[zdragnar]

> maybe they are required to attend some mandatory psych session

According to the social workers I know who work with this population, there is a persistent fear that any form of offered mental health help is a trap for institutionalizing people.

By and large, people who are chronically homeless due to mental health issues will prefer to remain homeless over being required to see a psychiatrist and having to take medicine, or so I'm told.

[lazide]

The issue is also that it’s selection bias - folks who permanently benefit from the treatment leave the system, so you end up with a more and more concentrated population of people who don’t (or refuse to) permanently benefit from it.

Barring other factors, of course.

[AStonesThrow]

The point of drugs is not to benefit the patient!! The drugs and treatments protect the community and serve the collective good.

The drugs are administered first to foster obedience, credulity, and fidelity. The patient learns to keep their appointments, lest the drugs be withdrawn. The patient becomes a regular customer at the pharmacy, which must also be done on precise schedules. The drugs must be taken as directed, and the patient learns how to read and understand and follow intricate rubrics for rituals at home, and what foods to avoid, how to coordinate meals with the drugs, etc.

The patient, having demonstrated obedience and fidelity is well-supervised now by the clinic and provider. The drugs are "virtual shackles" that stand in for actual restraints and confinement methods. Just as "chemical castration" substitutes for surgical mutilation, any patient who's on drugs and making regular appointments can be let loose, a feral in the human population, often undetected and blending in.

https://en.wikipedia.org/wiki/History_of_psychiatry#/media/F...

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

It's important to consider that Mental/BH has never been a medical discipline, and while today's scrubs and white coats are the priestly raiment of BHT, NP-LPN-RPh-BH, and M.D.s alike, they take blood pressure and do labs, and they prescribe drugs and work in clinical systems, even Western-style BH is, fundamentally, a religious temple cult of profound spirituality. In order to fit the mold of modernist secularism, the BH temple must array itself in trappings of science and respectable, professional jargon. The BH orthodox profession is that mental illness begins and ends in the body, somewhere, hopefully the brain, or at least where the neurotransmitters flow, to be manipulated by sacramental means. Because if mental illness is not bound or subject to the body, or the secret HIPAA-protected rites and liturgies are not concrete and high-tech, then treatments become subjective, outcomes are unpredictable, and evidence cedes ground to superstition or faith in deities and the intangible world of spirit, which must be ignored in order to promote and foster D.E.I.

Ramp up drug regimes trying to blunt aggression, anxiety, restlessness, independent thought and reason, resistance to authority, and other compulsions to harm others, or sometimes the drugs magnify those compulsions and homicidal ideations, and the patient just goes totally apeshit, until the hospital can get to billing their insurance in earnest. But since President Reagan "closed the asylums" the paradigm shifted to keeping people out and free and at-liberty. Because institutionalization is an excessive burden on taxpayers, families, and insurance carriers, and it's labor-intensive: this is recapitulated in the past 5 years because the "Flatten the Curve" mantra was promulgated because there are widespread staff shortages and a lack of skilled, certified HCPs, especially for Defence Against the Dark Arts. I recommend viewing the critically acclaimed, award-winning film "Ladybird" starring Saorsie Ronan; her mother is a psychiatric nurse played by Laurie Metcalf, and see how Ladybird herself turned out

Even for the HCPs on staff, BH facilities are closer to meat-grinders than revolving-doors, as they burn out, train up, move up, drink their own Flavor-Aid, circulate within the system. So those homeless psychos meet a new team of strangers every month or so. Over 25 years, I personally witnessed one clinic that changed its name/brand/ownership 5-6 times, expanded/moved at least 3 times, and there are literally dozens of BH systems that didn't exist 10 years ago, including 8-story hospitals with no 6th floor.

https://www.azahcccs.gov/Fraud/Downloads/ProviderSuspensions...

Would you believe dozens of New Religious Movements operating under auspices of BH services? You may find yourself in a shotgun shack, worshipping Shiva or Kali, or I don't know, in a UFO cult, or practicing tantric yoga with authentic Punjabi Guru, because Medicaid funding. BH Funding for Treatment is Public Safety and a National Security concern: every time a mass shooting is reported on the news, Congress acts to bolster BH funding and services, and so "every time a shell casing pings, someone's clinic builds a wing!"

Ask anyone working in hospice/palliative care and they may confide that drugs are administered when family or staff are irritated or vexed by the patient, rather than basing it on the needs of patient herself. An incoherent or insane patient may be unable to articulate their needs, but when they act out, or become criminally dangerous, they must needs smacked down. "The Squeaky Wheel Gets the Grease" indeed.

https://en.wikipedia.org/wiki/Rosemary_Kennedy#Lobotomy

The patient works with the provider to identify and treat more and more conditions. The drugs layer-up, and sometimes extra drugs are shoveled on top, to complement really debilitating effects. But in general, the drugs are exacerbating and magnifying the patient's sins and proclivities. The drugs are interacting and the patient is increasingly entangled in the intricate ritual of provider->pharmacy->daily pill rituals->pharmacy->provider->pills.

It's impossible to know whether recovery is attributable to a true underlying change or whether the drugs have papered over the worst symptoms. Therefore, it's never advisable to stop those drugs or titrate off them, because they don't get labeled with maximums or limits like the OTC stuff can be (this guy once OD'd on fiber supplements).

In the case of "lunatics" and other folks who just had a temporary nervous breakdown or trauma-based freakout, they certainly can recover and exit the system--anyone can exit the system until they're court-ordered or incarcerated, anyway.

There's plenty of other non-drug treatment for outpatients on the streets; counseling/therapy can be done 1:1 or in groups and other supports in the clinic for building life skills, etc. The homeless nutjob population can typically get benefits from us taxpayers to keep them in the clinic 3-5 days a week, just doin' stuff, because the clinic is pretty much a church, and the mentally ill need a religion with structure, rituals, priests, and sacraments like Prozac.

[lazide]

It does benefit the patient to not have to be smacked down by society, kill themselves, die of exposure, etc. right?

There is a reason why the old saw of ‘if you’re poor, you’re crazy. If you’re rich, you’re just eccentric.’ is largely true.

If you’re a threat to society, society will become a problem to you. If you don’t have the resources to deal with that, then you have a real problem.

[AStonesThrow]

It's typically illegal and possibly immoral to die by suicide, but again, as a matter of national security, it contributes to the collective good when insane persons fall by the wayside and lessen the harms and burdens for the proletariat, taxpayers and institutions. There are dozens of medications to help foment ideations and actual attempts of self-harm, so the patient benefits by staying out of courts and prisons and teenagers

The more cooperation that can be elicited from the mentally ill, in terms of becoming sicker, and medicated, and incapacitated or dead, the easier it becomes for citizens who support spouses and sane children, for citizens who work and pay taxes, for sane citizens who own property and generate revenue by leveraging assets, for free humans pumping iron, or those exercising the rights to liberty and the pursuit of happyness.

All of the above are increasingly threatened unless mentally ill humans stop procreating, and be removed from law-abiding democratic communities, and until then, controlled and supervised. An incapacitated patient won't leave home, won't start any fights, and won't disrupt a workplace or elementary schools, if the patient struggles for existence, barely able to prepare meals or get sufficient sleep.

The USA is deeply in debt, overpopulated, gripped and choked by a dark, imperceptible 6-year pandemic that marches through every corridor and vehicle, and still the immigrants flow inwards through the Golden Door, ready to work and assimilate, but is our national Zeitgeist on life support? The feeble-minded and mentally ill, malcontents: especially those without caregivers or supportive families, human weeds! They hinder progress, hinder democracy, and they threaten national security.

[lazide]

Uh, did you intend to literally write an argument for authoritarian eugenics? Aka, that darkest part of Nazi’ism?

[AStonesThrow]

Yes. I borrowed plenty of tired rhetoric and I'm deeply troubled by the knock-on effects of eugenic policies, but from a grassroots view here among the human weeds, I confess that I'm also describing the status quo in the developed West, and the duty of citizens of that Western culture to engage and participate in the darker side and a culture of death, according to the Divine Plan for each of us.

From across the pond, it seemed that Nazism resulted in the expelling/extermination of foreign, undesirable influences and a stirring up of nativist fervor in order to validate those actions.

Also here across the pond, we've had major immigration by Eastern Bloc or Soviet refugees in the past century. They're a huge influence on our culture and ideology and the direction we've taken since the Civil War. And we see nativist fears and xenophobia in things like the McCarthy "Red Scare", but were they entirely unjustified when today we're screaming about Facebook and soviet interference in elections? ... And our voices are raised in chorus of "get these homeless off the streets, expand [mental] [women's] [right-to-die] health care, defund Churches [and mosques, synagogues and Wiccans?] will no-one rid us of these troublesome [cops, judges]?"

Surprise plot twist: the vicious military expansion that was nipped in the bud left more of a historical mark than the mass emigrations and migrant movements going on underneath the wars. The USA got Albert Einstein, rocket science, a regime change in Hollywood, new captains of industry and finance, and lifeboats full of philanthropists. We children of the Cold War wouldn't know one another at all if it weren't for the IETF, NSF, ARPA-DoD, and TLAs that you can't stand.

Eugenics may be a pseudoscience or a discredited ideology, but is it also entirely without merit, or unjustified? What does a nation do when she's deeply in debt, and more people are struggling for smaller pieces of the pie, and her reputation and huge tracts of land are an attractive destination for refugees and migrants? I guess some of her citizens log into free websites and give unpaid "Billion Keyboard Monkeys" labor to the guys who host the servers.

[hnbad]

The obvious problem is that that fear is entirely justified and rational.

Even if you disregard history, the current POTUS literally talked about concentrating homeless populations into centralized camps away from the general population.

How realistic this fear is and how probable it is, is of course debatable. But given that these people probably didn't have any positive experiences with mental healthcare and institutions and that the public discourse often describes them as analogous to vermin or disease and focuses on "removing them" rather than helping them, trusting a psychiatrist - especially if it means having to go to them, especially into a clinical environment - let alone taking psychopharmaceuticals seems like it would require quite the leap of faith.

[zdragnar]

It is and it isn't. The conversations I'm referencing happened back when Obama was in office.

Every state does have some form of civil / involuntary commitment, though nothing like before the 80's.

Many drugs also come with unpleasant side effects, especially if someone steals them from you and you're stuck with withdrawals. I'm reminded of one person my friend was helping who hated taking his medicine, but if he didn't, he would inevitably become increasingly paranoid that vampires were out to get him. Helping the poor guy live anything close to a "normal" life was a constant challenge.