[joshtbradley]

Well written, but it says nothing. No real breakdown of the problem, certainly no solution. Just generic hatred for the rich and empathy for the poor. Like most people who use the word "unhoused," it's performative. If you want to help, volunteer. I have. It's heartbreaking. You realize how dehumanizing it is to try to help someone who is unstable. Mental health, addiction, and deep trauma cannot be solved with money, or shelter, or food. Real treatment is necessary. A modern asylum, crushing drug markets, and taking responsibility for those who cannot take responsibility for themselves needs to be seriously considered. We did this poorly in the past, but the current paradigm clearly is not working, and it might be time to try again. Hard problems need hard solutions, not soft words.

[gexla]

Right, it's an issue that requires intensive care to address mental health issues. The human resources required for this is always going to be a bottleneck. Much more so than housing shortages or funding for programs that are largely self service (if you can navigate the system, you may not be homeless for long.) Building, staffing, and funding such an institution seems like it would be extremely difficult.

[joshtbradley]

SF is currently spending $100K per homeless person. I agree, it will be extremely difficult, and that the human resources may be a bottleneck. But that's enough for an average person to live in SF, go out sometimes, and pay for therapy. There must be a way to deploy those funds effectively.

[sharts]

$100K per homeless and yet each homeless person doesn’t receive anywhere close to $100K of services.

[seanmcdirmid]

$100k/year, and ya, public orgs non-profits that get the money aren’t very efficient. What is worse is that much of that money goes to chronic cases with drug addiction and mental illness, the people who are just struggling to pay rent (much cheaper than $100k/year) and wind up living in their car often get ignored until they become chronic cases that are no longer easy to help.

[joshtbradley]

As Buffett says “Show me an incentive and I’ll show you an outcome.”

I’m not one to think in conspiracies. But here is a clear, structural issue. The reward to NGOs should be granted upon reintegration, not upon crises.

[bix6]

I’ve heard that this is an over simplification and conflates a bunch of factors.

The big question I have is how do you help people who refuse to be helped? That’s an ethical dilemma not necessarily a $ question.

[joshtbradley]

I'm sure it is a conflation, but it is directionally correct. We are burning money and making zero progress.

The ethical dilemma is deep. Is forcing someone into an asylum—where they can be sheltered, monitored, and treated—more ethical than giving someone the self-determination to self-destruct on the street?

I don't have the answer, I'm not Kant. But it's a question we have been unwilling to face because it is deeply unsettling. It goes against our liberal instinct.

[mlrtime]

I think the only way is to give up a bit of freedom for the person's best interested AND societies.

This never works though because once you decide to do this, it is abused. So to prevent abuse, you use law enforcement. What I mean is that we decided freedom is more important than forcing treatment. And since there are no other levers, law enforcement is left to deal with the problem.

[fragmede]

The question is what do you do in the face of abuse of the system? Do we shut everything down and walk away and pretend it didn't happen and let's just not talk about it, like an emotionally immature six year old child that pooped in the living room? Because that doesn't make the problem go away, but that's what we did.

You set up a system to help people that could be abused, and then you set up oversight committee, external auditors, regulators, board of trustees, ombudsman, inspector general. A giant pile of bureaucrats and bureaucracy. And yes, abuses will still happen. You get it all on camera, in writing, you find the abuses of the system and you close those down. New abuses happen, you find those loopholes and close them down. The problem is there's no will to do that. The systems broken, so we just threw it out and the people that it was helping got fucked. Instead of like, hey the systems broken, lets fix it.

So instead we got people living in tents with no running water, no sewage, no electricity.

[parpfish]

the human resources required to make it work are a bottleneck, but even if we had the resources we need to build a humane modern asylum system, there'd be a whole slew of civil liberties issues

[bofadeez]

Prohibition drives black markets where normal price discovery, quality control, and dispute resolution vanish, producing high prices, inconsistent purity, and violence. It does nothing to reduce demand. Low-level dealers effectively stabilize these markets through competition and supply continuity. Enforcement intensifies instability and empowers predatory actors. Mental health care and treatment work better alongside regulated supply, which reduces violence and desperation while letting users seek help outside illicit markets. Real solutions require rethinking the structures causing the crisis, not doubling down on failed approaches.

[joshtbradley]

I agree with what you said; "mental health care and treatment work better alongside regulated supply."

But open-air drug markets are not regulated supply. They are a scourge. America's problem with fentanyl is unique in it's scale and it is not something that can be solved with permissive policy. It must be systematically dismantled.

I do think decriminalizing all drugs for use in clinical settings would be a healthy step forward. I don't think allowing illicit markets for the most dangerous substances helps anyone except criminals.

[bofadeez]

If fentanyl were legalized, how much would you personally consume?

News flash: nobody does/does not do drugs based on legality.

The Rat Park experiment showed that rats in enriched, social environments consumed far less drugs than isolated rats, highlighting how environment strongly affects addiction.

In Defending the Undefendable, Jeffrey Moussaieff Masson’s chapter “The Pusher” argues that drug dealers, often vilified as destructive criminals, play a complex social role by supplying a demand that already exists. He suggests that punishing them does little to stop drug use and may actually exacerbate harm by driving the trade underground, increasing prices and danger. Since demand for illegal drugs is inelastic, higher prices directly leads to increase in petty crimes like theft that are often motivated by addiction. I.e. addicts wouldn't have to steal as many catalytic converters if drugs were pennies per day instead of hundreds of dollars. And it's only expensive because it's illegal. It's kind of ironic.

Dark speculation here, but addiction may even be an evolutionary coping mechanism, providing just enough short-term reward to keep individuals alive when life feels unbearable. The alternative to addiction might be even worse given e.g. an unusually strong biological emotional response to a (possibly accurate) negative assessment of their personal reality.

[joshtbradley]

I engaged in good faith, made a nuanced point, and you open with an insult? I appreciate the knowledge you bring, but I’m not exactly sure what you’re defending here. Breathe man, we’re all in this together.

[bofadeez]

I opened with a rhetorical question, not an insult. The answer is obviously "the same as I consumed before it was legalized" - presumably zero fentanyl use for you whether it's legal or illegal. I was not implying you do fentanyl lol. I was implying your decision not to do fentanyl has nothing to do with it being illegal.

[mlrtime]

It's still a poor question IMO.

99% reading this thread is not the problem. They are not taking your hypothetical offer.

But there is a small slice of the population that would take your offer. The small percent of people that would take more would have devastating effects on a community.

[joshtbradley]

I see, I appreciate the clarification.

[nradov]

The Rat Park experiment has never been directly replicated and rat behavior is quite different from humans. I wouldn't draw any policy conclusions from it.

[seanmcdirmid]

We’ve basically put most of our pharmacies out of business here in Washington state due to a state lawsuit against pharmacists not being more paranoid when filling opioid prescriptions (written by doctors). That sh*t is addictive and a permissive stance in illicit fent has only led to had things here.

[lapcat]

> No real breakdown of the problem, certainly no solution.

The article appears to be an excerpt from a 300 page book.

[joshtbradley]

Big enough to keep someone warm.

[fragmede]

> Mental health, addiction, and deep trauma cannot be solved with money

You use the money to pay for goods and services. Services like staff and therapists and psychologists and case workers. And yes, the occasional administrator as well. "Real treatment doesn't just happen. It's expensive, but under capitalism, you use the money to get it for the people that need it. The problem that I've seen volunteering is that money gets siphoned off, away from the people it's supposed to help, and it goes into pockets that part of the non-profit's stated mission.