[M1ch431]

Exactly. It's scary to think that a simple screening could dictate how you are treated for the rest of your life effectively.

You're declared a "latent schizophrenic" and people start doubting your credibility, sanity, independence, safety etc. at every change or milestone in your life. You are forced into therapy for your "benefit", because you are preemptively declared "incompetent" because your illness could manifest any time.

You are given "maintenance" doses of major tranquilizers and a cocktail of other poorly understood psychiatric drugs to balance the side effects out; and any spirituality, any epiphanies or sudden changes, any minute delusion is blown out of proportion and is put under a microscope.

This name-calling/magnification of "bad behavior" could happen to anybody, and does every day regardless of such screenings and tests. These psychological disorders are poorly understood, with flimsy and often biased/subjective diagnostic criteria (with no measurable physical damage, only a checklist - even in schizophrenia; those bunk brain scans of people who have been treated long-term with anti-psychotics are evidence of just that - it's not the natural progression of the disease).

"Wellness checks" are one way today where people can effectively send anybody to a mental hospital with no due process. Some states require that you be a threat to yourself or others, which is something that is easy to fabricate/exaggerate if you wish a person harm, or perhaps misunderstand a situation or are misguided and think you know better than the person that you want to "help".

In my state though, if there is "clear and convincing evidence that somebody needs treatment and would benefit from it" during such a check, it basically gives them the right to involuntarily commit you.

Imagine how devastating that could be to somebody who cannot afford to pay for the treatment/duration of stay, even if they were deemed subjectively to need treatment. It's highway robbery how much they charge. And their entire life could be upended in the 3 days they held them, if they did get out in only 3 days. They could lose their job, and it all cascades from there.

Instead of worrying how bad reality can get, or is, we really just need to attack the problem at its core:

Health care needs to be health care, not whatever the hell capitalism has twisted it to be.

Involuntary treatment should be made illegal, and there should be a much higher bar on what criteria makes somebody incompetent. One psychiatrist and a judge who is wooed by that psychiatrist is not enough. You should be able to direct your care to another psychiatrist or facility if you have any problem whatsoever, but that usually doesn't happen. There are courts specifically called "Mental Health Courts" in the US and I can tell you that "second opinions" and even small changes to your treatment can be hell to fight for.

And finally, suicide should be legal. There should be humane, detailed processes for it, and it should be done in a medical setting. If suicide were legal, then a lot of these frivolous interventions would become regulated. People shouldn't have an express ticket to the mental prison whenever they express wanting to die.

[2snakes]

On the other hand, it is arguable that the state has an interest in preventing the collapse of relationships that occur around schizophrenics. That's what the involuntary commitment analysis is for to determine safety/danger. If you don't have rules about this it can get a lot uglier quickly.

[swayvil]

Our vast prison industry suggests that they don't gaf about our relationships.

I think they just want to separate the sheep from the goats. And then dispose of the goats.

[M1ch431]

I think our laws largely in this area (involuntary commitment) reflect how hostile a particular state or geographic location feels towards their homeless population and other undesirables as you suggest.

Psychiatry is used to get these people off the street (for their own benefit of course), and either the state is content to just to disappear them into a hospital (the hospital loves the chance to reap all that money), or is happy to see them in and out, having them experiencing a combination of psychiatric drug withdrawal and side effects.

Perhaps it's not like that everywhere, and these people are provided the medication free of charge through some means, but I know that a pharmacy won't fill your prescription if you don't have money.

Imagine what this dynamic looks like if somebody also has an addiction to feed, or isn't educated properly on the powerful drug(s) they are being prescribed. There's a lot that can go wrong when you give prescription drugs with physical dependence to people who see the opportunity to 1) sell them 2) not take them consistently 3) or administer incorrectly (try to get high). Any of those things can risk withdrawal and other physical side effects, that could only make somebody more unstable, or their behavior even riskier.

Which is tantamount to poisoning these people (why prescribe something with physical dependence if you know they can't reliably get the medication? Where is the "Do no harm"?), and sounds pretty unconstitutional to me on many levels. In general, the homeless have more of their rights stripped than any other population that I'm aware of in the US.

You can't sleep in your car because city/town ordinances, benches are being made to prevent being slept on (hostile architecture in general has become a pretty common), in most areas you can't access or afford housing or property when there's empty housing and property everywhere, the shelters aren't safe, you can't build what you want on your property (e.g. tiny houses not being allowed in some areas), and lastly simply being homeless is enough justification to have all your rights stripped and your freedom taken away. For your own good, because just being homeless is a mental illness in itself for everyone concerned.

[M1ch431]

Of course, I do think there should be some effort to be made to stabilize individuals in crisis. Just like a typical hospital.

Especially those who may be having medication side-effects, which with psychiatric medication, incidence rates for some fairly severe side effects (such as the potentially irreversible condition called tardive dyskinesia) are fairly high across most commonly encountered drugs.

Add polypharmacy (5 or more drugs at the same time, which is common in illnesses such as schizophrenia, such as antipsychotic polypharmacy being used in 30% of such patients) and a mental hospital is probably the only place that is equipped to help somebody in such a situation. It's irresponsible, dangerous, and unethical what is happening in the current standard of care in my opinion.

I believe consent is the most important thing you need in medical care. Just as you should be able to refuse life-saving care for whatever reason you might have in a regular hospital, you should be able to reject (for example) a long-lasting intramuscular antipsychotic injection, which are usually part of commonly encountered treatment orders.

It's rape if you don't give somebody a choice, and think about what that does to somebody. I am an actual victim of rape, and I can tell you it's no different if a doctor or nurse does it to you. It's something you didn't want, and that should be good enough reason for a doctor to not administer such care. If you have other reasons, such as not liking how it makes you feel, etc. that's more than enough.

And you should be able to make decisions that affect your body especially if you're not a threat to yourself or others. If somebody needs to taper off to safely get off their medication, then have them taper off to get off the medication - but still overwhelm them with support in other ways they approve of if you determine they need it.

BUT there's a pretty valid alternative to scary things like involuntary treatment orders, restraints, locked doors, "Mental Health Courts", and disease-first care.

And that's Soteria Houses. You can read my thoughts on this (in my opinion) revolutionary and successful standard of care in my previous posts: https://news.ycombinator.com/item?id=37140331

The gist is: no locked doors, welcoming supportive environment, no dehumanization or medicalization of their psycho-social issues, minimal psychiatric intervention (mostly for stabilization from what I've read), and they have pretty impressive results treating a supposedly lifelong and chronic disease.

However, it or something like it will never manifest into becoming the dominating model unless we slash the greed out of mental health care and health care at large.

I firmly believe that the medications commonly used in this field today and especially in the past are prescribed irresponsibly, without the long-term testing they need, and side effect/interaction profiles are not studied in the detail they need to be before these drugs are unleashed. This creates a revolving door for these companies to cash out on these people, either through their hospitals or the doctors they brainwash. And boy, do they. You know it's bad when you see an advertisement for XYZ psychiatric drug on the television. It's been bad for however as long as the field has existed. A true horror that we will look back on with great pain as a world.

The fact is that most people probably never have heard about Soteria Houses, and that's by design. It breaks their big illusion. Schizophrenia and other serious mental illness need to be a boogeyman that only a psychiatrist can understand. They say it's a lifelong disease that only they can manage the symptoms of. And this is because they more often than not create the disease in these very, very vulnerable people with the chemicals they claim help more than they hurt.

I disagree that this is the best we can do, especially when it comes to the care of schizophrenia and other mood disorders. We can do better, we are way too primitive to be messing with an organ in ways we don't fully understand with definite greater health implications, especially so in people that may not be able to fully comprehend and communicate what is happening to their bodies.