I agree it doesn’t sound like a great idea, but someones rights are going to be violated either way. Either we forcibly admit people who appear to need it (with the false positive that come with) or we continue to violate the rights of the public to not be constantly harassed and assaulted by these people.

Don’t live in a city so poorly run that it has a large homeless problem. Not only am I not constantly harassed or assaulted by mentally I’ll people, but I have NEVER been harassed or assaulted by a mentally ill person.

How does this even make sense? What are you even saying here? Everyone just leave your city until you find one that's automagically well run? Surely you must understand that this conversation is abut ideas to better run a city. But you're saying nah, just leave instead! I'm sure Boise Idaho will be happy to have you!

It doesn’t make sense. They either dont live in an actual city, or they live in a city “without a problem” because they are bussing their homeless to California. Super convenient way to deal with it.

It is the only thing that makes sense on an individual level absent legislation and funding from the federal government, because of the lack of immigration controls.

I lived in Boise for years and spent time volunteering at the Boise Rescue Mission. You are right, Boise will be happy to have you (it's a very welcoming city). But, there are people in Boise who need help. Go Broncos

Ah, I should have been more careful then. I was under the impression that Boise was dealing with an overwhelming transplant issue and was resistant the way Austin and Portland have been.

I thought this site loved the free market - guess there needs to be a new forum to regularly check.

Very much agree. We'd need a very clear definition on what dangerous is before something like this is considered. Some now consider speech dangerous. An authoritarian government may choose to consider those who disagree with policy to be dangerously mentally ill. I mean, only crazies think like that, right?

My next door neighbor would scream at people passing by. I’d routinely be woken at 7am due to his swearing. Things started getting worse. He verbally threatened to kill people. He bashed in an RV parked on the road by his property, causing thousands in damage. He jumped off his balcony toward a neighbor he was threatening. I went, with some others, to the police. They couldn’t do anything. If he yelled on his propery, that was his business. If the RV owner wanted to press charges, that was their business. Oh, they could offer him help, but he’d have to take it. Shortly thereafter, I had heard him calmly yelling “You think I’m scared of the police?! I’m not scared of no *Ing police!” And why should he? They visited him multiple times a week and did nothing. Two weeks later he beat his mother to death with a tire iron. Yes, we need good ways to determine instability, but some of these cases are pretty clear cut, and we have a very real problem.

Once the side effects of the medications kick in nobody will ever find out they didn't need them.

Many problems were solved by authoritarianism, if by problem you mean people being alive.

Well, I mean NY has a general inclination towards being overly restrictive based on psychological tests. So I guess it makes sense to start it there.

I believe a big story a few years ago was how they stripped a retired cop of his gun license over his admission that he was "sometimes blue" even though there was no indication that he would be dangerous to himself or others.

I mean, you could say the same thing about jail sentences right? Presumably this forced treatment would be done via due process. Maybe in cases where a medical sentence is issued, half the jury are psychiatrists or neurologists or have some appropriate qualification.

The due process necessary to put someone in prison is generally far more rigorous and affords the accused more rights than the due process necessary to institutionalize someone.

It's possible to construct a system that respects the rights of the mental health patient, but we have historically not been able to do so.

Before the 80s, we'd just throw people into madhouses and toss away the key. That system, and its myriad of abuses was torn down due to public backlash, and was replaced with... Nothing.

Your third paragraph seems to contradict the first paragraph. If there is no system to institutionalize people, then how can it be less rigorous than the system to imprison people.

Are you suggesting there hasn't been any involuntary psychiatric in-patient treatment since the 1980s?

There probably is, but as I understand, there are some Supreme Court rulings from 1970s to 1990s that make it very costly and/or require a high bar of proof that accused is a threat to themself or others.

The workaround to the very high costs of working within these rulings was imprisoning people for drug or other non violent offenses, which was much cheaper and easier.

There still is a system to institutionalize people that haven't been breaking any laws, but it's very short-term. If you're interested in checking it out, a failed suicide attempt can give you a peek into it. They are unlikely to keep you for very long, though.

The long-term system was largely shut down in the 80s, because of the aforementioned abuses. The bar to get someone thrown in the loonie bin was very low, and once you're there, good luck proving that you're sane, or that you're being abused and mistreated.

> There still is a system to institutionalize people

why are we talking of "institutionalizing" people? Compulsory treatment of someone experiencing an episode involves depriving them of liberty, while staff ensure they take their drugs, and doctors monitor their effects. Institutionalization generally means that you've been incarcerated so long that the institution is now your home, and it would be a struggle to live back in the world. Institutionalization was a large part of the problem with the old asylums.

At least one mentally-ill person I've known had been taken off the street several times; she was bitterly critical of the abolition of the psychiatric hospitals.

See my comment regarding 18 U.S. Code § 3553(a)(2)(D). Due process is superseded by 'treatment in the most effective manner' under Federal law, including losing your Constitutional right to be sentenced by a judge (a treatment provider, not a judge, determines the rules of your Court Ordered treatment imposed with the full force of the Federal Government).

To be clear, are you saying people who commit crimes should (in some cases) face forced treatment. OR. That mental illness itself should mean forced treatment?

Sentencing someone to a secure hospital rather than a prison for crimes is one thing. Sentencing them for not fitting in is another.

Sorry if I have misunderstood

The case I was thinking about is something like, let's say there's a obviously mentally ill guy thratening to kill people. I'm talking hobo smeared with shit, reeking like all hell, tattered clothes, broken bottle in hand, screaming obscenities and frightening people with death threats in parking lots. You know, regulard tuesday evening in LA.

I think the police should be allowed to arrest this man. A DA might decide to file this new mental health charge against him. Assuming the crazy person doesn't accept the plea deal he would be offered, voluntary commitment in a mental health facility, this goes to trial. If the trial finds the defendant guilty of being insane, he is forcefully commited to said mental health facilty.

Are there issues? Sure. Is it somewhat ok because it's done via due process? Maybe. Is it better then letting potentially violent crazies in desperate need of mental health treatment run loose? Absolutely.

You can already be arrested for the things your describing, they're crimes. And if the judge feels it's appropriate sent to hospital. If that isn't happening it's because cities (understandably) cannot pay for the enforcement or treatment. I don't think we need any change in the law for this.

> what about the false positives (people who get forced treatment while claiming that they are not ill and don't need it and then that turns out to be actually true).

We have a criminal system even though the exact same is true in some crimes.

I will say this, I grew up in a time of asylums and I lived thru their gutting of them with the Reagan administration and back then law enforcement was very different it did not become militarized until the LA bank shootout and some other events in the same timeframe. To say it was a different world would be an understatement. In that world false positives where rare, usually there was a history of issue as well as close family that agreed that it was for their good.

Nowadays law enforcement does not know your name, they suspect you from first contact and family is not as tight knit as it was. I would be very leery of asylums in present society, due to the many ways in which society has changed.

The justice system has nontrivial checks on the power of the state to incarcerate people and it already has massive problems, what would a system without those checks do?

Probably similar things as the civil law parts. See the flagrant abuses of things like restraining orders and red flag laws in divorces, or civil asset forfeiture, etc.

Yeah, but there you come out the other end with your mind intact. These forcibly prescribed treatments have side effects that can do irreversible damage. Can't get that appeal hearing if you can't think straight anymore.

Agreed, it's basically the same argument as against the death penalty. Can't exonerate yourself if you're dead, can't be found mentally sound if you've been effectively lobotomized.

Obviously psychiatry has come a long way since lobotomy, but it doesn't have a great history when it comes to treating unwilling patients.

If a mentally unwell person is a demonstrated threat (ie commits crimes and harms/endangers people) the state already has the power to lock them up. In my view letting the state forcibly alter their brain and mind against their will is a bridge too far.

> In my view letting the state forcibly alter their brain and mind against their will is a bridge too far.

I don't share your view. It's quite clear to me that there are circumstances when a mentally-ill person benefits enormously from compulsory treatment (provided they are released; a system that rewards clinics financially for continuing to detain patients that are fit for release is a special kind of madness).

Highly debatable that regular prison leaves your mind intact.

Very true. Although the scope is quite different between the conditioning you face in a prison and the chemical alteration of various medications. Generally, one can be resisted or controlled, whole the other cannot.

You have a judicial system in place to prevent these false positives.

I dont understand. Can you explain that?

In the context of this comment thread:

False positives = someone wrongly accused of a crime by the police.

After the accusation follows a trial (this is the judicial system) where the wrongly accused can prove that they in fact did not commit the crime.

Thus judicial system is setup to deal with the false positives.

That doesn't prevent the false positives, just cuts the process off before prision. And studies show that 2-10% of the incarcerated are wrongly convicted or completely innocent. Also, involuntary commitment could be a civil law which does not carry with it the same protections as criminal law, depending on how it's defined. So I'm still not seeing how this prevents false positives.

I think you have a different threshold for the word "prevent". Which is fine by me.

It sound like maybe you mean reduce, not prevent.

> If you're all-knowing and all-good, great. Otherwise seems like a pretty gross violation of basic human rights - what about the false positives... We could temporarily solve many of the world's problems if we had more authoritarianism, but it never ends well in fiction or in real life.

I think this is a broad argument that applies equally to prison, too; would you bite that bullet and argue for abolishing prison as well? If not, I think your conclusion is a bit hyperbolic.

In practice the discussion is (should be) quite nuanced. If someone is a clear and present danger to themselves or others due to mental instability, then it seems reasonable to me to confine them until that danger is resolved. But of course, that's a slippery slope and so the danger should be clear and substantial, and involuntary commitment should not be an indefinite thing, a tool used to take homeless off the streets, for example. A robust and independent ethics board reviewing decisions is an important component.

One thing to note is that lots of other countries do this, and the US is something of an outlier; one could just look at other countries for examples to evaluate whether this idea would present a terrible slide into authoritarianism. For example, in the UK: https://www.nhs.uk/mental-health/social-care-and-your-rights....

One could also do an A/B test by analyzing California circa 1972 when the Lanterman–Petris–Short Act ended involuntary commitment: https://en.wikipedia.org/wiki/Lanterman%E2%80%93Petris%E2%80.... Was the US more authoritarian in the 60s, when involuntary commitment was common? It's reasonable to suggest it was overused (see, One Flew Over The Cuckoo's Nest), but so were many medical practices (see, forced sterilization of women). I think it's reasonable to suppose that we use a lighter touch if we tried again.

Fortunately, this is an issue that lots of smart people write on already: https://slatestarcodex.com/2016/03/07/reverse-voxsplaining-p....

> one could just look at other countries for examples to evaluate whether this idea would present a terrible slide into authoritarianism. For example, in the UK: https://www.nhs.uk/mental-health/social-care-and-your-rights....

The English system unambiguously leads to abuse. We see autistic people held for years in secure services because it's thought they pose a risk of harm to others, but often that risk is evidenced by behaviours they exhibit while under severe restriction in hospital. I'd argue that if you put anyone in a locked room with nothing but anti-ligature clothing and keep them there for a month they'd act aggressively. See also the many documentaries about abuse, eg Winterborne View, St Andrews, Edenfield Centre, TEWV, etc etc.

> I'd argue that if you put anyone in a locked room with nothing but anti-ligature clothing and keep them there for a month they'd act aggressively.

Anyone? I can't speak generally, but the people I know that have been forcibly treated didn't become more aggressive, they became less aggressive. They got on well with the care staff, continued taking the pills on release, and were glad they'd been treated.

I've known a couple of schizophrenics, but I know nothing about their response to treatment or incarceration. My experience is restricted to a handful of people with bipolar.

There's a difference between forcible treatment, and being kept in a room wearing nothing but anti-ligature clothing, with none of your belongings, no blankets, no furniture, food being provided through a hatch in a door, etc.

It's great that you've met a couple of people with severe mental illness that had good experience of care - most people do. But it's not relevant to what I said.

Solitary confinement is torture, which is why it's banned unless there's no other option. In the English system seclusion is used far too often, and often as a first not last resort. This is also true for restraint and rapid tranquillisation. There are national and local programmes of work trying to reduce use of force, and we've even had a recent law change to prevent the use of force in mental health units. The new law recognises that people's human rights were being abused.

https://www.legislation.gov.uk/ukpga/2018/27/enacted

https://www.gov.uk/government/publications/mental-health-uni...

https://restraintreductionnetwork.org/

We're reforming the mental health act because we recognise that people's human rights are not respected, and to improve the use of advance directives and reduce the use of compulsory treatment, especially the use of force: https://commonslibrary.parliament.uk/research-briefings/cbp-...

This is true.

It's worth noting that the same rules and protection that get applied to criminal sentences do not apply to 'treatment' and 'treatment providers' in sentencing. There are cases when treatment providers overrule/ignore judges orders and the treatment provider prevails. 18 U.S. Code § 3553(a)(2)(D) is used as a carveout for treatment in Federal code so that treatment providers can impose 'whatever is the most effective manner' even if treatment imposes rules that the Judge would not be able to impose. The Judge orders treatment, and the treatment provider then has carte blanche to impose their own sentence rules (the rules of treatment) even though in the USA only a Judge is supposed to be able to determine a sentence.