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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. I

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)
    - fusiongyro 14y ago
      Saying "that's a good point" has as much or more to do with social courtesy than "winning" the conversation. (Have you seen this? http://www.newyorker.com/humor/2012/09/03/120903sh_shouts_simms http://www.newyorker.com/humor/2012/09/03/120903sh_shouts_si... ) I say it's a good point because it may be worth making a distinction between early-mid 20th century institutional care in an asylum and early 21st century institutional care through a variety of assistance programs. You have presented a good case that the distinction is either meaningless or that there is a direct relationship between the former and the latter, but either way, the article doesn't spell out the link between the two.
      - tankbot 14y ago
        That's true, the article really didn't explain much about the programs he would like to see. I could have done a better job of explaining myself but it was late. These residential programs are providing the type of solid routines that allows a client to stabilize and are actually doing a better job than the large institutions (according to my data). Think of the difference between how well most students do in a large impersonal lecture hall vs. 1 on 1's with teachers who take a real interest in their education.
- tankbot 14y ago
  > "supportive short-term and long-term community housing and treatment", which doesn't sound like institutional care But it is. The housing/treatment he is referring to covers a range of facilities from supported housing to crisis centers to residential and secure residential treatment facilities based in the community. The goal of these facilities is to provide the stability necessary for a person to compensate and, ideally, re-enter society. Some folks need to enter a crisis center for a short stay during a time of instability. Some simply need a place to live (supported housing) with just a little more structure. There are also people who are chronically ill and do well (some not so well) in a residential or secure residential treatment program, but will never leave because they are unable to function without the stability of an institution. Mental illness is a spectrum, hence the array of different support tools. The programs the OP was if'ing about exist, and are progressing. For instance, there is new legislature in my state that expands these programs to include general medical and dental care.
  - fusiongyro 14y ago
    Just curious, which state are you in?
    - tankbot 14y ago
      Oregon, specifically Multnomah County. Part of my job includes tracking (arguably) quantifiable data on how clients respond to community-based residential treatment. I have not been in this space long, and I'm still learning about the underlying process/politics that our business model exploits. But I do have the data to show that residential treatment works, sorry I can't share.

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)
  - fusiongyro 14y ago
    Saying "that's a good point" has as much or more to do with social courtesy than "winning" the conversation. (Have you seen this? http://www.newyorker.com/humor/2012/09/03/120903sh_shouts_simms http://www.newyorker.com/humor/2012/09/03/120903sh_shouts_si... ) I say it's a good point because it may be worth making a distinction between early-mid 20th century institutional care in an asylum and early 21st century institutional care through a variety of assistance programs. You have presented a good case that the distinction is either meaningless or that there is a direct relationship between the former and the latter, but either way, the article doesn't spell out the link between the two.
    - tankbot 14y ago
      That's true, the article really didn't explain much about the programs he would like to see. I could have done a better job of explaining myself but it was late. These residential programs are providing the type of solid routines that allows a client to stabilize and are actually doing a better job than the large institutions (according to my data). Think of the difference between how well most students do in a large impersonal lecture hall vs. 1 on 1's with teachers who take a real interest in their education.
tankbot 14y ago
> "supportive short-term and long-term community housing and treatment", which doesn't sound like institutional care But it is. The housing/treatment he is referring to covers a range of facilities from supported housing to crisis centers to residential and secure residential treatment facilities based in the community. The goal of these facilities is to provide the stability necessary for a person to compensate and, ideally, re-enter society. Some folks need to enter a crisis center for a short stay during a time of instability. Some simply need a place to live (supported housing) with just a little more structure. There are also people who are chronically ill and do well (some not so well) in a residential or secure residential treatment program, but will never leave because they are unable to function without the stability of an institution. Mental illness is a spectrum, hence the array of different support tools. The programs the OP was if'ing about exist, and are progressing. For instance, there is new legislature in my state that expands these programs to include general medical and dental care.
- fusiongyro 14y ago
  Just curious, which state are you in?
  - tankbot 14y ago
    Oregon, specifically Multnomah County. Part of my job includes tracking (arguably) quantifiable data on how clients respond to community-based residential treatment. I have not been in this space long, and I'm still learning about the underlying process/politics that our business model exploits. But I do have the data to show that residential treatment works, sorry I can't share.