I strongly disagree with the housing first policy. I tried paying for temporary housing for my friend, and things spiraled. The housing has to be conditioned on some sort of recovery plan.

Threat of homelessness is basically the only remaining lever the law allows in these situations.

The other two points are spot on.

I don't know your circumstances, and first of all that is a great and generous thing you did for your friend.

The one place I know of where a housing-first policy has been implemented, Salt Lake City (or maybe all of Utah?), doesn't just give homeless people a set of keys. They do assign everyone a social worker at the same time. The goal is to minimize the risk of what happened to your friend; that isn't good for anyone, including the person spiraling.

It's key, though, to start with a home (and a social worker). The wealthiest country in the world can do that for its people -- and it shouldn't be on private citizens, though that was generous of you.

A big advantage of institutions is to collect the long term learning and lessons into more effective actions. Trying to handle it individually is admirable, but it's at a huge disadvantage and without experience with multiple cases to know what might work better or worse for various people.

Folks have different sorts of needs, and those need to be addressed as well.

My ex was schizo-affective (had traits of both schizophrenia and bipolar disorder). He was on disability. His doctors did not want him living by himself. Some things were simply too stressful and he couldn't do all of it. He'd only cook instant food. He wasn't good at budgeting money. And so on. For a while after we split up, he had a social worker coming to his house for wellness checks. My friend worked a similar job for another hospital: SHe'd visit mentally ill patients and help them, sometimes shopping and whatnot.

There was no recovery for him, only meds. That's it. Only meds.

I cannot fathom how stressful it would be to have your housing and your safe space be dependent on taking your meds, especially when your meds need adjustment... and paranoia strikes up again. Every stressor simply complicates things.

Housing is the first step in a recovery plan. And if they refuse a plan, what's wrong with letting them have a cheap dorm room? Are we so spiteful?

What do any of those have to do with a patient who refuses to go in voluntarily for treatment?

They can foster hope, and try to strive for happiness without struggles of a simple toothache, crippling debt and outright usurious lending practices, while emptying a cold can of chili into chip bag on bus bench for breakfast.

Why not add unlimited resources to the list and call it a day? The problem here isn’t a lack of compassion, political will or information. The problem is the costs, largely due to the legal system which incentivizes litigation and high level policy debate for aggregate clinical outcomes that would benefit societies at the cost of individual liberty.