It is. But it's possible for it to be broken in the opposite direction, too - mom's getting a little funny in old age, mom has lots of assets, kids get her declared mentally incompetent to get their hands on her assets without having to wait for her to die first. Or a hundred variants on that theme - using declarations of mental illness as a tool to control or remove people that you have no right to control or remove.

The current system is broken. But be careful and cautious with proposed fixes.

I do.

The harm is being done and the crime is being committed regardless of motivation, mental state, or ignorance of the law. Semantics can be argued all day, but the end result is a harm on society.

If criminal justice was actually about getting people the help they need rather than doing time, that'd be totally different.

What do you do in cases like that if prison is off the table?

I didn't watch the video mostly because I don't know what it contains and I have kids around. Making the assumption that it's about people who want to be homeless, honestly that's fine. There's nothing inherently wrong about being homeless if that's what you want. The problem is people causing public health issues because they defecate in public areas, tear apart trash bins, or cause other issues like attacking other people... none of which is acceptable to society. These people may not want to be part of society, but they are living where society exists.

The video explores the visibly-homeless issue in Seattle, as well as a program to address the problem that was implemented in Rhode Island (specifically, enforcement + long-term treatment). I found it worth the watch.

Only sometimes, and only for some crimes. It really is rather complicated. Legal philosophy recognizes that the primary purpose of punishments for crime is to deter people from committing crimes, and it therefore doesn't make sense to punish people who are too mentally ill to understand (a) what they were doing, or (b) that it was wrong, or (c) that they would be punished, or (d) what 'punishment' even is.

But legal philosophy is not a wasteland of common sense, and it's also recognized that one of the purposes of punishment for crimes is to prevent recurrence by making it impossible. The legal authority of the state to indefinitely imprison people who are dangerous to others through no fault of their own is well established.

From personal experience, in Illinois, someone can receive hospital care involuntarily if the doctors deem that they would deteriorate without intervention / become dangerous to others.

One look at the differences in law between the two is illustrative:

In CA -

To qualify for mandated treatment in a hospital or other inpatient facility, the person must be:

- dangerous to self/others; or - unable to provide for basic personal needs for food, clothing, or shelter.

in IL:

- be a reasonable expectation of danger to self/others - be unable to provide for basic physical needs so as to guard against serious harm without the assistance of others, OR - refuse or not adhere to treatment, unable to understand need for treatment, and, if not treated, reasonably expected to suffer mental or emotional deterioration and become dangerous and/or unable to provide for basic physical needs

Your sister conceivably wouldn't have reached that state because once she reached the stage in paragraph 3, if you brought her to a hospital in IL, a evaluation would've determined that she should be involuntarily hospitalized, and she would've received medication.

To my knowledge, she was never really aggressive, violent, nor into self-harm. She was only a risk to herself or her children due to impaired decision making. Her encounters with law enforcement would be things like running a red light while in a delusional panic or because she called to report imaginary prowlers. I think her family and doctor were instrumental in getting her committed when she resisted treatment and her condition regressed. It's possible that her first encounters in the 1960s happened when the system was more willing to declare someone unfit, and then her existing history made it easier to repeat the process in later decades. It takes someone to track and pursue, rather than just expecting some random public servant to recognize the need based on one transient encounter with the case.

But, it was also her family that kept her going outside the brief psychiatric holds. This supportive environment is what seems to be most lacking in modern society, but also is the least feasible for the state itself to provide. I don't see how you can expect much better than the kind of institutional living that has been dismantled. How many patients have to share one doctor, nurse, or orderly?

And, from what I know of this woman, even her successful case took a huge toll on those family members who provided ongoing support. Where can the state find caregivers to provide similar effort for all the less fortunate patients who do not have the supporting family or friends?

It would appear that mentally ill individuals are unable to seek help. Is it not the case that psychiatrists and mental hospitals exist and are covered by health insurance? It seems unfair to point the finger only at the system without acknowledging that helpers can't help without explicit consent on the part of the person being helped, or without some legal means by which they can be coerced to accept help.

That's kind of the problem though. You can't just blame someone who is mentally ill for not seeking help. In the UK, for example, you can be sectioned.

"The Mental Health Act says when you can be taken to hospital, kept there, and treated against your wishes. This can only happen if you have a mental disorder that puts you, or others, at risk.

You should only be detained under the Mental Health Act if there are no other ways to keep you, or others, safe."

https://www.rethink.org/advice-and-information/rights-restri...

Section 2 and 3 require two doctors and an approved mental health professional (AMHP). One of the doctors has to be specially trained in using the MHA. The other doctor should be someone who knows the patient. The AMHP is usually a social worker who knows the mental health act law and is there to protect the rights of the patient.

There are legal requirements placed on the patient's local MH Trust. One of these is that when that patient's nearest relative tell the trust about concerns and asks for an assessment under the act then the trust must consider that request.

A person detained under the act is provided with an advocate from an independent advocacy service. This is free legal advice. If they feel they are being unjustly detained they can go to tribunal to get the section overturned. And that process is also open to relatives too.

There are no fears that your loved one will be shot and killed if you involve the police.

I don't know anything about the US law, but it seems somewhat complex and expensive. There are laws at the state level, and at the county level. Some states say that the harm to self or others must be "imminent" which is a pretty high barrier to meet. Most states allow a forced treatment in the community option, but California requires the counties to adopt that law. So for California where you live decides whether your family can ask the courts to force you to take medication in the community.

Think about what you're saying. Really think about it. Your broken leg comparison completely misses the mark. How about this scenario?

You are walking and step into the street. You are hit by a bus but survive. You have massive head trauma. At this point nobody else should administer care without first speaking with you and having you acknowledge that you need care. You need to then respond in a coherent manner that explicitly allows you to be cared for before anyone is legally allowed to help you. How do you think that is going to work out for you?

Would you be willing to take serious anti-psychotic medication, with significant side effects, if you were 100% certain you were perfectly sane?

So, to answer your question: no, I'm not willing to take drugs, because I'm 100% certain that I'm perfectly sane.

IMHO this is what makes the mental health conversation so difficult: we don't all seem to share a consistent worldview in the best of times, let alone when one's mental faculties are impacted by illness. How can we find neutral cognitive ground where a mentally ill person can be brought up to speed with the Objectively So?

I suspect that the level of trust and compassion required to do this can only materialize in a family setting. I also find it ironic that the absence of a solid familial fabric is surely a significant contributor to mental illness to begin with.

Hard to imagine a familial fabric more solid than the Kennedy dynasty, and yet...

https://en.wikipedia.org/wiki/Rosemary_Kennedy

There is a fundamental hard problem here that many people who think there are easy solutions ignore: how do we as a society fairly determine who can have their autonomy taken from them? Where do we draw the line between personal responsibility, mental illness, and willful criminal intent?

In the past, the line was drawn too far towards the state and family and there were innumerable horror stories of "difficult" women being lobotomized and locked up in sanitoria for life because their family didn't want to deal with their rebellious ways.

The deinstitutionalization movement swung the pendulum the other way and said, basically, you're completely responsible for yourself all the way up until you commit an actual crime. Because criminality is now the line, it means the police end up dealing with the mentally ill more than they should.

The right point is somewhere between these, but drawing it fairly is hard and we don't have great social structures to support it. (In particular, how does society allow the medical infrastructure decide who should have autonomy in a country that doesn't even provide any right to medical access in the first place?)

[0] https://en.wikipedia.org/wiki/Anosognosia

And that's the crux-at what point do we do for them what they can't/won't do for themselves?

But that's part of the brokenness of the system being complained about.

We need to be careful about compulsory treatment and detention without trial, but other countries manage it without it being catastrophic - at least not as catastrophic as leaving people addicted to drugs, mentally ill, and living on the street.