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Without digging too deep into the nature of the statistics they use, I'm a little skeptical of this. The transition to using the word "homeless" has resulted i

Without digging too deep into the nature of the statistics they use, I'm a little skeptical of this. The transition to using the word "homeless" has resulted in transforming something we can't easily measure -- "drug addicted or mentally ill people being a public menace" -- into something that we can measure -- "people without a good living arrangement". Sure, the latter is important in a lot of ways too. And there housing is a tolerable solution. But the former is the actual problem that we care about. It's nearly impossible to measure. It's nearly impossible to fix. The horrors of involuntary commitment vs. the horrors of not having involuntary commitment vs. the horrors of using the criminal justice system vs. the horrors of not using the criminal justice system. The fact is that we have no real model for treatment of severely mentally ill people. We have a number of effective drugs, but they rapidly become ineffective if not taken. Our ability to treat or "cure" people in these conditions is essentially non-existent. The question I would ask of Finland before considering this data or analysis to be interesting is what is their state of involuntary indefinite commitment.

wesselbindt 2y ago
Have you ever considered that it may be the other way around? That the horrors of living on the street (and "horrors" is an appropriate term here, you are fighting for survival every day; it is beyond the realm of comprehension of the housed) might be causing the mental illness and drug use, rather than the other way around? If I want to get a homeless person off of drugs, it sure as crisps is not going to happen until they have a roof over their head. The core issue is the lack of affordable housing. That should be priority number 1.
- mmooss 2y ago
  In fact, that's one thing the article talks about. Finland's successful plan focuses on 'housing first'. "Finland’s success is not a matter of luck or the outcome of “quick fixes.” Rather, it is the result of a sustained, well-resourced national strategy, driven by a “Housing First” approach, which provides people experiencing homelessness with immediate, independent, permanent housing, rather than temporary accommodation (OECD, 2020)"
- Xortl 2y ago
  I'm happy to read evidence I'm wrong (I want to be wrong - it would make me much more optimistic about a fix), but my own life and everything I've read suggests the opposite - once someone develops a serious drug or alcohol addiction it leads to them destroying everything good in their lives and inevitably they either sober up or end up homeless. Nearly all of the people who stay homeless in the long term have some severe mental illness (including addiction). Short of an involuntary commitment which is its own kind of hell, helping these people is incredibly difficult. I have multiple family members who fit this pattern and it's absolutely godawful. The addiction literally rules them. They will perpetually ask for money for "needs" then spend it on drugs. If another family member houses them, they will sneakily maintain their addiction and steal from family to support it when necessary. If you offer them housing on condition of getting sober, they will choose addiction and homelessness. If you offer them housing without condition, they will use it to stay an addict in perpetuity, who everyone else is paying for. I don't think this last is a remotely viable solution with the number of addicts out there, which is only growing. I'm not saying this to condemn addicts/mentally ill people. I just want to give an idea of just how hard this problem is to fix.
  - kibwen 2y ago
    > Nearly all of the people who stay homeless in the long term have some severe mental illness (including addiction) The problem is that people can end up homeless for all sorts of reasons, and even if that reason is some sort of mental illness, being homeless is an often-traumatic experience that easily exacerbates and worsens a person's mental condition. There was a period of my life where I slept rough (long story) and I can personally confirm that a lack of sleep security (not to mention "stuff security", the fear of having my meager possessions stolen) will start someone on the path to mental illness; some amount of paranoia and mental fog seems almost inevitable in those conditions.
  - andriamanitra 2y ago
    A stable environment is certainly going to dramatically increase the chance of overcoming an addiction. It obviously does not guarantee success but it's a crucial first step in the process. As pointed out in the article the housing first approach is actually saving money in the long run by reducing subsequent costs incurred by social services, so the "everyone else is paying for their addiction" argument does not really work – there are going to be costs either way, and an addict who has a home is easier and cheaper to care for than one who is roaming the streets.
m2024 2y ago
A lot of words to say that doing anything at all must be impossible. Not understanding how homelessness (or poverty generally) leads to mental illness is remarkably disconnected.
Aunche 2y ago
> "drug addicted or mentally ill people being a public menace" Finland also is rather aggressive with involuntary detention of those deemed to be a potential danger to themselves or others.
annzabelle 2y ago
My understanding is that Northern Europe has a much more robust system of using Long Acting Injectable Antipsychotics (under court order if nessecary) and various group home options or Assertive Community Treatment teams that have nurses visit patients daily. They are also quicker to use lithium and clozapine when indicated. They also do much longer hospital stays when needed than our revolving door policies here. Also they don't have meth and fentanyl epidemics yet. We know that the longer psychosis goes untreated/the more times someone goes off the meds, the harder it is to treat, and that what happens in the first few years of someone developing a psychotic disorder makes a huge difference in long term outcomes. An American might develop psychosis in their mid 20s, end up committed for a few weeks and placed on antipsychotic pills until they're no longer floridly psychotic, and then go home, not follow up with doctors/refill meds, and end up on a cycle of this with more and more brittle symptoms until they're homeless and have no real chance of recovery. The same person in Northern Europe would likely be hospitalized for longer initially, started on an injectable that only needs to be given once a month, and they leave the hospital with fewer residual symptoms. They're then followed by an ACT team with a nurse visiting to check on them and make sure they're eating and keeping housing, and ensuring that shot goes in their arm every month. They don't necessarily fully recover, but a lot of them end up being able to do some kind of schooling/employment/volunteering and they are either stable enough to keep housing without being evicted for disruption, or are shuffled into staffed group homes.
- andrewla 2y ago
  Do we have any numbers on the number of people that are in this system? I'm frankly curious if the numbers in the original article can effectively be completely explained by this system rather than the policies listed in the article. In the US the system broke down in the 50s and 60s and collapsed completely in the 70s and 80s due to bad treatment options and often very inhumane conditions and cases of misdiagnoses. The widespread misdiagnosis problem only stretched the system further and compounded the existing problems. I would be curious to see where Finland's trajectory in this regard lies.
  - singleshot_ 2y ago
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mmooss 2y ago
You're assuming others share your perspective and understanding. > The transition to using the word "homeless" has resulted in transforming something we can't easily measure -- "drug addicted or mentally ill people being a public menace" -- into something that we can measure -- "people without a good living arrangement". > the former is the actual problem that we care about The word homeless is pretty old, not something people have 'tranistioned' to any time recently. I haven't seen anyone trying use 'homeless' as a euphemism; they are actually concerned about people without housing. That is the big problem. You apparently believe "drug addicted or mentally ill people being a public menace" is a comparable problem, but your comment is the first time I've heard that. Nobody is conspiring to hide it; they just don't think about it like you do. I spend a lot of time in cities and know others who do too. None feel menaced by people who are unhoused - why would that be menacing? - or high. High people generally don't know you are there, and are easily avoided. I've had zero problems; I don't know of anyone else who has. Also, the subtext is about eroding human rights. You have no more rights than a homeless or high person. Feeling 'menaced' is not sufficient to compromise someone's freedom. That's what freedom means - of course people can always do things that others don't mind; freedom means doing things other people don't like. I find your comment menacing; who decides who gets locked up?
- amiga386 2y ago
  > I spend a lot of time in cities and know others who do too. None feel menaced by people who are unhoused - why would that be menacing? - or high. High people generally don't know you are there, and are easily avoided. I've had zero problems; I don't know of anyone else who has. "Nothing ever happens" says person nothing happened to. Meanwhile, these are just some examples that made the news: * https://www.bbc.co.uk/news/world-us-canada-67386865 https://www.bbc.co.uk/news/world-us-canada-67386865 "A suspect has been arrested two days after former US Senator Martha McSally reported being sexually assaulted while on a run in Iowa [...] The suspect, who is thought to be homeless," * https://www.bbc.co.uk/news/uk-england-derbyshire-65569357 https://www.bbc.co.uk/news/uk-england-derbyshire-65569357 "Derby homeless man raped women who offered to help him" * https://www.bbc.co.uk/news/uk-41484206 https://www.bbc.co.uk/news/uk-41484206 "A "manipulative" homeless man who turned on a family who befriended him has admitted the "frenzied" murder of the mother and her 13-year-old son." * https://www.reuters.com/article/lifestyle/life-sentence-for-man-who-beheaded-screenwriter-idUSN04328783/ https://www.reuters.com/article/lifestyle/life-sentence-for-... "A severely mentally ill man was sentenced to life in prison on Friday for beheading a Hollywood screenwriter [...] a homeless former Marine described by his lawyer as "very, very mentally ill", pleaded guilty [...] in a crime without motive." * https://www.cbsnews.com/losangeles/news/long-beach-woman-sexually-assaulted-by-homeless-man-in-broad-daylight/ https://www.cbsnews.com/losangeles/news/long-beach-woman-sex... "Long Beach woman sexually assaulted by homeless man in broad daylight" Fortunately I haven't witnessed any murders or rapes, but the most shocking for me was that I've visited Vancouver twice in my life, and on both visits, lone women walking down the street in broad daylight were chased after and opportunisticly molested by drunk vagrants hanging around on Robson Street. Broad daylight. They had absolutely no shame. And other than the molested women fighting them off and running away, nobody did or said anything. Everyone has a right to walk about in public unmolested, and I would want the police to arrest those men and prosecute them for sexual assault. You're delusional or misinformed if you think this doesn't happen. Of course it happens. On the other hand, you can be molested or assaulted by drunk and beligerent homed people. And, more importantly, homeless people are much more at risk of assault or rape by the homed, than the homed are of being assaulted and raped by the homeless. For all the articles I linked above, they are dwarfed by news reports of homeless people being shot, beaten, stabbed, set on fire or raped. So, overall, homeless people as a whole are neither saints nor devils. They are who they are, and each individual has a different situation. We should feel a lot of empathy for them, and want to help them into a less precarious position... but we also want to do it because we're mindful of the danger to the public that untreated mental illness poses.
kiba 2y ago
It is more painful to treat someone who is homeless and mentally ill as opposed to just mentally ill.
t-3 2y ago
Finland is cold. People without adequate housing will freeze to death. Not finding bodies in the spring thaw is probably actually important to them.
- deleted 2y ago
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pavlov 2y ago
What is the question you’re asking here? I’m Finnish and I have a close family member with a severe mental illness, so I should be reasonably well positioned to answer your question. But it doesn’t make any sense to me. How does any of this relate to homelessness? To get people off the streets, you give them a place to live. Then you can start solving their other problems. It’s common sense.
- sonofhans 2y ago
  In some US popular culture “drug addict” is code for “weak or immoral person.” There’s very little empathy or understanding of people who are much less fortunate; there’s plenty of evidence in this thread. This misguided moral compass outweighs even sensible practices like harm reduction. People would rather see junkies die on the street of hepatitis than give them free housing and needles. It satisfies some primal need that, eventually I hope, our species will be better off with less of.
  - BoingBoomTschak 2y ago
    [flagged]
    - sonofhans 2y ago
      Thank you for making my point on my behalf :)
    - bowsamic 2y ago
      You’re not exactly demonstrating your moral strength by calling them parasites
  - sugarplant 2y ago
    this is such a dishonest characterization. the issue people have with free needles is that they end up everywhere but a sharps container. they throw loose needles in every park, walking path, bus stop, etc. in the entire city. my city has had this issue for years now. you should use some of the superhuman empathy you have to explore other perspectives on the issue. even for just a minute.
dp88 2y ago
The Pandremix issue has lots of issues to fix as well that will probably never see the light of the day. Essentially those few hundred with Pandemrix-induced narcolepsy are now a permanently disabled minority without organized legal advocacy. The party-opposing party, that should not be opposing them, Pharmaceutical Injury Insurance Pool (LVP) has significant financial and legal resources. LVP has substantially broader access to archives and expert knowledge. The impaired functional capacity and financial position of those affected makes it difficult to advocate for their rights. The state implemented the vaccination program and transferred responsibility to the insurance pool system with its own financial interests. The pool system determines assessment criteria and makes evaluations without external oversight. Initially, there was talk of "million-euro compensations." The government guaranteed to finance the remainder if pool funds were depleted. Legal cases have been fought against LVP regarding time limits of confirmed cases. Compensations have remained a fraction of original expectations. Narcolepsy patients are too small a minority to influence Parliamentary politics or re-enter public discourse. This special group has been left alone to defend their rights within the pool system. The compensations were based on Käypä Hoito Guidelines for accident injuries, which are unsuitable for narcolepsy: narcolepsy doesn't necessarily cause clear cognitive deficits despite its severity, and comparison to brain trauma is not medically possible. The drafters would probably agree if asked that it wasn't intended for this use. A person with narcolepsy can be formally capable of work, but this might consume all of their alert hours & energy, leaving nothing for actually having a life. The system may equate narcolepsy, in permanent damage, with injuries similar to a broken finger in workplace accidents, hence the permanent disability compensations are insufficient for dignified life. The wage compensation issue is more significant. The determination basis for loss of earnings compensation is problematic as it's based on achieved education and work history, although the illness has impaired these opportunities. The same neurological illness produces different compensations depending on onset timing, as those with established careers may fare better than those who couldn't compete for university placement. This particularly affects those who became ill in childhood/youth, as it doesn't account for lost opportunities. In practice, even those from educated backgrounds with academic potential (e.g. top grades or plans for university before narcolepsy) may receive compensation based on average or low income. Opportunity cost compensation appears unlikely. The state has not promoted reassessment of applicability of Käypä Hoito criteria. There is insufficient monitoring of equality in compensation decisions and appeals, inadequate communication about compensations (the question whether all victims are even aware of their rights seems open), and questionable document management and decision-making transparency. LVP defines compensation terms, makes compensation decisions, and handles appeals, creating a conflict of interest as LVP has financial incentive for strict interpretation. Permanent damage compensations are treated as earned income by Kela, requiring their use for basic living expenses, though they're meant as lifetime compensations for an incurable neurological illness. (this is partly machine-translated from personal notes)
ferociouskite56 2y ago
No, there are not "a number of effective drugs." I interviewed 100 mental patients and the rare ones with hallucinations were not cured. Benzos help anxiety, SSRI don't do much, Cobenfy is promising. Involuntary commitment wouldn't be horrible if violating injections and ECT electrocution were voluntary.
j45 2y ago
Finland has figured out a number of thing it seems other than homelessness. Their education system is pretty interesting, and their policing system has some approaches to interacting with the community as well. If I can find the links I'll share. Skepticism is fine, but it shouldn't be a reason to discount or dismiss something, nor does it mean to accept it. Take it in as a data point.
- usr1106 2y ago
  Finland elected the most right-leaning government in the history of the country in 2023. A lot of the education, social, and healthcare system is facing deep cuts at the moment. Economy has not recovered from the fall of Nokia around 2010, so needs for social services would actually be growing.
  - j45 2y ago
    Well, that's something else. Hopefully they don't dismantle their education system, and policing ways, and whatever else they have going.
tehjoker 2y ago
People are on the street because they don't have homes. If they had homes, they would be less depressed, less drug addicted, and less destitute and less likely to cause public problems. So just give them homes. A major upside: if you lose your job, you won't be at risk of becoming homeless! it would allow you to take a much stronger negotiating position with your boss. It would allow you to take a much stronger position with your landlord regarding rent increases too.
1propionyl 2y ago
> It's nearly impossible to fix. The horrors of involuntary commitment vs. the horrors of not having involuntary commitment vs. the horrors of using the criminal justice system vs. the horrors of not using the criminal justice system. I think, frankly, and I base this on experience with family undergoing involuntary commitment in Europe... we really are still a bit collectively traumatized or basing our takes on what happened prior here in the US from past abuse of involuntary commitment systems. It can be compassionate. It can help people get psychiatric and psychological help they didn't know how to access. It can help get people back on their feet and transition them into a return to normalcy. It can work.
- saulpw 2y ago
  It can be compassionate in other places, but I think the US has proven itself to lack compassion in some pretty essential ways.
  - throwawayq3423 2y ago
    This really does come down to comparing small countries, where programs like this can actually work, to large countries, where the scale makes it impossible. If your country is small and rich, government can be highly functional. But please stop comparing it to a larger place, it's apples to oranges.
grahamplace 2y ago
Charles Lehman was on the Ezra Klein show recently[1] and had a useful definition for disorder, re: your first point. This may not be exactly the quote, but it was something like "Disorder is domination of public space for private purposes." As an SF resident, that really resonated; day-to-day quality of life here (for me, at least) feels much more impacted by that type of "disorder" than "homelessness" generally (obviously we need housing solutions too) [1] https://www.nytimes.com/2024/10/18/opinion/ezra-klein-podcast-charles-fain-lehman.html https://www.nytimes.com/2024/10/18/opinion/ezra-klein-podcas...
- lostlogin 2y ago
  > “Disorder is domination of public space for private purposes." The first thought I had on reading this was ‘the world has a car disorder’.
theteapot 2y ago
I'm really sick of people lumping homeless people in with "drug addicted or mentally ill people". There is a lot of sober hard working people that are homeless because they got caught out with some bad luck and don't have friends or relatives to fall back on. Once your homeless everything becomes much harder.
more_corn 2y ago
The thing you claim to care about (drug addicted or mentally ill people being a public menace) is wildly easier to combat when the people in question have a stable living situation. The housing first initiative in Salt Lake City provides ample evidence that if people have a stable living situation it is way easier to get them to take their medication, get into rehab, keep them out of dangerous situations. It’s actually more cost effective in the long term to house the chronically homeless instead of kicking the can down the road. If you actually care about what you claim to care about you should be supporting housing first. That means 1) get people housed with minimal red tape and basically no conditions 2) treat mental health and drug addiction The evidence is clear that it works and that it is more cost effective than dealing with the fallout when homeless people unravel. Unfortunately politicians who had preconceived notions about this topic ignored the evidence and revoked funding for the program. Your statement that it is impossible to treat or cure mental illness and drug addiction (which the evidence does not support) places you in that camp. You, my friend are the worst part of the problem. Because the evidence exists to disprove your stance, but you hold a strong opinion without having bothered to check the science.
MobiusHorizons 2y ago
From what I have been able to learn from several community mental health friends, there are a lot of causes of homelessness. There are certainly nontrivial numbers of people struggling with mental illness, drug and alcohol abuse, or combinations of both in public on our streets. This tends to be very visible and off putting. Housing is only one of many challenges these people are facing, but there are also lots of services beyond housing aimed at this population. There are also plenty of people who are dealing with setbacks and just need to get back on their feet and rebuild. This population is much less visible most of the time, because they are much less likely to be inconveniencing people in public spaces. Sometimes they have more of a social network to tap and can stay off of the streets. For this group, cost of housing and availability of work are the primary issues. I don’t have a good sense of the size of this population relative to other populations though.
- andrewla 2y ago
  I don't think of this in terms of "causes of homelessness". These are different categories. The "visible" homeless, ironically, are extremely difficult to measure. They often don't carry or won't present identification, they often have no family or support structure, they often make little to no attempt to use services. The "invisible" homeless are the opposite, and can be easily measured, because they have all of those things. When you see numbers trying to measure homeless people, it will almost always be the "invisible" homeless. Sending people out with clickers to count the homeless people on the street is nearly impossible, so the best we can do is various sampling approaches with huge margins of error.
fsloth 2y ago
Speaking as a Finn. It's foremost NOT about mental&substance issues treatment but general financial aid to anyone in need. I think this phraze from the article summarizes it well. "The Finnish experience demonstrates the effectiveness of tackling homelessness through a combination of financial assistance, integrated and targeted support services and more supply: " It's a holistic system that actually kicks-in way before one is in danger of being homeless, and if someone would suddenly find themselves homeless, the state security blanket is available to all. So 1. direct assistance 2. support services and 3. supply. On the first order, this is not related to substance abuse or mental illness, and should not be viewed as such. They are just a way to make sure nobody freezes to death. The way these policies link with mental&substance issues is that before 90's you were denied housing if you had ongoing substance abuse issues. This policy was dialed back to allow all housing regardless of any other issues, specifically because it was considered being homeless does not help in any way to resolve the above matters. So viewing this as "something only for ill people" is the wrong lens. It's a system for everyone. Of course mentally ill and those suffering substance issue are often without financial means so they are represented in the population receiving support. But the actual treatment to the above issues is a separate policy matter (after nobody was excluded anymore). The downside is that unless a polity has similar wide cover social security system in place, I have no idea what learnings you could get from this.
- throwawayq3423 2y ago
  Sounds like the result of being a small and rich country. The scale of these actions in a country like the US (Or India) would be impossibly expensive.
  - fsloth 2y ago
    Finland rich? Not as such. Small and homogenous definetly (pop 5.6M). US is rich. Vastly richer than Finland. PPP GDP for US in 2023 was 73k $ and for Finland 64k $. The systems are quite different. But it’s not about total wealth as such. If we use GDP as rough back-of-the-envelope estimate (problematic I know!) us could implement similar system economically but politically probably not. The gini coefficient gives some hints about these differences (US 0.48, FI 0.28). In Finland people are taxed until there are very little income differences and then that money is used for social policies and healthcare. So everybody gets high quality healthcare for all of the serious stuff (until you reach best-before-date and government pulls the plug), you never need to freeze to death, go hungry (in theory at least) and your kids will have free education. Based on my limited understanding of US politics and social structure I find similar arrangement improbable. But it’s not about country’s total wealth!
watwut 2y ago
People without good housing options are an issue even if they are not drug addicted yet and they don't have mental illness.

wesselbindt 2y ago

Have you ever considered that it may be the other way around? That the horrors of living on the street (and "horrors" is an appropriate term here, you are fighting for survival every day; it is beyond the realm of comprehension of the housed) might be causing the mental illness and drug use, rather than the other way around? If I want to get a homeless person off of drugs, it sure as crisps is not going to happen until they have a roof over their head. The core issue is the lack of affordable housing. That should be priority number 1.

mmooss 2y ago
In fact, that's one thing the article talks about. Finland's successful plan focuses on 'housing first'. "Finland’s success is not a matter of luck or the outcome of “quick fixes.” Rather, it is the result of a sustained, well-resourced national strategy, driven by a “Housing First” approach, which provides people experiencing homelessness with immediate, independent, permanent housing, rather than temporary accommodation (OECD, 2020)"
Xortl 2y ago
I'm happy to read evidence I'm wrong (I want to be wrong - it would make me much more optimistic about a fix), but my own life and everything I've read suggests the opposite - once someone develops a serious drug or alcohol addiction it leads to them destroying everything good in their lives and inevitably they either sober up or end up homeless. Nearly all of the people who stay homeless in the long term have some severe mental illness (including addiction). Short of an involuntary commitment which is its own kind of hell, helping these people is incredibly difficult. I have multiple family members who fit this pattern and it's absolutely godawful. The addiction literally rules them. They will perpetually ask for money for "needs" then spend it on drugs. If another family member houses them, they will sneakily maintain their addiction and steal from family to support it when necessary. If you offer them housing on condition of getting sober, they will choose addiction and homelessness. If you offer them housing without condition, they will use it to stay an addict in perpetuity, who everyone else is paying for. I don't think this last is a remotely viable solution with the number of addicts out there, which is only growing. I'm not saying this to condemn addicts/mentally ill people. I just want to give an idea of just how hard this problem is to fix.
- kibwen 2y ago
  > Nearly all of the people who stay homeless in the long term have some severe mental illness (including addiction) The problem is that people can end up homeless for all sorts of reasons, and even if that reason is some sort of mental illness, being homeless is an often-traumatic experience that easily exacerbates and worsens a person's mental condition. There was a period of my life where I slept rough (long story) and I can personally confirm that a lack of sleep security (not to mention "stuff security", the fear of having my meager possessions stolen) will start someone on the path to mental illness; some amount of paranoia and mental fog seems almost inevitable in those conditions.
- andriamanitra 2y ago
  A stable environment is certainly going to dramatically increase the chance of overcoming an addiction. It obviously does not guarantee success but it's a crucial first step in the process. As pointed out in the article the housing first approach is actually saving money in the long run by reducing subsequent costs incurred by social services, so the "everyone else is paying for their addiction" argument does not really work – there are going to be costs either way, and an addict who has a home is easier and cheaper to care for than one who is roaming the streets.

m2024 2y ago

A lot of words to say that doing anything at all must be impossible. Not understanding how homelessness (or poverty generally) leads to mental illness is remarkably disconnected.

Aunche 2y ago

> "drug addicted or mentally ill people being a public menace" Finland also is rather aggressive with involuntary detention of those deemed to be a potential danger to themselves or others.

annzabelle 2y ago

My understanding is that Northern Europe has a much more robust system of using Long Acting Injectable Antipsychotics (under court order if nessecary) and various group home options or Assertive Community Treatment teams that have nurses visit patients daily. They are also quicker to use lithium and clozapine when indicated. They also do much longer hospital stays when needed than our revolving door policies here. Also they don't have meth and fentanyl epidemics yet. We know that the longer psychosis goes untreated/the more times someone goes off the meds, the harder it is to treat, and that what happens in the first few years of someone developing a psychotic disorder makes a huge difference in long term outcomes. An American might develop psychosis in their mid 20s, end up committed for a few weeks and placed on antipsychotic pills until they're no longer floridly psychotic, and then go home, not follow up with doctors/refill meds, and end up on a cycle of this with more and more brittle symptoms until they're homeless and have no real chance of recovery. The same person in Northern Europe would likely be hospitalized for longer initially, started on an injectable that only needs to be given once a month, and they leave the hospital with fewer residual symptoms. They're then followed by an ACT team with a nurse visiting to check on them and make sure they're eating and keeping housing, and ensuring that shot goes in their arm every month. They don't necessarily fully recover, but a lot of them end up being able to do some kind of schooling/employment/volunteering and they are either stable enough to keep housing without being evicted for disruption, or are shuffled into staffed group homes.

andrewla 2y ago
Do we have any numbers on the number of people that are in this system? I'm frankly curious if the numbers in the original article can effectively be completely explained by this system rather than the policies listed in the article. In the US the system broke down in the 50s and 60s and collapsed completely in the 70s and 80s due to bad treatment options and often very inhumane conditions and cases of misdiagnoses. The widespread misdiagnosis problem only stretched the system further and compounded the existing problems. I would be curious to see where Finland's trajectory in this regard lies.
- singleshot_ 2y ago

deleted 2y ago

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mmooss 2y ago

You're assuming others share your perspective and understanding. > The transition to using the word "homeless" has resulted in transforming something we can't easily measure -- "drug addicted or mentally ill people being a public menace" -- into something that we can measure -- "people without a good living arrangement". > the former is the actual problem that we care about The word homeless is pretty old, not something people have 'tranistioned' to any time recently. I haven't seen anyone trying use 'homeless' as a euphemism; they are actually concerned about people without housing. That is the big problem. You apparently believe "drug addicted or mentally ill people being a public menace" is a comparable problem, but your comment is the first time I've heard that. Nobody is conspiring to hide it; they just don't think about it like you do. I spend a lot of time in cities and know others who do too. None feel menaced by people who are unhoused - why would that be menacing? - or high. High people generally don't know you are there, and are easily avoided. I've had zero problems; I don't know of anyone else who has. Also, the subtext is about eroding human rights. You have no more rights than a homeless or high person. Feeling 'menaced' is not sufficient to compromise someone's freedom. That's what freedom means - of course people can always do things that others don't mind; freedom means doing things other people don't like. I find your comment menacing; who decides who gets locked up?

amiga386 2y ago
> I spend a lot of time in cities and know others who do too. None feel menaced by people who are unhoused - why would that be menacing? - or high. High people generally don't know you are there, and are easily avoided. I've had zero problems; I don't know of anyone else who has. "Nothing ever happens" says person nothing happened to. Meanwhile, these are just some examples that made the news: * https://www.bbc.co.uk/news/world-us-canada-67386865 https://www.bbc.co.uk/news/world-us-canada-67386865 "A suspect has been arrested two days after former US Senator Martha McSally reported being sexually assaulted while on a run in Iowa [...] The suspect, who is thought to be homeless," * https://www.bbc.co.uk/news/uk-england-derbyshire-65569357 https://www.bbc.co.uk/news/uk-england-derbyshire-65569357 "Derby homeless man raped women who offered to help him" * https://www.bbc.co.uk/news/uk-41484206 https://www.bbc.co.uk/news/uk-41484206 "A "manipulative" homeless man who turned on a family who befriended him has admitted the "frenzied" murder of the mother and her 13-year-old son." * https://www.reuters.com/article/lifestyle/life-sentence-for-man-who-beheaded-screenwriter-idUSN04328783/ https://www.reuters.com/article/lifestyle/life-sentence-for-... "A severely mentally ill man was sentenced to life in prison on Friday for beheading a Hollywood screenwriter [...] a homeless former Marine described by his lawyer as "very, very mentally ill", pleaded guilty [...] in a crime without motive." * https://www.cbsnews.com/losangeles/news/long-beach-woman-sexually-assaulted-by-homeless-man-in-broad-daylight/ https://www.cbsnews.com/losangeles/news/long-beach-woman-sex... "Long Beach woman sexually assaulted by homeless man in broad daylight" Fortunately I haven't witnessed any murders or rapes, but the most shocking for me was that I've visited Vancouver twice in my life, and on both visits, lone women walking down the street in broad daylight were chased after and opportunisticly molested by drunk vagrants hanging around on Robson Street. Broad daylight. They had absolutely no shame. And other than the molested women fighting them off and running away, nobody did or said anything. Everyone has a right to walk about in public unmolested, and I would want the police to arrest those men and prosecute them for sexual assault. You're delusional or misinformed if you think this doesn't happen. Of course it happens. On the other hand, you can be molested or assaulted by drunk and beligerent homed people. And, more importantly, homeless people are much more at risk of assault or rape by the homed, than the homed are of being assaulted and raped by the homeless. For all the articles I linked above, they are dwarfed by news reports of homeless people being shot, beaten, stabbed, set on fire or raped. So, overall, homeless people as a whole are neither saints nor devils. They are who they are, and each individual has a different situation. We should feel a lot of empathy for them, and want to help them into a less precarious position... but we also want to do it because we're mindful of the danger to the public that untreated mental illness poses.

kiba 2y ago

It is more painful to treat someone who is homeless and mentally ill as opposed to just mentally ill.

t-3 2y ago

Finland is cold. People without adequate housing will freeze to death. Not finding bodies in the spring thaw is probably actually important to them.

deleted 2y ago
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pavlov 2y ago

What is the question you’re asking here? I’m Finnish and I have a close family member with a severe mental illness, so I should be reasonably well positioned to answer your question. But it doesn’t make any sense to me. How does any of this relate to homelessness? To get people off the streets, you give them a place to live. Then you can start solving their other problems. It’s common sense.

sonofhans 2y ago
In some US popular culture “drug addict” is code for “weak or immoral person.” There’s very little empathy or understanding of people who are much less fortunate; there’s plenty of evidence in this thread. This misguided moral compass outweighs even sensible practices like harm reduction. People would rather see junkies die on the street of hepatitis than give them free housing and needles. It satisfies some primal need that, eventually I hope, our species will be better off with less of.
- BoingBoomTschak 2y ago
  [flagged]
  - sonofhans 2y ago
    Thank you for making my point on my behalf :)
  - bowsamic 2y ago
    You’re not exactly demonstrating your moral strength by calling them parasites
- sugarplant 2y ago
  this is such a dishonest characterization. the issue people have with free needles is that they end up everywhere but a sharps container. they throw loose needles in every park, walking path, bus stop, etc. in the entire city. my city has had this issue for years now. you should use some of the superhuman empathy you have to explore other perspectives on the issue. even for just a minute.

dp88 2y ago

The Pandremix issue has lots of issues to fix as well that will probably never see the light of the day. Essentially those few hundred with Pandemrix-induced narcolepsy are now a permanently disabled minority without organized legal advocacy. The party-opposing party, that should not be opposing them, Pharmaceutical Injury Insurance Pool (LVP) has significant financial and legal resources. LVP has substantially broader access to archives and expert knowledge. The impaired functional capacity and financial position of those affected makes it difficult to advocate for their rights. The state implemented the vaccination program and transferred responsibility to the insurance pool system with its own financial interests. The pool system determines assessment criteria and makes evaluations without external oversight. Initially, there was talk of "million-euro compensations." The government guaranteed to finance the remainder if pool funds were depleted. Legal cases have been fought against LVP regarding time limits of confirmed cases. Compensations have remained a fraction of original expectations. Narcolepsy patients are too small a minority to influence Parliamentary politics or re-enter public discourse. This special group has been left alone to defend their rights within the pool system. The compensations were based on Käypä Hoito Guidelines for accident injuries, which are unsuitable for narcolepsy: narcolepsy doesn't necessarily cause clear cognitive deficits despite its severity, and comparison to brain trauma is not medically possible. The drafters would probably agree if asked that it wasn't intended for this use. A person with narcolepsy can be formally capable of work, but this might consume all of their alert hours & energy, leaving nothing for actually having a life. The system may equate narcolepsy, in permanent damage, with injuries similar to a broken finger in workplace accidents, hence the permanent disability compensations are insufficient for dignified life. The wage compensation issue is more significant. The determination basis for loss of earnings compensation is problematic as it's based on achieved education and work history, although the illness has impaired these opportunities. The same neurological illness produces different compensations depending on onset timing, as those with established careers may fare better than those who couldn't compete for university placement. This particularly affects those who became ill in childhood/youth, as it doesn't account for lost opportunities. In practice, even those from educated backgrounds with academic potential (e.g. top grades or plans for university before narcolepsy) may receive compensation based on average or low income. Opportunity cost compensation appears unlikely. The state has not promoted reassessment of applicability of Käypä Hoito criteria. There is insufficient monitoring of equality in compensation decisions and appeals, inadequate communication about compensations (the question whether all victims are even aware of their rights seems open), and questionable document management and decision-making transparency. LVP defines compensation terms, makes compensation decisions, and handles appeals, creating a conflict of interest as LVP has financial incentive for strict interpretation. Permanent damage compensations are treated as earned income by Kela, requiring their use for basic living expenses, though they're meant as lifetime compensations for an incurable neurological illness. (this is partly machine-translated from personal notes)

ferociouskite56 2y ago

No, there are not "a number of effective drugs." I interviewed 100 mental patients and the rare ones with hallucinations were not cured. Benzos help anxiety, SSRI don't do much, Cobenfy is promising. Involuntary commitment wouldn't be horrible if violating injections and ECT electrocution were voluntary.

j45 2y ago

Finland has figured out a number of thing it seems other than homelessness. Their education system is pretty interesting, and their policing system has some approaches to interacting with the community as well. If I can find the links I'll share. Skepticism is fine, but it shouldn't be a reason to discount or dismiss something, nor does it mean to accept it. Take it in as a data point.

usr1106 2y ago
Finland elected the most right-leaning government in the history of the country in 2023. A lot of the education, social, and healthcare system is facing deep cuts at the moment. Economy has not recovered from the fall of Nokia around 2010, so needs for social services would actually be growing.
- j45 2y ago
  Well, that's something else. Hopefully they don't dismantle their education system, and policing ways, and whatever else they have going.

tehjoker 2y ago

People are on the street because they don't have homes. If they had homes, they would be less depressed, less drug addicted, and less destitute and less likely to cause public problems. So just give them homes. A major upside: if you lose your job, you won't be at risk of becoming homeless! it would allow you to take a much stronger negotiating position with your boss. It would allow you to take a much stronger position with your landlord regarding rent increases too.

1propionyl 2y ago

> It's nearly impossible to fix. The horrors of involuntary commitment vs. the horrors of not having involuntary commitment vs. the horrors of using the criminal justice system vs. the horrors of not using the criminal justice system. I think, frankly, and I base this on experience with family undergoing involuntary commitment in Europe... we really are still a bit collectively traumatized or basing our takes on what happened prior here in the US from past abuse of involuntary commitment systems. It can be compassionate. It can help people get psychiatric and psychological help they didn't know how to access. It can help get people back on their feet and transition them into a return to normalcy. It can work.

saulpw 2y ago
It can be compassionate in other places, but I think the US has proven itself to lack compassion in some pretty essential ways.
- throwawayq3423 2y ago
  This really does come down to comparing small countries, where programs like this can actually work, to large countries, where the scale makes it impossible. If your country is small and rich, government can be highly functional. But please stop comparing it to a larger place, it's apples to oranges.

grahamplace 2y ago

Charles Lehman was on the Ezra Klein show recently[1] and had a useful definition for disorder, re: your first point. This may not be exactly the quote, but it was something like "Disorder is domination of public space for private purposes." As an SF resident, that really resonated; day-to-day quality of life here (for me, at least) feels much more impacted by that type of "disorder" than "homelessness" generally (obviously we need housing solutions too) [1] https://www.nytimes.com/2024/10/18/opinion/ezra-klein-podcast-charles-fain-lehman.html https://www.nytimes.com/2024/10/18/opinion/ezra-klein-podcas...

lostlogin 2y ago
> “Disorder is domination of public space for private purposes." The first thought I had on reading this was ‘the world has a car disorder’.

theteapot 2y ago

I'm really sick of people lumping homeless people in with "drug addicted or mentally ill people". There is a lot of sober hard working people that are homeless because they got caught out with some bad luck and don't have friends or relatives to fall back on. Once your homeless everything becomes much harder.

more_corn 2y ago

The thing you claim to care about (drug addicted or mentally ill people being a public menace) is wildly easier to combat when the people in question have a stable living situation. The housing first initiative in Salt Lake City provides ample evidence that if people have a stable living situation it is way easier to get them to take their medication, get into rehab, keep them out of dangerous situations. It’s actually more cost effective in the long term to house the chronically homeless instead of kicking the can down the road. If you actually care about what you claim to care about you should be supporting housing first. That means 1) get people housed with minimal red tape and basically no conditions 2) treat mental health and drug addiction The evidence is clear that it works and that it is more cost effective than dealing with the fallout when homeless people unravel. Unfortunately politicians who had preconceived notions about this topic ignored the evidence and revoked funding for the program. Your statement that it is impossible to treat or cure mental illness and drug addiction (which the evidence does not support) places you in that camp. You, my friend are the worst part of the problem. Because the evidence exists to disprove your stance, but you hold a strong opinion without having bothered to check the science.

MobiusHorizons 2y ago

From what I have been able to learn from several community mental health friends, there are a lot of causes of homelessness. There are certainly nontrivial numbers of people struggling with mental illness, drug and alcohol abuse, or combinations of both in public on our streets. This tends to be very visible and off putting. Housing is only one of many challenges these people are facing, but there are also lots of services beyond housing aimed at this population. There are also plenty of people who are dealing with setbacks and just need to get back on their feet and rebuild. This population is much less visible most of the time, because they are much less likely to be inconveniencing people in public spaces. Sometimes they have more of a social network to tap and can stay off of the streets. For this group, cost of housing and availability of work are the primary issues. I don’t have a good sense of the size of this population relative to other populations though.

andrewla 2y ago
I don't think of this in terms of "causes of homelessness". These are different categories. The "visible" homeless, ironically, are extremely difficult to measure. They often don't carry or won't present identification, they often have no family or support structure, they often make little to no attempt to use services. The "invisible" homeless are the opposite, and can be easily measured, because they have all of those things. When you see numbers trying to measure homeless people, it will almost always be the "invisible" homeless. Sending people out with clickers to count the homeless people on the street is nearly impossible, so the best we can do is various sampling approaches with huge margins of error.

fsloth 2y ago

Speaking as a Finn. It's foremost NOT about mental&substance issues treatment but general financial aid to anyone in need. I think this phraze from the article summarizes it well. "The Finnish experience demonstrates the effectiveness of tackling homelessness through a combination of financial assistance, integrated and targeted support services and more supply: " It's a holistic system that actually kicks-in way before one is in danger of being homeless, and if someone would suddenly find themselves homeless, the state security blanket is available to all. So 1. direct assistance 2. support services and 3. supply. On the first order, this is not related to substance abuse or mental illness, and should not be viewed as such. They are just a way to make sure nobody freezes to death. The way these policies link with mental&substance issues is that before 90's you were denied housing if you had ongoing substance abuse issues. This policy was dialed back to allow all housing regardless of any other issues, specifically because it was considered being homeless does not help in any way to resolve the above matters. So viewing this as "something only for ill people" is the wrong lens. It's a system for everyone. Of course mentally ill and those suffering substance issue are often without financial means so they are represented in the population receiving support. But the actual treatment to the above issues is a separate policy matter (after nobody was excluded anymore). The downside is that unless a polity has similar wide cover social security system in place, I have no idea what learnings you could get from this.

throwawayq3423 2y ago
Sounds like the result of being a small and rich country. The scale of these actions in a country like the US (Or India) would be impossibly expensive.
- fsloth 2y ago
  Finland rich? Not as such. Small and homogenous definetly (pop 5.6M). US is rich. Vastly richer than Finland. PPP GDP for US in 2023 was 73k $ and for Finland 64k $. The systems are quite different. But it’s not about total wealth as such. If we use GDP as rough back-of-the-envelope estimate (problematic I know!) us could implement similar system economically but politically probably not. The gini coefficient gives some hints about these differences (US 0.48, FI 0.28). In Finland people are taxed until there are very little income differences and then that money is used for social policies and healthcare. So everybody gets high quality healthcare for all of the serious stuff (until you reach best-before-date and government pulls the plug), you never need to freeze to death, go hungry (in theory at least) and your kids will have free education. Based on my limited understanding of US politics and social structure I find similar arrangement improbable. But it’s not about country’s total wealth!

watwut 2y ago

People without good housing options are an issue even if they are not drug addicted yet and they don't have mental illness.