Live data from Hacker News

Reinventing the E.R. for America’s mental-health crisis

newyorker.com

51–60 of 113 posts

Re: Reinventing the E.R. for America’s mental-health crisis

#51

Alternative title: "Bringing back the asylums without admitting we were wrong about closing them"

Can you explain what policy you are advocating for? Asylums pretty egregious abuses of people's human rights; and that's to say nothing of instances where they were used to lock up mentally well but socially "undesirable" people. I'm guessing that you must have intended to advocate for something else?

Ok first check this out: https://www.dailymail.co.uk/news/article-12131455/Inside-Phi...

That's about 40 minutes from where I live and I can say first hand it isn't a exaggeration, since the pandemic those areas have been growing. Would you feel safe walking at night there? Now consider that children live in those communities. Do you think they feel safe?

I agree with you that many of the asylums were inhumane, shock therapy and the like. I think you'd also agree with me that modern asylums probably wouldn't be as bad had they been allowed to remain as they would've certainly been reformed over time. I am strong on personal liberty, and individual rights, However it is inhumane to those residents of those, very poor, communities to essentially have a open air asylum imposed upon them. Something must be done with these people, if not asylums what? Prison? I suspect that would have worse outcomes.

Re: Reinventing the E.R. for America’s mental-health crisis

#52
post #11
post #7

Earlier quoted context omitted.

> and then send them home In a lifetime of debt

Contrary to the stereotype, most Americans have health insurance that covers inpatient and outpatient mental health care. That's why we can't get a universal socialized system implemented: too many Americans already have good enough insurance that they don't want to change it.

Sure you just go to the hospital and show them your insurance then they ignore it and send you to collections half a year later and you get to spend weeks on the phone fixing their "mistake"

Re: Reinventing the E.R. for America’s mental-health crisis

#53
post #47

There’s gotta be some reason for the mental health crisis, along with all the other crises out there. It doesn’t make sense for every level of American to be meaningfully wealthier and higher income than 20 years ago and yet also be suffering (in multiple ways!) more as well. We even (mostly) fixed health insurance by massively redistributing income! The rest of the world seems to be tracking the same trends but 10 y…

> It doesn’t make sense for every level of American to be meaningfully wealthier and higher income than 20 years ago and yet also be suffering

It doesn’t? What if everyone is working more hours to maintain that income? Or taking on more stressful jobs and bringing that anxiety home with them?

I could believe that there’s a direct correlation between income and positive mental health in the very low bands of earning (i.e. living in poverty is stressful) but anything higher than that I’m dubious it’s so direct.

Re: Reinventing the E.R. for America’s mental-health crisis

#54
post #20

Earlier quoted context omitted.

I wonder how much can be attributed to legalization/decriminalization of drugs. Because if someone is on drugs but that is “fine” now are the classified as a mental illness incident?

Have you actually googled this at all? This reads like a question made in total ignorance of legal recreational substances, as well as their effects. I'm trying not to be insulting, but as someone who's social circle nearly universally consumes recreational drugs (not counting tobacco or alcohol), this comment is cringe-inducing how out of touch with reality it is. To answer your question, 0% can be attributed to it.…

It is well documented that marijuana can cause psychosis in some people that are predisposed for it. I know quite a few people, my self included, that started using cannabis way more often after it was legalized.

I think it's reasonable too assume that legalization of a formerly forbidden substance will increase overall use of that substance. I also think that it is reasonable to assume that increased use of a substance will increase the amount of people suffering the potential side effects.

That said, I think social media, the economy, the pandemic, pollution, and the war on terror drugs have done way more harm than legalized weed.

Re: Reinventing the E.R. for America’s mental-health crisis

#55
post #47

There’s gotta be some reason for the mental health crisis, along with all the other crises out there. It doesn’t make sense for every level of American to be meaningfully wealthier and higher income than 20 years ago and yet also be suffering (in multiple ways!) more as well. We even (mostly) fixed health insurance by massively redistributing income! The rest of the world seems to be tracking the same trends but 10 y…

People who even have health insurance are still going into bankruptcy when a severe illness like stroke or cancer befalls them. The US medical system still puts people into poverty due to medical circumstances every day.

Re: Reinventing the E.R. for America’s mental-health crisis

#56
post #47

There’s gotta be some reason for the mental health crisis, along with all the other crises out there. It doesn’t make sense for every level of American to be meaningfully wealthier and higher income than 20 years ago and yet also be suffering (in multiple ways!) more as well. We even (mostly) fixed health insurance by massively redistributing income! The rest of the world seems to be tracking the same trends but 10 y…

> It doesn’t make sense for every level of American to be meaningfully wealthier and higher income than 20 years ago and yet also be suffering…

Maybe optimizing for a high and perpetually growing GDP is not in fact conducive to the mental health of those who generate it. But in any case, I’m not sure that it’s true that every stratum of US citizen has experienced income growth relative to inflation. Thomas Piketty’s analysis of US national income data points to a decline on the bottom end - a group that experiences disproportionately higher rates of mortality and morbidity.

Re: Reinventing the E.R. for America’s mental-health crisis

#57
post #47

There’s gotta be some reason for the mental health crisis, along with all the other crises out there. It doesn’t make sense for every level of American to be meaningfully wealthier and higher income than 20 years ago and yet also be suffering (in multiple ways!) more as well. We even (mostly) fixed health insurance by massively redistributing income! The rest of the world seems to be tracking the same trends but 10 y…

> It doesn’t make sense for every level of American to be meaningfully wealthier and higher income than 20 years ago and yet also be suffering (in multiple ways!) more as well.

In what sense is every level of American meaningfully wealthier? Only the top quintile has higher income than they did 50 years ago, middle and lower income people have all stayed stagnant in both income and wealth.

Re: Reinventing the E.R. for America’s mental-health crisis

#58
post #38

Earlier quoted context omitted.

One way to cut the nonsense is to look at things that can't be fudged. Suicide is an example. You can't "overdiagnose" suicide unless you outright lie that it happened. The rate for suicide was something like 10/100K in 2001 and is hovering at 14/100K now. This is a significant increase. If more people are killing themselves, it's almost certain that there are far more people are also miserable or struggling than the…

> Suicide is an example. You can't "overdiagnose" suicide unless you outright lie that it happened. People have been outright lying about suicides for a long time.

If it's counted as an accident rather than a suicide then the numbers are still high.

If it's counted as a suicide rather than an accident then maybe. I would then ask who is lying.

If it's faking deaths then that's the coroner system which you would have to question.

Re: Reinventing the E.R. for America’s mental-health crisis

#59

Earlier quoted context omitted.

One way to cut the nonsense is to look at things that can't be fudged. Suicide is an example. You can't "overdiagnose" suicide unless you outright lie that it happened. The rate for suicide was something like 10/100K in 2001 and is hovering at 14/100K now. This is a significant increase. If more people are killing themselves, it's almost certain that there are far more people are also miserable or struggling than the…

I think you are probably correct that suicide is a decent proxy measurement. It is possible that it could be skewed by changes in how likely people are to honestly report suicide; as opposed to calling it an accident.

In which case the skew is positive.

Re: Reinventing the E.R. for America’s mental-health crisis

#60
post #47

There’s gotta be some reason for the mental health crisis, along with all the other crises out there. It doesn’t make sense for every level of American to be meaningfully wealthier and higher income than 20 years ago and yet also be suffering (in multiple ways!) more as well. We even (mostly) fixed health insurance by massively redistributing income! The rest of the world seems to be tracking the same trends but 10 y…

Well, for one thing we are all fatter, and the prevalence of depression in obese people has been found to be much higher than in healthy weight people. We are also more sedentary.

For another, most of us spend a lot of time on social media, the usage of which, at least for some demographics, has been strongly linked to depression. Also, due to screen usage and even LED lights interfering with melatonin production, we are getting one hour less sleep on average. That is actually an unreported crisis if you look into the effects of losing even one hour of sleep a night consistently.

Then there is the deterioration of social structures and "third places" such as church, clubs, and other social gatherings, which are shown to reduce depression.

Post reply on HN