4 ms·

My understanding is that Northern Europe has a much more robust system of using Long Acting Injectable Antipsychotics (under court order if nessecary) and vario

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
  > due to bad treatment options and often very inhumane conditions and cases of misdiagnoses. I thought that it broke down due to a Supreme Court decision (O’Connor v. Donaldson, 422 U.S. 563 (1975)) but perhaps they were interrelated.
- PaulHoule 2y ago
  That's a wrong chronology. Before the 1950s we did not have effective treatments for schizophrenia other than incarceration. In old books you read about https://en.wikipedia.org/wiki/Catatonia https://en.wikipedia.org/wiki/Catatonia being intractable, now it usually clears up in 15-30 minutes with benzodiazepine medication. In the 1950s we got the Phenothiazines which were the first hope for many patients, there has been a huge amount of progress since then and managing most of these people outside the hospital is possible. People also came to see involuntary commitment as immoral as described by Thomas Szasz, depicted by the movie "One Flew out of the Cuckoo's Nest" and shown by this experiment https://en.wikipedia.org/wiki/Rosenhan_experiment https://en.wikipedia.org/wiki/Rosenhan_experiment The trouble isn't that we tore down the old system but that we didn't completely build a new system to replace it. There are deep issues involving people's agency. Right now we are in a society that thinks it is wrong to make people to take drugs they don't want to take, a different society (maybe even ours in N years) will think is it wrong to not make people take drugs for serious mental illness.
  - gotoeleven 2y ago
    I really don't understand society's attitudes here. Why is it more humane to give a psychotic person agency, resulting in them living in filth like an animal, dangerous to themselves and others, than to commit them to a mental hospital? If you let a baby or an old person wallow in their shit, it would be considered abuse. Why is this not abuse?
    - PaulHoule 2y ago
      Part of it is the burden on the caregivers. It can be exasperating to care for an elderly person with dementia, they can range from very agreeable to rather disagreeable but most of them have had enough experience with caring for people and being cared for that they can have some empathy with their caregiver -- even if they have a hard time remembering it. People with serious mental illness have disturbances in those relationships (remember how Freud asked "tell me about your mother?") and are much harder. And if they want to kill you because they think you are something other than what you are they're more able to do it. Communities that adopted "housing first" early on had great success with it. In the fentanyl age there's a lot of fear that a volunteer or someone who isn't paid nearly enough will open a door from time to time to discover a dead body.
m0llusk 2y ago
Psychiatry has some of the worst reproducability of any science. People who are forced to live on the streets without good access to services begin to exhibit symptoms of psychosis within one to two days and lose those symptoms after a similar duration of one or two days with housing. In Europe such a policy might make sense, but in America where being dumped on the street is rather common the situation is different. Also, in America the general social situation is quite different from life in Finland.
- TOMDM 2y ago
  > Psychiatry has some of the worst reproducability of any science. People who are forced to live on the streets without good access to services begin to exhibit symptoms of psychosis within one to two days and lose those symptoms after a similar duration of one or two days with housing. Is this a studied phenomenon I can read about? I'd appreciate any literature suggestions if you have them.
  - sudosysgen 2y ago
    There is a lot of literature on acute sleep deprivation causing symptoms of psychosis, and there is a lot of literature on acute sleep deprivation as a result of homelessness.
- dsajames 2y ago
  I can see this. I knew someone who was homeless for a time. I asked her where she slept. She said "you don't sleep". You don't even have to run an experiment to know that sleep deprivation, even in your own home, causes psychosis. Now add the shock of being exposed to filth for the first time, poor climate control (homeless don't walk around with multiple layers of Patagonia and a nice backpack to stash them in as it warms up), the very real threat of sexual or physical assault, the shocking awareness that you are now "one of them" and know that a sizable percentage of your acquaintances would immediately distance themselves from you if they knew your plight. We're not even talking about food and vitamin quality here.
  - 2y ago

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
> due to bad treatment options and often very inhumane conditions and cases of misdiagnoses. I thought that it broke down due to a Supreme Court decision (O’Connor v. Donaldson, 422 U.S. 563 (1975)) but perhaps they were interrelated.
PaulHoule 2y ago
That's a wrong chronology. Before the 1950s we did not have effective treatments for schizophrenia other than incarceration. In old books you read about https://en.wikipedia.org/wiki/Catatonia https://en.wikipedia.org/wiki/Catatonia being intractable, now it usually clears up in 15-30 minutes with benzodiazepine medication. In the 1950s we got the Phenothiazines which were the first hope for many patients, there has been a huge amount of progress since then and managing most of these people outside the hospital is possible. People also came to see involuntary commitment as immoral as described by Thomas Szasz, depicted by the movie "One Flew out of the Cuckoo's Nest" and shown by this experiment https://en.wikipedia.org/wiki/Rosenhan_experiment https://en.wikipedia.org/wiki/Rosenhan_experiment The trouble isn't that we tore down the old system but that we didn't completely build a new system to replace it. There are deep issues involving people's agency. Right now we are in a society that thinks it is wrong to make people to take drugs they don't want to take, a different society (maybe even ours in N years) will think is it wrong to not make people take drugs for serious mental illness.
- gotoeleven 2y ago
  I really don't understand society's attitudes here. Why is it more humane to give a psychotic person agency, resulting in them living in filth like an animal, dangerous to themselves and others, than to commit them to a mental hospital? If you let a baby or an old person wallow in their shit, it would be considered abuse. Why is this not abuse?
  - PaulHoule 2y ago
    Part of it is the burden on the caregivers. It can be exasperating to care for an elderly person with dementia, they can range from very agreeable to rather disagreeable but most of them have had enough experience with caring for people and being cared for that they can have some empathy with their caregiver -- even if they have a hard time remembering it. People with serious mental illness have disturbances in those relationships (remember how Freud asked "tell me about your mother?") and are much harder. And if they want to kill you because they think you are something other than what you are they're more able to do it. Communities that adopted "housing first" early on had great success with it. In the fentanyl age there's a lot of fear that a volunteer or someone who isn't paid nearly enough will open a door from time to time to discover a dead body.

m0llusk 2y ago

Psychiatry has some of the worst reproducability of any science. People who are forced to live on the streets without good access to services begin to exhibit symptoms of psychosis within one to two days and lose those symptoms after a similar duration of one or two days with housing. In Europe such a policy might make sense, but in America where being dumped on the street is rather common the situation is different. Also, in America the general social situation is quite different from life in Finland.

TOMDM 2y ago
> Psychiatry has some of the worst reproducability of any science. People who are forced to live on the streets without good access to services begin to exhibit symptoms of psychosis within one to two days and lose those symptoms after a similar duration of one or two days with housing. Is this a studied phenomenon I can read about? I'd appreciate any literature suggestions if you have them.
- sudosysgen 2y ago
  There is a lot of literature on acute sleep deprivation causing symptoms of psychosis, and there is a lot of literature on acute sleep deprivation as a result of homelessness.
dsajames 2y ago
I can see this. I knew someone who was homeless for a time. I asked her where she slept. She said "you don't sleep". You don't even have to run an experiment to know that sleep deprivation, even in your own home, causes psychosis. Now add the shock of being exposed to filth for the first time, poor climate control (homeless don't walk around with multiple layers of Patagonia and a nice backpack to stash them in as it warms up), the very real threat of sexual or physical assault, the shocking awareness that you are now "one of them" and know that a sizable percentage of your acquaintances would immediately distance themselves from you if they knew your plight. We're not even talking about food and vitamin quality here.
- 2y ago