4 ms·

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.
  - michaelmrose 3y ago
    > one (unable to integrate) is the major fact that disproves the other (competent enough for self-determination). Except that just isn't even remotely anything like true. Every adult is presumed competent until a court has declared the converse and merely mental illness is not by itself sufficient to provide this. https://www.law.cornell.edu/wex/mental_competence https://www.law.cornell.edu/wex/mental_competence It has a legal meaning that isn't malleable to meet what you think ought to be true. Merely being a loser who wants to live in a tent and do meth doesn't make one legally incompetent and in fact any attempt to patch that bug with law alone will probably run into constitutional challenges
    - sbuttgereit 3y ago
      "Except that just isn't even remotely anything like true. Every adult is presumed competent until a court has declared the converse and merely mental illness is not by itself sufficient to provide this." Who's disputing this? If we start with the person already being hospitalized, which seemed to be true in your comment ("were interred there") my comment stands. If by "interred there" you mean self admitted, well, OK... sure they could check themselves out... but that's not the scenario that the article raises. The meaning of "interred" as I understood it, and a brief review of the article seems to agree with my understanding, we're talking about an involuntary commitment. If that's the case, we can presume a legal process was performed to get the person in question in the hospital in the first place: establishing legal mental incompetence. Therefore, a legal process regarding release should, if its to be consistent, operate on the premise that, "one (unable to integrate) is the major fact that disproves the other (competent enough for self-determination)". "Merely being a loser who wants to live in a tent and do meth doesn't make one legally incompetent and in fact any attempt to patch that bug with law alone will probably run into constitutional challenges" And the initial premise has been challenged, kind of... the 9th circuit stopped Boise, ID from breaking up a homeless encampment on the grounds of cruel and unusual punishment. But Boise didn't actually provide for an alternative to the encampment: it fined and sentenced them to a a day or two in jail (most of them were sentenced time served)... the response was entirely punitive. Note that the right to camp/do wherever you want, uninvited, on public or other's property wasn't the right being protected: there is no constitutional right to that. It was that arbitrary punishments were being dolled out. Having said that, there are already laws already instituting involuntary treatment and hospitalization, so the constitutional challenges may not be so clear cut as you might think: https://en.wikipedia.org/wiki/Baker_Act https://en.wikipedia.org/wiki/Baker_Act https://en.wikipedia.org/wiki/Lanterman%E2%80%93Petris%E2%80%93Short_Act https://en.wikipedia.org/wiki/Lanterman%E2%80%93Petris%E2%80...
sgath92 3y ago
> They need to be good, well run with compassion and care of course. And there lies the core of the paradox: We can't pull that off with run of the mill geriatrics. Bottom barrel nursing homes, like the kind medicaid pays for, are hell holes. And the plight of an old patient who has no family left to advocate for them, is not an acceptable one in the least bit. If we're not going to properly handle this responsibility -now- for a sympathetic polite and docile old granny, do you really think the funding & care for 20s-50s aged mentally ill patients would be appropriate?
- iancmceachern 3y ago
  True facts. Depsite the challenges, we must try. The existence of these challenges does not mean we shouldn't try. I think that's the problem, we spend so much energy arguing about the shoulda coulda woulda's that we never actually get started doing anything meaingful.
  - danShumway 3y ago
    > we must try Start with the existing system then. If you think we can do better, prove it. Bring that same level of optimism into improving existing standards of medical care -- then come back and we'll talk about expanding those systems. > we never actually get started doing anything meaingful. I think this regularly gets pulled out as a justification for expanding systems that have significant problems, and critics are supposed to take it at face value that we're all going to earnestly try to do better this time. But without something more concrete behind it, it's just talk, and talk is cheap. What often ends up happening is the same negative outcomes are expanded, and then the process repeats with the exact same line -- again and again and again. So let's all get together and fix at least a few of the things that are already broken, and then maybe I'll believe you that we can all band together and build something new. But this kind of optimism divorced from practical action doesn't actually address concerns and doesn't actually improve existing or future standards. I'm not saying everything needs to be perfect before we do anything new, of course that's never going to be the case. But I am saying that if all of our existing systems are garbage, the words "we must try" need to be backed up with something much more tangible than anyone is providing in this comments section.

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.
- michaelmrose 3y ago
  > one (unable to integrate) is the major fact that disproves the other (competent enough for self-determination). Except that just isn't even remotely anything like true. Every adult is presumed competent until a court has declared the converse and merely mental illness is not by itself sufficient to provide this. https://www.law.cornell.edu/wex/mental_competence https://www.law.cornell.edu/wex/mental_competence It has a legal meaning that isn't malleable to meet what you think ought to be true. Merely being a loser who wants to live in a tent and do meth doesn't make one legally incompetent and in fact any attempt to patch that bug with law alone will probably run into constitutional challenges
  - sbuttgereit 3y ago
    "Except that just isn't even remotely anything like true. Every adult is presumed competent until a court has declared the converse and merely mental illness is not by itself sufficient to provide this." Who's disputing this? If we start with the person already being hospitalized, which seemed to be true in your comment ("were interred there") my comment stands. If by "interred there" you mean self admitted, well, OK... sure they could check themselves out... but that's not the scenario that the article raises. The meaning of "interred" as I understood it, and a brief review of the article seems to agree with my understanding, we're talking about an involuntary commitment. If that's the case, we can presume a legal process was performed to get the person in question in the hospital in the first place: establishing legal mental incompetence. Therefore, a legal process regarding release should, if its to be consistent, operate on the premise that, "one (unable to integrate) is the major fact that disproves the other (competent enough for self-determination)". "Merely being a loser who wants to live in a tent and do meth doesn't make one legally incompetent and in fact any attempt to patch that bug with law alone will probably run into constitutional challenges" And the initial premise has been challenged, kind of... the 9th circuit stopped Boise, ID from breaking up a homeless encampment on the grounds of cruel and unusual punishment. But Boise didn't actually provide for an alternative to the encampment: it fined and sentenced them to a a day or two in jail (most of them were sentenced time served)... the response was entirely punitive. Note that the right to camp/do wherever you want, uninvited, on public or other's property wasn't the right being protected: there is no constitutional right to that. It was that arbitrary punishments were being dolled out. Having said that, there are already laws already instituting involuntary treatment and hospitalization, so the constitutional challenges may not be so clear cut as you might think: https://en.wikipedia.org/wiki/Baker_Act https://en.wikipedia.org/wiki/Baker_Act https://en.wikipedia.org/wiki/Lanterman%E2%80%93Petris%E2%80%93Short_Act https://en.wikipedia.org/wiki/Lanterman%E2%80%93Petris%E2%80...

sgath92 3y ago

> They need to be good, well run with compassion and care of course. And there lies the core of the paradox: We can't pull that off with run of the mill geriatrics. Bottom barrel nursing homes, like the kind medicaid pays for, are hell holes. And the plight of an old patient who has no family left to advocate for them, is not an acceptable one in the least bit. If we're not going to properly handle this responsibility -now- for a sympathetic polite and docile old granny, do you really think the funding & care for 20s-50s aged mentally ill patients would be appropriate?

iancmceachern 3y ago
True facts. Depsite the challenges, we must try. The existence of these challenges does not mean we shouldn't try. I think that's the problem, we spend so much energy arguing about the shoulda coulda woulda's that we never actually get started doing anything meaingful.
- danShumway 3y ago
  > we must try Start with the existing system then. If you think we can do better, prove it. Bring that same level of optimism into improving existing standards of medical care -- then come back and we'll talk about expanding those systems. > we never actually get started doing anything meaingful. I think this regularly gets pulled out as a justification for expanding systems that have significant problems, and critics are supposed to take it at face value that we're all going to earnestly try to do better this time. But without something more concrete behind it, it's just talk, and talk is cheap. What often ends up happening is the same negative outcomes are expanded, and then the process repeats with the exact same line -- again and again and again. So let's all get together and fix at least a few of the things that are already broken, and then maybe I'll believe you that we can all band together and build something new. But this kind of optimism divorced from practical action doesn't actually address concerns and doesn't actually improve existing or future standards. I'm not saying everything needs to be perfect before we do anything new, of course that's never going to be the case. But I am saying that if all of our existing systems are garbage, the words "we must try" need to be backed up with something much more tangible than anyone is providing in this comments section.