Society can deal with seriously mentally ill homeless people
The discussion highlights challenges in treating serious mental illness, especially among the homeless. It critiques current crisis intervention methods and advocates for long-term solutions and policy reevaluation to improve outcomes.
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The discussion centers on the challenges of addressing serious mental illness, particularly among the homeless population. Scott Alexander argues that the current system, which involves crisis intervention and temporary stabilization, is the best we can achieve. However, the author contends that this perspective overlooks the ideological constraints that limit effective long-term treatment options. The existing approach often leads to a cycle of crisis and temporary solutions, failing to address the underlying mental health issues. The author highlights the historical context of the Medicaid IMD exclusion, which restricts funding for long-term institutional care, resulting in a lack of adequate facilities for those in need.
The author proposes that serious mental illness should be viewed as an optimization problem, balancing individual liberty with the necessity of health care. They argue for the potential benefits of long-term institutionalization for those whose conditions require it, suggesting that the current prioritization of autonomy over health may be misguided. The author also discusses alternative strategies, such as court-ordered outpatient treatment and long-acting injectable medications, which could improve compliance and outcomes for individuals with serious mental illness.
Ultimately, the author calls for a reevaluation of mental health policies to prioritize effective treatment options, recognizing that the status quo incurs significant costs and fails to address the root causes of mental illness among the homeless population.
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7 commentsFor extreme example, how do you get someone committed to an IMD, given that that person genuinely needs it? What can be done less drastic than that, by people who care and are willing to turn the crank on a slow legal system?
> they are identified; arrested; committed to a hospital with a psych ward; put on antipsychotics; allowed to stabilize; and released, at which point the entire cycle begins again.
For the author the answer is to never release them, which for the numbers of people involved is a horrifying idea. Incarcerating large numbers of people because statistically a few of them might cause problems for others is not what a free & fair society should aim for.
There are other options, which is to add steps beyond release. Provide sheltered housing & levels of care for these people so that they can try to build meaningful lives in society. It will fail for some and for many it will be long term, but the costs are much less. My wife has worked in mental health in a couple of European countries at several of these levels of care and it's not perfect but it works for enough people that lives are changed and costs to society are reduced. This is also the case for drug abusers, providing the means for those that want to escape the vicious cycle to do so.
In short, other ways are possible, if the culture can be flexible enough to try them.
This is a drop in the bucket to me. People comment on things they have no expertise in all the time, sometimes with language loaded to brim with vitriol.
I'm not sure if it's an objective of the "Manhattan Institute" to spin up these institutions for indefinite detention, but I will point out that providing housing universally is definitionally cheaper than institutionalization, which is housing with paid orderlies, guards, service workers, etc. If providing housing is too big-government, eviction protections were seen to curb homelessness during the pandemic. And for these right-wing think-tankers, housing affordability also has an available "market" solution which just requires the loosening of zoning restrictions with little other public investment.
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