[refurb]

But most importantly you can blame Ronald Reagan for dismantling the states mental health infrastructure.

Please do some reading on this. Your comment is a gross oversimplification and ignores a lot of other factors, namely the fact that institutionalizing people against their will was regarded as inhumane. Mental health was defunded after it was decided to release these folks. Just like in most western countries.

[brianmcconnell]

Actually, what _you_ should do is have first hand experience of dealing with a good friend in the midst of a severe drug addiction crisis (who can't phone mommy and daddy for help with rehab). It was impossible to get him committed for any length of time, even after he set fire to someone's house. He would have been way better off if he had been on lock down for 3 to 6 months, but instead had to completely destroy himself, lose everything, get thrown in jail, etc. He's just lucky he didn't end up in our shadow mental health system also known as state prison, which happens to an awful lot of people whose only crime is to be mentally ill and poor.

[sseveran]

The ACLU was pivotal in forcing through the policy changes. They even take credit for it on their website: https://www.aclu.org/other/aclu-history-mental-institutions?...

I do have first hand experience with a family member who needed real mandatory mental help. We could not do anything for years until she tried to kill herself.

[M_Grey]

Ideological organizations often lose sight of basic human realities, or fight to end one ill only to birth another.

[aianus]

I was born in a country where declaring people insane and involuntarily committing them to mental hospitals was standard operating procedure for the secret police to shut up dissidents.

I think America has the right idea here, frankly. You should not be imprisoned by the state unless you are openly convicted of a crime.

[M_Grey]

The evidence seems to suggest that the people the state wants out of general circulation fare no better when they're tossed in prison or otherwise hounded/destroyed.

You also require doctors acting as criminals, with weak oversight to make your fears come true, in addition to a criminal government. If a government goes really wrong, and wants you out of the way, they'll get their way. Jean Seberg for example, didn't need to be locked up to be destroyed. We didn't need to lock people in hospitals to ruin their lives, we just used a blacklist.

You shouldn't be so frightened by your personal history that you lose sight of the fact that the root cause is a government out of control, not the means they use.

[aminok]

Then America should stop throwing people in prison for refusing to hand over a share of the currency they receive in private trade to pay for the goods and services the homeless receive from government organizations.

You can't impose authoritarianism to force productive people to support the poor, and then act sanctimonious about committing the mentally ill and drug addicted who contribute nothing to the economy.

[vertex-four]

This literally only makes sense if money/the economy is the only thing you care about.

[aminok]

Refraining from throwing people who have not violated anyone's rights in prison makes sense if you care about human rights.

You seem to throw all concern for human rights out the window when the object is to take someone's money from them.

[vertex-four]

Or... y'know... I care about people as a whole more than I care about a rich minority's desire to become a bit richer.

[BeetleB]

Edit: Deleted my earlier comment, as I misread yours.

Regarding what you said: The GP is not disputing the need for mental health institutions. He is pointing out that the ones that existed were horrible, to the point that closing them down was better than running them.

At the moment, too much of mental health is being handled by prisons. Whenever I read from people who study the problem, they all agree that:

1. It shouldn't be the prisons' responsibility.

2. The prisons are doing a better job than the mental institutions that were shut down.

[truthISpower]

Your first point is correct, but your second lacks clarity of insight.

If one were to read the history behind why the Reagan administration dismantled the mental health system, one would know that, in fact, what Reagan allowed to happen was a state sponsored ignorance of block grants that were initially allotted for the purpose of establishing local administration of mental health care. Reagan's mouthpieces said this was a wiser (letting states handle the money) way than Federal action to implement the plan Kennedy had initiated after witnessing his sister's incapacitation from her own 'treatment'.

The Reagan bunch then turned their heads and coughed while states deliberately ignored the intent of the money and spent it elsewhere, and did not, in fact, build mental institutions for short term treatment and release (with periodic checkups) that Kennedy's plan had described in exquisite detail.

To malign the intent and say that prisons are somehow better than the mental health treatment that was being administered is to suggest there was no alternative, which is implicit in your defense, though certainly not directly expressed. I seriously doubt you have spent any time in a correctional facility or mental hospital because you would then know that prisons are quite literally the worst place for a mentally ill person to be. Better they be homeless an under the care of the shelters and soup kitchens than locked in a concrete cell with hundreds, if not thousands, of undernourished, maltreated, and relatively unsupervised bangers.

There is the slimmest veneer of an attempt to rehabilitate addicts and/or treat mental illness within these facilities, but God knows there have been PLENTY of attempts for several decades to realign the institutions such that they are congruent with our understanding of what constitutes psychological healing.

It truly WAS Reagan's administration that put the decision to opt-out of locally 'sourced' mental health treatment in ultra conservative governor's and their respective cabinet advisors' hands.

Let us not obfuscate what the worst ever was with what may have been were cooler heads to have prevailed.

[tamana]

And what you should do is have first hand experience dealing with a poor or non-white or politically active person locked up in a hospital an declared insane for backtalking to a police officer or government official.

[whyenot]

> Please do some reading on this.

I really wish people wouldn't use this line in HN comments. It shuts down meaningful discussion by implying that someone would see things your way if only they were more well informed. Maybe they have done the reading and don't agree with you.

[iamdave]

Even better, which is what prompted my comment: if you're speaking in dissent, asserting there's more to a story, please for the sake of other readers who may so be inclined to learn, do more than drop a one liner as if this concludes all counterpoints of debate.

[convolvatron]

a reference would be great!

[M_Grey]

If it had been a decision concerned with "humane" considerations, there would have been a transition to outpatient treatment, family resources and education, and generally an attempt to change rather than destroy the mental health infrastructure of a country.

The result, which is an ugly combination of the profoundly mentally ill being incarcerated in jails and prisons, often among the general population, and homelessness, is hardly a decision calculated to improve anyone's lives. The population of people with schizophrenia living rough in this country also testifies to the lack of humanity in both the decisions that were made, and total lack of concern for people once they left an institution.

Now, we have to act shocked every time the Jared Lee Laughners of the world act in a tragically predictable course and murder a group of people. It's not shocking, it's predictable; when a family can't do a thing for a loved one who is falling apart in front of their eyes it's true that most of the time it only ends badly for the sick person. Sometimes though, it ends badly for society as a whole.

[iamdave]

Care to point towards any resources, authors, or links for those of us who might want to do more reading of our own? Seems like you have some knowledge on the subject, these would be much more helpful.

[hga]

My mother, as first a nursing resident, and then a nurse anesthetist in the '50s, saw the most important input into this process, the "major tranquilizers" AKA first generation anti-psychotics, which came into wide use in-between those two, she was astounded one day when she saw a "hopeless" patient she knew from her 3 months residency in a psych ward working in the same hospital as she was, in some custodial or runner role.

But I strongly suspect he had an informal network in that hospital, which made sure he took his nasty meds (and they are nasty, I had to take Zyprexa at full strength for a while to end a hypomanic episode caused by a doctor prescribing a drug which turned out to be a big mistake, and then not realizing it for a month until my GP noticed and mentioned this to him over lunch; if you're worried about this happening to you, and all sorts of drugs can cause it, keep a diary of your sleep, and if it e.g. has an entry of 3 periods of 30 minutes, seek competent help fast, uncontrolled like this mania is serious medical emergency, and insidious for the patient suffering from it).

See, the thing was, after millennia of psychosis being untreatable, and soon bipolar disorder falling to lithium carbonate, we'd achieved a true miracle. But the transition to a new management regime for these particularly severe disorders was utterly botched. It started with a commission in the '50s, leading to Federal legislation signed by JFK less than a month before his assassination, and only 4 years later does Reagan even come into the picture, seeing as how he wasn't even a position of power until 1967 (read the bare facts in the intro to this article: https://en.wikipedia.org/wiki/Community_Mental_Health_Act).

In short, blaming it on Reagan is Not Even Wrong; a wonderful opportunity for humane treatment of the most mentally ill was botched for a bunch of reasons, and he was only following the scheme "The Best And Brightest" came up with before its failings became all too apparent, in part due to the ACLU and willing courts eliminating the necessary force to make it work, e.g. forcing people to take their nasty meds or otherwise get fully institutionalized again.

A cynic would also note that redirecting money from mental hospitals to transfer payments was a much better way to buy votes.... And it's still happening, in the last year or two Missouri Governor Jay Nixon shut one down for the "retarded" just a bit north of me.

[hga]

Thinking about this further, the ACLU and the willing courts that followed its lead were all that was required to create the current even more inhumane system for our most mentally ill:

It doesn't matter if the venue is a state mental hospital or a community mental health center, if neither can force a patent to take their meds and otherwise get necessary treatment, or in the former case even stay in the hospital, then neither has the slightest chance of working.

And once that's true, and you're only allowed to pretend to take care of them, heck, you might as well fail in the cheapest way, which would be community mental health centers.

Sort of like how outsourcing can "work" for corporate software development projects: most of them fail, either outright or by not delivering even if they're declared to be a victory, so failing more cheaply by outsourcing can make sense.

[M_Grey]

American Psychosis is an excellent book on this topic.

http://www.nytimes.com/2014/01/14/health/american-psychosis-...

[Spooky23]

I'd start with Willowbrook, which was a rallying point for getting rid of institutional care.

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

It's a really complex and sad issue.