In the US the system broke down in the 50s and 60s and collapsed completely in the 70s and 80s due to bad treatment options and often very inhumane conditions and cases of misdiagnoses. The widespread misdiagnosis problem only stretched the system further and compounded the existing problems. I would be curious to see where Finland's trajectory in this regard lies.
In old books you read about
https://en.wikipedia.org/wiki/Catatonia
being intractable, now it usually clears up in 15-30 minutes with benzodiazepine medication. In the 1950s we got the Phenothiazines which were the first hope for many patients, there has been a huge amount of progress since then and managing most of these people outside the hospital is possible. People also came to see involuntary commitment as immoral as described by Thomas Szasz, depicted by the movie "One Flew out of the Cuckoo's Nest" and shown by this experiment
https://en.wikipedia.org/wiki/Rosenhan_experiment
The trouble isn't that we tore down the old system but that we didn't completely build a new system to replace it. There are deep issues involving people's agency. Right now we are in a society that thinks it is wrong to make people to take drugs they don't want to take, a different society (maybe even ours in N years) will think is it wrong to not make people take drugs for serious mental illness.
It can be exasperating to care for an elderly person with dementia, they can range from very agreeable to rather disagreeable but most of them have had enough experience with caring for people and being cared for that they can have some empathy with their caregiver -- even if they have a hard time remembering it.
People with serious mental illness have disturbances in those relationships (remember how Freud asked "tell me about your mother?") and are much harder. And if they want to kill you because they think you are something other than what you are they're more able to do it.
Communities that adopted "housing first" early on had great success with it. In the fentanyl age there's a lot of fear that a volunteer or someone who isn't paid nearly enough will open a door from time to time to discover a dead body.
IMO, I'd rather have to mitigate that hazard if it meant we got actual, effective treatment for folks with super fucked-up brains than have what we have today in the US... but I'm in no position to change the country's policies.
On the other hand I'm still a touch angry that it was missed in a psych eval I had in school that, I'm told, was a really superior psych eval for a kid in the 1970s. (Kohut's Analysis of the Self was a major discovery for me when I did a round of research trying to understand an crisis at work circa 2006 but I missed the literature connecting his work to schizotypy in the 1980s; a really good monograph came out in 2013 which fell into my hands a year ago... and I think "now it all makes sense" but "I lost so much time") It's hard to come out because (i) so much about it is offputting, and (ii) I find schizotypes on YouTube to be so annoying I can't stand to listen to them for more than 30 seconds. Those of you who think there's something weird about what I write here are right... It's what you get when you mix verbal intelligence too high to measure with a good measure of line noise. At least I find it easy to emphasize with people with schizophrenia and schizoaffective because "thought disorder" doesn't seem so strange to me.
I was at risk but dodged the bullet to get schizopherenia but I worry about psychotic dementia.
At least in the US, it's basically seen now as a violation of due process to be imprisoned like that without committing any crime. Psychiatric services are on offer, but can be refused.
To clarify, I don't know much about Finnish mental health in particular as opposed to the general trends in Northern Europe.
If using the technical term, I think you might mean “Continental climate”.
From the very Wikipedia article you shared:
> The north temperate zone extends from the Tropic of Cancer (approximately 23.5° north latitude) to the Arctic Circle (approximately 66.5° north latitude). The south temperate zone extends from the Tropic of Capricorn (approximately 23.5° south latitude) to the Antarctic Circle (at approximately 66.5° south latitude).[4][5]
I thought that it broke down due to a Supreme Court decision (O’Connor v. Donaldson, 422 U.S. 563 (1975)) but perhaps they were interrelated.
In Europe such a policy might make sense, but in America where being dumped on the street is rather common the situation is different. Also, in America the general social situation is quite different from life in Finland.
Is this a studied phenomenon I can read about? I'd appreciate any literature suggestions if you have them.
I asked her where she slept. She said "you don't sleep". You don't even have to run an experiment to know that sleep deprivation, even in your own home, causes psychosis. Now add the shock of being exposed to filth for the first time, poor climate control (homeless don't walk around with multiple layers of Patagonia and a nice backpack to stash them in as it warms up), the very real threat of sexual or physical assault, the shocking awareness that you are now "one of them" and know that a sizable percentage of your acquaintances would immediately distance themselves from you if they knew your plight. We're not even talking about food and vitamin quality here.
It's popped up in the news (and in the comments here too) a bunch about how parts of the US's prescribed 'solutions' to this is to put people on antipsychotic medications. One big effect is that these medications sedate. If someone has passed out and has an inability to be roused and can hardly function if roused is an insane risk for homeless people. People aren't getting no sleep for funsies. Antipsychotics being used to chemically restrain the inconvenient is just abhorrent. Making them considerably less safe as a result is just inexcusable.
Not to mention the extrapyramidal side effects of antipsychotics that compound chronic health problems like metabolic syndrome. I'm sure that the nurse who's hardest science class was in high school who's now allowed a prescription pad after an only only diploma mill 'masters' is prescribing complex medications appropriately and managing overall health impacts of such meds when even experienced psychiatrists fuck it up (but NPs are a rant for another time.).
Having been homeless and on antipsychotic medications (thankfully not at the same time) it's just nuts to me that it's even considered a possible solution to homeless people having mental health issues (arising from circumstance or not) or being 'nuisances' is to just sedate them and leave them for dead.
Disclaimer: Antipsychotics are a tool and they can greatly impact a person's life in positive ways. Also in negative ways. They're also not just used for psychosis. I just wanted to clarify I think there's nuances in my anti antipsychotic rant here lol
We know that the longer psychosis goes untreated/the more times someone goes off the meds, the harder it is to treat, and that what happens in the first few years of someone developing a psychotic disorder makes a huge difference in long term outcomes.
An American might develop psychosis in their mid 20s, end up committed for a few weeks and placed on antipsychotic pills until they're no longer floridly psychotic, and then go home, not follow up with doctors/refill meds, and end up on a cycle of this with more and more brittle symptoms until they're homeless and have no real chance of recovery.
The same person in Northern Europe would likely be hospitalized for longer initially, started on an injectable that only needs to be given once a month, and they leave the hospital with fewer residual symptoms. They're then followed by an ACT team with a nurse visiting to check on them and make sure they're eating and keeping housing, and ensuring that shot goes in their arm every month. They don't necessarily fully recover, but a lot of them end up being able to do some kind of schooling/employment/volunteering and they are either stable enough to keep housing without being evicted for disruption, or are shuffled into staffed group homes.