6 ms·

Alternative title: "Bringing back the asylums without admitting we were wrong about closing them"

sudosteph 3y ago
Did you read the article? It seems like this model actually results in fewer patients behind sent into hospitalization (which actually is like an asylum).
- ceejayoz 3y ago
  Hospitalization is very different from an asylum.
  - sudosteph 3y ago
    Length of stay is different, but the nature of confinement, and also the abuse and trauma the patients frequently experience sure is similar. While we all know asylums were horrific, I'd caution readers against underestimating just how awful some "modern" facilities are. Regardless, my point was that releasing people to their homes is the opposite of asylums, and should be preferred to hospitalization where possible.
    - egberts1 3y ago
      it is the “preferred to hospitalization, where[‘s] possible” right there that is causing the rise from 10/10K to 14/10K in suicide rate.
      - sudosteph 3y ago
        I don't think that correlation can be proven, but I'd be curious to see the data. From what I've read, 2/3s [1] of people who commit suicide have never sought any sort of treatment at all, so they'd never present at the ER in the first place or be candidates for hospitalization vs outpatient. If the suicide rate is still rising among that population, then that would probably disprove that. If it's not, then you may be right. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8804173/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8804173/
        egberts1 3y ago
        One thing that I've noticed in that paper appears to omit the exclusion of being under medication. Maybe that was the focus for this exclusionary modeling. Still, it is a lot of data to wade through, even under the most auspice of rigorous screenings for a purer validity.
woodruffw 3y ago
This article is about emergency care; it has nothing to do with long-term mental health facilities like asylums. Did you actually read it?
mattzito 3y ago
This seems to be the opposite of asylums - put people in temporary care, give them treatment beyond just sedation and anti-psychotics, help get them stabilized, put together a care plan, and then send them home or to the next stage of treatment.
- hanniabu 3y ago
  > and then send them home In a lifetime of debt
  - dingusdew 3y ago
    [dead]
  - bicx 3y ago
    You haven’t experienced the full inadequacy of the US health system until you’ve paid out the nose for a night of “observation” at the hospital.
  - ksenzee 3y ago
    Contrary to the stereotype, most Americans have health insurance that covers inpatient and outpatient mental health care. That's why we can't get a universal socialized system implemented: too many Americans already have good enough insurance that they don't want to change it.
    - zer8k 3y ago
      The problem is the people who need help most won't seek it because it will get them labeled. There are plenty of mental illnesses that create situations where doctor-patient confidentiality has to be breached (legally). This restricts their care. A more mundane example, in some states with red flag laws a lawful gun owner could potentially introduce liability by seeking a diagnosis for depression or anxiety. Even if they don't present as a threat to themselves or others. The diagnosis alone can form a legal basis for disarmament given the right DA. We need to fix the legal system to allow people to get the help they need. If you even remotely think asking for help will get the cops sent to kick down your door and shoot your dog you won't go get help. Often times when you do get help it's too late.
wahnfrieden 3y ago
those were prisons
- 77pt77 3y ago
  Prisons were and are far better. Those were endorsed torture centers with zero accountability. Prisons don't even come close.
  - wahnfrieden 3y ago
    The well known colloquial name for Rikers is torture island
- deleted 3y ago
  [deleted]
the-printer 3y ago
This comment is sensational, but the article here is eerily similar to one also on the front page published by the WSJ: "It’s Time to Bring Back Asylums" https://news.ycombinator.com/item?id=36826335 https://news.ycombinator.com/item?id=36826335
77pt77 3y ago
The asylum system was so much worse for the victims than homelessness that it's not even funny. It existed just to hide these facts of life from the most fortunate and spare their feelings. All at the expense of the committed that were horrifically abused. And no, you won't do it right this time.
- deleted 3y ago
  [deleted]
babyshake 3y ago
AI and computer vision could surely be helpful in a modern asylum or hospital setting, at least to help the humans better triage who most urgently seems to need their attention. The AI could also be used to communicate with patients but that's a bigger more long term goal with many more ramifications.
harimau777 3y ago
Can you explain what policy you are advocating for? Asylums pretty egregious abuses of people's human rights; and that's to say nothing of instances where they were used to lock up mentally well but socially "undesirable" people. I'm guessing that you must have intended to advocate for something else?
- willcipriano 3y ago
  Ok first check this out: https://www.dailymail.co.uk/news/article-12131455/Inside-Philadelphias-zombie-land-Tranq-addicts-crowd-sidewalks-shoot-broad-daylight.html https://www.dailymail.co.uk/news/article-12131455/Inside-Phi... That's about 40 minutes from where I live and I can say first hand it isn't a exaggeration, since the pandemic those areas have been growing. Would you feel safe walking at night there? Now consider that children live in those communities. Do you think they feel safe? I agree with you that many of the asylums were inhumane, shock therapy and the like. I think you'd also agree with me that modern asylums probably wouldn't be as bad had they been allowed to remain as they would've certainly been reformed over time. I am strong on personal liberty, and individual rights, However it is inhumane to those residents of those, very poor, communities to essentially have a open air asylum imposed upon them. Something must be done with these people, if not asylums what? Prison? I suspect that would have worse outcomes.
  - harimau777 3y ago
    Personally, the solution that I advocate is social reform to address root causes. Things like making healthcare more available, adopting harm reduction strategies, strengthening social safety nets, and building more housing to reduce costs.
    - willcipriano 3y ago
      Sure, but those kids don't have that kind of time. We need a solution with immediate effect now.
NoMoreNicksLeft 3y ago
Not that anyone ever did the mentally ill any favors when they were tossed out on the street... But it wasn't wrong to close them. They were torture dungeons where the government warehoused undesirables that it wasn't allowed to euthanize because we were supposed to be the good guys. Even now, they're literally a horror movie cliche... that doesn't happen by accident, it doesn't happen unjustifiably. If you think that people want to bring them back without admitting that society was wrong to close them in the first place, how much of that is "I want the homeless to stop shitting on my front door stoop in San Francisco"?

Did you read the article? It seems like this model actually results in fewer patients behind sent into hospitalization (which actually is like an asylum).

ceejayoz 3y ago
Hospitalization is very different from an asylum.
- sudosteph 3y ago
  Length of stay is different, but the nature of confinement, and also the abuse and trauma the patients frequently experience sure is similar. While we all know asylums were horrific, I'd caution readers against underestimating just how awful some "modern" facilities are. Regardless, my point was that releasing people to their homes is the opposite of asylums, and should be preferred to hospitalization where possible.
  - egberts1 3y ago
    it is the “preferred to hospitalization, where[‘s] possible” right there that is causing the rise from 10/10K to 14/10K in suicide rate.
    - sudosteph 3y ago
      I don't think that correlation can be proven, but I'd be curious to see the data. From what I've read, 2/3s [1] of people who commit suicide have never sought any sort of treatment at all, so they'd never present at the ER in the first place or be candidates for hospitalization vs outpatient. If the suicide rate is still rising among that population, then that would probably disprove that. If it's not, then you may be right. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8804173/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8804173/
      - egberts1 3y ago
        One thing that I've noticed in that paper appears to omit the exclusion of being under medication. Maybe that was the focus for this exclusionary modeling. Still, it is a lot of data to wade through, even under the most auspice of rigorous screenings for a purer validity.

woodruffw 3y ago

This article is about emergency care; it has nothing to do with long-term mental health facilities like asylums. Did you actually read it?

mattzito 3y ago

This seems to be the opposite of asylums - put people in temporary care, give them treatment beyond just sedation and anti-psychotics, help get them stabilized, put together a care plan, and then send them home or to the next stage of treatment.

hanniabu 3y ago
> and then send them home In a lifetime of debt
- dingusdew 3y ago
  [dead]
- bicx 3y ago
  You haven’t experienced the full inadequacy of the US health system until you’ve paid out the nose for a night of “observation” at the hospital.
- ksenzee 3y ago
  Contrary to the stereotype, most Americans have health insurance that covers inpatient and outpatient mental health care. That's why we can't get a universal socialized system implemented: too many Americans already have good enough insurance that they don't want to change it.
  - zer8k 3y ago
    The problem is the people who need help most won't seek it because it will get them labeled. There are plenty of mental illnesses that create situations where doctor-patient confidentiality has to be breached (legally). This restricts their care. A more mundane example, in some states with red flag laws a lawful gun owner could potentially introduce liability by seeking a diagnosis for depression or anxiety. Even if they don't present as a threat to themselves or others. The diagnosis alone can form a legal basis for disarmament given the right DA. We need to fix the legal system to allow people to get the help they need. If you even remotely think asking for help will get the cops sent to kick down your door and shoot your dog you won't go get help. Often times when you do get help it's too late.

wahnfrieden 3y ago

those were prisons

77pt77 3y ago
Prisons were and are far better. Those were endorsed torture centers with zero accountability. Prisons don't even come close.
- wahnfrieden 3y ago
  The well known colloquial name for Rikers is torture island
deleted 3y ago
[deleted]

the-printer 3y ago

This comment is sensational, but the article here is eerily similar to one also on the front page published by the WSJ: "It’s Time to Bring Back Asylums" https://news.ycombinator.com/item?id=36826335 https://news.ycombinator.com/item?id=36826335

77pt77 3y ago

The asylum system was so much worse for the victims than homelessness that it's not even funny. It existed just to hide these facts of life from the most fortunate and spare their feelings. All at the expense of the committed that were horrifically abused. And no, you won't do it right this time.

deleted 3y ago
[deleted]

babyshake 3y ago

AI and computer vision could surely be helpful in a modern asylum or hospital setting, at least to help the humans better triage who most urgently seems to need their attention. The AI could also be used to communicate with patients but that's a bigger more long term goal with many more ramifications.

harimau777 3y ago

Can you explain what policy you are advocating for? Asylums pretty egregious abuses of people's human rights; and that's to say nothing of instances where they were used to lock up mentally well but socially "undesirable" people. I'm guessing that you must have intended to advocate for something else?

willcipriano 3y ago
Ok first check this out: https://www.dailymail.co.uk/news/article-12131455/Inside-Philadelphias-zombie-land-Tranq-addicts-crowd-sidewalks-shoot-broad-daylight.html https://www.dailymail.co.uk/news/article-12131455/Inside-Phi... That's about 40 minutes from where I live and I can say first hand it isn't a exaggeration, since the pandemic those areas have been growing. Would you feel safe walking at night there? Now consider that children live in those communities. Do you think they feel safe? I agree with you that many of the asylums were inhumane, shock therapy and the like. I think you'd also agree with me that modern asylums probably wouldn't be as bad had they been allowed to remain as they would've certainly been reformed over time. I am strong on personal liberty, and individual rights, However it is inhumane to those residents of those, very poor, communities to essentially have a open air asylum imposed upon them. Something must be done with these people, if not asylums what? Prison? I suspect that would have worse outcomes.
- harimau777 3y ago
  Personally, the solution that I advocate is social reform to address root causes. Things like making healthcare more available, adopting harm reduction strategies, strengthening social safety nets, and building more housing to reduce costs.
  - willcipriano 3y ago
    Sure, but those kids don't have that kind of time. We need a solution with immediate effect now.

NoMoreNicksLeft 3y ago

Not that anyone ever did the mentally ill any favors when they were tossed out on the street... But it wasn't wrong to close them. They were torture dungeons where the government warehoused undesirables that it wasn't allowed to euthanize because we were supposed to be the good guys. Even now, they're literally a horror movie cliche... that doesn't happen by accident, it doesn't happen unjustifiably. If you think that people want to bring them back without admitting that society was wrong to close them in the first place, how much of that is "I want the homeless to stop shitting on my front door stoop in San Francisco"?