This isn't changed by an arrest being the first step. As an EMT I frequently transported people to hospitals (or from hospitals to psychiatric facilities) following their arrest. This just avoids the extraordinary cost to both society and the individual that comes along with an arrest being part of the process.

The medical authoritarian system you're worried about already exists and frankly I saw no evidence of its abuse. Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released - which is a far cry from having healed or become functioning members of society.

> Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released.

Having personally had family members and friends in such places, I can tell you this is false. It has often been the case they are 'magically' healed and capable when the insurance money runs dry.

While your anecdote is incredibly sad and messed up, it does not invalidate the parent's belief that most psych facilities are not like that.

You mean that one anecdote does not invalidate another?

it's true that one anecdote does not invalidate another, but assuming truthfulness of both anecdotes the first anecdote seems more wide ranging and likely to give a better view of problems in the system.

How is that the case? The first anecdote is someone with only glancing knowledge of the people taken to the mental health facility. They pick them up, probably on a very bad day, and drop them off without seeing evidence of wrongdoing. What evidence would they see? A mustachioed doctor twirling his mustache and laughing maniacally? By contrast, the other anecdote has intimate knowledge of an individual affected by the system for the course of their involvement with it.

I don't think either anecdote is compelling, but I do think it is wrong to weigh one as greater than the other.

To be fair, one anecdote is the viewpoint from the eyes of someone in the "system" while the other is a viewpoint of those affected by the system. Its essentially recreating the initial conversation of police vs people. One side says all good in the neighborhood, the other says corruption is still a problem.

This is fundamentally the problem of anecdotes and why objective data is needed to resolve these circular arguments

Not to mention the fact that neither comment says which country or region they're based in. I suspect these things can vary a lot by geography, yet both are making very generalized statements.

> objective data

A single anecdote is an existence proof.

(or a lie or misunderstanding)

True. Further complicating matters, I believe there is a correlation between misunderstanding and willingness to share anecdotes (across the general population, not specific to this thread).

Which may be indicative there is not enough data available to support a conclusion, so a person operates with the information most available to them, which may count as a contribution to that data ultimately.

For one thing, we frequently see many of the same patients again, back on the street or in their communities, which is pretty definitive reason to think they're not locked up indefinitely.

In your experience, do they get better after their stint in the psych ward, or are they pretty much the same, or are they worse?

My experience dealing with the homeless on the streets of Seattle is they seemed to either stay the same or get worse. I never saw one person get better from a stay in the psych ward, it seems at best a place to keep them locked up for a little bit and then turf them back out on the street.

Notice how psychiatrists and psych hospitals don't really advertise much anything about "cure rates" or percentages cured. You compare that to any other field of medicine which often talks about percentages of outcomes, especially for fields like surgery, infectious diseases, oncology, etc... and you find the primary reason why I personally (and many others) do not find the field of psychiatry to offer much beyond "medicate and manage" while syphoning insurance money and government funding, and while also causing potentially horrible side effects.

If the primary exploit is siphoning insurance money, is it possible that your frequent fliers have worse insurance than the subjects in the contra anecdote?

Yes, as I acknowledged in another comment.[0]

But it's not especially relevant to the point I was responding to: this program, where police are replaced by healthcare professionals, primarily deals with people who lack housing or income, which makes the commenter's concern a lot less relevant to this particular discussion.

[0] https://news.ycombinator.com/item?id=26033144

The existence of houses which are not fire does not mean the risk of house fires is unworthy of consideration.

Then I could counter argue with another anecdote that I visited thousands of such facilities and in all of them cases of magic healing once the insurance money dried up happened.

Merely extending the scope of an anecdote does not change the fact that it is an anecdote and does not provide greater power to convince.

The original comment claimed to be an EMT. That makes their comment a professional experience or professional opinion where as yours is an anecdote.

Professional experience? Inventing new speak for anecdotes on the fly, bravo.

I think it's more along the lines of one anecdote doesn't invalidate Occam's razor, and the Occam's razor in this scenario is that psych facilities are acting in good faith.

There is plenty of evidence of inhumane treatment in psych facilities over decades, including human experimentation, drug trials, debilitating brain surgeries, electroshock therapy etc. Psychiatry is probably the single medical field that has caused more harm than it has cured.

Just to be clear, electroshock therapy is still a thing.

Yes I know and there are some people in permanent psychiatric care without any perspective for improvement with current known methods, some are kept almost like animals or permanently sedated.

It also can be a long term cure more severe drug resistant depression. It worked for my wife. They do not do it without your consent.

It does highlight a perverse incentive that's everywhere within the system. It was useful to me.

It also sounds like a very much American problem due to American healthcare..

Its not unique to the US. Just a few years ago a high profile case happened in portugal where a man had a dispute with his parents and was forcibly committed for 2 years without the doctor his parents went to ever seeing him.

That's not really an example of the issue mentioned:

> "Having known several friends who got committed and held against their will in psych wards when there was no good reason to, because their insurance was good, this is an issue."

This is pretty much specific to the US (in developed countries). It would be impossible in Portugal.

Basically, the only advantage of American healthcare is that if pays for innovation better than others. The world benefits from it, Americans suffer due to it. As long as they're happy, good for them.

If the government is paying the facility to continue holding/treating the “patient”, I don’t see how it’s in any meaningful way different nor impossible in Portugal.

The way the fraud works is different. In the US it is their insurance is good, keep them in. In Portugal everyone has the same insurance so it is keep our faucility as full as possible, only releasing just enough people to make it appear like we are doing something.

I have no idea what fraud occurs. In either system. I know enough humans to know that some are honest and some are not. Thus if it is possible to get away with fraud odds are someone is.

The government doesn't pay the facility, it runs the facility.

It certainly creates its own set of problems, but not that one.

According to the first hits on google, roughly half of Portugal's hospitals are private.

Number of hospitals are not a relevant measure, since all the major hospitals are public. Here are more relevant measures: 70% of the hospitalizations and 73% of urgent care occur in public hospitals.

I don't have the numbers for psychiatric hospitalizations, but I would guess the number is higher than 70%.

The American part seems to be that our penny-pinching private insurance companies finally provide a benefit in protecting us from being committed forever?

Because plenty countries have private hospitals who can keep billing the govt as long as they can keep you there.

Raoul Wallenberg was allegedly thrown into a psychiatric ward in Russia when he came on a political visit, and held there till the end of his life.

The incentives may change by country, but it is pretty common to setup wards like prisons, for practical reasons. And that can be abused, as every form of power will eventually be.

He was arrested in Hungary during the siege of Budapest. Everything after that is pure speculation. When he went to meet General Malinovsky he famously said he didn't know if he'd be a guest or a prisoner.

I've never heard any of this about a psychiatric ward before and he was definitely not arrested in Russia on a visit.He was also an OSS asset - and there is a more than decent chance that the Russians knew it. I do not see any way this very special case with this very special man can be used to make a statement about broader issues to do with mental health. I walk by a memorial to him near Deák ter on a regular basis and think of him often.

USSR had a long history of putting disidents in psychiatric wards. Those who dared to criticize communism ("the greatest system ever") would be labeled as crazy and locked in a hospital.

Raoul Wallenberg wasn't what you'd call a dissident criticizing communism, and was mostly known for saving Jews from the Nazis by offering them Swedish protected passports.

Officially he was arrested by the Russians for espionage in Budapest in 1945, during the war, with later reports suggesting he was actually involved in an espionage effort. He allegedly died in prison a few years later. There were claims that he was sighted in prisons and psychiatric hospitals as late as the '80s but if they're true then this certainly wasn't used as a cover, he was already claimed dead. The psychiatric ward angle doesn't really make sense in these circumstances, there's no need for a cover story when the official story already sounds like a cover, and even presumably legitimate.

In my experience such facilities aren’t any better in some “nice” northern European countries.

The incentives might be slightly different, end results the same.

For example in Finland involuntary commitment is somewhat frequently used as an impossible-to-appeal alternative to investigative detention. You’d have to be crazy to do crimes, right?

Involuntary commitment is just inherently suspectible to abuse, I’m not sure anyone should have that power.

Happend in germany too: https://en.wikipedia.org/wiki/Gustl_Mollath

To silence someone being inconvenient to the powers that be, no less.

It always reminds to the USSR where critics where put in wardens as well, instead of arresting them.

Indeed, no such incentives (e.g. financial) are in place in the country in which I am in Eastern Europe, thus, no one is really interested in abusing those things. Were they given financial incentives to do so, they most likely would.

This used to be a big issue in the Soviet Union, but for political instead of financial reasons:

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

This often veered into straight-up torture, including electric shocks and drugs that caused pain as a means to "cure" people from not believing in communism.

Did you know Electric shock is still a very lucrative business in the USA, while the United Nations has deemed involuntary ECT (which is allowed if court-ordered in the US) as torture?

Meanwhile the FDA recently re-classified ECT as Category 2 "Safe and effective" devices, even though there are hundreds of studies showing they cause long term memory loss.

I'm not even sure why we still haven't reformed the FDA, but it is long overdue.

Or drilling healthy teeth without anesthesia and setting dental fillings so there would be no proof that the teeth was healthy.

Honest question: how do you know the issue is not hapening?

I used to work in health care for years, and I have an understanding of our health care system. Make no mistake, it still sucks in many areas, and there is some cover up between cops and health care workers when it comes to drug users, or anyone who goes to the detox room (alcoholics, mostly). They treat people inhumanly there.

Before I became a health care worker, I spent some time at the psychiatric ward, and at the detox room (voluntarily). I liked the psychiatric ward, the staff and roommates were nice, and I made some pleasant memories with a girl in there. :)

In any case, you are typically an inconvenience and they do not want you there, especially at the detox room.

Why would this be the case? Do healthcare facilities not receive "insurance money" based on patients in the rest of the world? Because I'm pretty sure they do. Whether is abused or not is a different matter.

When you write "anecdote" it seems you also didn't read the linked buzzfeednews article.

There's statistics in there, but it's quite long so I understand if most people won't read it

anecdote vs belief, wonderful... If I have to choose, I would pick anecdote over someones personal believes everytime!

Your experiences may be not contradicting each other. These facilities may release both healthy-enough people and those people whose insurance ran dry (i.e. underhealing them). But it doesn’t mean that they forcefully detain healthy ones until their insurance ends.

Aye. Sick people who have no funding for their treatment get released.

To the extent that our experiences differ, I'd bet that things resolve in my favor for these cases. In other words, the vast vast majority of encounters that this article describes are ones involving people with very low incomes or without housing (68% of calls were in this category) rather than people who have private insurance.

It does seem like a bit of a contradiction to use a market-based Homo economicus model of patient qua consumer behavior to motivate the widespread use of private insurance for the same individuals who are supposed to be institutionalized because they can't care for themselves! Single-payer may not always be the best model but at least it avoids this particular absurdity — of course Medicaid wouldn't stand for this.

Of course, when you absolutely need indefinite care, the situation changes and you get our monstrous nursing home ecosystem.

While those are the types of people most likely as a group to commit crimes, that doesn't means any individual does. Many of them are harmless, and know how to survive, and even take pride in their independence.

While I'm sure it is in your favor, if those who are harmless are taken off the street in addition to those who are harmful overall it is a loss.

> Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released - which is a far cry from having healed or become functioning members of society.

The problem of wrongful involuntary commitment (especially for insurance fraud reasons) is more rampant and widespread than one might initially guess.

Here is a good paper on it: http://wayneramsay.com/unjustified.htm

I've only skimmed the paper at present, but are all of their examples based around minors being involuntarily committed by their parents? Because that seems like a separate, if related, issue.

See the article at the bottom of my original comment for the Buzzfeed investigation into UnitedHealthCare psych wards. That was targeting adults, not children.

However, involuntary commitment of children (and subsequent rape too many of the girls who end up there, tragically) is a huge problem. Look up abuses of the "Baker Act" in Florida for example.

>Look up abuses of the "Baker Act" in Florida for example.

I have a friend who was involuntarily committed under the Baker act when she was in 9th grade. She was never suicidal, never threatened anyone, and was held for 2 days to evaluate her. A bully lied and claimed my friend made suicidal statements and thought it would be hilarious to tell the school administration that they were "concerned for another student". Rather than just a call to her parents and a long chat with a guidance counselor the school administration decided that clearly she was just lying and even though she denied everything and never showed any indication to any of them that she was a risk to herself or others they had her committed. The bully that lied to the school administration even went on to brag about doing it.

I think the real travesty here is that misuse is completely unchecked and the timeframe is absurd. If someone is being held against their will, without commiting a crime, why on earth is it considered fine to just hold them for days at a time before even being evaluated by a mental health professional? They already have to transport them to a mental health treatment center so why can't hospitals figure out an on call schedule for psychiatrists?

It's a farce that the standard of proof is so low supposedly in the name of safety and urgency and yet even while the situation is urgent enough to hold someone against their will it's not urgent enough to get a psychiatrist on the phone on a Sunday.

That article is about Universal Health Services (UHS) not UnitedHealth Care (UHC). UHS is not a subsidiary of UnitedHealth Group (UHG) UHC is.

To throw on the anecdote pile... my brother was committed due to overreaction of an LSD trip. He had been up for days and was almost incoherent after being brought in to the emergency room by the police. They said it would be 2 days, then 5 days, then another week. I called and told them that his insurance had contacted me and said they weren't going to be paying for any additional time. He was released the same day.

I was about to comment with a similar anecdote. Situations will be different depending on the psychiatric facilities, but there are some, usually the most expensive ones (and being expensive is not at all an indicator of being a good one), in which some physicians have no issue keeping people in there as long as there is money to be drained from the family. Worse, the psychiatric state of the patient has not necessarily improved during that costly stay.

I feel like this conversation has gone entirely sideways based on someones' random unrelated anecdote.

What does this have to do with the police showing up when you call 911 instead of a few social workers (who can't actually commit anyone)?

This program is far far more likely to deal with homeless people than people with insurance that can cover multiple days in a facility.

> Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released

Penitentiary system is overburdened and has no interest in keeping people around once they're safe enough to be released.

Makes equal amount of sense to me.

In USSR, punitive psychiatry was the tool of choice for the government in the times of wide international information dissemination.

I don't mean to ridicule the American struggle for fixing community policing - I understand that defunding and disbanding the police comes out of a desperate situation, and I admire this kind of courage for radical changes. But it's a mistake to think that one step is a complete solution.

In USSR, booking you into the ward for political reasons did involve an arrest and a trial.

I’m curious if you have any citations.

(I’m reading The Gulag Archipelago, and I haven’t gotten far enough yet to find out the exact procedures that were used for dealing with political dissidents via mental health charges.)

> As an EMT I frequently transported people to hospitals (or from hospitals to psychiatric facilities) following their arrest.

> I saw no evidence of its abuse.

Unless your EMT services is responsible for 100% of the patients that enter the psych facility, the set of patients you see is probably affected by survivorship bias[1]. The people you see may be biased towards people with a legitimate problem severe enough for someone to call an EMT.

> Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released

About 8 years ago had an experience with a facility (in the SF Bay Area). A psych I had seen once for <5 min had me arrested and sent for a 3 day hold. The justification fabricated; a few sentences of vague nonsense. After finally seeing a doctor on day 2 for about 1 minute, he upgraded the 3 day hold into a 2 week hold at a psych facility (supposedly on the suggestion of the original psych).

The facility was over-enrolled; the staff often complained about having to deny admission due to lack of room. Everyone at the facility that wasn't a doctor thought I obviously should be released immediately. I didn't see a doctor again until day 5 (I explained the situation for q few minutes, meeting over, nothing happened), while the facility was somehow able to justify to Medi-Cal why they should pay several thousand dollars to keep me there for another day. On day 10, I guess Medi-Cal stopped paying. The doctor showed up for a 2nd meeting, insisted I take a shitty SRNI and finally let me leave.

[1] https://en.wikipedia.org/wiki/Survivorship_bias

Thank you for sharing your story. Involuntary commitment is a vastly underreported human rights abuse which needs to be seriously addressed.

Psychiatry does not know how to cure mental illness. At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects.

Investing more money into this doesn't solve the societal issues which come from drug addiction, lack of economic opportunity, a failing education system, etc

I would rather see us focus on fixing schools and the economy than spend billions on these programs that have dubious outcomes

Fine. In the meantime, any objection to taking billions from a program that has dubious outcomes and involves violence and a permanent criminal record, and shifting it toward one that has dubious outcomes but doesn't?

You seriously cannot neither compare the two or shift calls from one to another. They should live in their own sphere like they do in many countries. There are problems in both (massively so in the US) but if you look in journals, books and magazine-articles by well respected psychiatrists you will see many saying that what we do today with medicine will likely be seen in the future as a medicinal/chemical lobotomy. People's lives aren't just ruined but people are ruined permanently by treatments.

Luckily I don't live in the US where there's a high risk of being shot by police if you call for help for mental problems or getting put away because of good insurance, but if I did I would pick the police over the risk of getting medicated by overworked and poorly educated hospital-workers. The police might pass you on but that is still a risk I'd willingly take if I had to pick Police or direct to the social-system in the US. Of course I would rather take a loved one to someone I knew would give them proper care in the first place but most that call the police does not have that option or we wouldn't have this problem in the first place.

In other words, the problem isn't as black and white as you appear to make it. The solution is educated police working with a better social system, not sending social-workers to do a job they aren't educated or prepared for. If you look at much better (but still not perfect) systems you will mostly see that even when mentally sick people that are already in the hospital get violent they still call the police as it isn't their job to pacify dangerous individuals. That is the job of a well educated, not over-worked, police-force.

https://www.psychologytoday.com/us/blog/out-the-darkness/201...

And what are the actual stats on that?

I'm willing to make a pretty safe bet that there are far more people in the US who have criminal records than have been committed to institutions against their will. I doubt it's even a contest, I'm seeing rough estimations online as high as 1/4 of the entire adult male population in the US.

And I'm also willing to make a pretty safe bet that the proportion of those criminal records that actually get expunged is a lot lower than you're making it sound like.

And lastly, I'm willing to make a bet that overall, the long-term effects of even a short criminal record are roughly comparable to the long-term effects of involuntary commitment. Yes, we can have a conversation about firearm privileges, that's worth talking about. But let's also not forget that the most immediate effects of a criminal record are things like loss of income, housing, and the ability to find employment, which can have an extremely significant effect on your entire future. In comparison, most employers will not ask you questions about your mental history.

And again -- you can still get involuntarily committed to an institution after you're arrested. The only difference is that now you have two problems instead of one, both a mental health record and a criminal record.

> And again -- you can still get involuntarily committed to an institution after you're arrested. The only difference is that now you have two problems instead of one, both a mental health record and a criminal record.

There are tens of thousands of serious sex offenders who, after serving their prison terms, are civilly committed to a prison-like treatment facility until the state decides they are safe. Only the most dangerous 2-4% of sex offenders are committed, and in some states it's rare that anyone is fully released. (Minnesota didn't fully release a single person in a two-decade period[0] In Texas, "only one person has been released from the program on a provisional basis since it was created 16 years ago."[1]). It's very expensive because the states do have to provide professional treatment, but apparently the states feel that the cost is worth it. In many cases being convicted of murder would be better than being civilly committed, since one would have a much better chance of eventually seeing freedom.

[0] https://www.pbs.org/newshour/nation/inside-minnesotas-sex-of...

[1] https://texasvoices.org/judge-plans-to-release-texas-sex-off...

How would this program make that problem worse?

You're talking about a situation that is almost always going to be accompanied by jail time. Even under this program, the top 2-4% of sex offenders are going to go through the justice system and see jail time. Look at the stuff you're citing (emphasis mine):

> This type of law grants Minnesota courts the ability to deem someone an ongoing threat

> here are tens of thousands of serious sex offenders who, after serving their prison terms, are civilly committed

If anything, this seems to lend credence to the idea that having more police officers is not a deterrent for involuntary commitment. Literally all of these people were committed after being arrested and going through the justice system.

----

Add to that the fact that you're talking about a relatively tiny proportion of a very specific crime. Doesn't mean that it's not a problem, but as a point of comparison, there are currently ~200,000 people in the US serving lifetime sentences in prison.

So I still don't see how I'm expected to treat those numbers like they're the same. Of course treatment facilities can be problematic, but I'm not seeing numbers that make me think they're a worse problem than our current incarceration system.

And I especially don't see how the current initiative is going to affect the numbers you're talking about. Is Denver planning to stop prosecuting sex offenders? Why does the first responder being a mental health professional or a police officer matter in that instance? I mean, on both sides here it's wild to be talking about the top 2-4% of sex offenders or prison life sentences in regards to a program that is bragging in press releases about how they handled a low-level trespassing case. You're looking at a different category of crime than this program is designed to address.

I have no idea why you're interpreting my post as an adversary. My post seems to support your position. I was giving an example of the situation you stipulated, where having both a mental health record and a criminal record is much worse than merely having a mental health record. It's the combination of the two that gets one locked away for life. If there were a mental health program that could address these problems before they become a criminal justice issue (granted, a huge if), then everyone would be far better off.

Not everything is a debate to win, and I'm not your opponent.

You still seem to be missing the fact that there is no additionality here. If the current system would put you in a psych ward, the prior system would arrest you then put you in a psych ward, which most folks would agree is strictly worse.

> Seems like a great avenue for disarming the populace

You say that like it's a priori a bad thing?

Coming from a county where the populace was never as heavily armed as yours, and in which we did "disarm the populace" fairly severely in response to a mass shooting, your gun violence problem is certainly one of the big big downsides to "living in America" for people I know.

> ... if the government needed to turn dictatorship.

And even this "reason we all need to own guns" seems kinda pointless? Do you honestly think what passes for "a well armed militia" in the United States these days stands _any_ chance of prevailing against the American Military and Law Enforcement? Your _cops_ drive tanks!!!

I totally get that America has a level of gun ownership and a legal marketer and blackmarket for guns that we in Australia don't even comprehend, and that any attempt to change that is not only seemingly politically impossible but that even if the political will to change it existed it'd be a multi generation program to reduce the sheer number of guns in circulation. But I'm nt at all convinced by any of the arguments claiming it would be a bad thing for sociality...

Consider how many people would need to be incarcerated against their will to make this work. Disarming the American populace would be nearly impossible by far more effective means. Taking this approach would be incredibly ineffective.

> Seems like a great avenue for disarming the populace

Doesn't seem like it would scale, tbh. You could disarm a few troublesome people, but not "the populace".

> Psychiatry does not know how to cure mental illness

Law enforcement doesn't know how to cure criminality, either. And it's much worse when it comes to mental illness.

> At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects.

Law enforcement isn't even that effective, at criminality or mental illness.

> Investing more money into this doesn't solve the societal issues which come from drug addiction, lack of economic opportunity, a failing education system, etc

Shifting resources into this from law enforcement responses to mental health issues does solve the societal issues that come from law enforcement’s egregious mishandling of mental health issues, plus saves money that can be used to deal with those other problems because it's cheaper per call handled. Also, alleviating mental health symptoms does mitigate many of those problems, which are, in many cases, direct consequences of mental health symptoms.

> I would rather see us focus on fixing schools

As if anyone knows how to do that.

> and the economy

Wasting less money on sending police to encounters where police presence is actively harmful is, among other things, fixing the economy.

> Law enforcement doesn't know how to cure criminality

No but I am sure places with more law enforcement are more lawful than places without it.

That isn't true: We don't police rich neighborhoods like we do poor ones, so there isn't as much opportunity to catch people doing crime, not to mention that crimes of poverty or opportunity are less when folks aren't needing to steal things. (yes, I realize that not everything people steal are things like food, but mental health is important, and things often fill these needs). In addition, poor people are more likely to get caught for some things simply because of living conditions. A decently middle class person can find a private place to smoke a joint or do drugs. Just go camping, for instance, or out in the backyard. City living plus lack of resources means you can't just go out in the courtyard of the apartments.

I'll also mention that rural places tend to have fewer cops and are seen as having a generally lower crime rate. (I didn't look up the numbers, but this is the stereotype).

A quick google suggests that evidence for a relationship between police numbers and crime rates is rather weak

> Psychiatry does not know how to cure mental illness. At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects.

I realize this is just a sidenote, but I just want to address this point for anyone who's struggling with problems like depression or other serious mental issues. Getting help can be a lifesaver, and sometimes medication is part of it.

Properly prescribed by a professional who knows what they're doing, medication to treat depression can in some cases literally change your life. It's not the only way to address mental issues, you absolutely should couple it with therapy. It's not for everyone. That's why a professional is involved. But stigmatizing people who take medication to help manage their problems is incredibly harmful.

Absolutely correct, it can be a life-saver, but patients should also be aware that many people get permanently ruined by the medication prescribed by so-called professionals - especially antipsychotics and antidepressants - so to try it is to take a big gamble. Medicine should be the very last thing tried to help people with mental problems. Not the first as it is today and likely not the second either. It is, in many many cases, incredibly harmful or totally superfluous. I'd go so far as to say that IMO at least 9 out of 10 in the psychiatric system is over-medicated and/or misdiagnosed. Most people I have seen that get medication end up in one of three situations being either life-long medicinal dependency, polypharmacy or misdiagnosis. All could be prevented by a working psychiatric system without close ties to Big Pharma.

Most people that get antidepressive medicine isn't heavily depressed and shouldn't get medicine at all:

>Conclusions: The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.

https://jamanetwork.com/journals/jama/article-abstract/18515...

>My guess is that future generations of psychologists will look back at our over-prescribing of psychotropic drugs with incredulity too, amazed at our blind enthusiasm for largely ineffective and damaging treatments, and at how such barbaric methods could become so widespread.

https://www.psychologytoday.com/us/blog/out-the-darkness/201...

If you go in with a headache and get prescribed an antipsychotic, sure. If you have severe depression that just goes away with the right drug, isn't that solving the problem?

The problem with overmedication is when the drugs don't work, or don't work properly. A competent professional would work with you to find the drugs that work for you, not say “here, take this, not interested in hearing your symptoms”. It's usually possible to know when you've got a bad doctor, and usually possible to seek a second opinion.

Better to seek help than suffer alone.

> If you go in with a headache and get prescribed an antipsychotic, sure. If you have severe depression that just goes away with the right drug, isn't that solving the problem?

The problem is that often medication is prescribed very quickly and virtually no supervision happens. This is a very bad combination in general, but especially if the patient is suffering from a mental illness. These drugs literally list things like suicide among their side effects and it is extremely irresponsible to prescribe them to someone and then tell them to check back in 3-6 months or so. But this represents standard practice.

Take a depressed person who wants to commit suicide, but is too depressed to do it. Put thing on an anti-depressant that raises their mood and improves them over the course of a few weeks. There risk for a period in there where a patient has not exited self-harm territory, but now has energy to do things - including self-harm.

The drug isn't causing suicide. It's just unfortunately taking a patient through a risky period.

Many people do not understand that anti-depressants don't work instantaneously. They take time. That is where the risk comes from.

I agree with the supervision part but imagine you're a doctor, you have these meds at your disposal and someone comes to you suffering with what you assess to be a condition that you know a certain med is 90% effective. Wouldn't you give it to them and simply risk that they might be in the 10% that it doesn't work or maybe the 0.1% that it'd cause a bad effect? Should we eliminate medication because it isn't 100% effective for everyone and sometimes has adverse effects?

If medication A is 80% effective, 10% useless and 10% major side-effecty, and medication B is 5% effective (half of the A-useless people), 90% useless and 5% “causes headaches”, which do you try first?

That's why there is a profession, to make these kinds of judgements. But what is the alternative? People that are going for medication don't usually have many choices. If it wasn't too taboo and there wasn't so much misinformation around this then people wouldn't have to end up in situations where you just need to take something asap because you've been catatonic for the past 4 months and/or you're having paranoia and delusions and your life is going to hell. These are real life struggles, we can't be theoretical and aim for the ideal. Science improves and it's certainly better than it was in the past.

> Medicine should be the very last thing tried to help people with mental problems

Really? They should just keep on suffering and do what? Snap out of it by the power of their will?

> Most people that get antidepressive medicine isn't heavily depressed

And let it evolve to chronic "mild" depression and possibly more severe mental illness, instead of treating it with an off the shelf anti-depressant today..

Medication helps lots of people and it's very effective, very quickly. If someone is suffering a lot of the time they don't need to be and this narrative of "only meds when it's severe" is why so many people go undiagnosed, untreated and later develop worse conditions in which they may not have a chance of full recovery.

Treat it when it's early, meds in moderation and with supervision.

It does however start to solve the issue of having people who don't belong in prison being sent to prison. A part of a complex set of issues that have led to the US having the largest prison population in the world despite being nowhere near the most populated country.

In the US in particular it seems bizarre that this discussion has descended into worry over being locked up in mental health facilities given a prison population so large it compares unfavourably to most authoritarian dictatorships.

>I would rather see us focus on fixing schools and the economy than spend billions on these programs that have dubious outcomes

I couldn't find an exact number in the five minutes of searching I was willing to put in, but the budget seems to be in the single digit millions, a far cry from billions.

And it also ignores that the alternative here is not "do nothing" but "send police instead", which also costs. And if it leads to arrests it costs even more. And if people end up getting a criminal record, it tends to reduce their long term employment prospect, and as a result reduce tax revenue/increase welfare costs. There seems to be plenty of potential for this to save money over time.

There are many physical illnesses that we can't cure. That doesn't stop people from going to the doctor for treatment for them. Just because the illness will be there doesn't mean we can't significantly improve someone's quality of life.

But we can usually objectively tell what is wrong. A test can be administered by different doctors and they're almost certainly going to arrive at the same conclusion. Mental illness has so much overlap and comorbidity that we can't really do that. Even for something like ADHD we don't really have an objective test for.

We can tell folks what is wrong if you have a common and fairly well understood disease that has indicators that we can test for. People sometimes wait years to be diagnosed with an autoimmune disorder, though, and these have medicines that can significantly improve life. We find cancer, but sometimes treat everything as aggressive (though it is starting to change). And so on.

Heck, we are still slowly discovering body parts.

The brain is one of those things we still don't know a lot about despite the seemingly broad knowledge we have. Some of the knowledge we have is fairly recent and can be thanked, in part, to modern scanning. I don't know how we can expect folks to have a definite test for this when there is so much we don't know.

>Psychiatry does not know how to cure mental illness

Psychiatry doesn't know how to cure mental illness and oncology doesn't know how to cure cancer, but they both work a lot better than the supplement aisle.

Agree for the case of oncology. Disagree for psychiatry.

The evidence is mounting that vitamins may actually be just as good a treatment for most people with mild depression or other similar ailments vs SSRIs and other psychiatric drugs.

Sources:

SSRIs don't work better than placebos for mild to moderate depression Study https://www.ncbi.nlm.nih.gov/pubmed/18303940

Low B12 and Folic Acid are associated with Depression Study https://journals.sagepub.com/doi/abs/10.1177/026988110504889...

Vitamin D can treat seasonal depression Study https://europepmc.org/abstract/med/10888476

B-12 levels are associated with ability to recover from depression Study https://bmcpsychiatry.biomedcentral.com/articles/10.1186/147...

Magnesium helps to handle depression Study https://journals.plos.org/plosone/article?id=10.1371/journal...

While this is partially true, it is important to realize that most of these papers are talking about mild to moderate depression (not severe depression or any other mental illness). There is a ton of evidence that medication helps in more severe cases (https://www.psychiatrist.com/JCP/article/Pages/efficacy-ssri...) the main debate is whether depression meds are being over-prescribed in mild cases.

My late father is a psychiatrist. My wife is a medical resident. What you said is fairly accurate. Both my wife and late father say if someone shows up with acute mental problem, you prescribe lithium-based meds, sleep-inducing meds and/or in extreme scenarios, shock (ECT) therapy. For mild forms, it's one-on-one therapy (most listening what the patient says). Psychiatry, as it is now, is more of an experimentation than it is a science.

> Psychiatry does not know how to cure mental illness. At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects.

I whole-heartedly agree with this. I was on anti-depressants at some point of my life. At that time I did something very stupid that jeopardized my life. I was lucky enough to get out of it unscathed. Although I am still traumatized by the incident.

Please be very careful taking anti-depressants.

It is well known that antidepressants, especially SSRIs and SNRIs, will often make the depression symptoms worse during the onboarding period (~2-6 weeks) before the symptoms become alleviated. I'd say this was a failure on your doctor's part for not indicating and emphasizing that.

It also depends on the medication as people have different reactions to different medications, even if they're in the same family of drugs (e.g. SSRI, SNRI, etc.). Some people will have the side effect you mentioned (e.g. suicidal ideation), but feel much better than before the medication after a few weeks. Those same people may not feel any difference on a different medication, even on the highest dosage, and never feel any improvements. Then there's a wide range of reactions in between. Unfortunately, it often takes a while to find the right medication for someone and the journey to do so is rarely pleasant.

This is one of the hardest things about psychiatric pharmacology. There's no go-to medication because you're trying to alleviate symptoms for something that you don't know the exact mechanisms involved (i.e. everyone's brain is different and a "chemical imbalance" or the cause of it in one person isn't the same as another's, even if their symptoms are the same).

With all of that said, I'd definitely recommend attempting cognitive-behavioral therapy before going to medication as a supplement or alternative to CBT, especially if the depression is mild/moderate. For those with severe depression (like me), however, they may not have the motivation/drive/confidence to consistently see a therapist. In those cases, medication might alleviate the symptoms enough for them to do so, which is what happened in my case. Although I don't continue CBT, mostly due to time constraints, I still take anti-depressants to maintain what I've climbed out of so far.

None of this even mentions those with severe, treatment-resistant depression in which the only relief they get is maybe from electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS). The former sometimes doesn't work and the latter's effectiveness tends to range from months to weeks and dependent on specific pulse train protocols for those cases.

I've been treated by multiple psychiatrists (the drugs did not work, as far as I can tell, and one made me significantly sicker) and never had a psychiatrist tell me the drug they gave me may make me feel worse at first. In fact since this warning is in my experience unheard of, I question whether you are confused about the above claim. (Though it's possible things have changed since a I was last treated, I suppose)

Since a lot of the benefits of these drugs may be the placebo effect, that would be a pretty odd thing to say since they could undermine their treatment.

Psychiatry is like a science that hasn't been invented yet. If someone is seriously depressed it may be worth a shot to try drugs but the psychiatrist will have no real clue what the drugs will do, just educated guesses based on flawed studies.

The service you are complaining about provides optional food and shelter instead of arresting homeless people. What's wrong with that?

> Psychiatry does not know how to cure mental illness.

Source on this? Keep in mind that psychiatry doesn't only deal with mild to moderate depression, but some really severe disorders.

There are a forest of sources. Psychiatrists and psychologists have made statements to this effect at their conventions.

In my opinion, where you can't definitively diagnose, you are already set for failure in the cure.

Here is some context: http://wayneramsay.com/diagnosis.htm

You can do both, and indeed they are both required. Fixing schools and the economy are the long term solution but we can’t let people be subjected to the inhumanity of our criminal justice system that exists today (especially if they’re part of a minority).

Being a minority tends to mean in America that you have a higher chance of growing up in areas with bad education, poor economic situations, and higher crime rates.

These are all factors that lead people to poor mental health, to drug abuse, and subsequently to committing crimes (often to feed the addiction or due to poor education/limited opportunities).

These problems aren't necessarily just problems minorities experience, white communities in poverty-stricken areas of the US have exactly the same issues (See Detroit for instance). It's just that there's more poor minority communities than there are white communities.

We need to fix it for everyone, regardless of race.

>>Being a minority tends to mean in America that you have a higher chance of growing up in areas with bad education, poor economic situations, and higher crime rates.

So I guess that would change once the majority of minorities are Asian.

I think your focus should be socioeconomic status, not race.

The majority of minorities are not Asian and likely will not be anytime soon.

The point, minority status is not the cause of poor treatment by police, behavior and socioeconomic status is.

That's not true, actually. Statistically minorities fare worse in their encounters with the justice system.

Not sure if you are genuine this was discussed at lot in the last year, below are two.

https://www.washingtonpost.com/news/wonk/wp/2017/11/16/black...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614457/

So people are downvoting this because I provided citations that the GP asked for, seriously?!

Counter-evidence from a controlled experiment:

https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=2674...

tl;dr police were 25 times less likely to shoot an unarmed suspect in a simulation, if that suspect was black instead of white.

A little bit of common sense explains why. It would simply be inconceivable that the officer who shot Daniel Shaver to death would have been acquitted had Shaver been black instead of white. The kind of social backlash that an acquittal in such a case would elicit would ensure the political and judicial system punish the officer.

First of all, you and the person you responded to are giving examples that covers wildly different types of interactions, so it's not "counter-evidence". It does provide additional evidence for a certain type of interactions, however.

With that said, there's a massive caveat here: This is based on simulations

For it to be generally applicable you also need to then demonstrate that this matched real-world observed behaviour. On its own it is not at all obvious whether or not this accurately reflects anything at all.

There are many possible confounding issues here. E.g. for starters a typical excuse in shootings is that the officers claim to have feared for their safety. You then need to account for whether or not the simulation accurate trigger the same fear, otherwise someone with a racial bias in what makes them scared in "real life" could be expected to act differently in a simulation where they know they're safe.

I don't know whether that is the case or not, but there are many enough possible issues like this that a simulation only allow us to draw very limited conclusions here without a far more complicated experiment. Without understanding why.

Yes, data from real cases has significant advantages over a controlled experiment using simulations, but also significant disadvantages.

Still, a 25 times lower likelihood of shooting a suspect if they are black in the simulation-based experiment..

That is entirely corroborated by what common sense would predict given the backlash a typical police officer would expect in the event that they shoot and kill a black suspect versus a white one.

I assign zero value to "common sense". "Common sense" to me would also suggest that people would reveal less of their real biases and more of their concern of what those observing them might think when in an artificial setting where they know their actions will be scrutinised. We can come up with all kinds of "common sense" ideas about what might happen to explain this, and they're all nothing more than wild guesses.

Common sense informs what hypothesis to test and what axioms to accept.

Putting common sense aside, a 25X lower likelihood of shooting unarmed black suspects in the experiment suggests massive bias in favor of black suspects.

Assuming it suggests bias in favor of black suspects is assuming a hell of a lot about the accuracy of the simulation relative to real life and whether or not it captures bias or peoples beliefs about how they are expected to act or changes to e.g. fear levels, that are not supported (it's also not contradicted - there's as far as I can tell no data either way) by the experiment in question.

All it tells us in isolation is that this is how a set of people in current society acts in a simulation of that kind. It does not tell us why, and trying to draw conclusions about why without further experiments is irresponsible.

The experiment would have to be flawed to an absurd degree for the findings to not be an indication of bias in favor of black suspects.

Even multiple minor/medium sized flaws in the experimental design that produce black favoritism not reflected in real world behavior wouldn't in the aggregate account for producing a 25 times exaggeration of bias.

The bias is undoubtedly there.

> It would simply be inconceivable that the officer who shot Daniel Shaver to death would have been acquitted had Shaver been black instead of white

Why is that inconceivable? The officers in the Breonna Taylor shooting weren't even charged. At least this officer went to trial and was found not guilty by a jury of his peers.

Because there is a video of Shaver crying for 2 minutes, while displaying zero defiance and total willingness to cooperate, before the officers shot him.

I cannot even imagine the kind of nation-wide riots that scenario would generate as the video of the shooting, which would be attributed to racial bias, circulated on social media.

That doesn't at all square with the actual data we have though. Why look at a "controlled experiment" instead of a wealth of real-life data?

The real life data we have is not obviously indicative of racism. Men are more than 10X more likely to be shot by police than women. Asians are less likely to be shot by police than whites. This doesn't prove police are sexist against men, or racially biased in favor of Asians.

I was detained 3x last summer in political retaliation under Iowa Code 229. Sheriff deputy takes you to the designated facility.

County hospitals are rife with abuse. Unjust detainments get billed to Medicaid for $$$.

Wow. Is there any place you’ve written about your experiences in detail?

Sounds like you have a story that needs to be told.

Arguing that psych facilities aren’t confining people who shouldn’t be because they’re over-full seems to be a contradiction.

Perhaps they’re over-full because...

> Most psych facilities are over-enrolled and have no interest in keeping people around

Seems you didn't read the linked buzzfeednews article.

If you read it you'll notice that many hospitals work fine -- but there's one particular psych facility company that abuses the system, Universal Health Services, or UHS.

No need to make accusations. It's just that the problem the article describes is with UHS, not with taking police out of the response to mental health issues and homelessness.

Observation != Accusation ?

Anyway yes I think / agree with you that the buzzfeednews article is ... off topic? Maybe it'd been better in its own discussion.

And sounds like a really good thing they're doing, sending health care workers instead of police

That is fiction. I recall my psychology 101 professor hating it because it makes it harder to use electro-shock treatment even though it works...

I'm not able to evaluate either side of it, but one side has a phd in the area.

Very well said!

It's not that avoiding an arrest or other police involvement isn't an improvement. It is. But it's easy to assume anyone committed to a psychiatric facility ought to be rehabilitated to society. Often you could just as justifiably argue the other way around.

What's the other way around? I'm having difficulty parsing what you mean.

I could be wrong, but I believe this is what the parent is saying: a) that people assume anyone committed to a mental institution should be rehabilitated and b) one could argue that this assumption is often false and that they shouldn't be rehabilitated.

It sounds like they're saying that if someone is committed to a mental institution, rehabilitation could be a bad idea because it's just as likely that they're not fit for society.

note: not agreeing with the above points, simply trying to interpret them.

> It sounds like they're saying that if someone is committed to a mental institution, rehabilitation could be a bad idea because it's just as likely that they're not fit for society.

I'm saying if we make unexamined assumptions about who's "fit for society" it's easy to sacrifice non-normative people on the alter of social harmony.

What is viewed as requiring rehabilitation can reflect neuroses endemic to the broader cultural context, not merely or necessarily the dysfunction of the institutionalized individual. It's a two-way mirror.

Except then they're not going to be released on account of demonstratably being an ongoing risk to society.

Of course this concern runs exactly contra to the "medical authoritarian" one further up. Frankly, which is it that means a successful program as the article notes shouldn't be continued?

That the social body might learn to accommodate some ways of being which defy initial expectations, rather than altering individuals to conform to rigid norms.

When certain behaviors are thought worthy of institutionalization, it may reflect a narrowness of heart and mind in the majority rather than a social danger.

The article is not about committing people to a psychiatric facility. That's a strawman.

Article isn't, but parent comment is. With respect, I didn't strawman anyone.

> No one is talking about the very big risk associated with this, that mental health professionals can commit you against your will with no trial

Increasing cop presence won't fix that problem. In multiple jurisdictions, cops can also refer you to be involuntarily committed.

So we're not creating an extra judicial system that has no checks and balances, that system already exists and cops are a part of it. We're talking about the potential benefits of removing one harmful part of the equation. If you want to also talk about the negatives of involuntary commitment and make progress in that area, that's totally worth examining as well, but it's not an argument for flooding the streets with more cops.

Getting arrested doesn't mean you can't be involuntarily committed afterwards.

Also note that in some cases, getting arrested and thrown in a holding cell can on its own be just as traumatic of an event as being held for an involuntary mental evaluation -- particularly if someone is genuinely suffering from a mental attack. And arrests don't require trials either. A sizable portion of the people in our jails have never been convicted of crimes, they're just stuck there because they can't pay cash bail.

> If you send a mental health professional to all sorts of situations, their solutions will be mental health related

Can you even say that with a straight face? Do you really think if these guys got sent to a robbery, they'd be all "the thief obviously needs Xanax!" instead of saying "This ain't one of ours, send a cop here please".

Cops have, for whatever reason, ended top being sent not just to criminal justice related incidents, but everything else as well, including mental health related incidents which they're manifestly untrained for and incapable of dealing with. But they "deal" in those situations anyway, in ways we're all tired of seeing from body cam footage and in the live crosses of news stories about police violence protests.

> One of these has a long history of strong checks and balances and improving itself over time

And yet "Some of those who work forces, are the same who burn crosses" is just as heavily quoted and relevant to 2021/01/06 as it was when it was written over 20 years ago... I do not agree with your claims about the relative track records of the two groups involved here.

Because there are a lot of cops, and they are on-call at all hours, they need training in all emergency situations.

That means they need to know enough first aid to deal with a heart attack until the EMTs get there. Likewise they should have enough psychology training to deal with the mentally ill until the experts can take over.

This is not reasonable. Everybody should know enough first aid to deal with a heart attack until EMTs get there. It's not that hard, the course only takes a couple of long days. Dealing with every variety of mental illness is orders of magnitude harder. Social workers have master's degrees, not a certificate from a 2-day course.

Just let cops figure out how to do their regular jobs right, rather than making them the first responders to an embarrassingly terrible social safety net.

We don't have a choice, cops will be first on the scene. If nothing else because until they arrive nobody even knows to call in someone else.

The police have more complete first aid kits than the average person, including such things as an AED. They also get a bit more than your standard firstly aid course.

>One of these has a long history of strong checks and balances and improving itself over time.

Sorry, it's hard to take you seriously if you make such a statement. It betrays serious ignorance of the background for why they started sending health care professionals over officers.

> Difference is, if your only tool is a hammer, everything is a nail.

Seems this program has a hammer and a screw driver for nails and screws.

> Can you guess which one is now being touted as the "new solution for all our societal ills" despite having no track record of actually being able to fix any of these ills?

Hyperbolic, no? One can certainly find people shouting from the halls on any issue. Doesn’t every startup need time and opportunity to create a track record.

> primarily fueled by giant corporate lobbies who spend a lot on every single political campaign (read: Big Pharma).

I wouldn’t be surprised if police unions and big pharma are within the same order of magnitude in political lobbying.

A couple of problems:

1. You have a pretty high opinion of our police if you think that police unions, donations, and endorsements don't have effects on political campaigns, that towns don't use both police fines and public prisons as a revenue source, and that the criminal justice system can't have comparably (or even greater) negative effects as involuntary mental health interventions.

2. You have a pretty low opinion of our current medical industry if you think that it hasn't improved itself over time. Our country used to lobotomize people and commit them for being gay. Things can and do get better over time. That doesn't mean there aren't still problems, there definitely are, but even in just my lifetime, the way the medical profession approaches mental illness has gotten much, much better. Absent some kind of better data, I am skeptical of the claim that our medical industry's problems are being solved significantly slower than our (also numerous) criminal justice problems.

3. It's possible that this will lead to more medical involvement, but I would be cautious about making strong claims about how much that will be the case and what changes that will have in people's outcomes. It's important to remember that prison is really bad. As just one example, being convicted of a felony removes 13th amendment protections, which is regularly exploited for both private and state revenue -- even in public prisons! What data do we have that indicates that mental interventions will increase at a drastic rate because of this, and what data do we have that says that involuntary incarceration is worse than our current prison system?

4. Denver hasn't gotten rid of its police, it's merely changed how it's using them and how quickly they respond to problems. So it's not that the only tool is a hammer, police officers can still respond to situations. I think it's early to jump to the conclusion that the city is going to start thinking that involuntary mental interventions are the only tool at its disposal. I don't see strong data that backs that conclusion up; in fact 35% of the calls to the STAR program came from police officers. Another way of looking at the data might just as plausibly be that the city was treating police officers as its only tool, and now it's striking a better balance and realizing that arrests weren't the only way to deal with every problem. That's the kind of thing that'll get revealed one way or another as we get more data.

----

> despite having no track record of actually being able to fix any of these ills?

Finally, again, just an unrelated side note, but I know people who are extremely grateful to both psychological therapy and psychiatric help in managing conditions. If you're struggling with this, you don't need to do it alone. Professionals can help. The idea that the only thing a psychiatrist is ever going to do is turn you into a zombie with drugs is bullcrap. And it also ignores that non-psychiatrist interventions don't always need to involve drugs. Cognitive behavioral therapy can have amazing outcomes.

I get that you don't have a high opinion of psychologists or psychiatrists, but they do help people. I just want to make that point very clear.

Have you even read the article? This does not send psychiatrists or doctors but social workers with mental health education.

I don't know about the US, but I highly doubt that these people would have the authority to involuntarily commit someone. Apart from the fact that you have yet to demonstrate that increased health workers lead to increase involuntary commitment, as if that's the only thing psychiatrists etc do.

It's also ironic that you somehow think that sending someone whose only tool is a gun (I know this is somewhat over the top, but much less so then saying involuntary commitment is the only tool of mental health professionals) is the better solution.

The suicide rate has been steadily increasing since 2000. The effectiveness of the mental health profession is falling at an alarming rate: https://www.macrotrends.net/countries/USA/united-states/suic...

The former does not implicate the latter. Total non sequitur.

The suicide rate measures death from mental illness. The death rate from mental illness has been steadily increasing. Therefore we are doing a bad job at treating and preventing mental illness. What other statistic would you like to use to measure how good of a job the mental health profession is doing? There have been several prominent speeches from professionals in the field who don't handwave away problems talking about the need for more analysis of what's gone wrong.

Literally every individual thing you wrote is wrong.

1. Suicide rate doesn’t “measure death from mental illness.”

2. The suicide rate isn’t “the death rate from mental illness.” (See #1)

3. What do you even mean by “we are doing a bad job”? Who is “we” there? Also, this “conclusion” you’re drawing is supported only by nonsense predicates (see #1 & #2).

4. The “mental health profession” isn’t responsible for moderating the suicide rate. Also literally every mention you make of “mental health profession” is fallacious because the suicide rate is not an actual metric for evaluating the efficacy of the “mental health profession”, so even addressing anything you’re saying about “measuring how good of a job the mental health profession is doing” would be legitimizing a nonsensical claim. This one covers how pretty much everything else you wrote here is wrong.

You just say the first proposition is false without any reasoning to back up why and without providing any better alternative. You're sticking your head in the sand and trying to ignore the problem by saying ignorance is better than any empirical approach to measuring the quality of the mental health profession.

It seems, by failing to provide any alternative, that you're saying that it is impossible to measure the effectiveness of the mental health profession as a whole? This decline is similar to how the economics profession has concluded that it is impossible to measure the success of any economic policy vs. any other because of all the confounding factors as Paul Romer has commented on extensively. This leads to methodological poverty. You can make up whatever policy or treatment you want. It's as good as any other whether it causes people to kill themselves at a higher rate or not or leads to lower or higher economic performance. It's all the same without metrics.

You’re ignoring the material conditions of people since 2000. The steady decline of that is more likely to do with suicide rates than failures of psychiatry.

While it might be valid to frame suicide as death from mental illness, how can you say that the death rate from mental illness has been increasing when we don't even really know the size of the population with mental illness. A lot of mental illness goes unrecognized.

I would argue that the problem is in recognizing mental illness and connecting those affected to the appropriate mental health professionals.

> If you send a cop, their solutions will involve the criminal justice system (citation, fines, arrest, jail time, etc...).

Shooting people. Choking them to death. Pinning them down till they freeze. I'll take my chances with mental health professionals, thanks.

There are more ways to harm a life than there are guns in the world. Just because a health professional gets a diploma and makes a promise doesn’t mean that worker will take good care of you or your loved one. There are plenty of cases all around the world where some health professionals killed tens of innocent people.

https://en.m.wikipedia.org/wiki/Niels_Högel

https://en.m.wikipedia.org/wiki/Charles_Cullen

>> His final victim said that a "sneaky male nurse" had injected her as she slept, but family members and healthcare providers at the hospital dismissed her comments as unfounded.

>There are plenty of cases all around the world where some health professionals killed tens of innocent people.

But this article is about US doctors vs US cops. And US doctors murder at a far lower rate. The argument isn't that doctors are perfect. The argument is that they are better than cops.

Health professionals are no different than cops or any other worker. There are good and bad professionals working in pretty much any domain. Good luck generalizing and classifying people into groups. That has always worked great throughout human history.

Hard to say. Not all doctors are saints

https://en.m.wikipedia.org/wiki/Harold_Shipman

> If you send a mental health professional to all sorts of situations, their solutions will be mental health related (medication, treatment, commitment, etc...).

> If you send a cop, their solutions will involve the criminal justice system (citation, fines, arrest, jail time, etc...).

The fact you list both of these out then say policing is the one with a "long history of strong checks and balances" (what does this even mean?) is appalling. It reads like authoritarian propaganda.

You're taking the classist and racist position, that force employed by agents of the state should be deployed against the poor & otherwise marginalized to prevent them from being a "burden to society." Also that employing people who are tasked with _helping_ instead of _enforcing laws_ should NOT be allowed to do that.

To be clear, you're not really making any falsifiable claims. It's just an endless appeal to emotion. "a long history of strong checks and balances and improving itself over time" is a bold claim about municipal agencies with their own regulations, city, and state laws to adhere to. Not to mention different missions, run by different organizations with different lines of reporting. Totally different cultures, etc. It's so vague but that's the beauty of it: you can make it mean whatever you want under scrutiny.

This is a miserable top comment. I also have a low opinion of the field of psychology, but cops can have you committed (and do) by bringing you to be evaluated by mental health professionals. Medical professionals can't shoot you.

There's nothing in the article about creating a shadow mental health justice system. What they have is a van containing blankets and food, driven by two social workers.

omg thank you, voice of reason.

No disrespect intended to parent posters (i appreciate them sharing their anecdotal experience), but def sobering to see that at the top, and realize "oh, this is the common view of hivemind i'm participating in"

I have this vague hope that maybe the 'top comment' position is also based on number of replies, not necessarily upvotes, but then... the discussion itself is pretty sobering. The current program cost relative pennies, proved to be effective at both helping people and freeing up police workers to focus on crime/traffic-related issues. More effective use of city tax $$$$ through targeted spending of $. Seems like a win win win. Anyway, I agree with this particular branch of the discussion-tree.

The FAQ doesn't have a specific entry about comment rankings, but I'd guess it's based off a similar system as the Stories rankings:

"How are stories ranked?

The basic algorithm divides points by a power of the time since a story was submitted. Comments in threads are ranked the same way.

Other factors affecting rank include user flags, anti-abuse software, software which demotes overheated discussions, account or site weighting, and moderator action."

HackerNews is a pretty miserable place when it comes to social issues.

> (i appreciate them sharing their anecdotal experience)

(I don't. This whole subthread can be dismissed by recalling that "the plural of anecdote is not data.")

It's very surprising to me how a personal anecdote is used to argue against any kind of social service, no matter how benign and that arresting these people will somehow be better.

Uh, citation needed? Getting committed 'because their insurance was good' is likely not an issue here, as ~70% of the interventions were with homeless people.

Here's the actual report: https://wp-denverite.s3.amazonaws.com/wp-content/uploads/sit...

"[T]he STAR van provided transportation to 41% of its calls for service where an individual's information was recorded. Of those incidents (107), the most common locations were a shelter or homeless services (30), the walk-in crisis center (24), or a hospital (18)."

It's unclear how many of these would involve an involuntary commit, and similarly unclear how the outcome would compare to a police encounter, which often comes with its own special brand of involuntary commit. One of the report recommendations is to create a longitudinal study to assess outcomes.

> No one is talking about the very big risk associated with this, that mental health professionals can commit you against your will with no trial,

We've had a program like this for years here in Eugene Oregon. It's called CAHOOTS.

One of the cornerstones of the program is it's all voluntary. There is no use of force, no dragging people off anywhere. People show up with a van and some basic medical supplies and help people. If the people don't want help and the only alternative is some form of restraint, they call the police.

They almost never end up calling the police because most people just want a little help and a patient person talking to them gets it done.

The fact that these people never themselves do anything against people's will is what makes this work so well.

That sounds awesome. Thanks for sharing.

I've posted this link elsewhere in this thread, but there are some details here: https://www.msn.com/en-us/news/us/this-town-of-170000-replac...

Is the risk alone a "very big" risk? Or are you saying the difference in risk of this happening with a cop vs. a medical person is a "very big" difference? Are cops not also able to commit someone involuntarily? Why are you talking about objective "very big risk" without comparing it to the current situation and what is different about this?

I did a google search for "can a police officer commit someone to a mental ward" and this is the first result, from harvard: https://blog.petrieflom.law.harvard.edu/2014/11/25/short-ter....

This says that a police officer is also able to commit someone in most jurisdictions. Why didn't you also mention this fact?

FUD

I'd rather take my chances with a medical person than an amped-up dude carrying a firearm with basically no chance of getting fired (let alone imprisoned) if he shoots me.

This is what I was looking for or I was going to post myself.

Why is the risk of being involuntarily committed so much greater than having a cop do the same. Or a cop just throwing you in jail? The anecdotes of peoples loved ones being 'committed and only getting released when the money runs dry', seems far more preferable than their loved ones being thrown in jail and released when they can pay the bond. Or sit in jail and wait for a judge.

>being thrown in jail and released when they can pay the bond. Or sit in jail and wait for a judge.

Or shot to death on site because the cop doesn't have (enough?) training to deal with a mental health episode without resorting to violence.

You do realize that jails (not prisons) already house people quite long due to various dubiously legal reasons?

Also that we got rid of most asylums so the risk of being committed is quite low by the pigeonhole principle?

The risk is of a judicial system without checks and balances.

When most people can't afford to go to trial (both financially, and because they'd be insane to not take a plea), the checks and balances of the judiciary are, in practice, only available to a privileged few.

When you piss off a cop, get arrested, and are released a few days later, without any charges, you also have exactly zero recourse through those checks and balances.

When you piss off a cop, and he brutalizes you, you may get some recourse (through a lawsuit, unlikely as your case may be), but it does not serve as a deterrent to subsequent police misbehaviour. (As we have seen over the past summer.)

People sue for unlawful arrest and bad police behavior and win all the time. Check out this YouTube channel dedicated to covering just that... https://youtube.com/c/AuditTheAudit

The bar that needs to be met for proving that you were subjected to an 'unlawful arrest' is so incredibly high, it's farcical. Ten times out of ten, you're better off moving on with your life, and forgetting it ever happened.

Are there a lot of minimum wage, single parent type people that do that?

As an upper-middle-class office worker with flexible hours and cash to spare, even pursuing a small-claims case was a major PITA for me. Took a ton of time, effort, and money.

Which existed even when cops were the ones making the arrests.

I'm not sure this point is relevant unless you're implying that because the system is imperfect we should introduce more systems in place that can be just as easily imperfect in the same ways.

The point is that we aren't introducing a new system at all. The system of people being involuntarily committed without a trial already exists.

Nonsense. Since nothing can be perfect then we shall never change anything. Makes sense?

The point though is that change is useless unless it’s change in a good direction. If something is going to be changed, it should be shown to be better in some way.

An article I read recently noted that there were zero arrests in 6 months of health care professionals replacing police officers.

No one would claim that the existing system is perfect, but there is a great deal of difference between the assessment of a physician or magistrate and trial by a jury of one's peers. A jury of twelve is standard; I know of no requirement that twelve physicians deem someone a threat to himself or others. Furthermore, there are stronger protections for habeas corpus than there are for people involuntarily committed. Those who are accused are guaranteed a lawyer; those who are committed have no right to an advocate, which is doubly bad considering that they are often drugged in ways that dull their mental faculties.

The great majority of cases don't go to trial. Instead people are threatened with punishments vastly disproportionate to their purported crimes, and thereby intimidated in to pleading guilty irrespective of their guilt. Defendants without the financial/social resources to mount a solid defense don’t want to take their chances when faced with a 20 year prison term or whatever, not to mention a slow process that leaves their life in limbo for months or years even if they do eventually prevail. A NYT story a few years ago claimed 97% of federal cases and 94% of state cases end via plea bargain.

For those who do go to trial, the right to a lawyer is often pretty weak support. Public defenders are grossly underfunded and overworked, and there is no guarantee that they will be competent or committed to the case.

Going to add to this.

A jury of ones 'peers' is rarely the case either. Yes, they are citizens, but they are rarely of the same background, ethnicity, or social status. They are hand selected by lawyers to remove people that might be sympathetic to your plight.

I've never heard that jurors are the best and brightest among us. Often the highly educated and analytical are removed from jury pool.

That's exactly what a jail is.

Police suspects you have committed a crime, holds you in jail until trial or until you pay bail and may never end up releasing you even if you are innocent.

What’s the difference between a jail and a psych ward again? When I was in one it was functionally indistinguishable from a jail.

There are a large number of people who take a plea just because they can't afford the bail and it would take a year or two to get to trial. Or because lawyers are expensive and it's cheaper to plead guilty than to defend your innocence.

I've recently had an issue with an incompetent trooper (1 successful complaint and one pending) and incompetent magistrate (complaint pending). It will cost between $100 (win) and $650 (lose) to go through the legal process and defend our innocence. It's been more than 6 months too. All this is over "leash law" violation. But it's great to see both the trooper and magistrate commit civil rights violations, and have the civil rights lawyer tell you that they are violations but that the system doesn't care unless you suffer serious financial damages. So much for a justice system.

I once had a cop issue me a moving violation for Jay walking. So I understand that there can be pettiness from certain cops.

But that's a far cry from a cop being violent against someone or killing someone wrongfully. The justice system also acknowledges it cannot right every wrong, but hopefully when there's a major wrong it should be able to right it every time.

I don't believe there's any room for misconduct or gross incompetence. It's one thing to not be able to fix every wrong, it's another when the system itself creates those wrongs.

If you have a trooper lying to a judge or continuing to hold a charge against you they know is false, they should be fired.

If a magistrate doesn't know the basics of the law (like due process and dismissing with prejudice), then how can they be qualified to rule on it?

Some judges are elected; they could easily be grossly unqualified.

Not only are magistrates elected in my state, but they aren't required to have a law degree nor pass the bar. They take a short training course and test. In this case the original magistrate was arrested for gambling with campaign money, perjury, etc. The second magistrate was a retired cop and former police chief. Needless to say he was hostile to the defense the entire time while not questioning anything the trooper said, even stuff that was blatantly false.

Just because it is a far cry from direct violence or murder doesn't mean that it shouldn't be taken care of. You can harass folks with "minor" civil rights violations and make life hell for someone. I'd argue that being lenient on "minor" civil rights makes the violent ones more likely because of the lenience towards other ones.

If you want to be in law enforcement, don't commit civil rights violations. Period. You might not be able to right every wrong, but once a wrong comes to light, you can very well do something about it.

This claim disregards those who take a plea deal because they believe they cannot win a federal criminal case, which is a superset of those who are actually innocent of their accused crimes.

Yeah. Oddly enough, the aforementioned “97%” stat brought me to an Innocence Project page[1] which leads with:

> In nearly 11% of the nation’s 349 DNA exoneration cases, innocent people entered guilty pleas.

Obviously a small and biased sample group, but guilty plea ≠ guilty.

[1] https://innocenceproject.org/guilty-plea-campaign-announceme... (2017)

> No one is talking about the very big risk associated with this, that mental health professionals can commit you against your will with no trial

Police can arrest you and hold you against your will with no trial, for a limited period of time (e.g., 48 hours excluding Sundays and holidays is a common tule, IIRC), on the premise that it is pending charges for criminal behavior (which may or may not be filed.)

Mental health professionals (and, in many jurisdictions, law enforcement officers and others, too, can initiate this) can hold you against your will and with no trial, on the premise that it is for emergency psychiatric evaluation, for a limited time (72 hours is common.)

Further involuntary detention, in either case, requires judicial process.

I'm not seeing a particular additional danger here.

> No one is talking about the very big risk associated with this, that mental health professionals can commit you against your will with no trial, which is an erosion of civil liberties (incarceration without trial). Having known several friends who got committed and held against their will in psych wards when there was no good reason to, because their insurance was good, this is an issue.

In California, this doesn't seem to be true. I got to see this in action from the sidelines. Within 24 hours of being committed, the patient will have an advocate appointed for them and within 72 hours the patient will be released unless the health team can put up justifications that pass the advocate AND then judicial scrutiny. The doctors can kick up a fuss, but 7 days is the limit before it MUST pass a judge.

I got to watch this in action, and the advocate was MUCH more aggressive on behalf of the patient than if the same person had been arrested and was relying on a public defender.

The police have the authority to place a person on a 48 hour medical hold, and will threaten to use that authority if you don't do what they tell you. They'll use it for something like a person who passes out not wanting to go to the hospital, even if they are with a friend who can take care of them if there is really an issue. I'd probably trust this crew in Denver more than I would a random police officer in making that assessment.

Absolutely, I don't think the level of experience or training with mental health issues is consistent among police. Innocent people have died because of officers refusal to commit an individual that was having a mental health crisis. I think a team like this (with police present to execute a 5150) would have been successful in this instance.

https://www.10news.com/news/team-10/body-camera-video-shows-...

Maybe the 3-4 people in Denver are fine. The issues come with scaling this up nation wide to where you have tens of thousands of variously trained "health professionals" where outcomes will not necessarily match what you're seeing in a pilot where they obviously handpicked competent people to run it...

We already have this in the form of child protective services. Social workers are plentiful and paid quite poorly for a degreed professional. Cops with GEDs and social workers with bachelors degrees make very comparable salaries. For an extra 5 grand or so you can get one with a masters degree. So there's no sane reason to hire variously trained "health professionals" with scare quotes. The really tough part is getting tens of thousands of independent, ossified bureaucracies onboard with the idea of and giving up/redirecting some of their responsibilities/power/budget.

Simply require a healthy percentage of staff be program successes. People who have been there and have come back.

Those people will know how this all needs to work in order to do the healthy, hard, very human work required.

They know stuff, hard earned, rough miles type stuff, that is both necessary and not taught effectively in any school other than when the bell rings at the fine school of hard knocks.

Naysayers should work at, or observe one of these programs in action before coming to conclusions. I have this experience and know those people and what they can do. Think of them as the immune system to defend against the potential disease discussed above.

It varies by state. In California, it’s essentially impossible to commit someone (source: I tried and failed, despite written permission from the person pre-episode, the blessing of their doctor, and the blessing of their family, multiple police reports from third parties, a divorce, eviction, repos, etc, etc.)

In CA if you do somehow manage to maliciously commit someone, they’re held for up to 24 hours, and an independent doctor assesses them. Also, there can be civil penalties (as in the article you cite, where the victim successfully sued the hospital).

If I had to choose between the two ridiculous extremes, I’d choose the Texas model.

I was going to come to say something similar. At least in CA or the part I am in (very liberal) getting someone committed for a longer period (3 months + etc) - I think may be pretty much impossible? This can be despite a whole host of criminal and self harming behavior. Pre pandemic I think it was probably easier to get folks in at least for a few days at a time to jail pending disposition of whatever the latest case was - which was time enough to fix locks / windows / doors etc or move.

In Michigan you can petition that someone be involuntarily committed for treatment and then they get a hearing in front of a judge. It has to happen within a few days.

(just enumerating, not particularly comparing)

Interesting. I wonder if that requires a lawyer or not. (Legal fees for this sort of thing are exorbitant in California, and the cases tend to be a stretch.)

It’s an odd (broken?) process if the judge would ascertain the person’s mental health. Hopefully, most judges would call in professionals.

The prosecutor brings it before the judge. There is testimony, the judge isn't directly doing the mental health assessment.

Typically a social worker is helping the petitioner figure it out.

https://courts.michigan.gov/administration/scao/forms/courtf...

Do you live in an area with high homeless rates? As in, "there's a homeless camp of tents consuming multiple city blocks"-level of homelessness?

It's horrible for everyone in the city--most of all for the homeless.

These people suffer from mental health or drug issues and need help. The status quo of "leave them to fend for themselves" is simply an unacceptable outcome.

The system launched by the DPD may not be perfect, but it's a whole lot better than what existed before. It's a huge step in the right direction.

People need to remember that perfection is the enemy. Better to step forward in the right direction now than be paralysed by the fear it will never come to pass — obviously, the latter is a self fulfilling prophecy.

> People need to remember that perfection is the enemy.

Yeah I'm getting real sick of the stance that if something only fixes 80% of a problem and doesn't perfectly resolve every issue every person might ever encounter, it is a failure and should never be implemented.

If it is not causing more harm, and especially if there is a way to address unforeseen harm that might arise, awesome! Let's give it a go.

Because sending armed officers out to deal with any little thing that happens is demonstrably not working well right now.

Yeah, there seems to be a real sense that we are scared to try anything or do anything anymore and an army of people ready to bite off the head of anyone who does.

A lot of interventions have "disparate impact" - we had that locally - so a big outcry. So yeah, "trying things" can be somewhat high risk. I think some police departments are trying to be proactive by reducing overall contacts (ie, don't pull folks over for things like missing plates / bad registrations etc, delay or avoid responding to certain other erratic behavior type calls).

It has a name https://en.wikipedia.org/wiki/Nirvana_fallacy and it seems to be surprisingly common among developers.

TIL. Thanks.

I really want this phenomenon explained.

Slippery slope fallacies, concern trolling, whataboutism, pearl clutching, feinting spells, Copenhagen Effect (blame anyone who tries to help for the original problem), Alistair Cockburn's wisdom about organizational change (tldr: people really, really hate change, of any kind, for any reason).

Ad nauseatingum.

It's exhausting.

Can you share any link regarding Copenhagen Effect? Thanks

Forgive me; I again biffed the name.

The Copenhagen Interpretation of Ethics

https://blog.jaibot.com/the-copenhagen-interpretation-of-eth... https://news.ycombinator.com/item?id=10367855 https://www.reddit.com/r/slatestarcodex/comments/7qxhqs/is_i...

I’m starting to feel like this perfect or nothing attitude is a massive amplifier of the problems we’re facing.

“God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”

We’re way out of balance. Lot’s of courage, less wisdom, no serenity.

There is a lot of evidence that housing the homeless is not only more humane, it's also smart economics. By the time you sum up all the costs of homelessness, it's a pretty nasty toll.

The biggest actual expense is the massive medical bills from exposure and neglect. Police and ambulance services are likely a close second, chasing around town and dealing with random mentally ill people in dire straits.

The other costs are less obvious. As homeless clutter your public spaces, your city starts to rot. Parks become open areas of blight as the homeless overwhelm them and destroy the services they offer. This means much of the money your city invests in parks and public spaces ends up going to waste. Unless you spend more money on police.

The final big expense is clean up and sanitation... unless your city doesn't clean up after homeless people in which case you just end up with actual shit in alleys on big piles of garbage on street corners.

Putting up housing isn't a perfect solution, but it certainly eliminates some significant parts of that.

Universal housing like SLC is doing is cheaper, more humane, and lightyears more effective.

Policy wise, proactive beats reactive, prevention beats treatment.

--

PS- I just cleaned up after an encampment. After the city cleaned. 20 used needles (mostly insulin) and dozens of other sharps, human waste, soiled diapers, everything else you can imagine. I'm just so pissed off. No one should have to live like that. Just put people in homes. Safe, clean, access to services. Even triage with microhouses along with honeybuckets and potable water would be better.

> Universal housing like SLC is doing is cheaper, more humane, and lightyears more effective.

I read about that program and it sounds amazing.

Decent public housing is pretty common in Europe as well.

I forgot to mention one major cost savings for a city. It is much easier for someone housed to get a job and recover financially than a homeless person.

> It's horrible for everyone in the city--most of all for the homeless.

Have you worked with the homeless? Yes there is a lot of mental illness, but there is a large number of people who choose to live this way.

>Have you worked with the homeless? Yes there is a lot of mental illness, but there is a large number of people who choose to live this way.

Having been homeless myself many years ago, I can tell you from experience that not having money to pay rent or anyone to take you in is the reason people "choose" to be homeless.

And once you are homeless, it's very difficult to work yourself out of it, for many reasons.

I assume you haven't considered that it's very hard to keep (or even get) a job if you have no place to bathe or store your stuff while you're working.

I've worked in shelters and offered people food and a place to get cleaned up and they decline.

I grant you many are not like this and perhaps you're more knowledgable with your first hand experience. I know I personally, also from trying to offer people shelters or even free room-and-board, they don't take it. I don't know why in all cases, but many wanted to do things "their own way". I find it commendable and I respect those who choose to refuse handouts.

That's my point, they may not choose to be in that situation. However, forcefully detaining them for "mental illness" for not wanting "assistance" is a different discussion.

Some shelters are pretty horrible. Sometimes, folks just don't want the shelter's help.

Horrible, as in: you can't stay here if you are a male with children. A female with children will have a curfew and need special permission if they happen to have part-time work that keeps them out after curfew. The children's father can't visit because it is technically for abused women. You can't make sure your medications are safe and you might not keep your belongings. You might be forced to go to AA meetings, church services, or to work in the thrift store. You might be turned away if you are trans or gay - I'm not sure that is supposed to happen legally, but it does nonetheless.

We should house folks, period. In actual housing. Shelters should always be a very, very temporary solution.

If you still get folks that insist on living on the street even though they have basically free housing, then surely, we can do better and create spaces for folks to live. You know, with showers and toilets available for use.

>That's my point, they may not choose to be in that situation. However, forcefully detaining them for "mental illness" for not wanting "assistance" is a different discussion.

Who suggested that anyone was doing that?

That's a rather bold assertion -- can you cite any statistics or surveys?

In some limited sense, they may "choose" homelessness over poor shelter conditions or unaffordable housing, but that can hardly be considered a choice.

>but there is a large number of people who choose to live this way.

Well, if they aren't mentally ill and thus able to act rationally and it's a mass phenomenon then doesn't that point towards an underlying cause that makes it rational for a large number of people to choose homelessness?

In my observation a lot of the homeless in the camps with mental health issues are on medication or have been through mental health facilities several times and it just made things worse for them

Source: working on the streets of Seattle a couple years ago every weekend.

My own belief is that there isn't a single simple issue, but rather a web of many simple things that have complex interactions.

Nearly all of those are political issues though. Technology can help with better communications and tools for debunking falsehoods in those communications.

It might also eventually help with strong AI that's smarter and better than humans at offering a set of solutions and then letting people debate the ones that we agree are also emotionally the correct answers.

If you think cops can’t commit you against your will I surely hope you never come up against their guns and nearly total lack of accountability.

Exactly, the people who will be committed against their will would still be committed against their will if police respond. I know this for a fact because the one guy I know who encountered police during a mental health episode ended up commitment.

The difference here is taking away the addition of police to the incidents. No handcuffs or jail holdings, no being roughed up or killed.

Hopefully the mental health person knows how to de-escalate the situation - I think this is huge. I think the friend I mentioned above could have avoided impatient treatment if he had a qualified mental health person respond instead of the police, due to the situation around his incident/arrest.

This just isn't a good faith argument.

This is the exact problem with that argument. Healthcare workers can commit you against your will just as police officers can as well.

Right. So the improvement is that health care workers who are actually qualified to make that determination show up and don’t escalate the situation with violence or legal trouble. That’s a whole lot of improvement. And sounds like very little downside since the risk associated is identical otherwise.

A cop in Seattle was found to have involuntarily committed multiple people because he had a crush on the EMT who had to come transport them. I don't think keeping police involved is going to improve any of the things you care about.

Police officers can end your life against your will with no trial, so I see anything being an improvement over that.

Anybody can do that regardless of their profession.

Yes but arresting the murderer is a far more difficult problem if he is a cop.

Civilians can end your life "without trial" if its in the right circumstance just like a police officer can. These are the the rules the courts put into place. And just to be clear I have no issue with self defense. A reminder we are not talking about police doing things against the law or if they get away with it more often.

Civilians aren't universally armed with firearms and both formal and informal legal immunity. They aren't called upon to put an end tension situations.

If the worst a health professional can do is commit you to a mental institution, it's still likely to be an improvement over being shot to death.

you have a vanishingly small chance of being killed by a police officer if you are unarmed. this is on the order of tens every year in a country of 300m+ people.

I'm not sure what the proportion of citizens armed with firearms has to do with this. Its about rights of citizens in the country, all of whom can defend themselves and end life without trial in the correct circumstance, being self-defence (as it should be).

And nobody in the country should have the right to detain you without trial. If you really believe this I'm afraid that is quite short sighted.

No, I’m just saying that, given two poor choices, I’d rather not have firearms in the equation.

But police do have the right to detain you without trial. For years, sometimes - see Kalief Browder.

I understand the media loves to hype these things when they happen, and they are all tragic incidents, but when you take a look at how often that actually happens compared to other things that can end your life, you realize it's really not actually that big a problem, compared to say... Murders or violent crime.

>Over the life course, about 1 in every 1,000 black men can expect to be killed by police.

I dunno, that sounds pretty high to me, regardless of how high other things are. https://www.pnas.org/content/116/34/16793

Pretty extreme protection measures are already in place for much less common causes, e.g. fire, drowning: https://www.iii.org/fact-statistic/facts-statistics-mortalit... (though there are obvious opposites as well, e.g. opioids)

This one's fun†, too:

https://www.washingtonpost.com/business/2019/08/08/police-sh...

"Among men of all races, ages 25 to 29, police killings are the sixth-leading cause of death, according to a study led by Frank Edwards of Rutgers University, with a total annual mortality risk of 1.8 deaths per 100,000 people. Accidental death, a category that includes automotive accidents and drug overdoses, was the biggest cause at 76.6 deaths per 100,000, and followed by suicide (26.7), other homicides (22.0), heart disease (7.0), and cancer (6.3)."

† fun == sickening

So for every man killed by police (note that this is all police killings including those of armed suspects fighting the police) there's 42 people killed in accidents, 13 people commit suicide, 11 murdered by normal people's, 3.5 that die of heart disease, and 2 that die of cancer. And this is specifically for the demographic most likely to commit violent crime: young men.

Another way of phrasing this is, "even among the gender and age group most likely to be killed by police, people are an order of magnitude more likely to die of accidents, at the hands of non-police, or by their own hand than at the hands of a police officer."

Yes? Just because other things happen more often doesn't mean something isn't an issue.

That includes violent criminals being shot out of self defense. I wonder what the stat is for murder by cops when the victim didn’t have a deadly weapon.

It says "police killings are the sixth-leading cause of death".

"Police killings" by definition includes shootouts, when they were fired at fist, seriously threatened with firearms etc.

Sure, police interaction can and should be strongly looked-at and there have been much too much unwarranted deaths by police but just attributing some cause-of-death ranking to police killings without justified/unjustified contextualization is downright misleading.

If you're aged 25-29 though, what else are you going to die of? Those 6 categories cover pretty much any way you can die except diseases.

I mean, they could just not be killed.

Those cases aren't represented in the list of top causes of death.

From your link:

> Our results show that people of color face a higher likelihood of being killed by police than do white men and women, that risk peaks in young adulthood, and that men of color face a nontrivial lifetime risk of being killed by police.

This is a problem. Whether you believe it is due to racial discrimination, societal pressures, or something else, the fact that BIPOC are being killed by police at a higher rate is a problem worth solving.

jesus fuck this place is basically becoming a white supremacist message board

Sorry you have an issue with statistical facts and that equates to "white supremacy" to you. The rest of us are not going to dodge reality because its uncomfortable to discuss.

>Dont commit over 50% of the homicides in the country despite being 13% of the population and the stats will go down.

Why do you think the statistics look like this? You must have some reason for bringing it up.

I'm confused why you are comparing risk of death to police action versus other causes. The linked research shows that of all deaths attributed to police action, people of color are extremely over-represented for their proportion of the population subject to police action. What does risk of death from other causes have to do with this conversation, and why do you think the research contradicts the results presented in the article?

I'm working off this:

>it's really not actually that big a problem, compared to say... Murders or violent crime.

It seems big enough to be "a big problem".

Taking your numbers at face value, it seems we have an inequity problem regardless of police involvement. The question becomes, why are Black people committing over 50% of homicides, and what impact does our current policing strategy have on that number?

Sure, but thats not at all the point I'm addressing and is outside the scope of this conversation.

Im not here to go deep down the rabbit hole with you on philosophy. Im just giving you the context on the numbers.

I'm not sure what the scope of the conversation is, then. The article is a report on a novel mechanism to reduce crime (novel in the US, that is). Your claim, as I understand it, is that the absolute number of excess deaths from police action in the Black population correlates with the outsized representation of the Black population in homicides, and you don't see a problem with this (please correct me if I misunderstand). I hypothesize, admittedly through leading questions, that addressing said outsized representation through means other than policing may have a beneficial effect on the overall crime rate, which seems to align with the reporting in the article. Is there something I'm missing?

> African Americans are 13% of the US population but commit over 50% of the homicides in the country

Given the source of that data (which is law enforcement agency reports), “are blamed by law enforcement for committing” would be more accurate.

So you believe that there are a significant amount of non-African-American murderers who managed to escape prosecution, and that these law enforcement agencies framed random African-Americans for murders they didn't commit? And you believe this happens across the country at rates high enough to change these numbers?

The FBI website statistics or statista as a shortcut to them.

This article has goods stats. https://quillette.com/2020/06/11/racist-police-violence-reco...

TL;DR: looking at numbers killed by police in absolute is meaningless. You also need to consider how many of these deaths occurred while the person who was killed by cops was also armed with a gun or deadly weapon. Hint: most of the people who get shot and killed by cops were trying to harm those same cops.

Except murderers and violent criminals don't have essentially legal immunity.

And this is the hyperbolic, overdramatic society we live in today, with no nuance or potential to see another side.

Qualified immunity -- qualified meaning limited. Yes it is easy to abuse and has been abused, but rest assured cops have gone to jail for murder and involuntary manslaughter.

I'd love for you to show me how many of these officers went to jail for murder: https://www.statista.com/statistics/585152/people-shot-to-de...

I'd love for you to first show me how many of those shootings were justified.

I don't think they mean qualified immunity. I think they mean juries acquitting officers, judges throwing out cases, grand juries declining to indict, and D.A.'s deciding not to bring charges.

This happens all the time for officers and not for officers. It depends on what the political agenda is of the mayor and DA. Counterexample: look at what is happening in Portland right now. The DA is flat out refusing to bring charges against criminals.

(Also for a longer history of counter examples, see what happens to people who are criminal finaceers. Spoiler alert: nothing.)

What people fail to realize time and time again is so many of our contemporary issues come down to power struggles. It all has to do with power dynamics and how one set of grifters is vying to keep it over another set.

My answer has always been limitations. Limited powers, limited government, limited terms. But happy to hear of other realistic solutions that don't resemble an anarcharist approach.

If you're in favor of limited government, why so negative about anarchy?

Because there is a qualitative difference between "limited government" and "no government"?

Never fails IME people who say they favor “limited government” really mean “government for thee, not for me.” They want laws enforced, sure, but mostly just the ones about keeping the rabble from getting in the way of the fReE mArKeT.

It’s painfully obvious to me, now, after everything, that pursuing a “limited government” requires making it harder for certain groups to vote and gerrymandering. Can’t have the rabble voting in their own welfare; that means higher tax rates on top earners —- aka “getting in the way of the fReE mArKeT” —- to pay for it.

It’s the inevitable conclusion, as we are seeing in the United States.

No, when I say "limited government" I mean just that. A government that has certain powers, but not others.

This is not just about enforcement of laws, it's about which laws are allowed to exist in the first place, and about government procedures adhering to those laws.

To give you concrete examples:

* I don't think "the government" (broadly defined) should have the power to stick some poor kid in Riker's Island for a few years while they think about getting around to trying them on a trumped-up charge.

* I feel like there is significant value in a number of protections enshrined in the US constitution (starting with the prohibition on ex post facto laws, as a pretty major one).

* I feel that asset forfeiture is a complete travesty and should never have been allowed under any sort of "limited government" approach.

That sort of thing. Of course then we have to have some debate about which powers governments should or should not have. And revisit that every so often as the situation (society, world power balance, technology) changes. But we should revisit it in a reasonable way, where everyone is clear that we are revisiting it, instead of the government just grabbing more power for itself unilaterally, whether it's through abuse of executive orders, pretending like everything is "interstate commerce", setting up secret courts, doing parallel construction, passing unconstitutional legislation and hoping no one notices, or whatever other things various governments in the US have tried over the last century or two.

This is sarcasm, right? There haven't been this many broad-as-daylight examples of "Laws for thee and not for me" than the authoritarian, wanna-be tiny-emperor governors and mayors, and representatives of a certain political ideology all across the country with their draconian, unscientific lockdowns.

> It’s painfully obvious to me, now, after everything, that pursuing a “limited government” requires making it harder for certain groups to vote and gerrymandering.

You have been reading way too much propaganda. First of all, Gerrymandering is enjoyed by each side of our ruling class. So that invalidates the rest of your nonsensical point.

uh huh

one "certain political ideology" stormed the capitol and murdered a police officer. maybe you saw it, it was led by a centaur furry right through them beating a cop to death on the steps of the capitol building. But sure, yeah, absolutely, it's the libs who are destroying america. Give me a break.

You're not a serious person. Go back to qanon or whatever new conspiracy theories you "liberatarians" are on to next.

edit: But since you're obviously struggling with a social life, I'll give you some help.

> I can't get people I am close with to even consider engaging in conversations about firmly held beliefs they have if I even remotely present myself as possibly holding a different opinion.

Yeah because you're an annoying asshole my guy. All you do is cast yourself as the victim. Gee whiz I wonder if you're a mediocre white-passing guy in tech, it's really a whole mystery. Have fun responding, I'll see you in 6 months when I check this account again.

Nancy Pelosi, Maxine Waters, et all all called for similar insurrections during their favorite completely debunked conspiracy theory that we've heard about incessantly for the last 4 years. When businesses were being burned and looted during the summer, and 24 people died, they complicity supported it, and used it as an opportunity to advanced their political talking points, and attack their political foes.

Get your head out of your own ass.

Ok so how does this risk compare to the risk of being involuntarily committed, which you say is a high risk. Moreover, how many of those are permanent like you are claiming. Put numbers behind your arguments.

This comment expressing support & encouragement for state-sanctioned violence against its citizens is authoritarian propaganda employing classist and racist tropes.

Nobody talks about how difficult it actually is to commit mentally ill people in many places.

Case in point, San Francisco, where severely mentally ill homeless people abound, many of whom who cannot look after themselves, and are left to suffer and die in the street out of respect for their civil liberties. Or those who terrorize neighborhoods for years on end, and everyone looks the other way out of respect for their civil liberties.

Civil liberties are important, but prioritizing civil liberties to an extreme, above all else, is often harmful for the individuals they’re supposedly serving.

> No one is talking about the very big risk associated with this, that mental health professionals can commit you against your will with no trial, which is an erosion of civil liberties (incarceration without trial). Having known several friends who got committed and held against their will in psych wards when there was no good reason to, because their insurance was good, this is an issue.

Do you have a citation for this being a real side effect of the type of program listed here? The program as described in this piece seems novel and this article certainly makes it sound like a success.

I know engineers and programmers like to poke holes and look for edge cases that might break any potential solution, but hopefully we can allow ourselves to celebrate the victories when we see them without letting the perfect become the enemy of the good.

What you're worried about is reasonable but it doesn't seem to have much to do with the article.

There's no mention of the mental health clinician and EMT in the van grabbing people, throwing them in the van, and hauling them off to be committed.

Instead they seem to be sympathetic listeners who can help with problems. Not solve, probably, and probably not permanently but anything that helps keep people from getting shot or locked up in jail is good.

I had a friend who was essentially committed against her will. She was never grabbed violently or thrown into a van. She was calmly told they would be committing her, then asked to strip and change into a gown, told to take the medication or it would be administered forcefully, etc...

You have a very "Hollywood" idea of how this stuff happens. Reality is a lot more insidious.

No idea what your friend went through, but that's not what this program does. The people in these programs can't commit anyone, or take them anywhere they don't want to go.

The service works much much better that way because when the van rolls up, there is no fight or flee reaction.

In these situations the Police basically have 2 options.

- Take into custody (Which could mean being committed)

- Shoot

I'll take my chances with trained health/mental health professionals who can understand "I took too much", or I'm having a mental health crisis and while I might seem "out of control" I'm really harmless. Frankly if those health professionals think I need to be committed I probably should be committed.

The police can take you into custody and commit you as well, but if you are having a mental health crisis, and can't really follow the rigid police directions more than likely it's going to end poorly, because the police will do what's necessary to take you into custody, including killing you.

If you’re high on drugs, yelling scary stuff, acting violently without technically doing anything illegal. and threatening to kill yourself, I’d restrain you myself if I could. What’s the alternative to locking you up or waiting until you hurt someone & shooting you dead? You’re out of your mind, ruining everyone’s day, and you need a timeout to get your shit together, so if you wanna act like a child with no regard for the well-being of those around you, I’d have zero problems with sending you to your room until you cool down. It just so happens your room is a padded cell at the local mental health facility.

OK, but were the other poster's friends doing any of the things you listed?

Not everyone has many friends, and if your one or two friends (literally 1 or 2) aren't there, there is no one. Your family might live out of town, too.

When my ex attempted suicide, he'd have succeeded if he lived alone. Few people would notice my own absence for some time if I lived alone, honestly.

> We should not create an extra judicial system that has no checks and balances

You should be way more concerned about police brutality then.

I don't see how that risk has increased. It's pretty normal for police officers to call paramedics and mental health professionals in when subjects show signs of mental issues and substance abuse (there are even laws requiring them in some places). If the subject is in lockup or on the street by the time they arrive makes no difference since they have the exact same power to involuntarily commit them.

Now, whether that power is something that should be more regulated is a different question entirely. I believe there is an appeal process for being committed and it can go to trial, so it's not like it's entirely authoritarian. If signs of abusing this power are found, then of course, something should be done about it, but again, who was the first respondent really doesn't matter in that discussion.

EDIT: I read the linked article and holy shit, the US health system really is fucked. Honestly, when the incentives are that misaligned, I can see why you were worried (I was looking at this from a 1st world perspective; mild offense at the US intended). Maybe it would be smart to add an additional sanity check to the STAR system, but of course, until your healthcare mess is sorted, that's like putting a bandaid over a stab wound.

There are a few issues with your statements. The first being that the staff of this program have no incentive to "commit you against your will". Why would they do that? I work in healthcare and have met people that work in these types of programs. By and large they do it because they care, the stress and risk you get from working with these populations isn't worth the money.

I work in Canada, so perhaps it's different in your country, but to be commited to a mental health facility here, a trained physician needs to "form" you, basically sign forms stating that you are a danger to society if not treated. There are strict laws surrounding this, it's not just some random decision.

Lastly, you say this will lead to some "medical authoritarianism". Programs like these, as well as the ability to commit people to mental health facilities has been around forever, yet I see no evidence of this medical authoritarianism you speak of.

They also like to do that with whistleblowers:

"Mollath's forensic incarceration for seven years and the surrounding legal judgments became the basis of a public controversy in Bavaria and the whole of Germany when at least some underlying elements of his supposedly fabricated paranoid story about money-laundering activities at a major bank turned out to be true after all. Mollath himself had consistently claimed there was a conspiracy to have him locked up in a psychiatric care ward because of his incriminating knowledge; evidence that turned up in 2012 made his claims appear plausible."

-- https://en.wikipedia.org/wiki/Gustl_Mollath

I would be shocked if the social workers riding around in vans are allowed to commit people. Social workers are kind of like nurses in that very few of them hold a PHD and they generally aren't allowed to diagnose or prescribe(varies by state and education level). They can provide all sorts of support, advice, counseling, etc to people in crisis, but when it comes to people who need to be committed, social workers mostly call 911 and hand it off to the cops, same as the rest of us. They can refer you for a voluntary psyc eval with a psychologist, or advise the judge that it might be a good idea to send you for an involuntary one rather than just sending you to prison, but they have very little power to decide anything for you. And if they're even remotely competent and you're not a blatant menace to society, then they're generally trying to keep you safe, stable, and out of institutions as much as reasonably possible. The whole ethos of social work is very different than psychology or law enforcement. It's very much focused on what concrete, practical things can be done to improve your health, happiness, safety, and quality of life. A lot of times it's simply hooking people up with services that they aren't savvy enough to find or access without help, or helping them get through stressful situation without falling apart and going to jail, using drugs, etc.

I imagine this also increases the surface area of interactions resulting in removal firearms from people, for reasons of mental health status.

Those people may, or may not deserve it.

E.g. California has a statute for 'mandatory relinquishment' of firearm, based on a mental health professionals findings [1] .

[1] - https://leginfo.legislature.ca.gov/faces/codes_displaySectio...

This is a dangerously bad take. Real progress is being made by this change and the assumptions you’re making risk taking wind out of its sails over essentially a non-issue.

If anything, I wouldn't worry about this given the article. The majority of the incidents shown are homeless people berating retail staff over welfare card issues; technically they would be charged with trespassing because the police have to be called to make them leave the store.

The example given was a mentally ill woman who had issues buying food with her debit card.

If anything, it looks more like a crew of people handling nuisances committed by "regulars" as they pop up. The danger is probably they DON'T commit as much as they could, and put out fires rather than secure help. That is, they just keep enabling the nuisance calls.

I'd be worried too about overreliance on this. If the guy suddenly pulls a gun or a knife on what was just being a public nuisance, you are having more or less medical workers in danger of their lives.

First, that seems needlessly absolutist. We're literally talking about upending decades of emergency response practice here, surely it should be reasonable to talk about tweaks to the process (mandatory judicial hearings within N days of mental health detentions seem very reasonable to me) without demanding that a change be thrown out because of a theoretical problem.

Second, is there data here? I mean, the article lists 748 tracked incidents. Did any even lead to an involuntary hospital admission? Shouldn't we figure this out first?

Inventing terms like "medical authoritarianism" seems like more noise than signal, basically. Surely the fourth amendment as it stands can speak to the needs of mental health cases just as it can accused criminals.

Indeed. It went the way Thomas Szasz described when he wrote The Therapeutic State [0].

It's a common trend in covertly authoritarian governments, but not only, to be able to remove people from the public without a fair trial: just question their sanity and have a doctor sign them in. Sometimes it isn't even the government, but someone well connected who needs someone else removed.

[0] https://www.goodreads.com/book/show/6680331-the-therapeutic-...

Yet neither you or op seem concerned of being killed by the police for no reason, like it happened to many. Perhaps you are in the demographic that wouldn't be shot by a cop but could still be judged unstable by a medical professional.

That's funny[0]. I'm not American, so don't pull the white guilt card on me.

I've spent a total of 12 days in the US in my life, and I was pointed a gun by the police once. That's infinity percent more than in any other country I've lived visited or lived in, and I've traveled my fair share off the beaten path.

When they saw their mistake, they spouted the generic excuse that I matched a description, something that wouldn't fly in any other first world country, but is somehow accepted in the US.

Anyway, I'm white and I did nothing wrong, so I guess that officer just pointed that gun as joke with no intention to kill,[1] right?

US police kills citizens at a rate seen only in developing countries. According to the wiki[2], US police kills 10 times as often per capita as the worst European offender of significant population (France), and ranks higher than places like Angola, Colombia or Rwanda, that have insanely higher crime rates. Let that sink in, and think whether the problem is race based or not.

But don't worry, Biden won, the rates will remain the same but it will no longer be an issue worth being reported in the media ;)

[0] https://www.statista.com/statistics/585152/people-shot-to-de...

[1] https://www.youtube.com/watch?v=VBUUx0jUKxc

[2] https://en.wikipedia.org/wiki/List_of_killings_by_law_enforc...

> don't pull the white guilt card on me.

Not at all, demographic doesn't relate only to race but other factors, like where do you live, etc.

I don't have data to back this up, but in every country, people living in middle/high class areas have to worry much less about being stopped on the streets by the police than others.

For the rest of your comment, I totally agree with you. I don't think Biden is going to change anything significantly here, considering both his and Harris history.

> Not at all, demographic doesn't relate only to race but other factors, like where do you live, etc.

My bad, too many arguments in that direction lately :)

> people living in middle/high class areas have to worry much less about being stopped on the streets by the police than others

Indeed. Another correlation I see interesting is, regardless of income, the urban/rural/suburban breakdown, with rural populations getting the short end of the stick here.

I see your point, but it’s worth considering that the tradeoff is potentially seeing said people shot by an armed officer, or thrown into jail where they’re likely to be hurt, abused, and otherwise suffer.

Portland had a similar program. It worked GREAT. (I am out of the city and have not kept up. Some form of it may still be a thing.)

Now, in that program they could hold you for 72 hours tops. No criminal record, no arrest, just a record private to that program for maintaining patient history. No attorneys, no bail, nothing. Outreach staff were deputies well trained in deescalation and conflict resolution as well as EMT and other related first responder skills. They do not perform law enforcement and need their status to execute the program tasks only.

We used to do that with law enforcement. We don't today. Some say we should. Some say we can't. No judgement from me. That is just the current lay of the land we all live with today.

These programs offer a strong, effective, humane option and they save a lot of money.

It saw a lot of use dealing with the following:

Drugs and alcohol inebriation, violence and general inability to do self care.

Homeless

Mentally Ill

Temporary mental distress.

Say one ends up there flat out hammered. Ok, you stay, until you aren't. Same for most drug scenarios.

The primary criteria for release? Not being hammered and or not being an asshole. This was the right thing to do almost every time too.

Worked great as a more serious crime prevention, and self harm reduction.

They could escalate to the court system, or a hospital, and or begin treatment at the integrated detox facility. All anyone need do was ask.

For homelessness, it typically required something be going on, like people going to die, or who were otherwise at some grave risk.

Those people could also just reach out. A ride in the van later, they can clean up, sober up, and then tap social services, or get into a shelter, temp housing, depending, or detox.

Police could DEescalate to this program as well and did so frequently.

People served by this program did not get criminal records, nor did they get a mental health record.

What they did get was help, and where it made sense, some tough love, and hard, lucid talk.

A significant percentage of the staff were former street people who had entered the program, got themselves good and then stuck around to help others. These people really matter. They have been there and are highly effective.

At the time, it was nationally recognized as a strong alternative to the typical judicial system grinder chewing lives up rather than lifting them out.

Here is something one of those people told me, and before I write it, I have in depth knowledge of the program via my spouse who worked front line outreach for many years:

Help buys time. Real help is sans judgement too. Time is what people in trouble need. When they get it, they have an opportunity to make different choices, and when they do, they are no longer people in trouble.

They become people getting out of trouble, improving. This is what they, and everyone else really need.

Nobody knows what reaches people. We only know when we continue to try some of them are reached and when we try harder, with genuine concern and zeal, more are reached.

Just reaching someone often is not enough. They fall back, need more time.

This is as good as it all gets.

Being human can really suck. Us lucky ones, who do not currently experience that suckage can count ourselves lucky and also for the help we may one day, ourselves need.

That, at the core, is what these programs and others like them are, or need to be about. When they are, they work.

Simple as that.

The best part is the bill you get after being involuntarily committed!

The problem you describe is real, but this program is a net positive (even in terms of the problem you're concerned about). Cops escalate mental health related scenes, which leads to people getting arrested and then put in a hold (which often gets extended).

If a social worker is able to resolve the situation without getting the cops involved, a cop isn't going to get personally offended that someone in crisis isn't "complying" and feel the need to punish them.

Well, there are places discussing this... just not anywhere which is for “defunding the police”

That being said, totally agree. This will be and probably already is being abused.

This is actually a big issue with child/family services as well. A lot of what they do is extra-judicial, though in theory there is often judicial review... eventually. This is coming from a foster parent. Don't get me wrong, a lot of these services are needed, but you would hear stories of abuse by the system.

Extra-judicial threats are something everyone should be on guard against.

> See https://www.buzzfeednews.com/article/rosalindadams/intake for an example of what I mean.

I stopped reading right after the patient admits to suicidal thoughts to a therapist.

That can easily get you committed against your will, and for good reason.

> and for good reason

What good reasons are those?

If you don't mind, what country do you live in and/or what thought process led you to "medical authoritarianism"? I would like more background on this, because it seems relatively absurd for the United States, where we struggle to even get a doctor involved when they clearly should be.

> Having known several friends who got committed and held against their will in psych wards

I don’t believe you

Agreed. It’s worth noting that your concerns absolutely have precedent.

In the USSR and other 20th century states, committing people against their will to mental health asylums was a very common way of dealing with political and religious dissidents.

Article covering political use of psychiatry in the Soviet Union: https://en.m.wikipedia.org/wiki/Political_abuse_of_psychiatr...

Presumably no arrests made though means people didn't fight the medical professionals trying to incarcerate them? So I assume most of them went voluntarily.

Explain what "insurance" has to do with it?

Private insurance often pays providers better rates than Medicaid, so patients with private insurance are on paper more "desirable" than patients without. The commenter is suggesting that translates into kidnapping, essentially.

I would be pissed if I were involuntarily committed and they billed me.

That is terrifying.

I feel like this point is not made in good faith especially considering your other comments specifically praising cops and denigrating BLM activists.

To address your point however, it’s still a huge step up from having an arrest record in addition to being committed.

If the arrest record is warranted, I fail to see your point. The outcome of not having a record when you probably should have one is probably net worse for society, given it won't show up later on a background check, for example.

It’s the same point as - if a person needs to be committed they should be. We are in this position because cops have not been shown to be fully trustworthy in a lot of these situations. It is infinitely better to not have the cops involved at all unless they are absolutely needed at which point the medical care workers can send for them. This new way is a win-win for everyone involved.

It’s still a step up in my opinion. This problem is also heavily mitigated by body cams.

Assuming the cops don't just turn them off or "lose" the footage, which "mysteriously" seems to happen every time there's an incident (unless the cop is too stupid to cover their tracks).

Corruption or stupidity? Is there really no room for doing the right thing?

Cops who do the right thing are punished by their fellow cops, look up what happened to the real Serpico.

>No one is talking about the very big risk associated with this, that mental health professionals can commit you against your will with no trial

So it's better to be suffocated on the sidewalk for the crime of selling single cigarettes?

What is the difference between a psych ward and a jail? No difference in tv shows, except they also drug you, do weird experiments, and you could get killed by fellow inmates without a problem. If getting committed to a psych ward replaces prison it sounds much worse.

Presumably we're discussing real ones, not TV ones.

My friend worked at a real one and it did not sound much different.

Yes, from the title I had expected it to be about health officials ignoring the law in instituting covid related restrictions. We definitely don't need more power in the hands of unaccountable technocrats.