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Time to bring back asylums?

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Re: Time to bring back asylums?

#311

Earlier quoted context omitted.

What sort of protections do you advocate putting in place to prevent that?

The medical community already has well-developed ethics and treatment rules.

The medical community also had ethics and treatment rules when asylums where common and they didn't seem to help much.

Even if the doctors themselves are moral, what prevents politicians from putting their thumb on the scale? We are already seeing them override physicians on gender affirming care.

What prevents politicians of finding a small number of immoral doctors who are willing to rubber stamp whatever they want?

Re: Time to bring back asylums?

#312

Earlier quoted context omitted.

I have ZERO doubt that the Ron DeSantis' of the world would try to lock up LGBTQ people. It's honestly hard for me to imagine anyone not thinking that people like him would try to do it.

Did Trump do it? Is Ron worse than Trump?

This is just the personal impression that I get, but I think that most progressives feel that Ron is worse than Trump. The one exception is that Ron seems to be worse at politics than Trump so I could see some people viewing him as less of a threat.

Re: Time to bring back asylums?

#313
post #264
post #259

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> Why is an ER fundamentally so much more expensive than another office visit? Two main reasons: you need to use personnel, equipment, and rooms that can offer the highest levels of care. And you need to pay for having a facility staffed to handle worst case loading (with triage) 24/7. You also tend to have pretty exhaustive testing on the "emergent" side to make sure everything is immediately OK prior to discharge.

Right, and ERs also charge high prices to insured patients in an attempt to recoup losses from treating uninsured patients (including those with serious chronic mental disorders).

This has vastly less to do with the cost than the level of care they have to be prepared to provide. I get that people really want to beat the medical cost horse, but it’s sometimes helpful to understand it, first. People use the ED as a PCP across the spectrum because they don’t know better, because they can’t find other options, and sometimes because they don’t have other options - and all of those things tend to cost the hospital, state or insurer vastly more than the patient.

Further, tacking on “serious chronic mental disorders” is basically a non-sequitur and could’ve been replaced with “diabetes” or “broken legs” or “tooth pain”.

Re: Time to bring back asylums?

#314
post #100

Earlier quoted context omitted.

ER visits are inordinately costly, but are generally the only way for homeless people to receive care (behavioral, chronic health conditions, etc). I'm having difficulty finding the source, but I've read that individual "frequent fliers" have consumed hundreds of thousands of dollars of emergency services without receiving substantive care that would improve their situation.

Why is an ER fundamentally so much more expensive than another office visit? Just an anecdote, I don’t see any late night “urgent care” places anymore. If they were sufficiently less expensive than ERs, it seems like insurance companies would incentivize them to have longer hours. Otherwise, after 9pm, you have to go to ER.

They are significantly less expensive - there are also massive doctor/nurse shortages, among other issues. Insurers, especially in the MA space but also in the ACA market, spend a significant amount of time trying to educate ED users about UCCs.

If your local urgent care can’t find a doctor or NP willing to be on call late, they can’t stay open late. Given the shortages, expect the problem to get worse.

Re: Time to bring back asylums?

#315

Earlier quoted context omitted.

What kind of "action" would you want the police to take?

Without getting too much into the details of a personal experience in San Francisco (decades ago), I can say that a person can act extremely crazy and threatening, have a history of serious mental illness and it was effectively impossible to get the police to intervene until the person became violent or made threats that make coherent sense. I am not a lawyer, or an expert on mental illness, but everyone in this situ…

The challenge is that 5150 holds are:

1) very temporary ‘fixes’ to what are almost always conditions caused by some kind of chronic situation - often bad environments, toxic families, serious psychiatric and drug problems, major life events which don’t just go away, ongoing manipulation or emotional abuse by someone near the person, etc. often many of these things all at once.

2) very traumatizing on their own with severe long term legal and monetary consequences. Practically speaking, people lose a significant amount of rights they never get back (including the right to own firearms [https://www.atf.gov/file/58791/download], the right to adopt kids, hold many jobs, etc.) the moment they get a 5150. Getting a 5150 is one of the few ways one could lose custody of their child for good, at least in California. If someone has a legitimate history of psychosis or other serious mental health conditions, that’s all probably a good idea and legitimate! there is also a history of abusive folks using things like 5150’s to abuse and target folks they are trying to control (like abusive parents, ex spouses, etc).

Getting thrown in a psychiatric hospital against one’s will is not a pleasant or comfortable situation for anyone, let alone someone going through a psychotic episode. But the best society has come up with so far, and definitely better than them stabbing random strangers on the street (or themselves), or being thrown in genpop. Usually, anyway.

It’s a short term ‘fix’ for what is often (but not always!) a serious long term problem. Which is better than nothing!

Emergency and Long term involuntary commitment has a long and storied history of being seriously abused to steal people’s assets and manipulate/control folks who clearly were not crazy or a danger to themselves or others by any real definition.

It’s also a necessary tool when attempting to manage serious mental health issues in the population.

In both of these cases though, do you really want to set the bar so that it doesn’t require a clear, documented by a third party and actual/present danger to someone before it gets used?

Because I guarantee if you do, it will be used by angry spouses, controlling parents, political/business opponents or leaders, etc. against sane people all the time. More than it already is, anyway.

Which is often.

SF has a serious problem. Actually using 5150’s more isn’t likely to help though as most of the people getting them likely already have gotten them before. It’s a revolving door.

They get screwed up enough to warrant an emergency hold. They get help, temporarily stabilize, and within a week are back to the same situation. Eventually, they go psychotic again, and rinse repeat until they die or figure out how to get out of the cycle. Many die.

Re: Time to bring back asylums?

#316

Earlier quoted context omitted.

Not really at all. In a sentence, we need a public infrastructure in place to care for the mentally ill that currently are forced to live on the streets of our major cities. We need a way to pay the people that do the work, buy the buildings, keep the lights on. We call this infrastructure asylums, whatever you want to call it we need it desperately. If you want to stop things like what you cited from happening, lobb…

Or make healthcare accessible. Make housing accessible. Make food accessible. We can house feed and care for every person on the planet but we don’t because money. A made up concept that has no actual value outside of what we place on it. It’s arbitrary, as much as markets would want us to believe otherwise. As a species we choose to let them have that power, and with it they will kill us all (seriously)

Why do you think healthcare isn’t accessible and to whom do you think it is inaccessible?

I’ll give you a hint: it’s not for the reasons you think or the people/places you’re talking about.

Re: Time to bring back asylums?

#317
post #199

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First off there’s lots of housing or housable space - office buildings with tons of vacant rooms, Airbnb style properties that are just profit machines, hotels rarely at capacity, abandoned or unaffordable houses, vacation homes. There’s plenty of housing. Then let’s talk about restaurants and grocery stores and farms and factories where food is routinely thrown away daily. Can’t let employees take food home from the…

All the excess you cite is a result of this (albeit flawed) capitalist system we live with. I believe there will come a time where it is no longer necessary, but this will require levels of cooperation, education, and coordination that we are not nearly prepared to handle as a species. For what it's worth, I worked for a while at a fast food joint that did allow employees to take food home, or to make extra of it and…

I think you reiterated the above commenter's point: we shouldn't have to rely on such excess and benevolence to make sure every last person is being fed. That should be a baseline human right. The existence of charity itself is an outcome of inequality.

Re: Time to bring back asylums?

#318

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In response to baby formula getting stolen, supermarkets put it at the front under lock and key. Which is an entirely logical conclusion under our current system and culture. But something is clearly wrong with how we distribute resources when helpless infants can't get what they need.

Government SNAP benefits provide poor kids baby formula and other necessities. Mothers do not have to steal it. It’s easy to fence is the reason it is locked up.

Such 'benefits' are yet another lock and key; another hurdle that people in need must jump over. It's baby formula. You are just reiterating their point.

Re: Time to bring back asylums?

#319

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"Just like we will always need jails." citation needed

Hitler.

I get what you're saying but Hitler never went to jail; his forces were eliminated by the armies of multiple world superpowers working together. Imagine if such manpower and might were used to eradicate homelessness and hunger.

Re: Time to bring back asylums?

#320
post #192

Earlier quoted context omitted.

Determining value is the value of money. Without it we might get too busy making paperclips and forget to feed people all the same. It's a crude system, more ad-hoc evolved than intelligently designed, and definitely historically manipulated at every chance. Nonetheless, anyone who lobbies for the dissolution of our monetary systems can't be taken seriously unless they also are arguing for a suitable replacement of t…

People are starving in the streets. I think this is a more spectacular failure than chandeliers produced by weight.

Fewer people are starving than ever before, all because of capitalism.

What alternative are you proposing? You are always welcome to donate food to the hungry, as many of us do.

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