Homeless Camp In Affluent Neighborhood

[marshwiggle]

De-institutionalization of the mentally ill was a humanitarian idea that turned into a catastrophic failure in the execution. 

History has shown repeatedly that the more elaborate the government plans, and the more precipitous their implementation, the worse the unintended consequences turn out to be.

"The road to Hell is paved with good intentions." It's not that they didn't mean well; it's that humans are terrible at thinking through the results of their actions. And the more desperate they are to act RIGHT NOW the worse it gets.

[dismalist]

Let's not confound mental illness with homelessness. They are not the same thing. Maybe 25% of the homeless have serious mental problems. More have mental problems. But then again, all of us do. :-)

At least the others will respond to incentives. The leisure/work tradeoff surely matters.

Lot's of credible information here: https://mentalillnesspolicy.org/consequences/homeless-mentally-ill.html

[Hegemony]

History has shown repeatedly that the more elaborate the government plans, and the more precipitous their implementation, the worse the unintended consequences turn out to be.

Let's not pretend that's an objective statement. There are plenty of arguments to the contrary, e.g. the New Deal, vaccinations in schools, even the establishment of the United States itself. An action is not automatically bad because it is elaborate, sponsored by the government, or done quickly. Let's evaluate a thing on the actual facts of the actual instances, rather than on generalizations.

[kaysixteen]

Random observations, strung together ad hoc, largely because I am not motivated enough to outline my thoughts to write an essay here.

1) Libertarianism is a cancer on this country, for many reasons.   It is one of the main reasons we have the homeless problem, because of addle-brained absolutist notions of freedom and the hatred of taxation.   As Justice Oliver Wendell Holmes noted, 'I like paying taxes, for when I pay taxes, I am buying civilization.'   We need to get back into the mental hospital business, and we need to be willing to force the mentally ill to take meds, submit to therapy, etc.   If it is unacceptable for your 80 yo mother with Alzheimer's to be sitting in a doorway baying at the moon and wallowing in her own filth, why is it acceptable for your 20yo niece with schizophrenia to do the same?
2) That said, not all homeless are mentally ill, so a one-size-fits-all approach won't work.   Jesus never said 'when did you see me in need of a fix, and not provide me with one?'   Drugs suck, and those who cannot refrain from their use should be prevented from doing so, for their own good, but more importantly, for the good of decent people whose neighborhoods are ruined by their unchecked presence.   And those wishing to purvey narcotics should receive free room and board for a goodly stretch.
3) Those homeless who are not mentally ill and not substance abusers should be able to work, and that is where we can use tax money effectively.  Biden's infrastructure bill can become but one plank on the way to dealing with this problem, by creating work opportunities that the private sector either cannot or will not provide for such people, and laws requiring appropriate minimum wages, preventing employers from learning about nonviolent offenses in job applicants' records, and the like would help as well.
4) For the short-term, homelessness needs to be addressed immediately, with short-term solutions that could perhaps be phased out going forward.   One of those solutions should be providing housing for these folks, but putting a large encampment of people in the midst of a residential neighborhood is a sledge hammer that is going to cause real problems.   Here in New England, many old towns still have streets in them called some variation of 'Town Farm Rd.', which was the location of the old poor farm that each town was required to have.   There, the homeless would become non-homeless, and those who could work worked to help maintain said farm.   Something like this should be done now.   And one of these colonial policies included the policy of 'warning out' vagrants from towns, requiring them to return to their home town, which had to take them, thereby preventing the mass accumulation in a comparative handful of mostly larger and poorer communities, whilst smaller, whiter, and wealthier communities get to pass their homeless problems along.

[financeguy]

I love the argument that the libertarian viewpoint is a cancer presented with the assumption that we have anything remotely approaching that philosophy being implemented. What we do have is a standard of bilegalism where those of us who can be threatened with state violence to extract money are made to "follow rules" and those who have nothing for the state to extract via threat of violence are left to "do their own thing." To put it simply, if I can be made to have 9 licenses for act of commerce that are voluntary, why can we not tell someone else they can't relieve themselves in the middle of the road, shoot up in public, sleep in such a way that prevents others from utilizing a sidewalk or maintain conditions likely to cause or exacerbate a public health crisis?

The federal register is growing at a rate far quicker than anyone could possibly read it by even devoting their entire time to this endeavor, not to mention similar activity in all 50 states. One in three occupations requires government permission via license. Permits are required for any number of activities including....wait for it....protesting. If you were to ask a random neutral observer from elsewhere what philosophy of government is implemented in the united states, Libertarianism would not be the answer in response during the current or previous administration. There is no major political figure that has a snowball's chance in hell in this country of achieving material control over governance who can even remotely be considered a libertarian, yet this phantom villain still exists. Why? The reason is obvious. You (those on either side of the political debate) have made the argument that a central authority needs to control our lives and its just a matter of finding the "right" people at the helm. After multiple failures to do so in every possible capacity, that argument becomes less and less plausible. Darn. Must be the fault of someone who wants to build their house, run a business or otherwise live their life without intervention from some incompetent and/or psychopathic bureaucratic scumbag.

[marshwiggle]

Random observations, strung together ad hoc, largely because I am not motivated enough to outline my thoughts to write an essay here.

1) Libertarianism is a cancer on this country, for many reasons.   It is one of the main reasons we have the homeless problem, because of addle-brained absolutist notions of freedom and the hatred of taxation.   As Justice Oliver Wendell Holmes noted, 'I like paying taxes, for when I pay taxes, I am buying civilization.'   We need to get back into the mental hospital business, and we need to be willing to force the mentally ill to take meds, submit to therapy, etc.   If it is unacceptable for your 80 yo mother with Alzheimer's to be sitting in a doorway baying at the moon and wallowing in her own filth, why is it acceptable for your 20yo niece with schizophrenia to do the same?

For the record, a lot (if not the majority) of the push to get people out of institutions was from the left, i.e. the social justice advocates. And those are the people you'll be up against in suggesting people be forced into treatment.

[Caracal]

1.we need to be willing to force the mentally ill to take meds, submit to therapy, etc.   

2. Drugs suck, and those who cannot refrain from their use should be prevented from doing so, for their own good, but more importantly, for the good of decent people whose neighborhoods are ruined by their unchecked presence.   And those wishing to purvey narcotics should receive free room and board for a goodly stretch.

4) For the short-term, homelessness needs to be addressed immediately, with short-term solutions that could perhaps be phased out going forward.   One of those solutions should be providing housing for these folks, but putting a large encampment of people in the midst of a residential neighborhood is a sledge hammer that is going to cause real problems.   Here in New England, many old towns still have streets in them called some variation of 'Town Farm Rd.', which was the location of the old poor farm that each town was required to have.   There, the homeless would become non-homeless, and those who could work worked to help maintain said farm.   Something like this should be done now.   And one of these colonial policies included the policy of 'warning out' vagrants from towns, requiring them to return to their home town, which had to take them, thereby preventing the mass accumulation in a comparative handful of mostly larger and poorer communities, whilst smaller, whiter, and wealthier communities get to pass their homeless problems along.

1. Is an offensive idea, as well as an impractical one. Being mentally ill shouldn't mean that people lose all of their rights. There's a reason the standard is whether someone is an imminent danger to themself or others. Other people should get to make choices. The alternative is what? Forced long term incarceration in mental facilities for people who don't really need to be there because there's no other way to make sure they take medications? I'm not a libertarian and I don't have any problem with drugs for psychiatric problems, but I do have an issue with that.

2.I can tell you right now that involuntary incarceration of any sort for drug users is not going to help. If it did, there wouldn't be a drug problem. This is why a harm reduction approach makes a lot more sense. Imprisoning drug dealers isn't any more effective and causes huge amounts of harm. I'd really recommend this series of podcasts on all of this. https://podcasts.apple.com/us/podcast/george-bushs-infamous-crack-speech-30-years-later/id1091031079?i=1000448743841

3. That was a system based on the idea that homelessness and unemployment were moral problems that should be punished. It was neither very pleasant nor particularly effective...

[jimbogumbo]

For those who might appreciate some nice background on the deinstitution of the mentally ill in the US there is the link below. In began on a large scale in the US in 1955, so whatever some of us think happened it's likely we forgot or never knew. FWIW I don't think I'm alone in misremembering or the never knowing.

https://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html

[apl68]

For those who might appreciate some nice background on the deinstitution of the mentally ill in the US there is the link below. In began on a large scale in the US in 1955, so whatever some of us think happened it's likely we forgot or never knew. FWIW I don't think I'm alone in misremembering or the never knowing.

https://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html

Yes, it happened in stages over a period of decades.  It wasn't any particular administration or set of politicians' fault.  The effects were no less catastrophic for that.

[Hegemony]

And it was done with the best of motivations, at least by some. The institutions were by and large backward, inhumane prison-like warehouses for people who might well never see freedom again. People were right to feel that society could and should do better than that. They were wrong in thinking that society would want to the costs of doing better. So in effect it was out of the frying pan into the fire. But we don't want to go back to the old ways, either.

[Puget]

And it was done with the best of motivations, at least by some. The institutions were by and large backward, inhumane prison-like warehouses for people who might well never see freedom again. People were right to feel that society could and should do better than that. They were wrong in thinking that society would want to the costs of doing better. So in effect it was out of the frying pan into the fire. But we don't want to go back to the old ways, either.

Yes, this-- the goal was right, and it is achievable. With modern treatments most people even with psychosis (and I think that's mostly what people mean when they talk about "mental illness" in the homeless) can live independently or in supportive group housing. The problem is as you note that we as a society haven't put in the resources required.

Instead, people tend to blame the individual (e.g., assuming they refused treatment) rather than looking at lack of access to treatment, including a critical shortage of psych beds (especially pediatric!) which leaves many people in crisis left "on hold" in the ER for days at a time. Hospitals have massively cut psych beds because they don't pay-- lots of uninsured/medicaid patients and no expensive procedures to bill for. Access to outpatient care is also hard-- in theory, there is insurance parity with other health coverage, but in practice many therapists don't take insurance (because they would need a full-time staff person just to manage the insurance billing) and those that do often have long wait times.

So someone gets discharged after a few days in the hospital, maybe never leaving the ER, in theory getting stabilized on meds, then is discharged with no real practical plan for follow-up outpatient care. And if they're discharged with no home to go to? Forgot it, they are not going to get effective treatment.

This is one of the reasons the "housing first" approach has been shown to be the most effective-- it is much easier to manage a psychiatric condition when you have a stable place to live, can get your prescriptions delivered and always know where your pills are, and have adequate sleep and regular meals (stress and sleep deprivation can trigger psychotic and manic episodes). Better yet these buildings generally have on-site social workers.

There are some tricky issues around autonomy (and some innovative solutions, like having people file care plans when they are lucid for use when they aren't), but that really isn't the primary issue-- house people, provide adequate *voluntary* treatment, and then when we've done all that we can have a debate about the best way to deal with those cases where people refuse treatment.

Editing to add for our local conservatives: housing first SAVES MONEY, both in both health care and law enforcement/jail costs.

[mamselle]

At least in the area I'm in, a one-two punch wreaked the plans for de-institutionalization in both directions.

I was part of the planning group for the meals program I mentioned earlier, so we were hearing information from people in various social services about this in the 1980s.

The plans to de-institutionalize those for whom it was deemed potentially helpful had been made with a safety-net structure for housing and aftercare set up and ready to go.

However, after the deinstitutionalization went forward, the legislature balked on funding the second phase of the project, pulling the safety-net out from under it.

So people suddenly were released with no-place to go; the deroulement we've been discussing followed. The agencies had been responsible in putting together a comprehensive, structured, protocol for follow-up, then were prevented from actually carrying it out.

Many non-profit groups worked to pick up the pieces as best they could--one was the feeding program itself.

But there was a lot of talk about the expectation that the nonprofit sector would just pick up the pieces the legislators had left lying on the State House floor, and a lot of discussion--never really serious, they were too invested in client care to actually do this--about whether it might not be better in the long term to let the broken pieces of the plan stay on the floor and make the legislature pick them up and put them back together as they'd originally planned and promised.

The human cost would have been worst, so of course they didn't. But they did go to the press. The two large dailies didn't do much; the more feisty weekly did, but the reps mostly ignored that, if they read it at all.

That pattern repeated itself in several other locales, with 'budget-minded folks' balancing that budget on the backs of the most needy members of the population, and then working very hard to obfuscate the issues so that no-one among the voting or reporting public connected the dots.

M.

[smallcleanrat]

Another factor of medication in institutionalized settings is that too often the aim is to sedate or otherwise make patients more tractable for the staff's convenience, not the patient's quality of life or ability to function.

[mahagonny]

It's a hard thing to deal with when someone trusts the voices in their head more than they trust you.

[kaysixteen]

I do not much care whether you are offended by the notion that someone who is mentally incompetent should be made to accept treatment that would restore his competency, or at least ameliorate his condition significantly.  Tough.   We make people do all sorts of things for their own good....and for the good of society, and for both of these goods, leaving people in an incompetent state when it is not necessary is a cancer, bolstered by idiot libertarians on the left and right.

As to scumbags who trash communities by selling narcotics, what we gots here be a failyah to communicate.