[maxharris]

To help contextualize this so I understand the situation better, can someone compare and contrast what treatment for debilitating mental health issues such as schizophrenia looks like in Finland vs. the US?

The second issue is, In the last 10 years, the “Housing First” programme provided 4,600 homes in Finland. In 2017 there were still about 1,900 people living on the streets. In the US, there are something like half a million people living on the streets.

[svantana]

The US has about 60x the population of Finland, so on a per capita basis the situation (sans programme) seems comparable.

[splitrocket]

Correct, and generally speaking, economic of scale should apply to social sector programs. In theory, it should be 60x easier for the US to house everyone, simply because we have more resources to aggregate.

Even when you compare per capita GDP, Finland's doing it with $50k, while the US is at $62.5k.

[mkohlmyr]

I'm actually not convinced on the surface of it that economies of scale apply to government. It seems to me like the larger the population, the more layers of government required to effectively deploy capital.

If you assumed a similar per capita tax rate, but more government is required to deploy the taxes in a larger nation, the larger nation would presumably end up with less money deployed per capita.

Of course I am neither a social scientist, economist or political scientist.

[joshspankit]

The simpler the program, the less layers you need. If the todo list for a homeless person is:

- Assign open apartment

- Digitally fill out form B12

- Deposit money

Then there is very little work required.

Where social programs have the highest overhead is where they do things like “Assess whether it’s ‘required’ based on binders 3 through 7” and “Continually check in with all other governmental arms to validate that they are meeting criteria”.

[chimeracoder]

> Correct, and generally speaking, economic of scale should apply to social sector programs. In theory, it should be 60x easier for the US to house everyone, simply because we have more resources to aggregate.

People always like to rush to talk about economies of scale, completely forgetting that diseconomies of scale are also a thing.

(And even that's all assuming that you think Finland's demographics are comparable to the US's and that causes of homelessness and poverty in Finland are representative of the causes of homelessness and poverty in the US.)

[SpicyLemonZest]

Is the US in fact spending less money on homelessness, though? My guess would be that it's spending a comparable amount on a per-person basis.

[claudeganon]

A great deal of spending in the US suffers the problem of direct versus some form of market disintermediation. So, instead of just building houses for people, we funnel it through myriad private or semi-private bureaucracies and suffer their corruption and graft.

[SpicyLemonZest]

That appears to be happening in Finland as well. The article says that state funding is funneled through "NGOs such as the Y-Foundation" who are responsible for actually getting the housing.

[claudeganon]

Yes, it’s not a binary situation. But Finland also directly took over several private/NGO shelters and converted them to apartment blocks. In the US, this would be considered verboten in most major cities because of the challenge it poses to everyone involved in real estate speculation and development.

[soulofmischief]

The US citizen sees a fraction of their tax dollar ever actually reach the ground. The rest gets caught up in people's pockets on the way down. We would need to adjust for this but it's unclear how to create a heuristic.

[_jal]

Do you have evidence that there's more friction/graft in the US than, say, Finland?

[pavlov]

There's the established Corruption Perceptions Index published annually by Transparency International:

https://en.wikipedia.org/wiki/Corruption_Perceptions_Index

Finland is ranked #3 while US is #22.

[soulofmischief]

I don't, because I don't know how to calculate it. Like I said, we need a heuristic but I don't know how to go about it. But it's an important qualifier when we're trying to isolate this problem to just the economics of solving homelessness.

[gamblor956]

They never had Reagan, so they still treat mental illness there.

More importantly, Finland allows for the involuntary commitment if the mentally ill. In the US, this is only allowed if the individual presents a danger to themselves or others.

[pjc50]

That's almost what the Finnish system requires: https://helda.helsinki.fi/bitstream/handle/10138/231986/comp...

"The current Finnish Mental Health Act stipulates thefollowing criteria for compulsory admission:

.a person should be found to have a psychotic illness,and

.because of this psychosis, they are

(.in need of psychiatric care as their condition would otherwise worsen [this is the main different criterion], or

.a danger to their own health or welfare, or

.a danger to the health or welfare of others)

.no other mental health services are suitable or adequate

(Finland of course has proper free at the point of use healthcare for all residents, a far more important point for mental health than involuntary commitment.)

[DataWorker]

You can imagine how that’s an artifact of a more socialized health system. Perhaps unintentionally, it would function in many ways as a cost saving feature that would be very difficult to implement in the US system. Think about junkies. Can they be involuntarily committed because their condition would “otherwise worsen”? Imagine the legal implications in a system where hmo and insurers get to influence the decision about who is committed.

[DuskStar]

Or imagine a woman who has children out of wedlock, causing financial distress. Obviously, if she's not institutionalized she'll continue to have children out of wedlock, which will cause her condition to worsen.

And only a mentally ill person would have children out of wedlock, right?

And before you say that that's unrealistic... I'm pretty sure that that exact logic was used to institutionalize people in the US back in the 20s and 30s.

[gamblor956]

The main different condition makes all the difference...

That would describe more than two thirds of the homeless.

[didericis]

My understanding was that many of the institutions that housed and treated mentally ill people were closed in the 70s due to public outcry about mistreatment. The wikipedia article on deinstitutionalization in the US seems to corroborate this: https://en.m.wikipedia.org/wiki/Deinstitutionalization_in_th....

It sounds like some institutions were closed after that movement got going, so I wouldn’t be surprised if institutions were closed under the Regan administration, but I think the decline in public mental institutions preceded his administration and was largely unrelated to it.

[gamblor956]

No, the closure of mental institutions occurred during the Reagan administration because he cut funding for treating mental illness from his budget.

In CA, when he was governor, Reagan ordered the closure of many facilities.

[refurb]

No, there was a society-wide push to close institutions. Reagan might make for a nice whipping boy, but putting it all on him is just silly.

[gamblor956]

No, this is false. The number of patients dropped but almost all facilities remained open and were improving care.

Reagan than decimated the mental health department in CA below sustainable levels, and followed that up by ending federal funding of mental health treatment only a few years after trying to make the federal government pay for it when he was governor. As most state budgets no longer covered mental health, the result was an enormous drop in government spending on mental health.

And yes, it's all directly traceable to Reagan.

[3fe9a03ccd14ca5]

It still amazes me that we closed down virtually all mental istitutions in the US, and then we’re surprised to see mentally ill people struggling on the streets?

According to research almost half of the homeless have a mental illness, with about 25% having a very serious one[1].

If you’ve ever been walking down SF you know exactly who that 25% is. They’re on the street and they need an institution not a needle exchange or free boarding.

1. https://mentalillnesspolicy.org/consequences/homeless-mental...

[raxxorrax]

The problem was that a lot of these mental health institutions were filled with dubious psychoanalysts that often worsened the problems of patients. They had to be booted out. Doesn't mean that there is not place for modern forms of mental health care.

[stjohnswarts]

The government shouldn't be able to just walk around pointing fingers trying to put individuals in "therapy". Particularly the sort the is available at minimal budget government facilities.

[AQuantized]

Do you feel that is an accurate characterization of mental health care in non-US countries with different requirements for commitment, like Finland?

[refurb]

They never had Reagan, so they still treat mental illness there.

This Reagan meme needs to die. The ACLU was very involved in "deinstitutionalization" as well since holding people against their will was regarded as problematic.

[gamblor956]

Deinstitutionalization is a very separate issue from closing facilities. The ACLU worked to prevent people from being committed who didn't need to be. Reagan simply shutdown mental health facilities regardless of need.

[Gravityloss]

There was a massive change from institutional care to ambulatory care at the start of the 90:s, coinciding with the severe recession. Basically a big resource cut. I don't think it was ever reversed. (Don't know much about the sector.)

[gamblor956]

Reagan was president in the early 1980s. The closure of most mental health facilities preceded the Bush recession.

[Gravityloss]

I'm talking about Finland.

[CryptoPunk]

The Deinstitutionalization movement started in California, long before Reagan. The reason institutionalization won't return is because of the left not because of people like Reagan.

[JanSt]

The US also has 60x as many people.

327/5,5*(4600+1900) = ~386.000

(at 1 person/home)

[ianleeclark]

Why are you adding the 4600 and the 1900 together? Those 4600 have been homed.

[TacticalTable]

Homed by a process that the United States also doesn't have and would need. It would be dishonest to compare the rates without including the cases that Finland has already solved through a similar (but not as far reaching) program.

[ianleeclark]

> It would be dishonest to compare the rates

No, I think it's perfectly honest to compare the rates of homelessness in a country that has worked to improve the situation versus a country that continues to let people die in the streets. It seems far more dishonest to compare the rates before the work was done, considering that work was done to reduce the problem. The reason that the US now has a roughly 5x rate of homelessness (and, let's face it, growing) vs a roughly 1.3x rate of homelessness is because the United States has no interest in fixing the problem.

[raxxorrax]

I still don't believe in fractional reserve banking.

[SpicyLemonZest]

They've been homed, but subsidies for the housing of previously homeless people are typically aggregated under homeless spending. (The US has a lot of programs like that as well.)

[duiker101]

Why can't the issue be looked at a state level then?

[MuffinFlavored]

source for 500,000 homeless people in America claim?

[Someone1234]

The US Government:

> According to the US Department of Housing and Urban Development's Annual Homeless Assessment Report, as of 2018 there were around 553,000 homeless people in the United States on a given night, or 0.17% of the population.

https://en.wikipedia.org/wiki/Homelessness_in_the_United_Sta...

[splitrocket]

The 2018 annual "point in time" count done by the federal housing administration:

https://www.hudexchange.info/resource/5783/2018-ahar-part-1-...