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This fatalistic attitude isn't wrong, but it is manifestly unhelpful and surprisingly expensive. Being homeless is not a zero-cost alternative to real treatment

This fatalistic attitude isn't wrong, but it is manifestly unhelpful and surprisingly expensive. Being homeless is not a zero-cost alternative to real treatment; in many cases, the cost of lavish treatment is far lower than the cost of ER visits and criminal proceedings that would otherwise be incurred. I believe Malcolm Gladwell wrote an article about chronic homelessness a few years ago, about Denver rolling out a program to take some number of homeless folks and set them up in an apartment free of charge with on-site nursing 24/7, and it was saving the city millions just by keeping them out of the ER. I believe the program ultimately came under fire because of how essentially un-American such a system is, even when it makes both ethical and financial sense.

debacle 14y ago
It's 2012 - no one in the world should go homeless, unclothed, or hungry. It's inhumane. But I don't think that's what this article was about.
- fusiongyro 14y ago
  The author is arguing that his son would not be homeless if institutional care had not be shut down, not that his son would be a productive member of society. It's practically tautological.
  - mcguire 14y ago
    "The author is arguing that his son would not be homeless if institutional care had not be shut down" Actually, he isn't. The only institutional care he mentions in the What I realize now section is "supportive short-term and long-term community housing and treatment", which doesn't sound like institutional care, in the sense of "When he was in jail, with its regular routines and meals, Tim usually stabilized". There was a reason why total institutions were, well, total. In fact, his "if I were a legislator today" comments are essentially the same as the "I jumped at the opportunity to" do actions in the 1980's.
    - fusiongyro 14y ago
      That's a good point. The article begins with him discussing the shutdown of institutional care in favor of integrative approaches. But you're right, the solution he's promulgating at the end isn't really the same thing.
      - guylhem 14y ago
        And that's what shocked me as well. He made the right diagnosis with the right title and the right observations, but jumped to the wrong conclusions :-/
        tankbot 14y ago
        He made the right conclusions and these programs have already been implemented. (at least in my state) There are many community-based mental health providers. They are private-sector companies, usually nonprofits, that provide treatment paid for by state funding (medicaid, etc.).
        guylhem 14y ago
        No, it contradicts his own title and facts : When he was in jail, with its regular routines and meals, Tim usually stabilized. But when he was released (...) he destabilized right away The "humane reforms" may not have been just for the good. More details in http://news.ycombinator.com/item?id=4662700 http://news.ycombinator.com/item?id=4662700
        tankbot 14y ago
        The point I was trying to make is that these smaller community-based facilities do provide the stability that clients need to compensate. In fact they do a better job than a large impersonal institution.
      - tankbot 14y ago
        It's actually not a good point, see my reply above. Upvote for using the word 'promulgating' though. Good show :o)
ArbitraryLimits 14y ago
> when it makes both ethical and financial sense. It saves money on a small scale because no one's trying to defraud it yet.
- wonderzombie 14y ago
  On the other hand, you have to ask whether the cost of trying to make sure not a single dollar is given to the undeserving outweighs both the monetary savings and benefits to society overall. Don't throw the baby out with the bathwater. I envision this to be a lot like crime. You'll never get rid of it completely, so you put into place some (ostensibly) cost-effective measures to mitigate the worst of it.
  - wooter 14y ago
    > On the other hand, you have to ask whether the cost of trying to make sure not a single dollar is given to the undeserving outweighs both the monetary savings and benefits to society overall. Don't throw the baby out with the bathwater. based on no data, what-so-ever? I believe the parent claiming that there would be no monetary savings at-scale or in the long term
    - wonderzombie 14y ago
      And you believe that, based on no data what-so-ever? ;) Right now, we spend a lot of money and get very little. If we chose to spend more rather than passively leak money, we'd at least be able to exercise some control over how it's spent, benefit from economies of scale, and so on. To be explicit, I'm drawing a distinction between efficiency of dollars and raw quantity of dollars. Given the choice between spending $250 and getting nothing versus spending $500 and receiving something of substantial value, I'd opt for the latter. And that's what the qualifier about "benefits to society overall" is about; there's more value to be had from this than some dollar amount. But if all we're thinking about is a) how many dollars it costs (and not how we're wasting money now), and b) that some small subset of people might game the system (which will always happen, regardless of counter-measures), I think that's self-defeating.
- 14y ago
wooter 14y ago
pretty bold claim... source? below you said it was tried on "tens" of people. both ethics and finance differ quite a bit at any larger scale.
- fusiongyro 14y ago
  Aha, I found it: http://www.gladwell.com/2006/2006_02_13_a_murray.html http://www.gladwell.com/2006/2006_02_13_a_murray.html

debacle 14y ago

It's 2012 - no one in the world should go homeless, unclothed, or hungry. It's inhumane. But I don't think that's what this article was about.

fusiongyro 14y ago
The author is arguing that his son would not be homeless if institutional care had not be shut down, not that his son would be a productive member of society. It's practically tautological.
- mcguire 14y ago
  "The author is arguing that his son would not be homeless if institutional care had not be shut down" Actually, he isn't. The only institutional care he mentions in the What I realize now section is "supportive short-term and long-term community housing and treatment", which doesn't sound like institutional care, in the sense of "When he was in jail, with its regular routines and meals, Tim usually stabilized". There was a reason why total institutions were, well, total. In fact, his "if I were a legislator today" comments are essentially the same as the "I jumped at the opportunity to" do actions in the 1980's.
  - fusiongyro 14y ago
    That's a good point. The article begins with him discussing the shutdown of institutional care in favor of integrative approaches. But you're right, the solution he's promulgating at the end isn't really the same thing.
    - guylhem 14y ago
      And that's what shocked me as well. He made the right diagnosis with the right title and the right observations, but jumped to the wrong conclusions :-/
      - tankbot 14y ago
        He made the right conclusions and these programs have already been implemented. (at least in my state) There are many community-based mental health providers. They are private-sector companies, usually nonprofits, that provide treatment paid for by state funding (medicaid, etc.).
        guylhem 14y ago
        No, it contradicts his own title and facts : When he was in jail, with its regular routines and meals, Tim usually stabilized. But when he was released (...) he destabilized right away The "humane reforms" may not have been just for the good. More details in http://news.ycombinator.com/item?id=4662700 http://news.ycombinator.com/item?id=4662700
        tankbot 14y ago
        The point I was trying to make is that these smaller community-based facilities do provide the stability that clients need to compensate. In fact they do a better job than a large impersonal institution.
    - tankbot 14y ago
      It's actually not a good point, see my reply above. Upvote for using the word 'promulgating' though. Good show :o)

ArbitraryLimits 14y ago

> when it makes both ethical and financial sense. It saves money on a small scale because no one's trying to defraud it yet.

wonderzombie 14y ago
On the other hand, you have to ask whether the cost of trying to make sure not a single dollar is given to the undeserving outweighs both the monetary savings and benefits to society overall. Don't throw the baby out with the bathwater. I envision this to be a lot like crime. You'll never get rid of it completely, so you put into place some (ostensibly) cost-effective measures to mitigate the worst of it.
- wooter 14y ago
  > On the other hand, you have to ask whether the cost of trying to make sure not a single dollar is given to the undeserving outweighs both the monetary savings and benefits to society overall. Don't throw the baby out with the bathwater. based on no data, what-so-ever? I believe the parent claiming that there would be no monetary savings at-scale or in the long term
  - wonderzombie 14y ago
    And you believe that, based on no data what-so-ever? ;) Right now, we spend a lot of money and get very little. If we chose to spend more rather than passively leak money, we'd at least be able to exercise some control over how it's spent, benefit from economies of scale, and so on. To be explicit, I'm drawing a distinction between efficiency of dollars and raw quantity of dollars. Given the choice between spending $250 and getting nothing versus spending $500 and receiving something of substantial value, I'd opt for the latter. And that's what the qualifier about "benefits to society overall" is about; there's more value to be had from this than some dollar amount. But if all we're thinking about is a) how many dollars it costs (and not how we're wasting money now), and b) that some small subset of people might game the system (which will always happen, regardless of counter-measures), I think that's self-defeating.
14y ago

wooter 14y ago

pretty bold claim... source? below you said it was tried on "tens" of people. both ethics and finance differ quite a bit at any larger scale.

fusiongyro 14y ago
Aha, I found it: http://www.gladwell.com/2006/2006_02_13_a_murray.html http://www.gladwell.com/2006/2006_02_13_a_murray.html