6 ms·

I’m not sure what the right answer is, but asking people who are used to rough and tumble life outside to then behave civilly indoors with zero tolerance seems…

I’m not sure what the right answer is, but asking people who are used to rough and tumble life outside to then behave civilly indoors with zero tolerance seems…set for failure? There are those that do succeed but those are certainly the most motivated to do so. Others are in transition: know they should get indoors but know their difficulties. Rather than kicking them out, maybe they are required to attend some mandatory psych sessions. Maybe they go maybe they don’t but at least there support to help them work thru their issues of why they blew up at the staff (as in this instance).

Aunche 2y ago
> asking people who are used to rough and tumble life outside to then behave civilly indoors with zero tolerance seems…set for failure? This is what I'm saying the ranger is doing. Someone who gets extremely distressed by indoor living is not a good candidate taxpayer funded indoor living. On the other hand, that housing given to someone who is capable of navigating welfare bureaucracy on their own may actually enable someone who is at risk spiraling down a path of no return to turn their life around.
- b112 2y ago
  I've always wondered why such people don't live in a rural area. You could literally set aside parks for people wanting to live in this fashion, used to living in this fashion, but also provide facilities (bedding, small cabins, water supplies, washing machines, etc, etc). You'd need, I think, to have security guards on hand. Not to stop drug use, but instead to stop violence against other homeless, to intervene if medical attention is required, and so on. While the costs would be higher than some other solutions, it would be lower (I think) than paying for private housing. Of course, you'd have to force move people, and that's not going to happen. That is, unless you make squatting in a park a crime, and the result is "you're going to be incarcerated in this very nice outdoor place" the "jail". Maybe a medical order. My point is, I don't see an issue with some of your logic. Some people won't transition to inside living, or being close to others. But if you take people used to living in parks, move them to a park with cabins(tiny homes), and state run water/facilities, the cost might be the same, but they'd have a warm bed, etc.
  - lupusreal 2y ago
    A few people might be cut out to be rural hermits, but most need other people to fuel their lifestyle with food, booze and drugs, etc. Hard to buy fent by stealing bicycles if you're in a remote park.
  - ninalanyon 2y ago
    What everyone wants, and these people want more than most perhaps, is autonomy. Your idea might work so long as there are few rules that would cause people to be kicked out and so long as money is also provided. It probably won't work if people are forced into it because being forced into things is one of the reason they are in their situation already. More carrot and less stick, more compassion and less puritanism might have a chance of working.
  - bombcar 2y ago
    The people who are capable of this do this on their own. The California high desert is full of variations of this in shacks and trailers across the nearly uninhabited expanse. The biggest problem is support, but if they can navigate enough to get government assistance they can survive for quite a long time.
  - pkaeding 2y ago
    Your last idea reminds me of https://mlf.org/community-first/ https://mlf.org/community-first/ From what I hear, it is quite successful, giving their residents the dignity and autonomy they need to stand on their own.
    - b112 2y ago
      Neat. I was thinking more rural, but if this works, it works!
- lazide 2y ago
  The ranger is a hero. And hero’s are often toxic in long running scenarios for exactly the reason outlined - they are trying to make up for a systemic failure through self sacrifice, therefore enabling the underlying system failure.
  - hnbad 2y ago
    This is needlessly cynical. The hero isn't toxic. The narrative of an individual effort in lieu of calling out the systemic issue is what's toxic. I don't see any way she could have better spent her energy contributing to systemic change whereas by doing what she does she literally improves the lives of others. Favoring narratives of individual heroes over narratives of systemic changes is a cultural problem. Whether it's Atlas Shrugged, the Odyssey or Harry Potter. It instills a learned helplessness and an artificial desire for a "strong man fix things" that can be very difficult to overcome. But it also atomizes and fractures society and benefits those with the most individual wealth and power. The ranger is a hero. What she is doing is good. But she shouldn't have to do it. And nobody should have to do so much. The article intentionally buries its lede: if this is what it takes to save one person, how can we save thousands? The implied answer is again helplessness: of course this isn't scalable so we can't. What she is doing is too much for one person, so we can't expect it of others. But the real answer is that literally none of this would be necessary if the system were actually built to help these people. Her work does not require a herculean effort because it is difficult. It requires so much effort because it is being made difficult. The right question isn't how can we scale this, the right question is how can we make it easy enough that we don't need her to be a hero. The question of scalability answers itself once you've removed the obstacles.
    - AStonesThrow 2y ago
      perhaps the pervasive narratives of systemic toxicity and chronic social issues that get us down? are those good for society? should we listen to those news stories all day? and believe that things are so awful that There Oughtta Be A Law And Reform? those who cried out to quote Tax The Rich unquote, were likewise upset by the tariffs being imposed which are taxes on the rich... a really uniform and effective one! taxing corporations by tariffs is much father reaching than taxing individuals. individual heroes. those who cannot interpret epic fantasy sagas as allegory or larger than Life metaphors are already helpless and they just need entertainment and some opiates.
- hnbad 2y ago
  > taxpayer funded I don't understand the reflexive nature many people present in jumping this kind of framing. Of course it's taxpayer funded. Everything is taxpayer funded. Even when it's not literally paid from taxes collected by the government, it's probably funded by people who pay taxes. The price you pay for your groceries funds not just the wholesale purchase of the goods you pay for but also the labor, facilities, equipment and resources used to purchase, deliver, store and sell those goods. Considering the total amount of taxes collected versus the revenue of the place you get your groceries, you probably contribute more of your income to operating that place than to any single service funded directly from taxes. The amount of those grocery expenses that goes directly into profits alone is probably still greater than that. Housing first specifically also literally is cheaper than the previous approach by reducing expenses for medical services, policing and incarceration. So "taxpayer funded" is neither a meaningful qualifier if taken literally nor do its implications stand up to scrutiny. The most common reason for using this phrase is an emotional appeal to selfishness. Your money is being spent without your say on services you don't benefit from. I find that framing morally appalling but even so, what is the alternative? What the US did before was more expensive. Not housing people means more health issues and ER visits. Throwing them in prison means housing and feeding them at a massive multiple of the cost of a housing first initiative. If you want to save costs without spending money on housing, I guess you could cut their access to medical services but then you might as well allow law enforcement to shoot them on sight as the outcome will be the same. > On the other hand, that housing given to someone who is capable of navigating welfare bureaucracy on their own What you're describing is triage, not housing the homeless. If your housing program is small enough that you have to engage in triage and turn people away, it's not addressing homelessness, it's addressing a fraction of the homeless population. It's better than nothing, sure, but it's not enough. Also triage means weighing the necessary resources for treatment against the likelihood of recovery and the likely extent of the recovery. You don't treat someone who can walk it off but you also don't treat someone who's in very poor health or too far gone to be saved without using a disproportionate amount of resources. Triage is not how you organize a hospital. Triage is how you respond to an overwhelming emergency situation without access to necessary resources. Triage is a last resort measure to reduce the number of people who will die, not a strategy for helping people survive and thrive. Homelessness is not a natural disaster, not a spontaneous pandemic. Homelessness is a longstanding social issue most often directly arising from poverty and lack of mental health support. If your concern is with the support being wasted on people with worse chances and not support being insufficiently funded for that kind of decision not having to be made, I think you might be overestimating your humanitarianism.
bnralt 2y ago
> I’m not sure what the right answer is, but asking people who are used to rough and tumble life outside to then behave civilly indoors with zero tolerance seems…set for failure? This is true, and that's why housing first is a terrible policy (I've seen it fail spectacularly first hand). Many of these people simply can't take care of themselves, and putting them in free apartments doesn't fix their situation, but it does make life miserable for long-term residents. All while being extremely expensive. > Maybe they go maybe they don’t Here they have frequent wellness checks. It doesn't solve anything. This shouldn't be a surprise - someone who's incapable of living civilly when given a free apartment likely isn't going to be a person who's going to put the time and effort into mental health classes.
- vidarh 2y ago
  You seem to be assuming a specific version of housing first that is by no means the only option, and then dismissing the concept as a whole on that basis.
  - bnralt 2y ago
    My "specific version" is the version used by government agencies, which specifically states that the government is giving people free permanent housing without requiring prerequisites. HUD[1]: "Housing First is an approach to quickly and successfully connect individuals and families experiencing homelessness to permanent housing without preconditions and barriers to entry, such as sobriety, treatment or service participation requirements." California Department of Housing and Community Development[2]: "Housing First is an approach to serving people experiencing homelessness that recognizes a homeless person must first be able to access a decent, safe place to live, that does not limit length of stay (permanent housing)...Under the Housing First approach, anyone experiencing homelessness should be connected to a permanent home as quickly as possible, and programs should remove barriers to accessing the housing, like requirements for sobriety or absence of criminal history." [1] https://files.hudexchange.info/resources/documents/Housing-First-Permanent-Supportive-Housing-Brief.pdf https://files.hudexchange.info/resources/documents/Housing-F... [2] https://www.hcd.ca.gov/grants-funding/active-funding/docs/housing-first-fact-sheet.pdf https://www.hcd.ca.gov/grants-funding/active-funding/docs/ho...
zdragnar 2y ago
> maybe they are required to attend some mandatory psych session According to the social workers I know who work with this population, there is a persistent fear that any form of offered mental health help is a trap for institutionalizing people. By and large, people who are chronically homeless due to mental health issues will prefer to remain homeless over being required to see a psychiatrist and having to take medicine, or so I'm told.
- lazide 2y ago
  The issue is also that it’s selection bias - folks who permanently benefit from the treatment leave the system, so you end up with a more and more concentrated population of people who don’t (or refuse to) permanently benefit from it. Barring other factors, of course.
  - AStonesThrow 2y ago
    The point of drugs is not to benefit the patient!! The drugs and treatments protect the community and serve the collective good. The drugs are administered first to foster obedience, credulity, and fidelity. The patient learns to keep their appointments, lest the drugs be withdrawn. The patient becomes a regular customer at the pharmacy, which must also be done on precise schedules. The drugs must be taken as directed, and the patient learns how to read and understand and follow intricate rubrics for rituals at home, and what foods to avoid, how to coordinate meals with the drugs, etc. The patient, having demonstrated obedience and fidelity is well-supervised now by the clinic and provider. The drugs are "virtual shackles" that stand in for actual restraints and confinement methods. Just as "chemical castration" substitutes for surgical mutilation, any patient who's on drugs and making regular appointments can be let loose, a feral in the human population, often undetected and blending in. https://en.wikipedia.org/wiki/History_of_psychiatry#/media/File:Philippe_Pinel_%C3%A0_la_Salp%C3%AAtri%C3%A8re.jpg https://en.wikipedia.org/wiki/History_of_psychiatry#/media/F... https://en.wikipedia.org/wiki/Philippe_Pinel https://en.wikipedia.org/wiki/Philippe_Pinel It's important to consider that Mental/BH has never been a medical discipline, and while today's scrubs and white coats are the priestly raiment of BHT, NP-LPN-RPh-BH, and M.D.s alike, they take blood pressure and do labs, and they prescribe drugs and work in clinical systems, even Western-style BH is, fundamentally, a religious temple cult of profound spirituality. In order to fit the mold of modernist secularism, the BH temple must array itself in trappings of science and respectable, professional jargon. The BH orthodox profession is that mental illness begins and ends in the body, somewhere, hopefully the brain, or at least where the neurotransmitters flow, to be manipulated by sacramental means. Because if mental illness is not bound or subject to the body, or the secret HIPAA-protected rites and liturgies are not concrete and high-tech, then treatments become subjective, outcomes are unpredictable, and evidence cedes ground to superstition or faith in deities and the intangible world of spirit, which must be ignored in order to promote and foster D.E.I. Ramp up drug regimes trying to blunt aggression, anxiety, restlessness, independent thought and reason, resistance to authority, and other compulsions to harm others, or sometimes the drugs magnify those compulsions and homicidal ideations, and the patient just goes totally apeshit, until the hospital can get to billing their insurance in earnest. But since President Reagan "closed the asylums" the paradigm shifted to keeping people out and free and at-liberty. Because institutionalization is an excessive burden on taxpayers, families, and insurance carriers, and it's labor-intensive: this is recapitulated in the past 5 years because the "Flatten the Curve" mantra was promulgated because there are widespread staff shortages and a lack of skilled, certified HCPs, especially for Defence Against the Dark Arts. I recommend viewing the critically acclaimed, award-winning film "Ladybird" starring Saorsie Ronan; her mother is a psychiatric nurse played by Laurie Metcalf, and see how Ladybird herself turned out Even for the HCPs on staff, BH facilities are closer to meat-grinders than revolving-doors, as they burn out, train up, move up, drink their own Flavor-Aid, circulate within the system. So those homeless psychos meet a new team of strangers every month or so. Over 25 years, I personally witnessed one clinic that changed its name/brand/ownership 5-6 times, expanded/moved at least 3 times, and there are literally dozens of BH systems that didn't exist 10 years ago, including 8-story hospitals with no 6th floor. https://www.azahcccs.gov/Fraud/Downloads/ProviderSuspensionsTerminations.pdf https://www.azahcccs.gov/Fraud/Downloads/ProviderSuspensions... Would you believe dozens of New Religious Movements operating under auspices of BH services? You may find yourself in a shotgun shack, worshipping Shiva or Kali, or I don't know, in a UFO cult, or practicing tantric yoga with authentic Punjabi Guru, because Medicaid funding. BH Funding for Treatment is Public Safety and a National Security concern: every time a mass shooting is reported on the news, Congress acts to bolster BH funding and services, and so "every time a shell casing pings, someone's clinic builds a wing!" Ask anyone working in hospice/palliative care and they may confide that drugs are administered when family or staff are irritated or vexed by the patient, rather than basing it on the needs of patient herself. An incoherent or insane patient may be unable to articulate their needs, but when they act out, or become criminally dangerous, they must needs smacked down. "The Squeaky Wheel Gets the Grease" indeed. https://en.wikipedia.org/wiki/Rosemary_Kennedy#Lobotomy https://en.wikipedia.org/wiki/Rosemary_Kennedy#Lobotomy The patient works with the provider to identify and treat more and more conditions. The drugs layer-up, and sometimes extra drugs are shoveled on top, to complement really debilitating effects. But in general, the drugs are exacerbating and magnifying the patient's sins and proclivities. The drugs are interacting and the patient is increasingly entangled in the intricate ritual of provider->pharmacy->daily pill rituals->pharmacy->provider->pills. It's impossible to know whether recovery is attributable to a true underlying change or whether the drugs have papered over the worst symptoms. Therefore, it's never advisable to stop those drugs or titrate off them, because they don't get labeled with maximums or limits like the OTC stuff can be (this guy once OD'd on fiber supplements). In the case of "lunatics" and other folks who just had a temporary nervous breakdown or trauma-based freakout, they certainly can recover and exit the system--anyone can exit the system until they're court-ordered or incarcerated, anyway. There's plenty of other non-drug treatment for outpatients on the streets; counseling/therapy can be done 1:1 or in groups and other supports in the clinic for building life skills, etc. The homeless nutjob population can typically get benefits from us taxpayers to keep them in the clinic 3-5 days a week, just doin' stuff, because the clinic is pretty much a church, and the mentally ill need a religion with structure, rituals, priests, and sacraments like Prozac.
Cemlolo 2y ago
[dead]
tiahura 2y ago
We used to have work farms, SF had a few. They were shut down by the same counterculture types that said turning a blind eye to drugs and vagrancy wouldn't be a problem.

Aunche 2y ago

> asking people who are used to rough and tumble life outside to then behave civilly indoors with zero tolerance seems…set for failure? This is what I'm saying the ranger is doing. Someone who gets extremely distressed by indoor living is not a good candidate taxpayer funded indoor living. On the other hand, that housing given to someone who is capable of navigating welfare bureaucracy on their own may actually enable someone who is at risk spiraling down a path of no return to turn their life around.

b112 2y ago
I've always wondered why such people don't live in a rural area. You could literally set aside parks for people wanting to live in this fashion, used to living in this fashion, but also provide facilities (bedding, small cabins, water supplies, washing machines, etc, etc). You'd need, I think, to have security guards on hand. Not to stop drug use, but instead to stop violence against other homeless, to intervene if medical attention is required, and so on. While the costs would be higher than some other solutions, it would be lower (I think) than paying for private housing. Of course, you'd have to force move people, and that's not going to happen. That is, unless you make squatting in a park a crime, and the result is "you're going to be incarcerated in this very nice outdoor place" the "jail". Maybe a medical order. My point is, I don't see an issue with some of your logic. Some people won't transition to inside living, or being close to others. But if you take people used to living in parks, move them to a park with cabins(tiny homes), and state run water/facilities, the cost might be the same, but they'd have a warm bed, etc.
- lupusreal 2y ago
  A few people might be cut out to be rural hermits, but most need other people to fuel their lifestyle with food, booze and drugs, etc. Hard to buy fent by stealing bicycles if you're in a remote park.
- ninalanyon 2y ago
  What everyone wants, and these people want more than most perhaps, is autonomy. Your idea might work so long as there are few rules that would cause people to be kicked out and so long as money is also provided. It probably won't work if people are forced into it because being forced into things is one of the reason they are in their situation already. More carrot and less stick, more compassion and less puritanism might have a chance of working.
- bombcar 2y ago
  The people who are capable of this do this on their own. The California high desert is full of variations of this in shacks and trailers across the nearly uninhabited expanse. The biggest problem is support, but if they can navigate enough to get government assistance they can survive for quite a long time.
- pkaeding 2y ago
  Your last idea reminds me of https://mlf.org/community-first/ https://mlf.org/community-first/ From what I hear, it is quite successful, giving their residents the dignity and autonomy they need to stand on their own.
  - b112 2y ago
    Neat. I was thinking more rural, but if this works, it works!
lazide 2y ago
The ranger is a hero. And hero’s are often toxic in long running scenarios for exactly the reason outlined - they are trying to make up for a systemic failure through self sacrifice, therefore enabling the underlying system failure.
- hnbad 2y ago
  This is needlessly cynical. The hero isn't toxic. The narrative of an individual effort in lieu of calling out the systemic issue is what's toxic. I don't see any way she could have better spent her energy contributing to systemic change whereas by doing what she does she literally improves the lives of others. Favoring narratives of individual heroes over narratives of systemic changes is a cultural problem. Whether it's Atlas Shrugged, the Odyssey or Harry Potter. It instills a learned helplessness and an artificial desire for a "strong man fix things" that can be very difficult to overcome. But it also atomizes and fractures society and benefits those with the most individual wealth and power. The ranger is a hero. What she is doing is good. But she shouldn't have to do it. And nobody should have to do so much. The article intentionally buries its lede: if this is what it takes to save one person, how can we save thousands? The implied answer is again helplessness: of course this isn't scalable so we can't. What she is doing is too much for one person, so we can't expect it of others. But the real answer is that literally none of this would be necessary if the system were actually built to help these people. Her work does not require a herculean effort because it is difficult. It requires so much effort because it is being made difficult. The right question isn't how can we scale this, the right question is how can we make it easy enough that we don't need her to be a hero. The question of scalability answers itself once you've removed the obstacles.
  - AStonesThrow 2y ago
    perhaps the pervasive narratives of systemic toxicity and chronic social issues that get us down? are those good for society? should we listen to those news stories all day? and believe that things are so awful that There Oughtta Be A Law And Reform? those who cried out to quote Tax The Rich unquote, were likewise upset by the tariffs being imposed which are taxes on the rich... a really uniform and effective one! taxing corporations by tariffs is much father reaching than taxing individuals. individual heroes. those who cannot interpret epic fantasy sagas as allegory or larger than Life metaphors are already helpless and they just need entertainment and some opiates.
hnbad 2y ago
> taxpayer funded I don't understand the reflexive nature many people present in jumping this kind of framing. Of course it's taxpayer funded. Everything is taxpayer funded. Even when it's not literally paid from taxes collected by the government, it's probably funded by people who pay taxes. The price you pay for your groceries funds not just the wholesale purchase of the goods you pay for but also the labor, facilities, equipment and resources used to purchase, deliver, store and sell those goods. Considering the total amount of taxes collected versus the revenue of the place you get your groceries, you probably contribute more of your income to operating that place than to any single service funded directly from taxes. The amount of those grocery expenses that goes directly into profits alone is probably still greater than that. Housing first specifically also literally is cheaper than the previous approach by reducing expenses for medical services, policing and incarceration. So "taxpayer funded" is neither a meaningful qualifier if taken literally nor do its implications stand up to scrutiny. The most common reason for using this phrase is an emotional appeal to selfishness. Your money is being spent without your say on services you don't benefit from. I find that framing morally appalling but even so, what is the alternative? What the US did before was more expensive. Not housing people means more health issues and ER visits. Throwing them in prison means housing and feeding them at a massive multiple of the cost of a housing first initiative. If you want to save costs without spending money on housing, I guess you could cut their access to medical services but then you might as well allow law enforcement to shoot them on sight as the outcome will be the same. > On the other hand, that housing given to someone who is capable of navigating welfare bureaucracy on their own What you're describing is triage, not housing the homeless. If your housing program is small enough that you have to engage in triage and turn people away, it's not addressing homelessness, it's addressing a fraction of the homeless population. It's better than nothing, sure, but it's not enough. Also triage means weighing the necessary resources for treatment against the likelihood of recovery and the likely extent of the recovery. You don't treat someone who can walk it off but you also don't treat someone who's in very poor health or too far gone to be saved without using a disproportionate amount of resources. Triage is not how you organize a hospital. Triage is how you respond to an overwhelming emergency situation without access to necessary resources. Triage is a last resort measure to reduce the number of people who will die, not a strategy for helping people survive and thrive. Homelessness is not a natural disaster, not a spontaneous pandemic. Homelessness is a longstanding social issue most often directly arising from poverty and lack of mental health support. If your concern is with the support being wasted on people with worse chances and not support being insufficiently funded for that kind of decision not having to be made, I think you might be overestimating your humanitarianism.

bnralt 2y ago

> I’m not sure what the right answer is, but asking people who are used to rough and tumble life outside to then behave civilly indoors with zero tolerance seems…set for failure? This is true, and that's why housing first is a terrible policy (I've seen it fail spectacularly first hand). Many of these people simply can't take care of themselves, and putting them in free apartments doesn't fix their situation, but it does make life miserable for long-term residents. All while being extremely expensive. > Maybe they go maybe they don’t Here they have frequent wellness checks. It doesn't solve anything. This shouldn't be a surprise - someone who's incapable of living civilly when given a free apartment likely isn't going to be a person who's going to put the time and effort into mental health classes.

vidarh 2y ago
You seem to be assuming a specific version of housing first that is by no means the only option, and then dismissing the concept as a whole on that basis.
- bnralt 2y ago
  My "specific version" is the version used by government agencies, which specifically states that the government is giving people free permanent housing without requiring prerequisites. HUD[1]: "Housing First is an approach to quickly and successfully connect individuals and families experiencing homelessness to permanent housing without preconditions and barriers to entry, such as sobriety, treatment or service participation requirements." California Department of Housing and Community Development[2]: "Housing First is an approach to serving people experiencing homelessness that recognizes a homeless person must first be able to access a decent, safe place to live, that does not limit length of stay (permanent housing)...Under the Housing First approach, anyone experiencing homelessness should be connected to a permanent home as quickly as possible, and programs should remove barriers to accessing the housing, like requirements for sobriety or absence of criminal history." [1] https://files.hudexchange.info/resources/documents/Housing-First-Permanent-Supportive-Housing-Brief.pdf https://files.hudexchange.info/resources/documents/Housing-F... [2] https://www.hcd.ca.gov/grants-funding/active-funding/docs/housing-first-fact-sheet.pdf https://www.hcd.ca.gov/grants-funding/active-funding/docs/ho...

zdragnar 2y ago

> maybe they are required to attend some mandatory psych session According to the social workers I know who work with this population, there is a persistent fear that any form of offered mental health help is a trap for institutionalizing people. By and large, people who are chronically homeless due to mental health issues will prefer to remain homeless over being required to see a psychiatrist and having to take medicine, or so I'm told.

lazide 2y ago
The issue is also that it’s selection bias - folks who permanently benefit from the treatment leave the system, so you end up with a more and more concentrated population of people who don’t (or refuse to) permanently benefit from it. Barring other factors, of course.
- AStonesThrow 2y ago
  The point of drugs is not to benefit the patient!! The drugs and treatments protect the community and serve the collective good. The drugs are administered first to foster obedience, credulity, and fidelity. The patient learns to keep their appointments, lest the drugs be withdrawn. The patient becomes a regular customer at the pharmacy, which must also be done on precise schedules. The drugs must be taken as directed, and the patient learns how to read and understand and follow intricate rubrics for rituals at home, and what foods to avoid, how to coordinate meals with the drugs, etc. The patient, having demonstrated obedience and fidelity is well-supervised now by the clinic and provider. The drugs are "virtual shackles" that stand in for actual restraints and confinement methods. Just as "chemical castration" substitutes for surgical mutilation, any patient who's on drugs and making regular appointments can be let loose, a feral in the human population, often undetected and blending in. https://en.wikipedia.org/wiki/History_of_psychiatry#/media/File:Philippe_Pinel_%C3%A0_la_Salp%C3%AAtri%C3%A8re.jpg https://en.wikipedia.org/wiki/History_of_psychiatry#/media/F... https://en.wikipedia.org/wiki/Philippe_Pinel https://en.wikipedia.org/wiki/Philippe_Pinel It's important to consider that Mental/BH has never been a medical discipline, and while today's scrubs and white coats are the priestly raiment of BHT, NP-LPN-RPh-BH, and M.D.s alike, they take blood pressure and do labs, and they prescribe drugs and work in clinical systems, even Western-style BH is, fundamentally, a religious temple cult of profound spirituality. In order to fit the mold of modernist secularism, the BH temple must array itself in trappings of science and respectable, professional jargon. The BH orthodox profession is that mental illness begins and ends in the body, somewhere, hopefully the brain, or at least where the neurotransmitters flow, to be manipulated by sacramental means. Because if mental illness is not bound or subject to the body, or the secret HIPAA-protected rites and liturgies are not concrete and high-tech, then treatments become subjective, outcomes are unpredictable, and evidence cedes ground to superstition or faith in deities and the intangible world of spirit, which must be ignored in order to promote and foster D.E.I. Ramp up drug regimes trying to blunt aggression, anxiety, restlessness, independent thought and reason, resistance to authority, and other compulsions to harm others, or sometimes the drugs magnify those compulsions and homicidal ideations, and the patient just goes totally apeshit, until the hospital can get to billing their insurance in earnest. But since President Reagan "closed the asylums" the paradigm shifted to keeping people out and free and at-liberty. Because institutionalization is an excessive burden on taxpayers, families, and insurance carriers, and it's labor-intensive: this is recapitulated in the past 5 years because the "Flatten the Curve" mantra was promulgated because there are widespread staff shortages and a lack of skilled, certified HCPs, especially for Defence Against the Dark Arts. I recommend viewing the critically acclaimed, award-winning film "Ladybird" starring Saorsie Ronan; her mother is a psychiatric nurse played by Laurie Metcalf, and see how Ladybird herself turned out Even for the HCPs on staff, BH facilities are closer to meat-grinders than revolving-doors, as they burn out, train up, move up, drink their own Flavor-Aid, circulate within the system. So those homeless psychos meet a new team of strangers every month or so. Over 25 years, I personally witnessed one clinic that changed its name/brand/ownership 5-6 times, expanded/moved at least 3 times, and there are literally dozens of BH systems that didn't exist 10 years ago, including 8-story hospitals with no 6th floor. https://www.azahcccs.gov/Fraud/Downloads/ProviderSuspensionsTerminations.pdf https://www.azahcccs.gov/Fraud/Downloads/ProviderSuspensions... Would you believe dozens of New Religious Movements operating under auspices of BH services? You may find yourself in a shotgun shack, worshipping Shiva or Kali, or I don't know, in a UFO cult, or practicing tantric yoga with authentic Punjabi Guru, because Medicaid funding. BH Funding for Treatment is Public Safety and a National Security concern: every time a mass shooting is reported on the news, Congress acts to bolster BH funding and services, and so "every time a shell casing pings, someone's clinic builds a wing!" Ask anyone working in hospice/palliative care and they may confide that drugs are administered when family or staff are irritated or vexed by the patient, rather than basing it on the needs of patient herself. An incoherent or insane patient may be unable to articulate their needs, but when they act out, or become criminally dangerous, they must needs smacked down. "The Squeaky Wheel Gets the Grease" indeed. https://en.wikipedia.org/wiki/Rosemary_Kennedy#Lobotomy https://en.wikipedia.org/wiki/Rosemary_Kennedy#Lobotomy The patient works with the provider to identify and treat more and more conditions. The drugs layer-up, and sometimes extra drugs are shoveled on top, to complement really debilitating effects. But in general, the drugs are exacerbating and magnifying the patient's sins and proclivities. The drugs are interacting and the patient is increasingly entangled in the intricate ritual of provider->pharmacy->daily pill rituals->pharmacy->provider->pills. It's impossible to know whether recovery is attributable to a true underlying change or whether the drugs have papered over the worst symptoms. Therefore, it's never advisable to stop those drugs or titrate off them, because they don't get labeled with maximums or limits like the OTC stuff can be (this guy once OD'd on fiber supplements). In the case of "lunatics" and other folks who just had a temporary nervous breakdown or trauma-based freakout, they certainly can recover and exit the system--anyone can exit the system until they're court-ordered or incarcerated, anyway. There's plenty of other non-drug treatment for outpatients on the streets; counseling/therapy can be done 1:1 or in groups and other supports in the clinic for building life skills, etc. The homeless nutjob population can typically get benefits from us taxpayers to keep them in the clinic 3-5 days a week, just doin' stuff, because the clinic is pretty much a church, and the mentally ill need a religion with structure, rituals, priests, and sacraments like Prozac.

Cemlolo 2y ago

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tiahura 2y ago

We used to have work farms, SF had a few. They were shut down by the same counterculture types that said turning a blind eye to drugs and vagrancy wouldn't be a problem.