This article does a decent job of summarizing some of the issues that face the mentally ill and pointing out that psychiatry without strong community support is almost useless.
However, it's really just a subtle ad for a book, which probably just reiterates the same points in greater detail via lots of anecdotal data and case histories, points the finger at the government for not spending more money on programs designed to support the mentally ill within their communities, and doesn't provide any further concrete solutions.
Hasn't this same book been written over and over again?
I agree with this perspective. Absent from this article is the recognition that the absence of all these things is rooted in American culture that is inherently uncaring, eg. Hyperindependence instead of interdependence, puritanical moralizing instead of compassionate listening, scientific certainty instead of intellectual curiosity, silent/vocal denials and blame-shifting instead of acknowledgment, engagement, accountability, and responsibility. Oh, and financial anxiety and racism. Where are the leaders talking about how they got over their financial anxiety (instead of patching/feeding it with more money) or how they're renouncing whiteness? White-body supremacy started with the lie that there are white bodies, yet even social justice warriors will try to shame me into keeping it going, instead of acknowledging people who think they're white need to stop practicing the lie if they want to get anywhere past the racism of the day. We can use white privilege to help those who don't pass for white while refusing to base our identities on literal lies.
I also see these things as endemic to academia, especially in the sciences, and regard them as roots of our current replication crises, alongside capitalistic pressures.
As the article points out, access is a huge issue. Also a culture that criminalizes rather than treats. Guess we can thank Reagan for that omnibus budget reconciliation that gutted the MHSA
Sure mental health treatment and agencies are notoriously underfunded, understaffed, and underpaid. But
Mostly we have a society that views those with mental health struggles as 'less than' and not fully adults, because they can't support themselves in some fashion and contribute to the GDP (from a very 10,000 foot view).
We can pay for support all we want, until society at large stops viewing these people as burdens, it's not going to really fix anything.
To to be fair, a big part of the solution is recognizing these people as burdens, and deciding who will carry that burden and how. The idea that some of these people will ever be self sufficient is equally a challenge.
Ignoring that many folks in this place are not only burdens, but severely incapable of handling themselves in a way normally required for adults doesn't help the situation either.
It's a sliding scale, and one that people can show up on at different points on every single day. Ignoring that a specific individual can and or is spending all or most of it in a place that would have them dead in a week without external help, or injuring innocent bystanders, just makes the problem worse.
With medication and lack of compliance, some very bad cases could get from perfectly functional to that state in a day or less.
Yes yes, let's argue which is more abstractly authoritarian - "capitalism" xor "communism" - rather than focusing on the substance of the point OP was making. Or better yet, just get back to work.
Mostly, I am pretty tired of the "I got a really small serving of fries today; capitalism has failed." commentary. I see it everywhere: something negative happens, someone has to tie it into capitalism. Now, I am well aware of the fallacy of the excluded middle, but let's not kid ourselves that the "capitalism has failed" crew are anything but collectivists kvetching. I bring it up because a younger generation has little to no idea of various atrocities and grinding misery that also happened under various collectivist -isms, somewhere between ignorance and willful blindness.
Maybe capitalism isn't great, but dang, some of the replacements turned out to be a lot worse. It'd be nice if that context were provided instead of just another jibe at capitalism, which is one field of attempted solutions to the vast and intricate problem of resource management.
Is it not appropriate to say "capitalism has failed" when the central bank continually inflates the money supply so the finance industry can centrally plan the economy? Is it not appropriate to say "capitalism has failed" when most industries are dominated by two large market makers that move in lock step? Is it not appropriate to say "capitalism has failed" when the supply of essential goods necessary to have a distributed economy, like home ownership, has been priced out of reach of most people? Is it not appropriate to say "capitalism has failed" when it's easier to get investment money for outlandish throwaway subscription bets rather than long term development? Or topically, is it not appropriate to say "capitalism has failed" when it has paperclip-maximized its way to ignoring our human concerns?
Communism deviated from its ideal model, precessed, and collapsed. Capitalism can, and is, failing similarly. If you're truly interested in preserving capitalism, then it behooves you to take criticism of it to heart, and examine how it is falling apart. Your failure to accept criticism as "anything but collectivists kvetching" will only further its demise.
That sounds suspiciously like the "true communism has never been tried!" bit I have heard so often.
I don't particularly care about capitalism, myself, but the endless shallow attempts to tie whatever woe is being discussed to it is terribly reminiscent of how I used to hear about problems being the inevitable result of our nation turning away from Christ or whatever.
> That sounds suspiciously like the "true communism has never been tried!" bit I have heard so often.
Then you need to read my comment more deeply. Yes, it's adjacent to that no-true-Scotsman. The difference is I'm pointing out the inevitably of such, cf Goodhart's law. Just like implementing communism inevitably results in a concrete model that differs from the ideal, which will then be optimized for, the same thing is happening to capitalism. The objective difference is that it has taken capitalism longer to precess, but that's not particularly exceptional given the lasting power of say monarchy.
> I don't particularly care about capitalism
By your comments, you effectively do. You can't make an argument and then feign nihilism.
> the endless shallow attempts to tie whatever woe is being discussed to it is terribly reminiscent of how I used to hear about problems being the inevitable result of our nation turning away from Christ or whatever
Sure, there is always much groupthink and false attribution. Still, specific arguments need to be judged on their own merits. Reflexively opposing the prevailing groupthink is just another type of following.
Imagine someone keeps making this odd squawking noise in some language you do not understand, every time there is a discussion where something remotely negative is discussed. You don't have to really care about what that noise means, or its opposite, to not want to hear it anymore. That's all. "Capitalism has failed" is that squawk, because who knows what will be put in its place but just the sheer amount of hearing it all the time is irritating. That's what I mean by mentioning how shallow it is as a critique, it's just this sound people keep making.
> Imagine someone keeps making this odd squawking noise in some language you do not understand, every time there is a discussion where something remotely negative is discussed. You don't have to really care about what that noise means, or its opposite, to not want to hear it anymore. That's all. "Capitalism has failed" is that squawk, because who knows what will be put in its place but just the sheer amount of hearing it all the time is irritating. That's what I mean by mentioning how shallow it is as a critique, it's just this sound people keep making.
Try as I might, I cannot come up with a consistent good faith reading of your comments.
You're tired of hearing about something, yet not so tired that you won't create arguments about it by pulling in more distant topics? And when I try to connect with what seems to be your larger concern, you'll say you're just bored of the whole topic? All while ostensibly wanting to hear discussion of a related issue by reading this thread?
The best I can come up with is some kind of coping mechanism. If you're bored of the discussion, just stop responding. But perhaps next time, don't throw out the false dichotomy red herring.
You've made this way more complicated than it needs to be: "I'm tired of hearing about something ... STOP MAKING THAT NOISE!"
Try to imagine someone on Hacker News who followed your every comment. Should you complain about something, they mention that this is the result of a world which has turned away from Christ, or has not embraced TimeCube, whatever. Just over and over again. You'd get sick of it, right? That's how I feel about the squawk of "capitalism has failed us." It's not much more complicated than "Your probable alternate wasn't that great, either."
It appears "way more complicated than it needs to be", because I'm a second person with my own perspective, and I don't agree that your being bored of the argument constitutes a logical rebuttal. As I said, if you're bored of the topic, you didn't and don't need to engage with it. Starting an argument and then supporting it with your own disinterest is a very odd tack.
Furthermore you keep referencing this "probable alternative" bogeyman while completely ignoring that my criticism is coming from a place of reform rather than wholesale replacement. It's likely everything sounds like "squawking" to you because you're not listening to the specifics of what anyone says. It's very odd that you want to engage with the topic just enough to reject it. It takes all types, I guess.
You're equating hearing similar criticisms from many different people, in the form of message board comments, to a single individual following you around and sonically assaulting you? Respectfully, you may want to see a psychologist.
"Maybe capitalism isn't great, but dang, some of the replacements turned out to be a lot worse."
Well in terms of history we have not had a very long time for this experiment to play out. It is very possible that the construction of a system which allows both the generation of several billions of dollars also causes far greater harm than some of the other systems which were too heavy on the gas so to speak.
If history is a guide, all forms of a system fall due to avarice, vanity, or an external system which is operating 'better' at the current time.
Just as a point, your argument is a false dichotomy. The only two choices you allow are a ruthless capitalistic society or a communist society. The poster could have allowed for any colorful regions of societies in between.
I would argue most societies throughout history have treated people with mental illness less than kindly. But if wish to treat them better we must stop thinking of people as factors of productivity, and therefore their worth is only as useful as the amount they add to the bottomline. (Though I'd presume, albeit with little evidence currently, that society would be benefited in probably cost and happiness if we were to take on the task of providing adequate mental care to all.)
I don't think it's meant as a dichotomy. It's just important to note that "thinking of people as factors of productivity" is a common problem that happens in all sorts of economic systems.
> ... We present background information and an interview with the President of the Cuban Society of Psychology to learn about current mental healthcare in today's Cuba. Mental and medical healthcare are free and fully integrated. Early diagnosis and intervention is standard as each patient is known by their community doctor/nurse team from infancy through old age and by yearly home visits.
There are more, it seems they do a pretty good job of supporting community-based approaches given low funding. It'd be interesting to see some harder numbers on outcomes. Not surprising that supporting small, integrated communities has positive effects on mental health though.
It is also supported by immense oil wealth, and managed by a culturally homogenous (relatively) society for it's own benefit.
So being spent way better than, say, some random central African republic's mineral wealth, but not a model which is easy to duplicate much of anywhere else.
>”Guess we can thank Reagan for that omnibus budget reconciliation that gutted the MHSA”
I keep hearing this, but if this move was such an obviously bad thing why hasn’t it been undone yet?
I know the local chapter of the ACLU screams bloody murder whenever the city tries to institutionalize some of the local homeless population. Even if there was substantial bipartisan support for undoing what Regan changed in the 80’s, it seems like a plethora of other challenges stops it.
In which case, it seems unproductive to keep blaming Reagan.
Perceptions are not exactly glowing in 2022. Currently, the popular public face of involuntary custodianship is Britney Spears, and even I'll acknowledge that the justice system's relationship to mental health seems catastrophically broken. I would honestly rather be sent to prison than an institution in most situations, for a shorter term sentence situation.
The fact that anyone who has sought mental health treatment can be at a disadvantage in civil or criminal cases as a result is abhorrent. There should be much more stringent limits on the availability of this kind of information in the discovery process.
I have a schizophrenic family member. It costs six figures annually to keep them in a facility - which is designed to handle a completely different type of disability - and off the street.
It’s dumb luck that this facility accepts them and cares for them despite a lot of drama and irregularity. Many others have shown them the door.
It’s even dumber luck that the money exists to pay for the care.
If an American or someone they love winds up with a similar affliction, the chances of finding such a disaster-averting outcome are close to nil.
Yeah, I don't know how the author can be so flippantly optimistic about existing treatment options.
The system is not set up to help people get better.
The medications, which have the "best track record". Have an NNT of 5-10, severe side effects, and are so strong you risk rebound psychosis if you ever stop taking them. I think they really just help the institutions to manage patients in perpetuity.
Good essay, though it's a little tilted towards the 'medical model' of mental health treatment. I appreciate the 'insight from epidemiology': "Health care itself explains only a small fraction of health outcomes. Much of what we need for better outcomes is fundamental, but it is not part of health care. Social factors [...] are much more important for health outcomes than your specific diagnosis or health-care plan."
I've commented somewhat extensively about my friend's struggle with the mental health industry. They've decided she's a chronic psychotic who requires anti-psychotics for the rest of her life.
A year after she was formally misdiagnosed by the mental health industry I found videos on my phone from ~2 weeks before that 2015 hospitalization. I think my videos prove that my friend's supposedly-chronic condition can be entirely explained by substance abuse.
The tragedy of "American Mental Health Care" is the use of palliative drugs, when the various causes of the various diagnoses have actually been figured out by researchers. Science knows exactly how stimulants harm the metabolism [0]. The symptoms of mental illness can usually be explained as a metabolic problem - sometimes caused by substance abuse, sometimes by diet, always exacerbated by 'stress'.
Emotional stress is the most important drain on the body's metabolism. I have a bunch of references from books about stress - went to the ASU science library to read a book referenced in Gabor Maté's In The Realm of Hungry Ghosts [1], and found a discussion of how 'stress' contributes to psychosis.
In 2018, after her treatment center perpetrated fraud on the District Court, my friend got annoyed about how all the new clients at her treatment center were getting cheek-swabbed. She herself had not been cheek-swabbed when she was sent there 2 years before, and asked to have this genetic test. It revealed that she is a poor methylator, who cannot turn the provitamin folic acid (commonly used to fortify food as it is shelf-stable) into Vitamin B-9. She said that adding L-Methy-Folate to her routine was like flipping a switch from "depressed" to "not-depressed" [1].
The Supreme Court of the United States is going to be considering my petition soon. I'm optimistic that it will be one of the handful that they grant. All I'm asking is for them to order the district court to hold the evidentiary hearing that is required by the case law. (I'm currently working on a write-up of my experience for https://MadInAmerica.com, using some tips from HN moderator dang.)
This seems like a culture/economy wide problem. Like in my local city they're running fewer buses due to staffing issues while planning to spend $130 million on a BRT line and billions more on other capital projects. There's a huge bias towards the big bang/silver bullet solution and against the simple/mundane but effective solution.
It's a lot harder to graft the simple/mundane solution, and you don't get high priced consultants going around wining and dining the decision makers for it either.
I've been to 43 countries, and nowhere have I seen such a blatant abundance of mentally insane homeless people than SF, LA, and NYC. The problem is so bad that I believe it should be considered a national state of emergency, and international embarrassment. It's one of the reasons I left NYC after 5 years, and many others are as well.
I'm not going to pretend like I know what the solution is, but it starts by actually addressing it as a serious problem, which the U.S has not done. I guess politicians thinks it's normal for mentally insane homeless people to be shouting to people on sidewalks everywhere, and assaulting and even murdering random pedestrians? [1] For anyone who hasn't left the U.S - this isn't normal anywhere else in the world. What a shame that the wealthiest country can't manage its cities.
It wasn't just Reagan. It was also a reaction against the sometimes very real abuses and problems of the institutionalized mental health industry. A film called One Flew Over the Cuckoo's Nest help publicize the issue and generated a strong reaction against the idea of institutionalization in the US.
Problem is instead of reform they just shut down the entire system. Now we have loads of people on the street who really do need continuous professional help.
Institutionalization is a kind of arbitrary detention; left-leaning civil liberties types were against it too. I'm not an expert on this time period but the story I learned is that by the time Reagan defunded the hospitals they were already mostly empty, having lost the authority to hold all but the most extreme cases.
As JSavageOne said, "What a shame that the wealthiest country can't manage its cities." which is correct. Blaming long term policies on any single politician from decades ago is a disingenuous.
Yes, lets shift blame to the local governments! Despite the fact that Reagan passed the "Lanterman-Petris-Short Act" in California as Governor and then removed all funding for Mental Health at the State and Federal level. Hey, at least people that aren't a harm to themselves or others can die on the street in dignity now.
> Despite the fact that Reagan passed the "Lanterman-Petris-Short Act"
Reagan was governor. Governors sign bills. Legislatures pass them. This was a bipartisan effort and was viewed as a civil rights issue, to not hold people in confinement against their will. Lanterman was a Republican, Petris and Short were Democrats. Reagan could have vetoed it, so he shares in the responsibility, but it was a bipartisan, popular bill.
> removed all funding for Mental Health at the State and Federal level.
Do you really believe that all funding was removed? What is your basis for this shocking claim? It's very hard to cut government spending, and Reagan wasn't known for doing that (spending in almost every area increased under Reagan). Reagan was known for tax cuts, and since spending went up, Reagan was also known for big budget deficits (not like today, where Reagan would be viewed as a model of restraint, but compared to his predecessors the peacetime deficits were shocking). What you are saying is just wildly false.
From 1983-1992, Government spending on mental health grew an average of 6.5% annually in real terms.[1] "Cost-cutting" -- really a slowing down of spending increases, happened in the 2000s, where spending on mental health grew only by 4.7% annually in real terms. This was the slowest spending growth in history for mental health. The U.S. spends an enormous amount on mental health, with dubious results.
Here are two good rules of thumb when thinking about these issues if you are honestly trying to understand our history, rather than trying to score a political point and blame things on your enemies. These two should be your null hypothesis:
1. social spending always goes up. It never goes down. It does not matter who is President. Presidents don't cut social spending in any area.
2. Nothing in America happens because of one person. We have separation of powers and divided government. Everything is always a compromise reached by those in power at the time. This is a good explanation for 1, since the best way to get agreement is to buy people off with more spending.
> but it starts by actually addressing it as a serious problem, which the U.S has not done
Well it should really start at the county or state level, IMO. There are plenty of US states/cities outside of California that don't have the huge mental illness/homeless problem that SF has. So really SF County or the state of California needs to declare an emergency first before it is escalated to the national level.
Lack of affordable housing is a major underlying cause of homelessness in the US, moreso than lack of mental health support.
Early on in the pandemic, I saw some people saying things like "Housing is healthcare." And it's true.
I just don't know how to get anywhere harping overly much on that, so instead I'm making sketches and notes and if I don't end up homeless again and dying on the streets, maybe I can do a pilot project.
Probably not, but we all need an occupation (as was said in The importance of being Earnest).
Affordable housing alone will not solve this. We have to actually expand use of Kendra's Law. Homeless people in NYC that are mentally ill, using drugs, and engaging in criminal activity will not use any more additional resources provided to them. These are people that refuse help. Affordable housing would not solve for these people.
I never said affordable housing alone would solve it.
I'm quite confident that doubling down on going draconian on people who have no means to fix their own problems absolutely won't make anything better. If you take that far enough, the logical conclusion is something inane like "we should just shoot all homeless people" or something.
People have to be given a path back. Cutting them off will not magically cure what ails them.
I'm all for affordable housing. But when a homeless man commits murder, the answer to that isn't a one liner about the importance of affordable housing which is always the first and only thing that's mentioned when it comes to the homeless. There is nothing draconian about Kendra's Law by the way. It is far more humane to make sure treatment, psych beds are used, especially for people that do not have the capability of knowing when they need help.
When anyone commits murder, the appropriate response is jail time. That's not peculiar to homeless people.
I know a whole lot about homelessness and have left many comments on the subject over the years. If you want to have a meaty discussion about it, I'm capable of doing so, though this approach to engaging me isn't a good way to get that.
I write less about homelessness than I used to. These days, I try to focus on community development.
I think that's the best antidote we have and one that gets too little attention.
There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they're falling in. ― Desmond Tutu.
Crisis management is always a necessity during a crisis but you don't crisis manage your way to a solution.
I'm not interested in investing more of my time in crisis management for this problem space. I'm looking to find ways to actually shrink the problem.
I'm not saying we should stop doing any crisis management and I'm baffled that multiple people are reacting as if I had.
I'm saying one key piece is we need to resolve our housing supply issues. It's one piece. It's not a comprehensive solution but I think it's really important and far too many people seem to think lack of housing is somehow wholly unrelated to homelessness, which also baffles me.
I don't see how anyone can assert that but I run into pretty frequently.
The crisis management (in California referred to as 5150) is a revolving door that only 'helps' anyone by temporarily patching them up and letting them go back to whatever bad habits and environment got them there in the first place.
Better housing will help some. Better accessible care will help some. Better other things will help some.
But there is no fall through default option here being exercised if those options don't help those who aren't helped enough by those options they stop being a repeated danger to themselves or others. In theory it's possible to still get committed. It's almost impossible to actually get committed (as in persistently kept away from society in a controlled institution), and those places are so underfunded and terrible, the street might actually produce better outcomes for everyone.
'Crisis management' is about taking a crisis and not making it a crisis anymore.
But it's generally about a short term emergency intervention, not about long term control of a situation that is fundamentally unstable, unsound, and not 'resolvable' due to a persons own actions. There are people who cannot and will not do what is necessary to stay sane. There are not a lot of them. But they do exist.
We can reduce the overall size of the problem through housing reform. But it doesn't remove the need for some kind of not-a-humanitarian-disaster institutionalization in a non trivial number of cases
People don't refuse help that they need and want. If large groups of people are consistently refusing the help then it is not the help they need.
Yes yes people don't always know what they need it can be complex. But the majority of homeless people I know and have known needed and wanted help, but were unable to accept the terms of the help offered by the state, or various charities.
I have been homeless and not some cute "living in my car for six months after college" but open sores untreated addiction rotting teeth in the subway station homeless. People I love are still out there dying those deaths and it hurts so so much to hear the way you talk about them in comments today. Not just this one either.
"These people" need anything but more carceral violence directed at them. I've spent time both in jail and institutionalized. Jail is worse but the difference is more a matter of degree than type.
What you want is to have them removed. You're entitled to your wants of course and even to pursue them. But don't use helping homeless people as part of your justification. It is very hard to read these comments and believe you have ever known or cared about someone who was homeless in your city.
> People don't refuse help that they need and want. If large groups of people are consistently refusing the help then it is not the help they need.
This is a tautology. You are essentially defining the word "help" as whatever homeless people define help to be, yet you give some credence to the fact that homeless people might not actually know what is actually helpful for them. What is good for homeless people that are on drugs, that don't want to go to a homeless shelter, that don't want psychiatric help are very often bad for everyone else around them. So maybe we should stop making decisions that put the liberties of homeless people first.
In NYC where I live, two Asian women were killed by black, homeless men in this past month. I'm frankly not interested in making my language any more flowery for your taste with homeless people. I'm only interested in real policy solutions. Until you actually acknowledge the violence, the degeneration of our subway, streets, and city, then we're not going to be able to talk any further.
They are talking about Chronic Visible Homeless... a very different group than the majority of homeless population who don't; live on the street, talk to themselves, or murder complete strangers.
Shrink the problem generally and your worst case scenario cases get less problematic as well. Follow the 80/20 rule and help those most easily helped so society is more generally functional and our worst cases will be something we are more able to manage.
That makes sense if they are the same problem. In this case I think we've just linguistically bundled them together as "homeless" but they are actually completely distinct problems and groups.
I agree that lack of housing is a tremendous stressor and may cause or exacerbate mental health or substance use issues. Affordable housing has lots of benefits.
But when you look at the path that people took to being chronically visibly homeless on the street the pre-cursor in general isn't affordable housing.
> Roger’s parents wondered why, with so many advances in the science of mental health, their brilliant son was talking to voices and eating out of garbage cans.
One of the known problems is that it's common for schizophrenics to go to a hospital for inpatient treatment, get better, go home to family and get worse again.
Their family members may care about them and still be part of the problem. It's really common for people to want to save face and swear it's not their fault, it's something else. In such cases, they won't change. They won't take responsibility for their role. They will blame something else, anything else.
I think it's a mistake to just take the word of a relative as to what went wrong in a case where they might be part of what went wrong. But I usually don't say that because I know that's likely to get really negative reactions from people.
Suffice it to say I still don't agree with you and there's probably nothing to be gained from discussing this further.
I've already told you and you have hand waved it off as not a solution: I think we need to fix our very, very serious and longstanding housing supply issues.
If it were feasible for someone to rent a room for not much money and live decently without a car in a walkable neighborhood such that working part-time with decent wages or full-time minimum wage allowed a person their independence, then people with impairments wouldn't be prisoners of dysfunctional and stressed families who are often doing all the wrong things because their scared to death and don't know how to fix anything.
We've built a world in which only a small number of people can possibly keep up the rat race. We've torn down more than a million SROs which used to be normal housing and we now think of that as only housing for homeless people, not housing for young, single adults or childless couples or seniors or students.
(SRO stands for single room occupancy. Copy-paste isn't working for me at the moment, so I can't provide a link.)
In the US, it's nigh impossible to live without a car. It's nigh impossible to find someplace really cheap in a walkable neighborhood that's suitable for a household of one to three people.
Parents who know their child can't function well enough to work all the damn time and afford an expensive home and expensive car etc know this is a nightmare from which the entire family has no escape route.
The escape route for everyone is to make affordable housing in walkable neighborhoods the norm again so ordinary people who can function some of the time but can't run full throttle all of the time can protect their own agency, establish their independence and not be driven crazy by other people freaking out about the burden of caring for them forever with no hope of a solution.
I can work part-time. I can't work a regular job.
I currently live someplace cheap in a walkable setting. I've grown healthier and more functional because of it.
I would like to replicate that and make it more the norm in this country, like it once was.
That's a thing that works but it's a thing you aren't going to find plausible if your focus is on how to deal with people after everything has gone wrong and it looks unfixable. It's fixable. It's also very much preventable in many cases.
We just refuse to work on that. We are too busy screaming about how the sky is falling.
If that isn't computing for you, it isn't going to get better to keep telling me I'm wrong and you don't agree.
Your mental models of this problem space and mine clearly aren't jibing. This form of engagement isn't likely to bridge the gap between where you are on this and where I am.
I've spent years talking about this stuff online, including on HN a whole lot. It's not been a waste of time but there's only so far that goes.
At this point, my focus is on trying to flesh out a potential pilot project -- like I said in my first comment.
Sometimes words get in the way. Sometimes the best thing to do is do it and show people.
That's what I hope to do though I may not be able to. I'm not wealthy. I'm not connected. Most of the world does not see what I see.
I'm not sure why you keep talking at me instead of answering my simple question. I never once disagreed about the importance of affordable housing if you actually read what I said instead of getting so easily offended by what I am saying. I am repeatedly saying that we need to instead reinforce mandatory treatment, provide psych beds, and mitigate dangers of homeless people (that are a danger to themselves and others), especially for those that are committing violent crimes. To you, this is crisis management that is extremely convenient to ignore. That is not convenient for the rest of us that deal with the negative externality from these types of homeless people every single day.
Repeatedly mentioning that you spent years talking about this has absolutely no bearing on me. It's not my mental model that isn't working with yours. It's really your language and how you are approaching basic questions that are asking for a clarification on your insight.
It definitely seems like words are getting in the way for you then if you can't do the simplest of explanations. Have a good day.
I live in Seattle, and I would say that homelessness there is also reaching a state of crisis. Sometimes I see people in pain, sometimes I ask them about how they are doing or if they need anything or if there would be something that can help them; sometimes I can help them a little. Most of the time I don't understand what's happening.
You've obviously thought about this a lot more than I have so I'd like to gain some insight from you. I won't ask you about what the solution should look like since you didn't claim to know what it would be, but I'd like to learn more about what you think it would look like to actually address it as a serious problem?
Honestly I don't even claim to understand what the problem actually is, just that there seems to be some sort of problem and it seems to be growing rather than getting better. Could you write a little more about this? I'm curious about your thoughts here.
Here are some contrasting viewpoints I consider:
- Some believe that the US does not have much of a social safety net; some believe this to be by design; some believe this to be beneficial
- Some believe the US to be an individualistic society; some believe this to be beneficial in that it promotes the strong, the efficient, the productive, etc, to outcompete the weak, the wasteful, the lazy, etc.
- Some in the US believe that everyone should get therapy, psychiatry, etc under the guidance of a licensed professional; some in the US believe that psychiatric issues are just excuses made by the lazy to avoid work; some in the US believe that religion will save you and it's all the work of the devil; in some well-to-do places in the US, waiting lists for psychiatric care are months-long even with really good insurance; some believe that we are also in a worldwide pandemic that has had deleterious mental health consequences for everyone, and that many have been pushed to the brink
- Some believe we should increase taxes and have the government do things for people, or force people into doing things for themselves; some believe in reducing taxes and government interference; some believe people should fend for themselves and if they are losers, so be it; some believe in charity and doing good deeds; some people donate to virtue signal, some use donations for tax write-offs, and some people donate anonymously and never tell anyone and nobody else ever knows of what they did
- According to some studies, the US ranks #1 in charitable giving, or generosity towards strangers; contrast this with other countries that some believe have better safety nets and more direct government action, though perhaps higher taxes
- There's a saying that goes something like "charity begins at home"--some take this to be a call-to-action for your daily interactions with others you come across, including strangers since that would have the most immediate impact; some believe in a utilitarian mode of action where energy/time/money should be directed where they'd have the most effect or return the greatest value; some believe charities to be scams; some believe charities to be ineffective
I live in NYC and Christina Yuna Lee's death on Sunday morning has left me in complete shock. I have an older sister that is the same age and lives in that area as well. We are also Korean just like Lee for that matter.
Lee's death, along with Michelle Go, is a spectacular failure by NYC in so many ways. We are living in this city pretending like Penn station isn't literally a homeless camp now with addicts shooting up heroin openly in the streets. These are people that are refusing treatment or help and destroying this city and the subway.
Christina Yuna Lee's murderer had multiple charges on him, including assault charges. He should never have ever been on the street. We need to stop valuing the life of criminals above normal citizens. And we need to actually enforce Kendra's Law and build mental institutions outside of the city.
Let me guess this person had a long rap sheet and was out on some low bond that was probably paid by a group backed by VP Kamala Harris ? Let's face it, what is happening today is the cause of NYC liberal policies. And if you say being hard on crime isn't the solution then what has NY been doing about the out of control crime, homelessness and mental issues? They had years and years to come up with something and now people are being being murdered left and right.
Eliminating easily preventable murders like this one should be considered higher priority than anything else. Divorce rate and obesity of course are issues, but to put them above murder? Come on.
>(not sure all of those are still accurate, but sadly it's most likely)
I felt the need to fact-check these because I felt they were not accurate. Below are the results of about 2 minutes per bulletpoint.
> Highest incarceration rate in the world.
True
> Highest percentage of obese people.
US is #12
> Highest divorce rate.
US is #3
> Highest rate of illegal drug selling.
Might be true. Not super easy to get numbers on this.
> Most car thefts per year.
US is #11 per capita. Probably #1 in raw cases, but that data was not super easy to find.
> Highest amount of rapes per year.
True, but per capita like #12
> Highest amount of reported murders.
Per capita nowhere close to true. Raw numbers #6
> More police officers than anywhere else.
Not true at all per capita or raw.
> Spends more on healthcare than any other place in the world, which is completely bonkers considering what's offered.
Just true.
> More people taking drugs, for whatever reason, than anywhere else.
See above drug selling. I couldn't actually find stats that specifically distinguish the two.
> Student loan debt.
True
> The vast majority of all pornography comes from the US.
US does about a quarter of all pornography, but has a much higher gdp than other countries producing porn. UK produces about twice as much porn per gdp.
> Bad literacy rate.
US has a literacy rate of 99%. I would not call that bad.
> A military budget exceeding many countries combined.
True
> Over 90% of all media owned by a handful of people.
> A military-industrial complex paying politicians to invent lies for war.
Not sure how to fact check either of these
> 50% of private and public schools teach Abstinence instead of actual sex education.
It's hard to find hard numbers for this. Abstinence is taught as the most effective method of preventing pregnancies and STDs, but other sex ed is present (often in addition to abstinence) in at least 60% of schools.
So I would say this is not true because of the "instead"
Thanks, mate! Sorry for not putting the effort into it myself. At some point in time they all were true, so at least it's not as bad as completely made-up claims.
Oh and, regarding literacy rate... 88% and that doesn't mean they're all good readers.
And that's in a place where they have “Universal” socialized healthcare. I mean, a lot of the people on the streets are natives, so I guess they don’t really count as real citizens anyways.
Definitely is; NYC wasn't as bad as the west coast cities you named, but it's been a few years since I visited.
Part of the reason is the “temperate” climate in those coastal cities making it possible to live in an RV or camp most of the year. The other one is that there’s a policy of not preventing the encampments in the first place (check out Santa Monica for instance).
Health care itself explains only a small fraction of health outcomes. Much of what we need for better outcomes is fundamental, but it is not part of health care. Social factors (your zip code, not your genetic code), lifestyle (how you live, not how many medications you take), and livelihood (your work, not just your wealth) are much more important for health outcomes than your specific diagnosis or health-care plan.
I was suicidal for decades. I rarely feel suicidal anymore and it's like a bad habit, a mental tic that occasionally comes back when I'm having an excessively stressful day. Eating and sleeping are usually the way to make that stop.
There are two main components to mental health: physical health and social factors. To whatever degree a mental illness is treatable with medication, it can be viewed as a physical ailment with somatopsychic symptoms.
But even if you can genuinely cure the physical roots, you still need to deal with negative social patterns and "habits" (for lack of a better term) that may remain after the physical roots are resolved. If you can do both things, you can actually resolve it.
It's a better article than a lot I've seen. I find this piece encouraging.
I recently read "Unwinding Anxiety" by Dr. Judson Brewer. He's a psychiatrist and explains the habit part of negative behaviors very well and provides an approach to "unlearn" these bad habits.
I was astonished when I encountered suicidal ideation as a coping strategy: "It's not so bad, I could always kill myself." Humans never fail to violate preconceptions.
This focuses on the American problem, but the phrasing makes it sound like other places do better. What lessons or practices can we borrow from mental health care in other countries? Short of building a large single-payer system (which I'm guessing the US will continue to refuse to do), how do other countries make care accessible and affordable?
Many places actively hide the problem in various ways, or ship folks off to 're-education camps' from which they may not come back, or classify it so it doesn't show up so much.
America seems to be pretty unique in that it lets it all hang out, front and center, and has a bunch of social activists groups running around publicizing the issue without gov't or society telling them to sit down and shut up.
It also has a much worse problem, also due to the socioeconomics of how the country exists (imo), and the legal structures and social disconnectedness of it's various urban and rural areas.
97 comments
[ 2.3 ms ] story [ 163 ms ] threadHowever, it's really just a subtle ad for a book, which probably just reiterates the same points in greater detail via lots of anecdotal data and case histories, points the finger at the government for not spending more money on programs designed to support the mentally ill within their communities, and doesn't provide any further concrete solutions.
Hasn't this same book been written over and over again?
I also see these things as endemic to academia, especially in the sciences, and regard them as roots of our current replication crises, alongside capitalistic pressures.
Sure mental health treatment and agencies are notoriously underfunded, understaffed, and underpaid. But
Mostly we have a society that views those with mental health struggles as 'less than' and not fully adults, because they can't support themselves in some fashion and contribute to the GDP (from a very 10,000 foot view).
We can pay for support all we want, until society at large stops viewing these people as burdens, it's not going to really fix anything.
It's a sliding scale, and one that people can show up on at different points on every single day. Ignoring that a specific individual can and or is spending all or most of it in a place that would have them dead in a week without external help, or injuring innocent bystanders, just makes the problem worse.
With medication and lack of compliance, some very bad cases could get from perfectly functional to that state in a day or less.
I am willing to bet that those examples aren't exactly brimming with fellowship and charity towards those unfortunate comrades.
Maybe capitalism isn't great, but dang, some of the replacements turned out to be a lot worse. It'd be nice if that context were provided instead of just another jibe at capitalism, which is one field of attempted solutions to the vast and intricate problem of resource management.
Communism deviated from its ideal model, precessed, and collapsed. Capitalism can, and is, failing similarly. If you're truly interested in preserving capitalism, then it behooves you to take criticism of it to heart, and examine how it is falling apart. Your failure to accept criticism as "anything but collectivists kvetching" will only further its demise.
I don't particularly care about capitalism, myself, but the endless shallow attempts to tie whatever woe is being discussed to it is terribly reminiscent of how I used to hear about problems being the inevitable result of our nation turning away from Christ or whatever.
Then you need to read my comment more deeply. Yes, it's adjacent to that no-true-Scotsman. The difference is I'm pointing out the inevitably of such, cf Goodhart's law. Just like implementing communism inevitably results in a concrete model that differs from the ideal, which will then be optimized for, the same thing is happening to capitalism. The objective difference is that it has taken capitalism longer to precess, but that's not particularly exceptional given the lasting power of say monarchy.
> I don't particularly care about capitalism
By your comments, you effectively do. You can't make an argument and then feign nihilism.
> the endless shallow attempts to tie whatever woe is being discussed to it is terribly reminiscent of how I used to hear about problems being the inevitable result of our nation turning away from Christ or whatever
Sure, there is always much groupthink and false attribution. Still, specific arguments need to be judged on their own merits. Reflexively opposing the prevailing groupthink is just another type of following.
Imagine someone keeps making this odd squawking noise in some language you do not understand, every time there is a discussion where something remotely negative is discussed. You don't have to really care about what that noise means, or its opposite, to not want to hear it anymore. That's all. "Capitalism has failed" is that squawk, because who knows what will be put in its place but just the sheer amount of hearing it all the time is irritating. That's what I mean by mentioning how shallow it is as a critique, it's just this sound people keep making.
Try as I might, I cannot come up with a consistent good faith reading of your comments.
You're tired of hearing about something, yet not so tired that you won't create arguments about it by pulling in more distant topics? And when I try to connect with what seems to be your larger concern, you'll say you're just bored of the whole topic? All while ostensibly wanting to hear discussion of a related issue by reading this thread?
The best I can come up with is some kind of coping mechanism. If you're bored of the discussion, just stop responding. But perhaps next time, don't throw out the false dichotomy red herring.
Try to imagine someone on Hacker News who followed your every comment. Should you complain about something, they mention that this is the result of a world which has turned away from Christ, or has not embraced TimeCube, whatever. Just over and over again. You'd get sick of it, right? That's how I feel about the squawk of "capitalism has failed us." It's not much more complicated than "Your probable alternate wasn't that great, either."
Furthermore you keep referencing this "probable alternative" bogeyman while completely ignoring that my criticism is coming from a place of reform rather than wholesale replacement. It's likely everything sounds like "squawking" to you because you're not listening to the specifics of what anyone says. It's very odd that you want to engage with the topic just enough to reject it. It takes all types, I guess.
Well in terms of history we have not had a very long time for this experiment to play out. It is very possible that the construction of a system which allows both the generation of several billions of dollars also causes far greater harm than some of the other systems which were too heavy on the gas so to speak.
If history is a guide, all forms of a system fall due to avarice, vanity, or an external system which is operating 'better' at the current time.
I would argue most societies throughout history have treated people with mental illness less than kindly. But if wish to treat them better we must stop thinking of people as factors of productivity, and therefore their worth is only as useful as the amount they add to the bottomline. (Though I'd presume, albeit with little evidence currently, that society would be benefited in probably cost and happiness if we were to take on the task of providing adequate mental care to all.)
> Despite its limited resources, Cuba has developed an integrated mental health system that emphasizes prevention and community care.
https://pubmed.ncbi.nlm.nih.gov/3610072/
> ... We present background information and an interview with the President of the Cuban Society of Psychology to learn about current mental healthcare in today's Cuba. Mental and medical healthcare are free and fully integrated. Early diagnosis and intervention is standard as each patient is known by their community doctor/nurse team from infancy through old age and by yearly home visits.
https://onlinelibrary.wiley.com/doi/abs/10.1111/ppc.12548
There are more, it seems they do a pretty good job of supporting community-based approaches given low funding. It'd be interesting to see some harder numbers on outcomes. Not surprising that supporting small, integrated communities has positive effects on mental health though.
So being spent way better than, say, some random central African republic's mineral wealth, but not a model which is easy to duplicate much of anywhere else.
I keep hearing this, but if this move was such an obviously bad thing why hasn’t it been undone yet?
I know the local chapter of the ACLU screams bloody murder whenever the city tries to institutionalize some of the local homeless population. Even if there was substantial bipartisan support for undoing what Regan changed in the 80’s, it seems like a plethora of other challenges stops it.
In which case, it seems unproductive to keep blaming Reagan.
Public perception of mental health facilities were dire in that era. Think of how influential One Flew Over the Cuckoo's Nest was.
http://thespiritscience.net/2014/06/16/what-a-shaman-sees-in...
What if we have it all wrong? I do love the hopeful perspective this article has.
I have a schizophrenic family member. It costs six figures annually to keep them in a facility - which is designed to handle a completely different type of disability - and off the street.
It’s dumb luck that this facility accepts them and cares for them despite a lot of drama and irregularity. Many others have shown them the door.
It’s even dumber luck that the money exists to pay for the care.
If an American or someone they love winds up with a similar affliction, the chances of finding such a disaster-averting outcome are close to nil.
The system is not set up to help people get better.
The medications, which have the "best track record". Have an NNT of 5-10, severe side effects, and are so strong you risk rebound psychosis if you ever stop taking them. I think they really just help the institutions to manage patients in perpetuity.
I've commented somewhat extensively about my friend's struggle with the mental health industry. They've decided she's a chronic psychotic who requires anti-psychotics for the rest of her life.
A year after she was formally misdiagnosed by the mental health industry I found videos on my phone from ~2 weeks before that 2015 hospitalization. I think my videos prove that my friend's supposedly-chronic condition can be entirely explained by substance abuse.
The tragedy of "American Mental Health Care" is the use of palliative drugs, when the various causes of the various diagnoses have actually been figured out by researchers. Science knows exactly how stimulants harm the metabolism [0]. The symptoms of mental illness can usually be explained as a metabolic problem - sometimes caused by substance abuse, sometimes by diet, always exacerbated by 'stress'.
Emotional stress is the most important drain on the body's metabolism. I have a bunch of references from books about stress - went to the ASU science library to read a book referenced in Gabor Maté's In The Realm of Hungry Ghosts [1], and found a discussion of how 'stress' contributes to psychosis.
[0] My comment/quote/submission: https://news.ycombinator.com/item?id=18211048 - "I learned from a Hacker News comment/submission a while ago that cocaine causes its harm by shredding the mitochondria. [searching] Ahh, found it, this one:" https://news.ycombinator.com/item?id=10956058
[1] https://www.google.com/books/edition/In_the_Realm_of_Hungry_...
In 2018, after her treatment center perpetrated fraud on the District Court, my friend got annoyed about how all the new clients at her treatment center were getting cheek-swabbed. She herself had not been cheek-swabbed when she was sent there 2 years before, and asked to have this genetic test. It revealed that she is a poor methylator, who cannot turn the provitamin folic acid (commonly used to fortify food as it is shelf-stable) into Vitamin B-9. She said that adding L-Methy-Folate to her routine was like flipping a switch from "depressed" to "not-depressed" [1].
[1] https://news.ycombinator.com/item?id=27990331 (also some good responses to my comment - search for 'histamine')
The Supreme Court of the United States is going to be considering my petition soon. I'm optimistic that it will be one of the handful that they grant. All I'm asking is for them to order the district court to hold the evidentiary hearing that is required by the case law. (I'm currently working on a write-up of my experience for https://MadInAmerica.com, using some tips from HN moderator dang.)
I'm not going to pretend like I know what the solution is, but it starts by actually addressing it as a serious problem, which the U.S has not done. I guess politicians thinks it's normal for mentally insane homeless people to be shouting to people on sidewalks everywhere, and assaulting and even murdering random pedestrians? [1] For anyone who hasn't left the U.S - this isn't normal anywhere else in the world. What a shame that the wealthiest country can't manage its cities.
[1] https://nypost.com/2022/02/13/woman-stabbed-to-death-inside-...
Thanks Reagan...
Problem is instead of reform they just shut down the entire system. Now we have loads of people on the street who really do need continuous professional help.
Reagan was governor. Governors sign bills. Legislatures pass them. This was a bipartisan effort and was viewed as a civil rights issue, to not hold people in confinement against their will. Lanterman was a Republican, Petris and Short were Democrats. Reagan could have vetoed it, so he shares in the responsibility, but it was a bipartisan, popular bill.
> removed all funding for Mental Health at the State and Federal level.
Do you really believe that all funding was removed? What is your basis for this shocking claim? It's very hard to cut government spending, and Reagan wasn't known for doing that (spending in almost every area increased under Reagan). Reagan was known for tax cuts, and since spending went up, Reagan was also known for big budget deficits (not like today, where Reagan would be viewed as a model of restraint, but compared to his predecessors the peacetime deficits were shocking). What you are saying is just wildly false.
From 1983-1992, Government spending on mental health grew an average of 6.5% annually in real terms.[1] "Cost-cutting" -- really a slowing down of spending increases, happened in the 2000s, where spending on mental health grew only by 4.7% annually in real terms. This was the slowest spending growth in history for mental health. The U.S. spends an enormous amount on mental health, with dubious results.
Here are two good rules of thumb when thinking about these issues if you are honestly trying to understand our history, rather than trying to score a political point and blame things on your enemies. These two should be your null hypothesis:
1. social spending always goes up. It never goes down. It does not matter who is President. Presidents don't cut social spending in any area.
2. Nothing in America happens because of one person. We have separation of powers and divided government. Everything is always a compromise reached by those in power at the time. This is a good explanation for 1, since the best way to get agreement is to buy people off with more spending.
[1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...
Well it should really start at the county or state level, IMO. There are plenty of US states/cities outside of California that don't have the huge mental illness/homeless problem that SF has. So really SF County or the state of California needs to declare an emergency first before it is escalated to the national level.
Early on in the pandemic, I saw some people saying things like "Housing is healthcare." And it's true.
I just don't know how to get anywhere harping overly much on that, so instead I'm making sketches and notes and if I don't end up homeless again and dying on the streets, maybe I can do a pilot project.
Probably not, but we all need an occupation (as was said in The importance of being Earnest).
I'm quite confident that doubling down on going draconian on people who have no means to fix their own problems absolutely won't make anything better. If you take that far enough, the logical conclusion is something inane like "we should just shoot all homeless people" or something.
People have to be given a path back. Cutting them off will not magically cure what ails them.
I'm all for affordable housing. But when a homeless man commits murder, the answer to that isn't a one liner about the importance of affordable housing which is always the first and only thing that's mentioned when it comes to the homeless. There is nothing draconian about Kendra's Law by the way. It is far more humane to make sure treatment, psych beds are used, especially for people that do not have the capability of knowing when they need help.
I know a whole lot about homelessness and have left many comments on the subject over the years. If you want to have a meaty discussion about it, I'm capable of doing so, though this approach to engaging me isn't a good way to get that.
I write less about homelessness than I used to. These days, I try to focus on community development.
I think that's the best antidote we have and one that gets too little attention.
There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they're falling in. ― Desmond Tutu.
Some stats I pulled up: - Minimum wage in NYC is $15/hr, coming out to ~$30k/yr pre-tax @ 40hrs/week and 50 weeks/year, or $22,752 yearly after tax.
- At 30% of income rule for rent, that comes out to $568/month for rent. At 80 hrs/week that's ~$1k
- "The Bronx neighborhood of Bedford Park has the lowest median rent in the city—$1,558 for a one bedroom"
Forgive me if I'm misunderstanding something, but how is this not a problem of lack of affordable housing?
Those people exist. Not a huge number of them, but they have an outsized effect.
We used to have sanitariums, or locked folks up in jail if they got that bad. They suck, it's expensive, they are ripe for abuse.
But having random insane people wandering the streets accosting people, or in rare cases even murdering them, isn't working either.
I'm not interested in investing more of my time in crisis management for this problem space. I'm looking to find ways to actually shrink the problem.
I'm not saying we should stop doing any crisis management and I'm baffled that multiple people are reacting as if I had.
I'm saying one key piece is we need to resolve our housing supply issues. It's one piece. It's not a comprehensive solution but I think it's really important and far too many people seem to think lack of housing is somehow wholly unrelated to homelessness, which also baffles me.
I don't see how anyone can assert that but I run into pretty frequently.
Better housing will help some. Better accessible care will help some. Better other things will help some.
But there is no fall through default option here being exercised if those options don't help those who aren't helped enough by those options they stop being a repeated danger to themselves or others. In theory it's possible to still get committed. It's almost impossible to actually get committed (as in persistently kept away from society in a controlled institution), and those places are so underfunded and terrible, the street might actually produce better outcomes for everyone.
'Crisis management' is about taking a crisis and not making it a crisis anymore.
But it's generally about a short term emergency intervention, not about long term control of a situation that is fundamentally unstable, unsound, and not 'resolvable' due to a persons own actions. There are people who cannot and will not do what is necessary to stay sane. There are not a lot of them. But they do exist.
We can reduce the overall size of the problem through housing reform. But it doesn't remove the need for some kind of not-a-humanitarian-disaster institutionalization in a non trivial number of cases
Yes yes people don't always know what they need it can be complex. But the majority of homeless people I know and have known needed and wanted help, but were unable to accept the terms of the help offered by the state, or various charities.
I have been homeless and not some cute "living in my car for six months after college" but open sores untreated addiction rotting teeth in the subway station homeless. People I love are still out there dying those deaths and it hurts so so much to hear the way you talk about them in comments today. Not just this one either.
"These people" need anything but more carceral violence directed at them. I've spent time both in jail and institutionalized. Jail is worse but the difference is more a matter of degree than type.
What you want is to have them removed. You're entitled to your wants of course and even to pursue them. But don't use helping homeless people as part of your justification. It is very hard to read these comments and believe you have ever known or cared about someone who was homeless in your city.
This is a tautology. You are essentially defining the word "help" as whatever homeless people define help to be, yet you give some credence to the fact that homeless people might not actually know what is actually helpful for them. What is good for homeless people that are on drugs, that don't want to go to a homeless shelter, that don't want psychiatric help are very often bad for everyone else around them. So maybe we should stop making decisions that put the liberties of homeless people first.
In NYC where I live, two Asian women were killed by black, homeless men in this past month. I'm frankly not interested in making my language any more flowery for your taste with homeless people. I'm only interested in real policy solutions. Until you actually acknowledge the violence, the degeneration of our subway, streets, and city, then we're not going to be able to talk any further.
I spent nearly six years homeless. I spent a lot of years suicidal. I have an incurable medical condition.
I'm back in housing. I'm healthier. I'm rarely suicidal these days.
But when you look at the path that people took to being chronically visibly homeless on the street the pre-cursor in general isn't affordable housing.
> Roger’s parents wondered why, with so many advances in the science of mental health, their brilliant son was talking to voices and eating out of garbage cans.
Their family members may care about them and still be part of the problem. It's really common for people to want to save face and swear it's not their fault, it's something else. In such cases, they won't change. They won't take responsibility for their role. They will blame something else, anything else.
I think it's a mistake to just take the word of a relative as to what went wrong in a case where they might be part of what went wrong. But I usually don't say that because I know that's likely to get really negative reactions from people.
Suffice it to say I still don't agree with you and there's probably nothing to be gained from discussing this further.
If it were feasible for someone to rent a room for not much money and live decently without a car in a walkable neighborhood such that working part-time with decent wages or full-time minimum wage allowed a person their independence, then people with impairments wouldn't be prisoners of dysfunctional and stressed families who are often doing all the wrong things because their scared to death and don't know how to fix anything.
We've built a world in which only a small number of people can possibly keep up the rat race. We've torn down more than a million SROs which used to be normal housing and we now think of that as only housing for homeless people, not housing for young, single adults or childless couples or seniors or students.
(SRO stands for single room occupancy. Copy-paste isn't working for me at the moment, so I can't provide a link.)
In the US, it's nigh impossible to live without a car. It's nigh impossible to find someplace really cheap in a walkable neighborhood that's suitable for a household of one to three people.
Parents who know their child can't function well enough to work all the damn time and afford an expensive home and expensive car etc know this is a nightmare from which the entire family has no escape route.
The escape route for everyone is to make affordable housing in walkable neighborhoods the norm again so ordinary people who can function some of the time but can't run full throttle all of the time can protect their own agency, establish their independence and not be driven crazy by other people freaking out about the burden of caring for them forever with no hope of a solution.
I can work part-time. I can't work a regular job.
I currently live someplace cheap in a walkable setting. I've grown healthier and more functional because of it.
I would like to replicate that and make it more the norm in this country, like it once was.
That's a thing that works but it's a thing you aren't going to find plausible if your focus is on how to deal with people after everything has gone wrong and it looks unfixable. It's fixable. It's also very much preventable in many cases.
We just refuse to work on that. We are too busy screaming about how the sky is falling.
I was asking specifically about the person that is dealing with schizophrenia in the example that you provided. What are the next steps in resolution.
To whatever degree a mental illness is treatable with medication, it can be viewed as a physical ailment with somatopsychic symptoms.
I've already said that, elsewhere in this article discussion:
https://news.ycombinator.com/item?id=30334409
If that isn't computing for you, it isn't going to get better to keep telling me I'm wrong and you don't agree.
Your mental models of this problem space and mine clearly aren't jibing. This form of engagement isn't likely to bridge the gap between where you are on this and where I am.
I've spent years talking about this stuff online, including on HN a whole lot. It's not been a waste of time but there's only so far that goes.
At this point, my focus is on trying to flesh out a potential pilot project -- like I said in my first comment.
Sometimes words get in the way. Sometimes the best thing to do is do it and show people.
That's what I hope to do though I may not be able to. I'm not wealthy. I'm not connected. Most of the world does not see what I see.
(Shrug)
Repeatedly mentioning that you spent years talking about this has absolutely no bearing on me. It's not my mental model that isn't working with yours. It's really your language and how you are approaching basic questions that are asking for a clarification on your insight.
It definitely seems like words are getting in the way for you then if you can't do the simplest of explanations. Have a good day.
You've obviously thought about this a lot more than I have so I'd like to gain some insight from you. I won't ask you about what the solution should look like since you didn't claim to know what it would be, but I'd like to learn more about what you think it would look like to actually address it as a serious problem?
Honestly I don't even claim to understand what the problem actually is, just that there seems to be some sort of problem and it seems to be growing rather than getting better. Could you write a little more about this? I'm curious about your thoughts here.
Here are some contrasting viewpoints I consider:
- Some believe that the US does not have much of a social safety net; some believe this to be by design; some believe this to be beneficial
- Some believe the US to be an individualistic society; some believe this to be beneficial in that it promotes the strong, the efficient, the productive, etc, to outcompete the weak, the wasteful, the lazy, etc.
- Some in the US believe that everyone should get therapy, psychiatry, etc under the guidance of a licensed professional; some in the US believe that psychiatric issues are just excuses made by the lazy to avoid work; some in the US believe that religion will save you and it's all the work of the devil; in some well-to-do places in the US, waiting lists for psychiatric care are months-long even with really good insurance; some believe that we are also in a worldwide pandemic that has had deleterious mental health consequences for everyone, and that many have been pushed to the brink
- Some believe we should increase taxes and have the government do things for people, or force people into doing things for themselves; some believe in reducing taxes and government interference; some believe people should fend for themselves and if they are losers, so be it; some believe in charity and doing good deeds; some people donate to virtue signal, some use donations for tax write-offs, and some people donate anonymously and never tell anyone and nobody else ever knows of what they did
- According to some studies, the US ranks #1 in charitable giving, or generosity towards strangers; contrast this with other countries that some believe have better safety nets and more direct government action, though perhaps higher taxes
- There's a saying that goes something like "charity begins at home"--some take this to be a call-to-action for your daily interactions with others you come across, including strangers since that would have the most immediate impact; some believe in a utilitarian mode of action where energy/time/money should be directed where they'd have the most effect or return the greatest value; some believe charities to be scams; some believe charities to be ineffective
Lee's death, along with Michelle Go, is a spectacular failure by NYC in so many ways. We are living in this city pretending like Penn station isn't literally a homeless camp now with addicts shooting up heroin openly in the streets. These are people that are refusing treatment or help and destroying this city and the subway.
Christina Yuna Lee's murderer had multiple charges on him, including assault charges. He should never have ever been on the street. We need to stop valuing the life of criminals above normal citizens. And we need to actually enforce Kendra's Law and build mental institutions outside of the city.
A small town with a couple of people living in vans might quietly exceed the per capita homelessness rate of a city with a giant tent city.
Mate, pick a number ...
---
- Highest incarceration rate in the world.
- Highest percentage of obese people.
- Highest divorce rate.
- Highest rate of illegal drug selling.
- Most car thefts per year.
- Highest amount of rapes per year.
- Highest amount of reported murders.
- More police officers than anywhere else.
- Spends more on healthcare than any other place in the world, which is completely bonkers considering what's offered.
- More people taking drugs, for whatever reason, than anywhere else.
- Student loan debt.
- The vast majority of all pornography comes from the US.
- Bad literacy rate.
- A military budget exceeding many countries combined.
- Over 90% of all media owned by a handful of people.
- A military-industrial complex paying politicians to invent lies for war.
- 50% of private and public schools teach Abstinence instead of actual sex education.
---
... and get in line.
(not sure all of those are still accurate, but sadly it's most likely)
I felt the need to fact-check these because I felt they were not accurate. Below are the results of about 2 minutes per bulletpoint.
> Highest incarceration rate in the world.
True
> Highest percentage of obese people.
US is #12
> Highest divorce rate.
US is #3
> Highest rate of illegal drug selling.
Might be true. Not super easy to get numbers on this.
> Most car thefts per year.
US is #11 per capita. Probably #1 in raw cases, but that data was not super easy to find.
> Highest amount of rapes per year.
True, but per capita like #12
> Highest amount of reported murders.
Per capita nowhere close to true. Raw numbers #6
> More police officers than anywhere else.
Not true at all per capita or raw.
> Spends more on healthcare than any other place in the world, which is completely bonkers considering what's offered.
Just true.
> More people taking drugs, for whatever reason, than anywhere else.
See above drug selling. I couldn't actually find stats that specifically distinguish the two.
> Student loan debt.
True
> The vast majority of all pornography comes from the US.
US does about a quarter of all pornography, but has a much higher gdp than other countries producing porn. UK produces about twice as much porn per gdp.
> Bad literacy rate.
US has a literacy rate of 99%. I would not call that bad.
> A military budget exceeding many countries combined.
True
> Over 90% of all media owned by a handful of people.
> A military-industrial complex paying politicians to invent lies for war.
Not sure how to fact check either of these
> 50% of private and public schools teach Abstinence instead of actual sex education.
It's hard to find hard numbers for this. Abstinence is taught as the most effective method of preventing pregnancies and STDs, but other sex ed is present (often in addition to abstinence) in at least 60% of schools.
So I would say this is not true because of the "instead"
Oh and, regarding literacy rate... 88% and that doesn't mean they're all good readers.
https://www.thinkimpact.com/literacy-statistics/#:~:text=The...
You might be disappointed [0].
And that's in a place where they have “Universal” socialized healthcare. I mean, a lot of the people on the streets are natives, so I guess they don’t really count as real citizens anyways.
[0] https://www.youtube.com/watch?v=7FdTlZbUb14
In any case, the U.S, especially NYC, SF, LA, and Seattle is still worse than anywhere I've been in this regards.
Part of the reason is the “temperate” climate in those coastal cities making it possible to live in an RV or camp most of the year. The other one is that there’s a policy of not preventing the encampments in the first place (check out Santa Monica for instance).
Health care itself explains only a small fraction of health outcomes. Much of what we need for better outcomes is fundamental, but it is not part of health care. Social factors (your zip code, not your genetic code), lifestyle (how you live, not how many medications you take), and livelihood (your work, not just your wealth) are much more important for health outcomes than your specific diagnosis or health-care plan.
I was suicidal for decades. I rarely feel suicidal anymore and it's like a bad habit, a mental tic that occasionally comes back when I'm having an excessively stressful day. Eating and sleeping are usually the way to make that stop.
There are two main components to mental health: physical health and social factors. To whatever degree a mental illness is treatable with medication, it can be viewed as a physical ailment with somatopsychic symptoms.
But even if you can genuinely cure the physical roots, you still need to deal with negative social patterns and "habits" (for lack of a better term) that may remain after the physical roots are resolved. If you can do both things, you can actually resolve it.
It's a better article than a lot I've seen. I find this piece encouraging.
Many places actively hide the problem in various ways, or ship folks off to 're-education camps' from which they may not come back, or classify it so it doesn't show up so much.
America seems to be pretty unique in that it lets it all hang out, front and center, and has a bunch of social activists groups running around publicizing the issue without gov't or society telling them to sit down and shut up.
It also has a much worse problem, also due to the socioeconomics of how the country exists (imo), and the legal structures and social disconnectedness of it's various urban and rural areas.