> 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.