Reinventing the E.R. for America’s mental-health crisis • Hacker News Board

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

#111

Post by egberts1 » Mon, Jul 24, 2023, 3:30 AM UTC

sudosteph wrote: post #30

ceejayoz wrote: post #17

Earlier quoted context omitted.

Hospitalization is very different from an asylum.

Length of stay is different, but the nature of confinement, and also the abuse and trauma the patients frequently experience sure is similar. While we all know asylums were horrific, I'd caution readers against underestimating just how awful some "modern" facilities are. Regardless, my point was that releasing people to their homes is the opposite of asylums, and should be preferred to hospitalization where possible.

it is the “preferred to hospitalization, where[‘s] possible” right there that is causing the rise from 10/10K to 14/10K in suicide rate.

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

#112

Post by sudosteph » Tue, Jul 25, 2023, 10:59 PM UTC

egberts1 wrote: post #111

sudosteph wrote: post #30

Earlier quoted context omitted.

Length of stay is different, but the nature of confinement, and also the abuse and trauma the patients frequently experience sure is similar. While we all know asylums were horrific, I'd caution readers against underestimating just how awful some "modern" facilities are. Regardless, my point was that releasing people to their homes is the opposite of asylums, and should be preferred to hospitalization where possible.

it is the “preferred to hospitalization, where[‘s] possible” right there that is causing the rise from 10/10K to 14/10K in suicide rate.

I don't think that correlation can be proven, but I'd be curious to see the data.

From what I've read, 2/3s [1] of people who commit suicide have never sought any sort of treatment at all, so they'd never present at the ER in the first place or be candidates for hospitalization vs outpatient. If the suicide rate is still rising among that population, then that would probably disprove that. If it's not, then you may be right.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8804173/

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

#113

Post by egberts1 » Thu, Jul 27, 2023, 5:48 PM UTC

sudosteph wrote: post #112

egberts1 wrote: post #111

Earlier quoted context omitted.

it is the “preferred to hospitalization, where[‘s] possible” right there that is causing the rise from 10/10K to 14/10K in suicide rate.

I don't think that correlation can be proven, but I'd be curious to see the data. From what I've read, 2/3s [1] of people who commit suicide have never sought any sort of treatment at all, so they'd never present at the ER in the first place or be candidates for hospitalization vs outpatient. If the suicide rate is still rising among that population, then that would probably disprove that. If it's not, then you may b…

One thing that I've noticed in that paper appears to omit the exclusion of being under medication.

Maybe that was the focus for this exclusionary modeling.

Still, it is a lot of data to wade through, even under the most auspice of rigorous screenings for a purer validity.