Trump Supports Helping the Mentally Ill

 

We have failed the mentally ill of this country. In trying to save government money, we have watched them become subject to increasing job loss, homelessness, imprisonment, emergency room treatment, substance abuse, or vulnerable to violence. How did this happen and what is being done?

The Institutes for Mental Disease (IMD) exclusion began in 1965 as part of the Social Security Amendments Act of 1965, which created Medicaid and Medicare. Here are the basics of the exclusion:

The IMD exclusion prohibits the use of federal monies through Medicaid for any care (including non-mental health services) provided to patients from 21 to 65 years old, in mental health or substance abuse residential treatment facilities with more than 16 beds. A facility is determined to be an IMD based on its ‘overall character,’ or the totality of whether the facility is a licensed psychiatric facility, is under the state’s mental health authority’s jurisdiction, specializes in providing psychiatric care or treatment (based on the proportion of staff trained in psychiatric care), or whether more than 50 percent of patients are admitted to the facility for mental health care.

It’s no surprise that the states figured out how to manipulate the system:

Before Medicaid was enacted, states paid for psychiatric hospitalization, and it was readily available. But states soon realized that if they kicked patients out of hospitals, Medicaid would kick in and pay half the cost of care. This “deinstitutionalization” continues. The country has lost more than 450,000 mental-hospital beds since the 1950s, 12,000 of them since 2005.

For people who are seriously ill, receiving treatment is difficult and expensive. Few hospitals have psychiatric wards and, in some cases, mental health professionals may not be available to provide services. And due to the IMD exclusion, facilities are “incentivized to keep their bed count below 16 to preserve their Medicaid payment eligibility.”

What are the impacts of mental illness in this country?

  • Mental illness and substance use disorders are involved in 1 out of every 8 emergency department visits by a U.S. adult (estimated 12 million visits).
  • Mood disorders are the most common cause of hospitalization for all people in the U.S. under age 45 (after excluding hospitalization relating to pregnancy and birth)
  • Across the U.S. economy, serious mental illness causes $193.2 billion in lost earnings each year
  • 20.1% of people experiencing homelessness in the U.S. have a serious mental health condition
  • 37%of adults incarcerated in the state and federal prison system have a diagnosed mental illness
  • 70.4% of youth in the juvenile justice system have a diagnosed mental illness
  • 41% of Veteran’s Health Administration patients have a diagnosed mental illness or substance use disorder

Meanwhile, Rep. Eddie Bernice Johnson, D-TX, a former psychiatric nurse, has introduced legislation to abolish the exclusion. President Trump supports the legislation, and even Amy Klobuchar and Pete Buttigieg back these bills. A number of ways to deal with this change have been suggested in the past. There are those who are arguing against the legislation, including civil libertarians and mental health advisors; others mistakenly believe that treatment can be successful by providing drugs and “wellness initiatives.”

At this point, I’m not informed enough to debate how to replace or modify the exclusion. The big question for me is: do we have a responsibility to those who are mentally ill, and to those families and communities who are subject to the burdens of their conditions, to help these folks, or not?

Published in Healthcare
This post was promoted to the Main Feed by a Ricochet Editor at the recommendation of Ricochet members. Like this post? Want to comment? Join Ricochet’s community of conservatives and be part of the conversation. Join Ricochet for Free.

There are 54 comments.

Become a member to join the conversation. Or sign in if you're already a member.
  1. TBA Coolidge
    TBA
    @RobtGilsdorf

    Susan Quinn (View Comment):

    Stad (View Comment):

    There was also a movement against forced institutionalization under the guise of violation of civil rights of the mentally ill. Granted, many state institutions were cesspools, but the inmates were freed from the asylum with no place to go but the streets.

    And of course people thought if you just gave medication to people who needed it, everything would be fine. The problem was that many didn’t stay on the meds for many reasons: disliking the side effects, lack of discipline to monitor meds, and other issues. Now they live in homeless camps.

    Another very popular reason for quitting meds; “I feel better so I don’t need them.” 

    • #31
  2. TBA Coolidge
    TBA
    @RobtGilsdorf

    Jim McConnell (View Comment):

    MarciN (View Comment):

    [a good, but long comment, snipped to make room for my comment because egotism] 

    All of the above is true. But first there must be a change in law to allow for involuntary commitment of those who are unable to care for themselves. We have lots of volunteer programs, including shelters, warming rooms, food, etc., in Eugene; but there are many, many on the streets who refuse to make use of them. I know, I’ve tried.

    And to me this is the crux of the problem; we need people who can declare someone unfit  to the degree that we can institutionalize him but we don’t – and probably shouldn’t – trust those people with that amount of power. 

    • #32
  3. Gumby Mark (R-Meth Lab of Demo… Coolidge
    Gumby Mark (R-Meth Lab of Demo…
    @GumbyMark

    For those interested in learning more about how we got to the current situation regarding the homeless and the mentally ill I highly recommend My Brother Ron: A Personal and Social History of the Deinstitutionalization of the Mentally Ill by Clayton Cramer (available for $1.49 on Kindle).  As the title states it recounts both the story of Cramer’s schizophrenic brother and the history of the deinstitutionalization movement and its current state.  Some of you may recognize the author’s name – Cramer did some of the groundbreaking research on early American state laws regarding firearms that was used by the plaintiffs to help establish that the 2nd Amendment was indeed a personal right as the Supreme Court decided in Heller.

    • #33
  4. MarciN Member
    MarciN
    @MarciN

    Jim McConnell (View Comment):
    But first there must be a change in law to allow for involuntary commitment of those who are unable to care for themselves.

    The laws you are looking for exist. The law is very plain that a person can be committed against his or her will if he or she is a danger to himself or others. That has never changed, not even through the deinstitutionalization years.

    The two reasons judges don’t commit people is that (a) there’s no place to put the patients (either the existing facilities are truly dreadful and overcrowded or the facilities don’t exist in any form within the judge’s jurisdiction) and (b) having had a few doses of antipsychotics has made the patient so lucid the judge can’t see the reason for the commitment. There’s also a presently inexplicable phenomenon in which patients suddenly even without medication seem to snap to lucidity just due to the stress of the involuntary commitment.

    The antipsychotics are a bane and a blessing for mentally ill people with respect to involuntary commitments. Doctors know this happens: thirty days on the medication and the person is functioning quite normally. It strikes a judge as absurd to commit that person to a locked ward.

    What is needed is intensive rehabilitation. We’ve had great success with a combination of psychiatric support and medications, housing, and jobs.

    What is needed in the United States is for local cities and towns to understand their own role in creating housing and support services for mentally ill people.

    I’m less informed about addiction issues, but from what I’ve read, it’s the same problem. Rehabilitation is all about sustained jobs, support, social structure, and housing.

    • #34
  5. MarciN Member
    MarciN
    @MarciN

    Deinstitutionalization would have been a positive event if the cities and towns had built the housing and support services that were needed. The federal government contributed a lot of help–SSI, Medicaid, Section 8 housing, Food Stamps, assistance with utility bills. 

    It’s a tragedy that the cities and towns couldn’t muster the will to build the other support pieces. 

    The first piece that needs to be addressed is decent housing. We need a lot more affordable rental units than we have now. 

    • #35
  6. Gumby Mark (R-Meth Lab of Demo… Coolidge
    Gumby Mark (R-Meth Lab of Demo…
    @GumbyMark

    MarciN (View Comment):

    Deinstitutionalization would have been a positive event if the cities and towns had built the housing and support services that were needed. The federal government contributed a lot of help–SSI, Medicaid, Section 8 housing, Food Stamps, assistance with utility bills.

    It’s a tragedy that the cities and towns couldn’t muster the will to build the other support pieces.

    The first piece that needs to be addressed is decent housing. We need a lot more affordable rental units than we have now.

    Decent housing will not solve the problem for most.  This is primarily a medication and addiction issue. 

    • #36
  7. TBA Coolidge
    TBA
    @RobtGilsdorf

    MarciN (View Comment):

    Jim McConnell (View Comment):
    But first there must be a change in law to allow for involuntary commitment of those who are unable to care for themselves.

     

    The laws you are looking for exist. The law is very plain that a person can be committed against his or her will if he or she is a danger to himself or others. That has never changed, not even through the deinstitutionalization years.

    The two reasons judges don’t commit people is that (a) there’s no place to put the patients (either the existing facilities are truly dreadful and overcrowded and no judge wants to send someone to them unless it’s simply unavoidable or the facilities simply don’t exist within the judge’s jurisdiction) and (b) having had a few doses of antipsychotics makes the patient so lucid the judge can’t see the reason for the commitment. There’s also a presently inexplicable phenomenon in which patients suddenly even without medication seem to snap to lucidity just due to the stress of the involuntary commitment.

    The antipsychotics are a bane and a blessing for mentally ill people with respect to involuntary commitments. Doctors know this happens: thirty days on the medication and the person is functioning quite normally. It strikes a judge as absurd to commit that person to a locked ward.

    What is needed is intensive rehabilitation. We’ve had great success with a combination of psychiatric support and medications, housing, and jobs.

    What is needed in the United States is for local cities and towns to understand their own role in creating housing and support services for mentally ill people.

    I’m less informed about addiction issues, but from what I’ve read, it’s the same problem. Rehabilitation is all about sustained jobs, support, social structure, and housing.

     

    I suspect we could make supervised clinic visits – in lieu of institutionalization – a thing; set up a dispensary, give patients shots (or very carefully watched pills) on a daily basis (or weekly if there are meds/delivery systems that can work like that) as a condition to walk free. Hire a psychiatrist to monitor for twitchiness. 

    • #37
  8. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    TBA (View Comment):

    Jim McConnell (View Comment):

    MarciN (View Comment):

    [a good, but long comment, snipped to make room for my comment because egotism]

    All of the above is true. But first there must be a change in law to allow for involuntary commitment of those who are unable to care for themselves. We have lots of volunteer programs, including shelters, warming rooms, food, etc., in Eugene; but there are many, many on the streets who refuse to make use of them. I know, I’ve tried.

    And to me this is the crux of the problem; we need people who can declare someone unfit to the degree that we can institutionalize him but we don’t – and probably shouldn’t – trust those people with that amount of power.

    WOrrying about edge cases does not help. If you had seen the people I Have seen, there are people for who it is a 100% clear. There are safeguards in place, and multiple doctors, judges, and everyone gets an attouny. We are not talking Stalin here. 

     

    • #38
  9. MarciN Member
    MarciN
    @MarciN

    Gumby Mark (R-Meth Lab of Demo… (View Comment):

    MarciN (View Comment):

    Deinstitutionalization would have been a positive event if the cities and towns had built the housing and support services that were needed. The federal government contributed a lot of help–SSI, Medicaid, Section 8 housing, Food Stamps, assistance with utility bills.

    It’s a tragedy that the cities and towns couldn’t muster the will to build the other support pieces.

    The first piece that needs to be addressed is decent housing. We need a lot more affordable rental units than we have now.

    Decent housing will not solve the problem for most. This is primarily a medication and addiction issue.

    Decent housing with social and medical support will solve the problem for a large percentage of mentally ill people. (I can’t really express an informed opinion about addiction issues because I don’t have any firsthand knowledge about them. I suspect it is the same three-legged stool most addicts need.)

    • #39
  10. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    MarciN (View Comment):
    Decent housing with social and medical support will solve the problem for a large percentage of mentally ill people.

    @marcin, the question comes up about whether they must consent to the housing and medical support. Must they stay there and must they take the meds? Can that be forced on them? I’m just wondering if this is your perception or if your have seen data to support the success of this approach. I just know how resistant mentally ill folks can be.

    • #40
  11. Gumby Mark (R-Meth Lab of Demo… Coolidge
    Gumby Mark (R-Meth Lab of Demo…
    @GumbyMark

    I’m adding my Amazon review of My Brother Ron (the only Amazon review I’ve done) because it goes to a larger issue which had some influence on changing my political views:

    My Brother Ron works well as both a personal memoir of the impact of severe mental illness on a family and as an analytical study of the theory and practice around deinstitutionalization of the mentally ill. Clayton Cramer does a fine job interweaving both aspects in this book. It is a difficult task to be willing to discuss and convey the heartache involved in this type of situation but it is essential to making the reader understand the significance of the various legal, legislative and administrative changes that led to deinstitutionalization. It is also a case study in how good intentions can go wrong and how hard it can be to do mid-course corrections even when it becomes widely recognized that something has gone drastically wrong with public policy. It is an object lesson that extends beyond deinstitutionalization on how “wanting to do the right thing” is not enough – those pushing for change need to be willing to think through the implications of what is being proposed, know enough of the real world to have some sense of how theory plays out in reality and be willing to admit failure or at least be willing to significantly change course.

    • #41
  12. MarciN Member
    MarciN
    @MarciN

    Susan Quinn (View Comment):

    MarciN (View Comment):
    Decent housing with social and medical support will solve the problem for a large percentage of mentally ill people.

    marcin, the question comes up about whether they must consent to the housing and medical support. Must they stay there and must they take the meds? Can that be forced on them? I’m just wondering if this is your perception or if your have seen data to support the success of this approach. I just know how resistant mentally ill folks can be.

    I don’t know how often social workers make a deal with their patients. I made that deal with my mother, but she had excellent psychiatrists in Boston who also adjusted her medications so they worked for her. For example, they prescribed Klonopin, which my mother liked because it alleviated her anxiety. She had an excellent daily life for twenty years. Her psychiatrists were always available to me for help.

    Truthfully, I don’t know how many social workers have tried this approach. Most of the mentally ill people I’ve met would be grateful to have a room and a bathroom of their own and would work to keep it to the best of their ability. Part of that solution is patiently working with them to get the medications right.

    One of the problems we are facing right now as a country is that we’ve neglected this problem for so long that the numbers have  grown wildly. We’ll have to get creative and whittle the numbers down one by one to find the best solutions for patients as individuals.

    The last time I checked, the numbers of patients who can be helped by medication broke out this way: A third of the people diagnosed with schizophrenia have one bout of it, it is corrected with medication, and it never returns. That’s usually true for older patients who succumbed around the age of 35. (The three ages at which people are stricken with schizophrenia are generally 17, 22, and 35.) A third are helped by medication and can live on a small maintenance dose forever, basically. The problem for this group is keeping them on the steady low maintenance dose. The lower the dose, the lower the chances of incurable tardive dyskenesia setting in. What happens unfortunately to this group is that they feel better or they gain weight, they go off the medication, and when they decompensate, the doctors put them on very high stabilizing doses. If we can keep these patients from bouncing around on the antipsychotic, they can live a wonderful life. The third group is largely resistant to the currently available antipychotics.

    If we could get the second group into treatment and housing and rehabilitation, then we could focus on the third group and come up with answers for them too.

    • #42
  13. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    MarciN (View Comment):

    Susan Quinn (View Comment):

    MarciN (View Comment):
    Decent housing with social and medical support will solve the problem for a large percentage of mentally ill people.

    marcin, the question comes up about whether they must consent to the housing and medical support. Must they stay there and must they take the meds? Can that be forced on them? I’m just wondering if this is your perception or if your have seen data to support the success of this approach. I just know how resistant mentally ill folks can be.

    I don’t know how often social workers make a deal with their patients. I made that deal with my mother, but she had excellent psychiatrists in Boston who also adjusted her medications so they worked for her. For example, they prescribed Klonopin, which my mother liked because it alleviated her anxiety. I gave her her medication every morning for twenty years. I was her legal guardian. She took both pills every day. She had an excellent daily life for twenty years. Her psychiatrists were always available to me for help.

    Truthfully, I don’t know how many social workers have tried this approach. Most of the mentally ill people I’ve met would be grateful to have a room and a bathroom of their own and would work to keep it to the best of their ability. Part of that solution is patiently working with them to get the medications right.

    One of the problems we are facing right now as a country is that we’ve neglected this problem for so long that the numbers have grown wildly. We’ll have to get creative and whittle the numbers down one by one to find the best solutions for patients as individuals.

    The last time I checked, the numbers of patients who can be helped by medication broke out this way: A third of the people diagnosed with schizophrenia have one bout of it, it is corrected with medication, and it never returns. That’s usually true for older patients who succumbed around the age of 35. (The three ages at which people are stricken with schizophrenia are generally 17, 22, and 35.) A third are helped by medication and can live on a small maintenance dose forever, basically. The problem for this group is keeping them on the steady low maintenance dose. The lower the dose, the lower the chances of incurable tardive dyskenesia setting in. What happens unfortunately to this group is that they feel better or they gain weight, they go off the medication, and when they decompensate, the doctors put them on very high stabilizing doses. If we can keep these patients from bouncing around on the antipsychotic, they can live a wonderful life. The third group is largely resistant to the currently available antipychotics.

    If we could get the second group into treatment and housing and rehabilitation, then we could focus on the third group and come up with answers for them too.

    Thanks, @marcin, for the information. And God bless you for taking such good care of your mother.

    • #43
  14. MarciN Member
    MarciN
    @MarciN

    Just to throw this out there: I read an interesting story about fifteen years ago (I think it was that long ago–I’ve been unable to find it again) written by a reporter for the LA Times. He lived among homeless people for a year or two. He wrote that the group as a whole could be divided into three parts: one part was made up of people addicted to drugs or alcohol, one part was made up of mentally ill people, and the last third was made up of people who had simply given up trying to put a normal life together that had a home, a job, and a social circle.

    So if we can get the substance abuse patients into longer-term treatment than they are now and at least half of the mentally ill people into therapeutic housing and social services settings, that would leave us with the third group, which seems eminently helpable to me. :-) We have developed some great ideas and programs for helping long-term unemployed people.

    And we can work on prevention. We know there some life events that often lead to homelessness: divorce, young people who age out of foster care, and so on. We need to systematically intercede at those moments to make sure vulnerable people don’t fall through the cracks or simply give up of their own volition.

    During the Volunteer Summit under George H. W. Bush, a reporter asked Colin Powell how we could solve our problems when there are so many people in need of help. He replied, paraphrasing, “The same way we always have. One person at a time.”

    If we start building affordable housing, in the present prosperous job market (thank you, President Trump!), we could make some significant progress in our homelessness problem.

    • #44
  15. Rodin Member
    Rodin
    @Rodin

    In reading through the comments a thought experiment comes to mind:

    Homeless are made to go through a mandatory health assessment. Those with mental illness a institutionalized temporarily to determine whether a medical protocol will correct their state of mind and make them functioning and able to live somewhat independently in housing. Those that can are then sent to a private facility which offer food and housing in exchange for work and supervised medical protocol. There are house rules and the workers are retained only so long as they copy with the protocols, the house rules and perform work adequately.

    I think there are issues to be worked out regarding what types of businesses could use these workers and at what price point for the enterprise. Obviously training cycle would need to be fairly minimal and compensation in addition to food and housing would be modest (likely below minimum wage). Someone wouldn’t need to be there forever but patterning behavior and habits would be useful for their next place of living/employment.

    Maybe there is something like this already being done? Is it a successful model? Remember, the “perfect is the enemy of the good”. When I see the tent encampments I think there has to be better solution.

    • #45
  16. The Reticulator Member
    The Reticulator
    @TheReticulator

    MarciN (View Comment):

    I hate homelessness, but I am worried about the idea behind this legislation. The fact that it is based on the idea that we need bigger institutions makes me question the thinking and how well it might work, and frankly, who will get hurt by it.

    A sixteen-bed hospital or assisted living facility is actually a pretty good size that has a good shot at remaining focused on rehabilitation and helping patients live the fullest life they can. Much bigger than that and conditions can deteriorate.

    What you want most of all in a housing facility is a place where outsiders feel comfortable and want to visit. Smaller is better to achieve that end.

    I have a concern too that a lot of Alzheimer’s and dementia patients and the frail elderly will end up in whatever we build. Large institutions have a build-it-and-they-will-come aspect to them. One positive outcome of the deinstitutionalization movement in health care was that states discovered many people who were confined in these places were actually just handicapped physically but not mentally–they had simply become too difficult for their families to care for (or their families had died). Many were what we now call “developmentally disabled.” Deinstitutionalization forced the states to come up with better alternatives.

    This is not a federal issue. It is a local issue. There’s no federal fairy godmother that is going to fix this for cities and towns. And that’s a good thing because at the federal level and even at the state level, you get some bureaucrat who sees a captive population who cannot advocate for themselves, and you will see the quality of the facility, the food, and the staff degenerate. There’s an obvious reason for this, and that is economies-of-scale thinking. But what sounds cheaper in Washington is often unusable at the local level. And there’s nowhere for the staff to turn. Just answering machines in Washington.

    I truly wish the America Psychiatric Association would become the advocates they can be and should be for mentally ill people. The nation needs to hear from them directly.

    We need rehabilitation facilities all across the country.

    Mentally ill people need what we all need: to belong somewhere. They need friendship more than anything else.

    The test for nursing homes, rehabilitation facilities, and other housing situations should be to ask, “Would I want to live there?”

    If this bill passes, every city and town in the country should immediately form a citizens’ committee whose sole purpose is to supervise the local facility.

    I nominate this for Best Comment of the Day

    • #46
  17. The Reticulator Member
    The Reticulator
    @TheReticulator

    Jim McConnell (View Comment):
    All of the above is true. But first there must be a change in law to allow for involuntary commitment of those who are unable to care for themselves. We have lots of volunteer programs, including shelters, warming rooms, food, etc., in Eugene; but there are many, many on the streets who refuse to make use of them. I know, I’ve tried.

    There are people on the street who don’t want to live in those shelters or have anything to do with social work volunteers or professionals. You need to make a case for forcing them to give up their druthers, and you need to distinguish between those who have the right to make their own decisions and those who shouldn’t have that right. It is not easy to make those distinctions. 

    • #47
  18. Gumby Mark (R-Meth Lab of Demo… Coolidge
    Gumby Mark (R-Meth Lab of Demo…
    @GumbyMark

    The Reticulator (View Comment):

    Jim McConnell (View Comment):
    All of the above is true. But first there must be a change in law to allow for involuntary commitment of those who are unable to care for themselves. We have lots of volunteer programs, including shelters, warming rooms, food, etc., in Eugene; but there are many, many on the streets who refuse to make use of them. I know, I’ve tried.

    There are people on the street who don’t want to live in those shelters or have anything to do with social work volunteers or professionals. You need to make a case for forcing them to give up their druthers, and you need to distinguish between those who have the right to make their own decisions and those who shouldn’t have that right. It is not easy to make those distinctions.

    That is the core issue.  I was in the same situation as @marcin but eventually could not make the deal.  Whatever other changes you make around the homeless there will be a substantial percentage who will not agree to medication and/or give up on drug/alcohol abuse.  The question is what do we do and how to make distinctions?  If we can’t figure that out we will only achieve marginal improvements.

    • #48
  19. MarciN Member
    MarciN
    @MarciN

    Gumby Mark (R-Meth Lab of Demo… (View Comment):

    The Reticulator (View Comment):

    Jim McConnell (View Comment):
    All of the above is true. But first there must be a change in law to allow for involuntary commitment of those who are unable to care for themselves. We have lots of volunteer programs, including shelters, warming rooms, food, etc., in Eugene; but there are many, many on the streets who refuse to make use of them. I know, I’ve tried.

    There are people on the street who don’t want to live in those shelters or have anything to do with social work volunteers or professionals. You need to make a case for forcing them to give up their druthers, and you need to distinguish between those who have the right to make their own decisions and those who shouldn’t have that right. It is not easy to make those distinctions.

    That is the core issue. I was in the same situation as marcin, but eventually could not make the deal. Whatever other changes you make around the homeless there will be a substantial percentage who will not agree to medication and/or give up on drug/alcohol abuse. The question is what do we do and how to make distinctions? If we can’t figure that out we will only achieve marginal improvements.

    I’m afraid I had an unfair advantage. My mother met her grandchildren and loved them. I get no credit for this. Her tiny grandchildren adored her and she adored them. She was willing to try making the deal work. :-)

    She lived with us for about a month after I rescued her from a mental hospital. It helped, making that deal there because she was desperate to get out. In our final interview, her psychiatrist, Dr. Green, said to me, “I advise you not to do this. She will not last two weeks.” I said, “She’s not getting better here. She’s getting worse.” So I took her home with me while I found an apartment. One evening I was making supper, and I found my mother ballet dancing in my living room with her two granddaughters, four and six years old. :-)

    My mom did very well–on a bumpy road for sure, and with a lot of help from friends and neighbors, doctors, and ministers, and a whole lot of other people. She lived independently though for the rest of her life, and she passed away at 75 about ten years ago. But for many years, I smiled at the image of Dr. Green in my head. We made it!

     

    • #49
  20. TBA Coolidge
    TBA
    @RobtGilsdorf

    Susan Quinn (View Comment):

    MarciN (View Comment):
    Decent housing with social and medical support will solve the problem for a large percentage of mentally ill people.

    @marcin, the question comes up about whether they must consent to the housing and medical support. Must they stay there and must they take the meds? Can that be forced on them? I’m just wondering if this is your perception or if your have seen data to support the success of this approach. I just know how resistant mentally ill folks can be.

    Would contract law work for something like this? Or would it be null and void because they are crazy? 

    • #50
  21. TBA Coolidge
    TBA
    @RobtGilsdorf

    I propose the US military  figure out which of its vets are nuts on the street, bring them forceably back to service and inflict on them the care they need by way of the laws that these soldiers would now be under. I suspect many would respond well to the structure – and dignity – and could do work on a par with most reservists. And we are already paying for military mental health facilities. 

    • #51
  22. TBA Coolidge
    TBA
    @RobtGilsdorf

    TBA (View Comment):

    I propose the US military figure out which of its vets are nuts on the street, bring them forceably back to service and inflict on them the care they need by way of the laws that these soldiers would now be under. I suspect many would respond well to the structure – and dignity – and could do work on a par with most reservists. And we are already paying for military mental health facilities.

    I’ll go further. I have no idea what percentage of vets end up homeless, or what percentage of those homeless are homeless because of trauma incurred during service. But those who were damaged in the name of the flag must be cared for from the country’s wallet – it is part of the contract. 

    • #52
  23. TBA Coolidge
    TBA
    @RobtGilsdorf

    MarciN (View Comment):

    Just to throw this out there: I read an interesting story about fifteen years ago (I think it was that long ago–I’ve been unable to find it again) written by a reporter for the LA Times. He lived among homeless people for a year or two. He wrote that the group as a whole could be divided into three parts: one part was made up of people addicted to drugs or alcohol, one part was made up of mentally ill people, and the last third was made up of people who had simply given up trying to put a normal life together that had a home, a job, and a social circle.

    So if we can get the substance abuse patients into longer-term treatment than they are now and at least half of the mentally ill people into therapeutic housing and social services settings, that would leave us with the third group, which seems eminently helpable to me. :-) We have developed some great ideas and programs for helping long-term unemployed people.

    And we can work on prevention. We know there some life events that often lead to homelessness: divorce, young people who age out of foster care, and so on. We need to systematically intercede at those moments to make sure vulnerable people don’t fall through the cracks or simply give up of their own volition.

    During the Volunteer Summit under George H. W. Bush, a reporter asked Colin Powell how we could solve our problems when there are so many people in need of help. He replied, paraphrasing, “The same way we always have. One person at a time.”

    If we start building affordable housing, in the present prosperous job market (thank you, President Trump!), we could make some significant progress in our homelessness problem.

    I think Powell’s phrase and the undercover reporter’s findings really point up the idea that when we speak of ‘the homeless problem’ we are going to miss our target. Some of these people don’t have homes. Some of them can’t keep a home. Others don’t want a ‘home’ as we think of a home. Any pathologies cannot be dealt with en masse as they are specific to each person. 

    • #53
  24. TBA Coolidge
    TBA
    @RobtGilsdorf

    MarciN (View Comment):

    Gumby Mark (R-Meth Lab of Demo… (View Comment):

    The Reticulator (View Comment):

    Jim McConnell (View Comment):
    All of the above is true. But first there must be a change in law to allow for involuntary commitment of those who are unable to care for themselves. We have lots of volunteer programs, including shelters, warming rooms, food, etc., in Eugene; but there are many, many on the streets who refuse to make use of them. I know, I’ve tried.

    There are people on the street who don’t want to live in those shelters or have anything to do with social work volunteers or professionals. You need to make a case for forcing them to give up their druthers, and you need to distinguish between those who have the right to make their own decisions and those who shouldn’t have that right. It is not easy to make those distinctions.

    That is the core issue. I was in the same situation as marcin, but eventually could not make the deal. Whatever other changes you make around the homeless there will be a substantial percentage who will not agree to medication and/or give up on drug/alcohol abuse. The question is what do we do and how to make distinctions? If we can’t figure that out we will only achieve marginal improvements.

    I’m afraid I had an unfair advantage. My mother met her grandchildren and loved them. I get no credit for this. Her tiny grandchildren adored her and she adored them. She was willing to try making the deal work. :-)

    She lived with us for about a month after I rescued her from a mental hospital. It helped, making that deal there because she was desperate to get out. In our final interview, her psychiatrist, Dr. Green, said to me, “I advise you not to do this. She will not last two weeks.” I said, “She’s not getting better here. She’s getting worse.” So I took her home with me while I found an apartment. One evening I was making supper, and I found my mother ballet dancing in my living room with her two granddaughters, four and six years old. :-)

    My mom did very well–on a bumpy road for sure, and with a lot of help from friends and neighbors, doctors, and ministers, and a whole lot of other people. She lived independently though for the rest of her life, and she passed away at 75 about ten years ago. But for many years, I smiled at the image of Dr. Green in my head. We made it!

    This is what the homeless don’t have, and what government can’t possibly give. 

    • #54
Become a member to join the conversation. Or sign in if you're already a member.