[dbcurtis]

No, there are a huge number of people that are on the edge w.r.t. mental health. Not quite capable of handling activities of daily living and/or their own finances. Or not 100% of the time, and that fraction of the time that they can't, their money evaporates, and/or relationships evaporate.

The crisis in mental health care in the US is shameful. It is true that in the bad-old-days people were over institutionalized. So the pendulum has swung, and now unless a person is very clearly dangerous to themselves or others, it is nearly impossible to get a person resistant to treatment the help that they really need.

We talk about people "falling through the cracks", but the "crack" is a mile wide. It is pretty hard to convince me that a cardboard box under a freeway overpass is better housing than the mental institutions of old. That said, I don't think many of the mentally ill need to be forced into an institution under the old model, but we really do need a mechanism to deal with ill people resistant to treatment.

[edit: spelling]

[DSingularity]

Yeah man it’s serious. Someone asked me to help an individual recently and I’m struggling to figure out how to help. He is a programmer who suffers from schizophrenia. His hallucinations got out of control until he lost his job, his life, and his kids. Social workers pretty much forced the one person in his life who cares for him (his wife) to have him removed by the police. Now he hates her. Then he proceeded to miss his hearing so he was arrested. Now he is thrown in jail. I feel guilty but I don’t know how to handle this.

[dbcurtis]

I feel for you. Lacking appropriate training, it is hard for us to actually help, even though we care. The first thing to remember is that whatever you say or do will be processed through the lens of his reality. He will try to fit it into the framework of his world. The eventual fit may be very skewed. It is difficult to know how to be helpful in that situation. Sorry I don’t have more for you.

[username223]

That's terrible, and I don't think there are any easy answers. Just be there if he reaches out, and help in small ways when you can.

[ende]

> That said, I don't think many of the mentally ill need to be forced into an institution under the old model, but we really do need a mechanism to deal with ill people resistant to treatment.

This is the mission statement right here. Very well said.

There are quite a few articles/blogs/etc out there from psychiatric professionals who were practicing before deinstitutionalization, many of whom were champions of the reforms, but who in retrospect question whether it should have happened (or at least how it was executed and how ‘community mental health’ never really took off).

Maybe it’s time to revisit the concept of mental institutions, albeit a more humane model.

[DanBC]

> Maybe it’s time to revisit the concept of mental institutions, albeit a more humane model.

There isn't a more humane model. If you're forcing people into an institution you're also going to be forcign them to take medication and if you're not very careful there's a bunch of other restrictive practice and other bad stuff that happens. The main ones would be use of rapid tranquilisation, use of prone restraint and supine restraint, and sexual assualt from staff and other patients.

A better model would be correctly funded assertive outreach teams.

[ende]

All true, but I guess I mean a ‘better’ model not at the expense of the perfect model.

Can you tell me more about assertive outreach teams?