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It's Time to Mandate Treatment of the Dangerously Mentally Ill

47 点作者 lxm超过 2 年前

34 条评论

sixhobbits超过 2 年前
&gt; What’s needed is a single agency, let’s call it “New York Psych,” to address this growing crisis<p>That... doesn&#x27;t sound like a great idea. If you&#x27;re all-knowing and all-good, great. Otherwise seems like a pretty gross violation of basic human rights - what about the false positives (people who get forced treatment while claiming that they are not ill and don&#x27;t need it and then that turns out to be actually true).<p>We could temporarily solve many of the world&#x27;s problems if we had more authoritarianism, but it never ends well in fiction or in real life.
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phren0logy超过 2 年前
I&#x27;m a forensic psychiatrist. If there were an easy answer to this, we would have found it already, but I&#x27;ll offer the following observation:<p>I currently work in Oregon, where (in practice) it&#x27;s more difficult than any other state or country where I have worked to admit someone involuntarily to the hospital. This has resulted in a greater number of mentally ill people staying untreated until the point that they do something that gets them arrested (which may or may not involve serious harm to someone else).<p>In my opinion, this particular balance between individual autonomy vs involuntary treatment does not seem to be a net positive for either the community or individual rights.
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souterrain超过 2 年前
Persons suffering from mental health conditions suffer them long before they warrant the &quot;dangerous&quot; moniker. The solution lies in substantive treatment of all mental health conditions.<p>The disparity of care between mental health conditions and all other health conditions is laughable, including in New York State, despite &quot;mental health parity&quot; rules. For those with Medicaid (public health program for those meeting certain low-income or disability criteria), this disparity isn&#x27;t as severe. However, many young adults with serious mental illness are covered by commercial health plans via their parents, and it is these plans that are relatively weak when it comes to mental health coverage.<p>These plans do well when it comes to emergency, in-patient interventions, but fall short when it comes to ongoing outpatient support. Much of this is due to lack of participation by mental healthcare providers in the insurance reimbursement system, likely as a result of low reimbursement rates. Why see patients with serious mental illness reimbursed at $100 a session when one can see less complex patients paying cash at $150 or even $200 a session.<p>This has been exacerbated by the prevalence of mobile app-based therapy arrangements, which, again, are suitable for someone who is reasonably healthy and needs some additional support, but may be completely inappropriate for those with a serious mental health condition.<p>Mental health care parity laws need teeth. The free market will not solve this.
blfr超过 2 年前
Most psychiatric treatments either don&#x27;t work or have terrible side effects. People go off them not just because they&#x27;re crazy. Which means that mandated treatment boils down to jailing many of these patients indefinitely.<p>I can&#x27;t find it right now but Freddie deBoer had a pretty good, and by good I mean harrowing, description of psychiatric medication, then medication for the side effects of psych meds, then... It&#x27;s definitely not like taking antibiotics.
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devteambravo超过 2 年前
Define dangerously mentally ill please. I&#x27;m afraid that such definition might not be the same, depending on who you are, your religion, your sexual preference...etc<p>Will the definition of dangerously mentally ill be the same in urban Vermont vs rural Mississippi?<p>We have a lot of problems with racism in the US. How do we ensure that this won&#x27;t become another tool of oppression?<p>Maybe we start by not electing the dangerously mentally ill to the presidency instead.
chatterhead超过 2 年前
&quot;It&#x27;s Time to...&quot;<p>In my experience, these kinds of headlines are written by specific kinds of people for specific kinds of people and don&#x27;t really have anything to do with the rest of us other than being forced to see it.
ttpphd超过 2 年前
It&#x27;s such a terrible, terrible idea to turn mental and behavioral health into arms of the police state. Horrible plan that will radically harm everyone regardless of any medical conditions they have.
hoppyhoppy2超过 2 年前
&gt;<i>Common Sense: Honest news for sane people brought to you by Bari Weiss.</i><p>Interesting branding. I don&#x27;t think I&#x27;ve ever seen e.g. a newspaper or magazine marketed as &quot;for sane people.&quot;
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duxup超过 2 年前
Are we going to forcibly medicate them?<p>I don&#x27;t have a good answer to the problem here myself. But I&#x27;m pretty nervous about forcibly medicating folks...
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NoraCodes超过 2 年前
When people say that conservatism is fundamentally at odds with concepts like the human right to bodily autonomy, this kind of nonsense is what they mean.<p>There is no authoritative or even moderately reliable way to diagnose &quot;dangerous&quot; mental illness. It is a fairly well established fact that mental illness is more associated with _victimization_ than perpetration of violence. This kind of scaremongering is entirely based in ableism, not actual &quot;common sense.&quot;
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larvaetron超过 2 年前
I&#x27;ve been mostly a lurker on HN for over a decade. I never thought I&#x27;d see the day where a large portion of the userbase supports bringing back mental asylums and forced medication.
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generalizations超过 2 年前
Reminds me of what happened to Alan Turing.
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denton-scratch超过 2 年前
There&#x27;s a reason people with serious mental illness don&#x27;t take their medicines: they have unpleasant side-effects.<p>The main type of medication is anti-psychotics. These drugs are also classed as &quot;major tranquilizers&quot; - drugs such as the notorious &quot;chemical cosh&quot; haloperidol are in this class. They suppress delusions, or at least delusional behaviour; but they make you gain weight, rock, tremble, mumble. The side-effects are progressive. Modern anti-psychotics have less side-effects than the old ones, but their effects are very marked.<p>For people with bipolar, their illness sometimes makes them feel alive and cheerful, and the drugs take that away from them, depriving them of affect and zest for life. Basically the pills make them unhappy.<p>So we&#x27;re discussing forcing people to take pills that make them feel ill or unhappy. That&#x27;s only justifiable if the compulsion regime is completely trustworthy. We have a compulsion regime in the UK (we tore down our asylums back in the 80s, just like the US). If you have an episode, you can be incarcerated for a few months on the say-so of two doctors. It seems to work alright - as far as I can see, they farm you out to some private secure clinic.<p>But between the train-wreck of US law enforcement and the US reluctance to spend money on public health, along with the heavy, heavy politicization of everything in the USA, I think it would be dangerous to adopt the same model in the USA.
sudden_dystopia超过 2 年前
Who exactly is doing the mandating though? And then it’s just a matter of time until the political party in power starts having their opposition committed for being “dangerously mentally ill”.
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adventured超过 2 年前
No it&#x27;s not.<p>First you have to further pacify the policing and government systems of the US, which are far too often hyper violent and cruel. That process has only just barely begun as it is (starting with reducing sentencing, sane drug laws, reducing police brutality, etc).<p>If you mandate X for the dangerously mentally ill (which ones are supposedly dangerously mentally ill?), what you&#x27;ll get is terrifying abuse of the mentally ill broadly, in many different ways.<p>The US is not Finland. The US is not Norway. The US is not Estonia. We&#x27;re not some soft, cuddly European-style welfare state. The US has a very, very, very violent government, a superpower government that likes to abuse its power, one that often does not respect the rights of its citizens.<p>Before you give the governments in the US (federal, state or local) such powers of treatment (which would include forced detainment against their will, instantly walking to the thin line of human rights violations) you better pacify it first, or you will not like the results. Then we&#x27;ll be here 20 years from now and it&#x27;ll be an avalanche of laments about all the horrific human rights violations that happened under the Treating Mentally Ill People With Respect Act. Who could have seen it coming?!? We didn&#x27;t expect them to do such horrible things with those powers! And so on.
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A4ET8a8uTh0超过 2 年前
It is high time, we only allow one type of person to exist on this planet. I am comfortable that this type of person will not be me or anyone I personally care about so it is ok. Anyone who does not fit the mold must be identified, broken into malleable pieces and then, ideally, reset, but failing that removed from polite society.<p>It is a hard read, but that is this article is arguing for.<p>edit: Hell, I get freedom is scary. There are times I see and hear of people who use it in ways I would never think of considering thinking of dreaming about, but blanket convenient labeling, followed by drugging to ensure they can rendered docile is one of the more horrifying things a civilization can do to a person all the while proponent of the policy managing to feel warm and fuzzy about it. It certainly does not help ( and likely colors my thoughts ) that I regularly attend conferences where some well-meaning soul asks a seemingly benign question along the lines of &#x27;We are already have data X; why are we not using it to do Y.&#x27;
jacksnipe超过 2 年前
This article presents an absolutely DISTURBINGLY disingenuous view of the civil-rights-forward view here.<p>&gt; The underlying problem is that the ACLU and other progressive libertarians view the mentally ill as victims of society deserving of special rights, including a he right to avoid the consequences of their behavior.<p>No, the ACLU believes that without strong protections against forced hospitalization and treatment, people will be abused and stripped of rights in the false name of community safety.<p>The ACLU doesn’t just believe this on idealist grounds, they believe this because <i>that is the legacy of asylums in the USA</i>.
throwhn83962超过 2 年前
Many people want treatment but cannot find it because it&#x27;s stigmatized, too expensive and&#x2F;or the waiting lists are too long. This seems like a bad but easy solution to a serious problem
Overtonwindow超过 2 年前
This alarms me considerably, as would anything that forces someone to do anything they do not want to do, whether it&#x27;s for their own good or not. That said, however, I think there must be a system to treat those who are dangerous to themselves, or to society. I see the problem but once you go down that pathway where does it stop?<p>Government does not back down, and I am deeply concerned that a system that mandates the treatment of someone for a disease could expand that definition, far beyond what anyone intended.
tevon超过 2 年前
We should be looking at models for how this system has worked elsewhere. If in fact the cause here is strictly biological (its likely a mix of biological and societal) factors, then there should be an even distributions in other populations.<p>We should look to the Netherlands or similar to find models for effectively dealing with potentially violent mental illness.
jimbob45超过 2 年前
I&#x27;m confused. Is the author not simply advocating for a federalized version of Florida&#x27;s Baker Act[0]?<p>[0] <a href="https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Baker_Act" rel="nofollow">https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Baker_Act</a>
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pyuser583超过 2 年前
This already happens. Often plea bargains include “must receive mental health treatment.”
akira2501超过 2 年前
This article itself highlights the absolute discomfort I have with this proposal, and why I think it&#x27;s ultimately unethical.<p>They completely switch from presenting a case about the &quot;dangerously mentally ill with a propensity for murder&quot; casually to just the &quot;mentally ill.&quot;<p>Even drawing a line between the two in the first place can be fraught with ethical difficulties, and all the &quot;advocates&quot; in this process are not duty-bound to the person who&#x27;s mental health status is about to be &quot;determined&quot; by the state; and it&#x27;s highly likely everyone else involved in the process will have some financial incentive to start as much treatment as is possible.<p>It&#x27;s easy to see the imputed process here making more errors than it prevents, since it seems to be a process that can be applied before any guilt is established.
jdlyga超过 2 年前
I knew this was New York before even reading this. It&#x27;s getting bad out there, and we need to find a solution to address it.
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charlieyu1超过 2 年前
I am not sure these places are nice to the mentally ill. Are we going back to lock them in the madhouse like it is a century ago?
mplewis超过 2 年前
Yeah, the thing we need is more policing and non-consensual treatment. What the hell is wrong with you?
giantg2超过 2 年前
I mean, there used to be assylums. Of course those had their own problems&#x2F;abuses too (as the article points out).<p>&quot;including the right to avoid the consequences of their behavior.&quot;<p>To me, this reeks of bias. They don&#x27;t avoid consequences. The consequences are different (secure psychiatric facility vs prison). The main point of the punishment for a crime is to prevent it from happening again (and Gove the victim closure&#x2F;recourse within the confines of the law). Stick a psychotic person in prison, they likely will be even worse when they come out. At least with treatment there&#x27;s a chance at recovery and prevention.<p>There needs to be a balance between mandating treatments and freedom. Can we mandate testing, treatment, and restrictions in freedoms for infectious diseases in the name of protecting society? It seems like there&#x27;s a lot of conflicting precedent on that (STIs, vs covid, vs flu, etc).<p>Also, if the state institutions shut down so long ago, is there any background information on the increase in the mentally ill in prison and on the street? Is there an overall increase in mental illness, or just a distribution issue? Or could it even be diagnostic sensitivity or scope creep of the definitions (likely what the ACLU and others are truly worried about, in addition to the Minority Report-esque pre-crime element)?
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kelseyfrog超过 2 年前
Strange that the article left out of the history the pivotal point where the Mental Health Systems Act of 1980 was about to go into effect and then was entirely repealed in The Omnibus Budget Reconciliation Act of 1981 because the new person in charge hailed from a part of the country where psychiatry was associated with Communism even though he was shot by a person with untreated schizophrenia six months before.
bezier-curve超过 2 年前
Perhaps in the US we could make healthcare affordable to just the &quot;non-dangerously&quot; mentally ill first before vilifying mental illness in general. Or perhaps, we could take a hard look at gun control laws that enable the danger instead of using mentally ill people as a scapegoat, which is what conservatives prefer to do any time there&#x27;s a mass shooting.
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kmeisthax超过 2 年前
Motte: Maybe deinstitutionalizing the mentally ill has gone too far<p>Bailey:<p>&gt;The underlying problem is that the ACLU and other progressive libertarians view the mentally ill as victims of society deserving of special rights, including the right to avoid the consequences of their behavior.
seer-zig超过 2 年前
The first question that comes to mind is why has mental illness been substantially increasing recently over the past few decades? Something about our lifestyle definitely contributes to it.
aaaaaaaaaaab超过 2 年前
Love how people in this topic keep arguing about the most strawman interpretation of the article.<p>Noone is saying we should commit &quot;neurodivergent&quot; individuals with a minor Adderall addiction into mental asylums where they will be subjected to shock therapy... The article is about severely ill paranoid schizophrenics, who are ticking timebombs when off their meds.<p>Sorry, but this is not some &quot;on the spectrum&quot; hippy bullshit - these people are seriously ill and need to be treated, and kept in check to make sure they stick to their treatment.
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jeffbee超过 2 年前
If the definition of insanity is doing the same thing repeatedly and expecting success, then a person who got trounced in the California gubernatorial election twice is clearly insane, therefore it’s time for mandatory treatment of Michael Shellenberger.
rajeshp1986超过 2 年前
Leaving them out is inhumane to the rest of the society. Is the right of an individual greater than society? especially one who has been violent in the past towards other members of the society either through one&#x27;s volition or not?<p>The lawmakers and the public in American in general are not able to digest this correctly. There is no ethical dilemma here. One person who is&#x2F;can harm another human being needs to be put in a place where they can&#x27;t cause harm(This includes self-harm as well).
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