a system for taking homeless off the street, my idea would be: 1) Outlaw vagrancy, and arrest people for vagrancy, the crime specifically being living on the street instead of paying for their own upkeep, but the important part is... 2) They can get their freedom quickly by working some minimum wage job, provided by the city, like cleaning the highways or picking up trash, for a week. Then when they're released, they can still work that job, or they can get out of dodge. This is a clumsy proposal and not fully thought through -- but there can be some mechanism that lets people who aren't totally deranged get themselves quickly released while directing the others to treatment. An obvious criticism of this is, it's not hard to come up with counterfactuals. What if somebody is homeless with their family, and they get arrested for vagrancy. Now their kids are separated from them. Then what? What if they have a dog?

mixmastamyk 3y ago
I think that's starting at the wrong end. Need to get sick people help, addicts support, halfway housing available. Only much later would you start thinking about arresting folks who refuse.
- SamReidHughes 3y ago
  I agree, maybe not the same way because instead of "helping" people, you could target much of addiction by arresting and hanging drug dealers. But aside from that, getting these people help apparently requires forcing them into custody. I don't want the more functional people, or people parking their RVs in the wrong place, to get swept up in that.
  - mixmastamyk 3y ago
    Focus on vengeance is a mental illness in itself; I’ll make sure you get on the list. ;-)
vore 3y ago
This doesn't really solve any kind of housing supply problem. If you're forced to live on the street because you can't afford any kind of housing, you're just going to get arrested and forced into a minimum wage job where you still can't afford housing. Then you're still not affording housing, aren't you now basically enslaved if you're just going to get arrested again and forced to work a minimum wage job?

01100011 3y ago

One problem with this line of thought: no one wants to fill the jobs needed to warehouse the mentally ill and socially incompetent. As it is, we can't seem to staff health care jobs adequately and we think we can just magic up the workers who would take these demanding jobs. It's not even about funding. You can pay people insane wages but if they burn out quickly or just flat out refuse the working conditions you're stuck.

whyenot 3y ago

Santa Clara county, one of the wealthiest locations in California, has only 211 inpatient psychiatric care beds. Soon, the number will be reduced to 193. Based on population, it should have 960 beds{1]. Is it really any wonder that the current system doesn’t work all that well? 1. https://www.mercurynews.com/2023/07/02/this-should-be-a-wakeup-call-mission-oaks-inpatient-psychiatric-care-unit-to-close/ https://www.mercurynews.com/2023/07/02/this-should-be-a-wake...

ThinkBeat 3y ago

Hell no and yes. Asylums in the post were often horrid places of torture and severe lack of productive treatment. (Here I define productive treatment, as treatment tailored for the patient with an aim of improving their quality fo life and their ability to cope. It might very well not be able to make the patient able to function in society but it can help give them a better life) We have this in a different form now in prisons. Due to lack of universal healthcare and for-profit prisons and "what the hell todo" Prisons are today's asylums, and it has a severe lack of productive treatment. Good, appropriate care in a safe environment, for both the patient, health workers and society. This works for the majority of cases. Then you have a small group of patients who are downright dangerous for all. They can either be kept in a mental health hospital and drugged into a calmer state (not ideal), or be kept in prison or prison like surroundings (not ideal). For them we do not yet have an ideal model of treatment that does not impose a severe treath to personell.

noelwelsh 3y ago

"A much higher percentage of the population suffer from mental illness in more unequal countries; differences in inequality tally with more than triple the differences in the percentage of people with mental illness in different countries. Rates of depression in US states are associated with income inequality (after adjusting for income, proportion of population with a college degree and proportion over 65). The more unequal the state, the higher the prevalence of depression." (https://equalitytrust.org.uk/health https://equalitytrust.org.uk/health) If you want to actually address the problem you'd look at inequality, and all the many problems that stem from it. But this is the WSJ, so I guess they prefer to throw poor people into jail, err, asylums, when they been broken by the current system and have no economic value.

black_13 3y ago

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RecycledEle 3y ago

This has been a used in the past to steal wealth from people, and it will be used to steal wealth in the future. This has been used in the past to silence rape victims, and it will be used again to silence rape victims. The State should not have this power.

ygmelnikova 3y ago

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