How we failed the mentally ill..

[Magical Realist]

https://www.kiteandkeymedia.com/videos/s...zu106GJRfc

[C C]

So, beginning in the 1960s, we shut them [asylums] down. ... Just one problem: When we got rid of the asylums, we replaced them with a system that may be even worse.

Why did America suddenly decide to reject mental institutions in the middle of the 20th century? Part of the explanation was journalistic exposés that brought the conditions within them to the attention of the public.

But there was also another factor at work: We thought we didn’t need them anymore...

It was a deeply humanitarian impulse...and it went horribly, horribly wrong.

[...] After all, if hospitals were as dangerous and dysfunctional as the mental institutions used to be...would we have just gotten rid of all of them? Or would we have built better ones?

When we look back at the rotting asylums of an earlier generation, we find it hard to believe we ever treated the severely mentally ill with so little compassion. But if, in the present day, we continue to relegate the mentally ill to prison or the streets rather than getting them the help they deserve...will future generations judge us any less harshly?

[...] The severely mentally ill are no longer suffering in asylums...they’re just suffering everywhere else. ... they’re about 30% of America’s homeless population.

And many who aren’t on the streets...are behind bars. In 44 states, a jail or prison holds more mentally ill individuals than the largest state psychiatric hospital. In fact, any honest accounting of the numbers would show that the three largest mental institutions in America are the Los Angeles County Jail, the Cook County Jail in Chicago, and the jail at Riker’s Island in New York City.x

[...] The obvious solution would be to entrust their care to loved ones. But medical privacy laws prevent doctors from disclosing to family members both the diagnosis of a severe mental illness and any medications that have been prescribed. The only people who can help are kept almost completely in the dark.

Real compassion would involve policies that aim to help the mentally ill—not to leave them alone and tortured by their illness.

Thankfully, we know what some of those policies are:

Programs like Assisted Outpatient Treatment (AOT)—which allows courts to compel treatment, in the community, for people who otherwise won’t get help.

[...] And they’re only part of the puzzle. Policymakers will have to change laws to empower family members to adequately care for their loved ones. And for the sickest individuals we may even need dedicated facilities to play the role asylums were once supposed to.

Despite the imperfections (which will be the case with any solution) the best thing they ever had going was the state hospitals.

Nursing homes have their own list of complaints and horrors projected upon them, but no country in its right mind would end those in this ongoing era of tiny, non-extended families[*] that lack capable, albeit non-professional caregiving adults in the household during working hours. Good, hired caregivers are in short supply, too, IF their pricey pay is even covered by _X_. [* I.e., grown relatives can't tolerate living with each other in big houses like they more often had to in bygone times, and still do in some non-Anglo cultures.]

I have little confidence in AOT persistently handling the cases sufficiently (especially funding wise), and the idea of most families being able to properly monitor and tend to their mentally ill members is as ludicrous as their being available to care for their elderly parents they otherwise would place in nursing homes. Again, even the "sane" ones can't abide other family members interfering in or managing their lives these days, much less those that are fully paranoid.

So yeah, on target with respect to: "for the sickest individuals we may even need dedicated facilities to play the role asylums were once supposed to."

Never get those back, though. The pale imitations they might resurrect today certainly won't allow Hobo Johnny to simply sign himself in to get out of the cold whenever winter starts, minus two hundred hoops of bureaucracy and examinations to leap and perform tricks through.

[stryder]

So, beginning in the 1960s, we shut them [asylums] down. ... Just one problem: When we got rid of the asylums, we replaced them with a system that may be even worse.

Why did America suddenly decide to reject mental institutions in the middle of the 20th century? Part of the explanation was journalistic exposés that brought the conditions within them to the attention of the public.

But there was also another factor at work: We thought we didn’t need them anymore...

It was a deeply humanitarian impulse...and it went horribly, horribly wrong.

[...] After all, if hospitals were as dangerous and dysfunctional as the mental institutions used to be...would we have just gotten rid of all of them? Or would we have built better ones?

When we look back at the rotting asylums of an earlier generation, we find it hard to believe we ever treated the severely mentally ill with so little compassion. But if, in the present day, we continue to relegate the mentally ill to prison or the streets rather than getting them the help they deserve...will future generations judge us any less harshly?

[...] The severely mentally ill are no longer suffering in asylums...they’re just suffering everywhere else. ... they’re about 30% of America’s homeless population.

And many who aren’t on the streets...are behind bars. In 44 states, a jail or prison holds more mentally ill individuals than the largest state psychiatric hospital. In fact, any honest accounting of the numbers would show that the three largest mental institutions in America are the Los Angeles County Jail, the Cook County Jail in Chicago, and the jail at Riker’s Island in New York City.x

[...] The obvious solution would be to entrust their care to loved ones. But medical privacy laws prevent doctors from disclosing to family members both the diagnosis of a severe mental illness and any medications that have been prescribed. The only people who can help are kept almost completely in the dark.

Real compassion would involve policies that aim to help the mentally ill—not to leave them alone and tortured by their illness.

Thankfully, we know what some of those policies are:

Programs like Assisted Outpatient Treatment (AOT)—which allows courts to compel treatment, in the community, for people who otherwise won’t get help.

[...] And they’re only part of the puzzle. Policymakers will have to change laws to empower family members to adequately care for their loved ones. And for the sickest individuals we may even need dedicated facilities to play the role asylums were once supposed to.

Despite the imperfections (which will be the case with any solution) the best thing they ever had going was the state hospitals.

Nursing homes have their own list of complaints and horrors projected upon them, but no country in its right mind would end those in this ongoing era of tiny, non-extended families
[*] that lack capable, albeit non-professional caregiving adults in the household during working hours. Good, hired caregivers are in short supply, too, IF their pricey pay is even covered by _X_.
[*] 

I have little confidence in AOT persistently handling the cases sufficiently (especially funding wise), and the idea of most families being able to properly monitor and tend to their mentally ill members is as ludicrous as their being available to care for their elderly parents they otherwise would place in nursing homes. Again, even the "sane" ones can't abide other family members interfering in or managing their lives these days, much less those that are fully paranoid.

So yeah, on target with respect to: "for the sickest individuals we may even need dedicated facilities to play the role asylums were once supposed to."

Never get those back, though. The pale imitations they might resurrect today certainly won't allow Hobo Johnny to simply sign himself in to get out of the cold whenever winter starts, minus two hundred hoops of bureaucracy and examinations to leap and perform tricks through.

Prior to asylums there was workhouses. It might be possible to do a kind of workhouse revival, however it would have to be done differently to how it was done back then.

For instance a large parcel of land could be split into small lots. Each lot could be assigned a person (or group of persons) to manage and operate. A team could then exist to keep things running, if someone is overwhelmed and needs some help they could come into aid them to keep things ticking over. The idea is that the people working in this situation would have freedom that is lost when a person is incarcerated in an institute, they'd have the support they need should they be overwhelmed but not too much that they have no individual identity or feeling of accomplishment from being able to stand on their own two feet (figuratively)

Inturn they could be compensated for their work efforts, while aiding the funding of such a project to maintain that it continues to thrive. It would also bolster some of the areas that have currently been lacking (at least in the UK) such as the labourforce necessary to pick weeds or harvest crops etc. Ideally if education played a role in it too (to increase the understanding of how to farm with synergy rather than using environmentally damaging chemicals etc) then they could also gain important knowledge which can aid them further should they choose to continue along such a field (no pun intended).

The main problem though is such operations have to be done properly, and most of the time they either fail due to inadequate funding or they become too exploitive of the people involved and end up with a corrupt oligarchy cashing in on their labour.

Incidentally working outside can be enjoyable in the right atmosphere and relatively stress free if of course a person agrees that they want to do such a job.

[Syne]

Forced commitment has never cured mental illness. It's only every been a way to hide the unsightly from society, and no one ever really cared how the unseen were treated. They'd just medicate them into a nice docile and silent stupor, if not abuse them, exercising their own sadistic demons. It's just a fact that no one can overcome mental illness without the personal impetus to do so. Just like quitting any vice. MR doesn't go get therapy to deal with the voices in his head because he's too busy justifying them to himself, and doctors are quick to prescribe pills to treat symptoms rather than find and treat causes. And the increase in mental illness is a direct result of enabling mental illness with a welfare state making life easy enough for people to afford to dwell on their internal demons instead of working to survive. Housing the mentally ill homeless and criminals would just be more welfare, further exacerbating the mental illness.

[C C]

Prior to asylums there was workhouses. It might be possible to do a kind of workhouse revival, however it would have to be done differently to how it was done back then.

For instance a large parcel of land could be split into small lots. Each lot could be assigned a person (or group of persons) to manage and operate. A team could then exist to keep things running, if someone is overwhelmed and needs some help they could come into aid them to keep things ticking over. The idea is that the people working in this situation would have freedom that is lost when a person is incarcerated in an institute, they'd have the support they need should they be overwhelmed but not too much that they have no individual identity or feeling of accomplishment from being able to stand on their own two feet (figuratively)

Inturn they could be compensated for their work efforts, while aiding the funding of such a project to maintain that it continues to thrive. It would also bolster some of the areas that have currently been lacking (at least in the UK) such as the labourforce necessary to pick weeds or harvest crops etc. Ideally if education played a role in it too (to increase the understanding of how to farm with synergy rather than using environmentally damaging chemicals etc) then they could also gain important knowledge which can aid them further should they choose to continue along such a field (no pun intended).

The main problem though is such operations have to be done properly, and most of the time they either fail due to inadequate funding or they become too exploitive of the people involved and end up with a corrupt oligarchy cashing in on their labour.

Incidentally working outside can be enjoyable in the right atmosphere and relatively stress free if of course a person agrees that they want to do such a job.

The defunct state hospital that I'm familiar with via photographs and old literature had garden and park-like grounds that patients could stroll and partake in, as well as providing supervised trips of better-adjusted groups to the town that the facility sat just on the edge of. It also assigned tasks to those safe, capable and willing -- like sweeping floors, washing clothes, mowing, aiding hired workers, etc.

The situation today is akin to that of the 19th-century, where the roaming mentally ill had fragile shanty-like settlements outside of major cities like Chicago, some occupying wooden crates at night as their counterparts of today sleep in cardboard boxes. They may have likewise filled the jails and prisons, too, if many asylums only catered to paying family customers. The outdoors "natural surroundings" trend had started then for some institutions (with the "eccentric brutal remedy efforts" philosophy fading at times, too) but that fluctuated in popularity until picked-up again in the 20th-century.

[Yazata]

So, beginning in the 1960s, we shut them [asylums] down. ... Just one problem: When we got rid of the asylums, we replaced them with a system that may be even worse.

Why did America suddenly decide to reject mental institutions in the middle of the 20th century? Part of the explanation was journalistic exposés that brought the conditions within them to the attention of the public.

Yes, between activist journalists and several popular novels of the time, the public got the idea that mental hospitals were without exception absolutely horrible places, hell on earth. We still see that idea reflected in some of the horror movies of today.

But there was also another factor at work: We thought we didn’t need them anymore...

It was a deeply humanitarian impulse...and it went horribly, horribly wrong.

The biggest problem is that nobody really knows how to treat mental illness. Certainly not the major psychoses. The best that psychiatrists and clinical psychologists can do today is drug mental patients until their worst symptoms subside. Unfortunately the drugs have such devastating side effects that most mental patients would rather live with their symptoms, or self-treat themselves with opioids that while they don't improve the symptoms, make the individual feel good and not care any longer.

These people can't work, can't support themselves, and they end up on the street.

The severely mentally ill are no longer suffering in asylums...they’re just suffering everywhere else. ... they’re about 30% of America’s homeless population.

More than that, I'd wager.

Public assistance used to put them up in cheap hotel rooms, in the 'single room occupancy' residential hotels. But pack too many psychiatric cases into those and they turn into psychiatric hospitals without staff. People screaming incoherently out their windows, assaulting each other and openly dealing drugs. The police were called almost every night.

Cities everywhere tore those residential hotels down as urban renewal measures, to eliminate urban blight. In San Francisco, they were replaced with upscale condos inhabited by a whole new population. The few residential hotels remaining today are owned by and filled with recent immigrants. So the psychiatric population that was once housed with public-assistance housing vouchers in those places has been forced out onto the streets.

Then the cities set up homeless shelters. Except that they are so sordid and so dangerous that most homeless people avoid them and prefer to live with their friends in their little encampments where they can use drugs freely, face less confrontation and physical threat and aren't hassled by social workers. Homeless people tend to avoid homeless shelters, for good reason.

The obvious solution would be to entrust their care to loved ones. But medical privacy laws prevent doctors from disclosing to family members both the diagnosis of a severe mental illness and any medications that have been prescribed. The only people who can help are kept almost completely in the dark.

That's fantasy-land. The extended family disappeared 50 or 100 years ago. And more recent feminism has pretty much destroyed the nuclear family as well. Today the public schools are expected to take over the child raising functions once exercised by parents. It's a social experiment that's unprecedented in all of human history and I don't expect it to end well. The point being that there's no family there any longer to take care of the crazy person, except perhaps a few people at the end of their own rope and unable to cope. Most of the unhoused psychiatric population don't have anyone willing and able to take them in, except their little circles of friends on the street, their fellow crazies.

Real compassion would involve policies that aim to help the mentally ill—not to leave them alone and tortured by their illness.

Except that nobody knows how to treat mental illness, and there's the fact that packing too many psychiatric individuals in close proximity creates severe problems of its own, not only for them, but for the surrounding population. It's a problem that nobody at present knows how to solve.

[Magical Realist]

My niece underwent a mental health crisis beginning back in June. She just left her family and took off, having sex with random guys and refusing to talk to alot of us. My brother made 2 attempts to get her committed with the police's help but the psych wards refused and let her go. She had to prove she was a danger to herself or to others within the last 48 hours.

As of now she has married some 22 year old guy with the brain capacity of a 12 year old (she's 42) and lives with him in his apt near Dallas. She was already married for 22 years and has two boys in their twenties. It's like she's a whole different person now. None of us know what to do and it's only a matter of time till she winds up on the streets. They make it too hard to commit people imo. There has to be a line drawn over which needful things are allowed to happen. It's for the good of the mentally ill to get treatment. But it's hard to convince them they're mentally ill. Harder still to get them on medications if those would even help.

[C C]

My niece underwent a mental health crisis beginning back in June.

Coincidentally, that's about when a woman I'm second-handedly acquainted with via a friend reached a peak in unstable and creepy behavior, that had gradually been building over several months. They did get her admitted. But it was probably only because she was pregnant, and may have issued threatening statements directed against both the unborn and her husband.

Eventually the facility did find the right combination of meds that brought her back to her old self. The baby was born healthy, and she's back home and all returned to normal as before. (Or so the friend reports; ought to add that.)

She just left her family and took off, having sex with random guys and refusing to talk to alot of us. My brother made 2 attempts to get her committed with the police's help but the psych wards refused and let her go. She had to prove she was a danger to herself or to others within the last 48 hours.

As of now she has married some 22 year old guy with the brain capacity of a 12 year old (she's 42) and lives with him in his apt near Dallas. She was already married for 22 years and has two boys in their twenties. It's like she's a whole different person now. None of us know what to do and it's only a matter of time till she winds up on the streets. They make it too hard to commit people imo. There has to be a line drawn over which needful things are allowed to happen. It's for the good of the mentally ill to get treatment. But it's hard to convince them they're mentally ill. Harder still to get them on medications if those would even help.

That's what so upside-down in this era. Well beyond a half-century ago, a person who was simply eccentric or oddball could walk in and get themselves deliberately committed. Now, somebody who is truly 100% bonkers is refused admittance unless all the bureaucratic checker pieces land on the red and black squared board in the correct arrangement.