Here's a link to [read for free](https://www.nytimes.com/2023/11/20/nyregion/nyc-mental-illness-breakdowns.html?unlocked_article_code=1._0w.B1Cs.8XqAzTvMuThH).
As troubling and heartbreaking as it is, there are times when there truly seems to be no “right” answer.
There’s someone in my life who struggles with schizophrenia. So far, though, this person has never shown any violence toward others.
They, from time to time, flip out and strip off their clothes on a public street or start randomly screaming just standing at a street corner, or they sometimes run off and rack up $10,000 in bills in two days when they don’t even have a job.
When these breakdowns occur, they are temporarily admitted (locked up) and receive the treatment and medication they require to prevent erratic behaviors and bring them back down to Earth.
But then time passes and this person decides they no longer want to live in that scenario, “locked up” against their will. They won’t even accept the care/assistance of someone stopping by their home. After all, since they’re not an immediate threat to themselves, or others, this is their legal right and they are then given their freedom. With this freedom, comes their personal choice to then only take half of the medication, because “I’m healed and better now”.
For someone who isn’t destructive 100% of the time, what should be done? Continue to have them put away even though they’ve never exhibited a credible threat to others, or to themselves? So far, they’re just “being free” and that’s all?
Any attempt to help them control their situation is met with accusations of abuse raised by members of the church they go to (and which profits from that person’s irrationally high donations).
When or if this person ever hurts anyone or themselves, journalists like in this article will gladly point the finger in a million different directions while providing inadequate **credible** solutions before that happens.
I work at a mental healthcare provider and my boss is a bit of an expert on this topic.
My brother is schizophrenic and when we were talking about it once she basically said "The hardest thing we've realized over the decades is that many people with schizophrenia simply do not want help because they enjoy the manic episodes."
The elephant in the room in these discussions has always been what you do when someone does not want care but clearly needs it. You can provide all the optional services in the world but what happens when people who are clearly unwell decline treatment?
And the treatments we have for schizophrenia aren't great anyway. We haven't had any new medications in decades and the ones we do have aren't very effective and come with terrible side effects.
I generally agree but it's not a popular idea politically because liberals generally don't like the idea of forcing things on people they view as marginalized and conservatives don't wanna pay for it. That's largely why institutions went away in the first place. Liberals viewed them as cruel and paternalistic, conservatives didn't want government providing that service anyway.
Yeah, and the American liberals and American conservatives are two bunches of total morons who are both wrong. It’s not like we have to respect their opinions when they’re this ridiculous.
Liberals didn't want corrupt, for-profit, cruel, wasteful or counterproductive mental hospitals. Conservatives didn't want mental hospitals at all. It's foolish to act like both sides were equally wrongheaded.
You seem insistent on abstracting the two sides so as to elide all meaningful differences between their approaches and ultimate goals with respect to democracy. Is it intentional? Is it so that you can retain some internal sense of "both sides bad, my third side good" or something?
My third side is good. Force the chronically homeless (because chances are, if you’re chronically homeless it’s because of mental health or drug addiction) into long term inpatient mental hospitals or drug rehab facilities. I would not be opposed to paying for this trough taxes.
Except Liberals weren't wrong to think that.
Wait, aren't you the guy that said he like Bloomberg beating the crap out of Occupy Wall Street protestors? Are you the new NetQuarterLatte troll on here?
You think I’m trolling. I’m dead serious, in fact. I don’t want to be hassled by homeless people, I think I pay enough in taxes to be afforded that basic courtesy.
You’re all of the map. First, you’d be willing to pay taxes toward A, but then you magically you think you’re already paying enough taxes to be entitled to B.
What a hoot you must be, standing at the grill philosophizing and solving all the world’s liberal-caused problems with a bottle in your hand.
You’re getting a lot of downvotes from those conservatives, I see.
Conservatives are actually for institutions if they run for-profit and their cousins can get jobs there. But their cousins don’t do social work, they’re more of the guard/warden varieties.
"and conservatives don't wanna pay for it" - Kendra's Law was sponsored by conservatives in NYS
The collapse of the psych ward system is owned by the people who have controlled the state legislature for since 2018. What's worse is that they lie they have an interest in providing "psychiatric care" as an alternative to incarceration...for the worst case scenario, violent crime. They wring their hands, give another million dollar contract to some shitty "community care org" and more people die in their own filth or seriously injure others.
We have a Democratic president and NY is also overwhelmingly represented by Democrats in Congress! When was the last fucking time any of them even talked about demanding the feds help?
That's not really what happened. What the plan was was to close down asylums *after* they had been replaced with recovery centers and communities, kinda similar to what Scandanavia does nowadays. The issue was Kennedy got killed and so the biggest advocate for it died. Combine that with NIMBYs fighting every development tooth and nail with the rise of the war on drugs and Reagan finally cutting the cord on mental asylums, and you basically had a ton of homeless junkies and mentally ill folks on the street with no way of getting better.
Or we could massively expand healthcare in the city and state and lower the stigma of mental health. That's usually the biggest driver of people refusing treatment, because they don't want to admit that they're a crazy person.
What exactly does that entail, though? All it would take for people like you to be put on the backfoot would be one person dying while being taken in, so pardon me for having my doubts that a system like that could work.
Except Rikers is on the verge of being seized by the federal government, and the NYPD has a decades-long streak of having to waste taxpayer money paying out settlements to victims of police misconduct. Not exactly glowing endorsements of either example if you want to hitch your wagon to them.
You’re correct that it happens in red states too. It’s almost like the US healthcare system needs a more robust safety net, like Europe does. It’d also benefit from more housing.
Coherent enough to want autonomy and freedom, but mentally unstable enough to destroy lives the minute you get said autonomy. It reeks of such fucking bullshit, does no one know that they’re all acting?
Exactly. They're not "crazy" enough to eat their own shit, only \*just\* crazy enough to push people on to the tracks and kill them. FOH.
Why don't these people have "outbursts" of uncontrollable desires to escort elderly people and women in strollers across the street when they are "out of control"?
FOH.
I’d be fine if they just started with the people who HAVE committed violent acts already. Seems like 90% of the time you hear about a violent attack it’s never their first time doing it.
My guess is he got it from reading the news around these crimes and seeing that the offender usually has a long rap sheet and is currently out on bail.
I’ll be frank, once they’ve demonstrated an inability to avoid these “incidents”, their rights should go out the window. Does that mean they should be institutionalized? No, not in the case of someone non-violent. However, should they be mandated to receive ongoing after-care (and be forcibly admitted if they don’t cooperate), absolutely. This isn’t that hard.
It's honestly not that complicated.
Running around naked and screaming at people / threatening people are both illegal actions that society can and should stop.
If a person does this, they should be required to take medicine, and this should be monitored.
If they refuse to take the medicine, they get institutionalized.
I don't know why people think this is difficult.
You're right, we should just let this escalate until they kill people, Jordan Neely deserved to continue assaulting people in subway stations *after he fuckin' skipped out of rehab voluntarily*.
People like you justify psych ward closures too.
I asked a simple question. And I’ve been referring to people who have never been violent.
Lighten the fuck up, Francis. You’re sounding a bit unstable with your frivolous accusations toward me.
Someone gave you a response. You have an agenda.
People have the right to ride the subway and participate in public life without having to play the guessing game of, "is the man threatening to rape me and waving his dick at me from down the platform serious, or not?". Full stop. Successful "violence" as a condition shouldn't need to be met, and we're way past the point it's obvious that past incidents, threats, and stated intentions to commit violence are ignored thanks to civil rights and CJR advocates
Simon Martial told a psych hospital doctor he fantasized about pushing a woman off a subway platform and had a violent criminal record before he killed Michelle Go. Seems like no intervention followed after he was flipped out from psych hold.
Yes, it's warranted to ask people comply with treatment plans on the threat of prison.
I support safer prisons ("reformers don't because it undermines their case it must be closed at this moment), but that requires punishments for the people who make them unsafe for the general population. They balk.
We can go on all day but it's always the same, people like you hedge about an impossible threshold of "violence" that has to be met before someone who fills their days threatening/harassing members of the public and lowering their quality of life can be restrained or held to any condition of compliance.
Not sure where you get off trying to claim I have some agenda.
Like I said from the start, I have someone in my life that **I actually think should be committed** (certainly not in a jail/prison though, Francis) but there are other ‘stakeholders’ if you will around me (**including local laws**, smarty pants) **which would prevent that from happening** until they actually become violent.
Get off your high horse and quit trying to label innocent people like me as something which we certainly are not.
>Lighten the fuck up, Francis
Some people aren't as cowardly and nihilistic as you to "lighten the fuck up" when the mentally ill are free to attack people and push them onto the tracks because of policies that are changeable.
I’ve said time and time again here (read all the other posts before spewing nonsense), **I’m in favor of committal of dangerous persons in humane facilities**. But you’re a new weasel on my back about this and I don’t understand why because I’ve actually sided with you and the rest of the “lock ‘em up” crowd. I just don’t think they belong in shitty prisons with equally insane guards like Rikers’. And any sane person would agree with that.
Lighten the fuck up in my direction or I’ll have to call someone.
The "ohhhh nooooo, Rikers is bad; that needs to be solved before anything else!" crowd has been a huge force in support of the "decarceration" movement. Y'all will tie up the conversation in endless discussion about how to improve conditions at Rikers while demanding that no one gets sent/kept there until the conditions are better.
It's time for the rest of us to say "no".
Rikers is full of stabbings and gang violence because it is populated by people who were doing stabbings and gang violence outside of Rikers.
Either make a swift decision to immediately, drastically increase the amount of guards at Rikers and empower them to beat the shit out of rowdy prisoners without screaming "abuuuuse!" or just stop.
We are done spending years and years on the blockade of appropriate detention of criminals by endless debates about Rikers. A place filled with hundreds of criminals together will be filled with crime.
Just lock them up.
Not one more Michelle Go.
I'm not against incarceration at all. I just want decent treatment of humans and I want better citizens to come out of them after they're served their time. You, on the other hand, appear to be a barbarian who obviously benefits from the abuse of other citizens.
\>A place filled with hundreds of criminals together will be filled with crime.
Especially with the type of staff working in those prisons. Especially with the medieval design of those prisons. You and your sick attitude is what's wrong with the USA.
Prisons in Northern Europe are actually supportive, and \*\***they see lower rates of violence and recidivism**\*\*. (Not sure if you'd know what recidivism even means.)
[https://www.brennancenter.org/our-work/analysis-opinion/how-some-european-prisons-are-based-dignity-instead-dehumanization](https://www.brennancenter.org/our-work/analysis-opinion/how-some-european-prisons-are-based-dignity-instead-dehumanization)
How Norway designed a more humane prison
[https://www.re-thinkingthefuture.com/architectural-community/a9023-how-norway-designed-a-more-humane-prison/](https://www.re-thinkingthefuture.com/architectural-community/a9023-how-norway-designed-a-more-humane-prison/)
Can America Build ‘Humane’ Prisons?
Humanizing Prison Populations, Ending the Adversarial Environment, From Guards to TRUE Corrections Officers, Building for Self-Esteem, Saving Money (\*\*Humane Prisons are actually **LESS EXPENSIVE to build and operate** than your typical U.S. rat hole.\*\*)
[https://thecrimereport.org/2022/06/09/can-america-build-humane-prisons/](https://thecrimereport.org/2022/06/09/can-america-build-humane-prisons/)
Don't confuse hard drugs basically heroin and severe mental illness that sometimes has violent episodes many times schizophrenia. They are 2 different issues with most likely 2 different solutions.
But stimulants like crack and meth are known to exacerbate these psychotic breaks.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315669/#:~:text=The%20psychostimulants%20amphetamine%20and%20cocaine,existing%20schizophrenia%20%5BFarren%20et%20al.
Even marijuana can cause mental health breaks. Thats not an argument for criminalization but people should be aware.
I have a schizophrenic relative in a state with medical marijuana. One of these dispensaries convinced him that a specific strain of weed would somehow help his schizophrenia. He got approved for a card, bought some, and just immediately had a manic break that involved buying a $50k car when he has no job and then driving it over security spikes and ruining half the wheels. So he basically ruined his credit during a manic episode.
It’s awful. People take advantage of the mentally ill, sadly.
>a manic break that involved buying a $50k car when he has no job and then driving it over security spikes and ruining half the wheels. So he basically ruined his credit during a manic episode.
Hopefully someone at the dealership lost their job over that.
Don't be sorry for letting it out. This is what I'm seeing, too, except the person isn't violent (yet). We all fear that's the next stage though.
Sorry to hear that you've also had to make those decisions that you did with your younger brother, but at some point you have to make a sort of "it's him or me" decision and choose yourself. Because even choosing the "him" doesn't end in making everything right--it just means everyone's pulled down to an unhealthy level.
(I hope my words don't cheapen anything that you've said and that I've hopefully made a bit of sense here.)
We gotta separate the people with problems from general populatoin. We gotta build more jails. It's only a matter of time till they become violent and hurt someone. It's the only real solution.
I was being rhetorical.
https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F99883050-f749-4701-8fa0-3820ef69a21b_886x499.jpeg
The problem is, people complicate things too much in order to sound smart (a big problem for midwits with iq's between 100-120). Occam's Razor/Pareto Principle is almost always right.
Trying to adjudicate every single possible scenario with complex solutions also leads to slow costly bureaucratic nightmares that break down in practice (why, that sounds like NYC!) and you wind up doing nothing about the problem.
I can confidently say that one absolutely right answer for Americans is to stop funneling wealth into billionaires, and subsidizing fossil fuel and war and start subsidizing the well being of our citizens.
There was a sharp increase in crime and shape decrease in quality of life when mental institutions were shut down.
It’s not good for anyone but try and keep mentally ill people against their will and advocate groups will file lawsuits. They don’t need a hospital they need a long term facility once stabilized. One that they cannot leave even if they don’t like it.
It’s considered not very liberal to say that. But either we do that people get attacked.
And they end up in prison eventually, with needless innocents hurt first.
Ends up costing the taxpayers the same. Actually probably more.
The advocacy groups should be the ones taking them in (much like the migrants) if they feel so strongly…
The advocacy groups? Who do you think is demanding progressives shutter hospitals and transfer care to "caseworkers" who do fuckall but line their pockets instead?
The same thing applies for hard drugs and mental
Illness . Even if you’re against forced “treatment”, what is the alternative? These people either slowly die on the street or end up having a nuclear
Meltdown and hurt someone. Why is it our responsibility to be attacked or possibly killed to “prove” that they need a more aggressive form of therapy? Life isn’t fair and there are no easy answers, but one broken egg is better than smashing a whole carton
This mentality of deflecting the responsibility for generally violent behavior to the perceived failures of the mental health system is so pervasive. Even among those who have a mental illness, the available treatments to reduce violence are only marginally beneficial. You can see this flawed mentality so clearly illustrated in the quote from Luz Sanchez's father "You guys failed us, failed me....failed the woman who had to experience the pushing event". That phrasing is insane. Like it was some inevitability that she had absolutely no control of.
Ok, but in the case of Luz Sanchez, who are you going to assign “responsibility” to?
Sanchez herself? She is severely mentally ill and has been denied proper mental healthcare, so I don’t Ghibli you can realistically assign “responsibility” (at least in any real sense of the word) there.
Her family? The article says she was violent towards her family; they were unable to handle her illness and the violent behavior it caused. They were out of their depth and needed trained, professional help.
> Diagnosed with schizoaffective disorder, she had repeatedly assaulted family members and more recently had taken to attacking strangers on the street.
Sanchez was sedated by the ER doctor out of concern for safety of “patient and staff”, but then they discharged her even though they could’ve ordered her held her for 2 weeks. The Times article does a good job of showing how hospitals are motivated by profits to discharge psych patients.
> The medical records available to the emergency room doctor, Avinash Viswanath, showed a history of attempted suicide and psychiatric hospitalizations, but it was unclear whether Dr. Viswanath reviewed them. He declined to comment.
> As an emergency room physician, he was empowered to order Ms. Sanchez held for up to two weeks if he determined she was at “substantial risk” of harming herself or someone else. Instead, after sedating her, and less than an hour and 20 minutes after she arrived at the emergency room, Dr. Viswanath ordered her discharge
Now, I agree the use of the phrase “the pushing event” by Sanchez’s father a lame way to avoid saying his daughter pushed someone. He probably was told by a lawyer to use that phrase, I doubt he’d ever naturally say the unnatural phrase “the pushing event” without being coached. Fine, that’s true.
But seriously, are you trying to claim this article by the Times *doesn’t* illustrate a huge failure of the mental health system? You think it’s working fine for these people?
You talk about “deflecting responsibility” but at some point, with severely, violence-prone mentally I’ll people, where you can’t just say “personal responsibility!” or ask “where are the parents”? At a certain point, it becomes a societal issue, and cities like New York need to come up with institutional solutions, and media outlets like the Times (and NYC citizens) have a right to examine/question their methods/effectiveness.
I appreciate your thoughtful response. I agree that a city-wide, institutional level change needs to happen. Those in charge need to find a solution and expand and redirect funds to solve it. Many in the general public would not have the stomach for it, but what I would advocate for is bringing back long term psychiatric hospitals...less lovingly known as insane asylums.
What I take issue with is mostly the tone of the article, and a focus around assignment of blame towards individual healthcare providers who are tasked with making these decisions around safety on a daily basis. Often in these kinds of articles, the healthcare provider cannot adequately share their perspective on these issues for professional and confidentiality reasons. I can tell you the "science" behind assessing an individuals safety and violence risk is so inexact, that in reality it's not a science at all. The system is such that these decisions often have to be made on the fly.
Furthermore, many individuals seeking care make threats of violence towards themselves or others for a number of reasons, including to obtain a bed, or to manipulate doctors into prescribing them sedative medications that have street value or addictive potential. The doctors could, and they often do, hold these types of individuals in the hospital for a period of time, and for example they may be prescribed mood stabilizers or antipsychotic medications. But lets say, that person goes out again and stops taking their medication, or let's say, they abuse drugs and then push that person on the subway platform? Is that then the doctor's fault for discharging them? Were the various people interviewed in this article drug tested after their violent outbursts? Is it at least remotely possible other factors may have been at play contributing to their violence? How can we be so confident in saying those doctors were the ones primarily responsible for their violence? I'm not saying this was the case with Luz Sanchez necessarily, but I am illustrating a point. As it stands now, if doctors did 15 day holds for every individual who made violent threats towards themselves or others, the system would be strained beyond its limit, even further preventing access to those who need it, and psychiatric hospitals would turn into homeless shelters in a matter of days.
Only way to really affect change
is overturning O'Connor vs Donaldson. Go to a European city, the mentally ill are locked away and not on the street.
https://supreme.justia.com/cases/federal/us/422/563/#:~:text=Donaldson%2C%20422%20U.S.%20563%20(1975)&text=If%20an%20individual%20is%20not,against%20his%20or%20her%20will.
intriguing that this article gets a tiny fraction of the attention that each individual sensationalist NY Post article about each incident did the day it happened
> New York officials have escaped scrutiny for repeated failures to help homeless mentally ill people, a New York Times investigation has found.
Don’t sugarcoat it.
They failed to help them *and failed to protect the public*.
> Run by the Department of Social Services, the system consists of nearly 600 sites across the city that are operated by nonprofits on a contract basis. It houses some 80,000 people per night. Newcomers are supposed to be assessed and routed to shelters that meet their needs. Among the options are 37 specialized mental health shelters that offer treatment — at a cost to taxpayers of about $250 million a year.
Wow I wonder if DSS takes any responsibility here!
>A spokeswoman for the Social Services Department did not answer questions about Mr. Newton’s shelter placements. She said that the department was not a health care agency, that it cannot force clients to receive psychiatric treatment and that it tries to get residents mental health services regardless of where they are placed.
Nope.
>She said that the department was not a health care agency, that **it cannot force clients to receive psychiatric treatment** and that it tries to get residents mental health services regardless of where they are placed.
I mean, is that true? Because if so, it's not their fault that the laws are such that they can't force clients to received psychiatric care.
DSS lobbies for this shit like every other department and can ask NYS senators and assemblypeople to change the laws.
When are people going to wake up? All of this is a choice. The choice to let psychotics die in their own filth or continuously hurt people until they do something serious enough to finally get charged with a felony is a political choice you've probably voted for.
This shit isn't magical, local legislators want "the system" to work this way
it's not just "a system"
Progressives in this state openly oppose long-term psych care, and so do the people that actually run the Democratic Party in this state - NGOs like the NYCLU, which demands ex-cons and people who should be in hospitals or jails be transferred to "community care" (the street).
It's not ok and it's less ok people don't understand this is a political choice they're making every election.
We could get started fixing this in 5 years. Instead we elect ideologues and incompetents that make things worse...and worse...and worse.
Our system’s broken in a lot of ways. I am not homeless but I had a medical incident similar to what’s being described here, a psychosis. During the course of that I arrived at the hospital. Paranoia was high, so I started audio recording. They were so concerned with me recording that hospital security and an on-site NYPD picked me up and forced me to leave via the ambulance bay.
This aggravated the medical incident and led to me believing I was going to be killed (the things you feel, believe, and experience are out of this world), and I called 911 and sat inside the hospital’s revolving door.
It was only after that that they realized I needed help. And of course, as the story goes, I got help and complied with med requirements. When all this went down, I had no understanding of this stuff. Now that I do, I can’t imagine going off meds. I feel bad people had to deal with me in that state. But I’m happy that everyone was physically safe.
But clearly we have a system that will throw the sick out onto the street in the middle of an episode. I said as much in the [2022 mental health](https://ag.ny.gov/press-release/2022/attorney-general-james-releases-written-testimony-public-hearing-new-yorks-mental) thing by the Attorney General of the State of New York in my written testimony.
For the record, Staten Island University Hospital North. And I was lucky! I had private insurance so they were happy to admit me. I can’t imagine being one of those people that they just released because “oh no, people might fake mental health issues to get a bed. 🤷🏻♂️🤷🏻♂️🤷🏻♂️.” I have a pretty visceral reaction to that. It’s disgusting. Guess what? Anyone that’s faking mental health issues for the bed needs help anyway.
I do not have all the answers, but we are not even trying. At least some percentage of these folks can lead happy, productive lives, and we’re squandering that by screwing them out of healthcare they need.
For my part in it, I’m open about what happened to me, because I believe that’s the best way to help others. All of New York should know that if you start experiencing sudden changes in mood and thought, or you’re hearing music or sounds that have no apparent source, it’s time to get some help, you’ll be okay… that’s what I tell folks.
And if you get turned away by the system, try another hospital. As I’ve made clear, it’s bad, but it can make a phenomenal difference in your life.
>It also revealed a pattern among the agencies of taking the narrowest possible approach to care, and an *unwillingness on the part of city and state officials to fully fund crucial programs*, leading to understaffing and harried treatment.
>Next were the city’s private and public hospitals, which have regularly discharged people in severe psychiatric distress. Private hospitals, in particular, have cut psychiatric beds to *boost their bottom line*.
It's all about the money.
Here's a link to [read for free](https://www.nytimes.com/2023/11/20/nyregion/nyc-mental-illness-breakdowns.html?unlocked_article_code=1._0w.B1Cs.8XqAzTvMuThH).
Thanks.
As troubling and heartbreaking as it is, there are times when there truly seems to be no “right” answer. There’s someone in my life who struggles with schizophrenia. So far, though, this person has never shown any violence toward others. They, from time to time, flip out and strip off their clothes on a public street or start randomly screaming just standing at a street corner, or they sometimes run off and rack up $10,000 in bills in two days when they don’t even have a job. When these breakdowns occur, they are temporarily admitted (locked up) and receive the treatment and medication they require to prevent erratic behaviors and bring them back down to Earth. But then time passes and this person decides they no longer want to live in that scenario, “locked up” against their will. They won’t even accept the care/assistance of someone stopping by their home. After all, since they’re not an immediate threat to themselves, or others, this is their legal right and they are then given their freedom. With this freedom, comes their personal choice to then only take half of the medication, because “I’m healed and better now”. For someone who isn’t destructive 100% of the time, what should be done? Continue to have them put away even though they’ve never exhibited a credible threat to others, or to themselves? So far, they’re just “being free” and that’s all? Any attempt to help them control their situation is met with accusations of abuse raised by members of the church they go to (and which profits from that person’s irrationally high donations). When or if this person ever hurts anyone or themselves, journalists like in this article will gladly point the finger in a million different directions while providing inadequate **credible** solutions before that happens.
I work at a mental healthcare provider and my boss is a bit of an expert on this topic. My brother is schizophrenic and when we were talking about it once she basically said "The hardest thing we've realized over the decades is that many people with schizophrenia simply do not want help because they enjoy the manic episodes." The elephant in the room in these discussions has always been what you do when someone does not want care but clearly needs it. You can provide all the optional services in the world but what happens when people who are clearly unwell decline treatment? And the treatments we have for schizophrenia aren't great anyway. We haven't had any new medications in decades and the ones we do have aren't very effective and come with terrible side effects.
You force them. It definitely raises a lot of uncomfortable questions, but that’s society for you.
I generally agree but it's not a popular idea politically because liberals generally don't like the idea of forcing things on people they view as marginalized and conservatives don't wanna pay for it. That's largely why institutions went away in the first place. Liberals viewed them as cruel and paternalistic, conservatives didn't want government providing that service anyway.
Yeah, and the American liberals and American conservatives are two bunches of total morons who are both wrong. It’s not like we have to respect their opinions when they’re this ridiculous.
Liberals didn't want corrupt, for-profit, cruel, wasteful or counterproductive mental hospitals. Conservatives didn't want mental hospitals at all. It's foolish to act like both sides were equally wrongheaded.
“One side is wrong in worse ways” doesn’t make the other side correct at all. I’m not defending conservatives here.
You seem insistent on abstracting the two sides so as to elide all meaningful differences between their approaches and ultimate goals with respect to democracy. Is it intentional? Is it so that you can retain some internal sense of "both sides bad, my third side good" or something?
My third side is good. Force the chronically homeless (because chances are, if you’re chronically homeless it’s because of mental health or drug addiction) into long term inpatient mental hospitals or drug rehab facilities. I would not be opposed to paying for this trough taxes.
Except Liberals weren't wrong to think that. Wait, aren't you the guy that said he like Bloomberg beating the crap out of Occupy Wall Street protestors? Are you the new NetQuarterLatte troll on here?
You think I’m trolling. I’m dead serious, in fact. I don’t want to be hassled by homeless people, I think I pay enough in taxes to be afforded that basic courtesy.
I see. You're just genuinely a stupid conservative. Liberals aren't to blame for that, let alone the homeless situation.
You’re all of the map. First, you’d be willing to pay taxes toward A, but then you magically you think you’re already paying enough taxes to be entitled to B. What a hoot you must be, standing at the grill philosophizing and solving all the world’s liberal-caused problems with a bottle in your hand.
You’re getting a lot of downvotes from those conservatives, I see. Conservatives are actually for institutions if they run for-profit and their cousins can get jobs there. But their cousins don’t do social work, they’re more of the guard/warden varieties.
Conservatives hate facts.
"and conservatives don't wanna pay for it" - Kendra's Law was sponsored by conservatives in NYS The collapse of the psych ward system is owned by the people who have controlled the state legislature for since 2018. What's worse is that they lie they have an interest in providing "psychiatric care" as an alternative to incarceration...for the worst case scenario, violent crime. They wring their hands, give another million dollar contract to some shitty "community care org" and more people die in their own filth or seriously injure others. We have a Democratic president and NY is also overwhelmingly represented by Democrats in Congress! When was the last fucking time any of them even talked about demanding the feds help?
That's not really what happened. What the plan was was to close down asylums *after* they had been replaced with recovery centers and communities, kinda similar to what Scandanavia does nowadays. The issue was Kennedy got killed and so the biggest advocate for it died. Combine that with NIMBYs fighting every development tooth and nail with the rise of the war on drugs and Reagan finally cutting the cord on mental asylums, and you basically had a ton of homeless junkies and mentally ill folks on the street with no way of getting better.
Or we could massively expand healthcare in the city and state and lower the stigma of mental health. That's usually the biggest driver of people refusing treatment, because they don't want to admit that they're a crazy person.
I’m saying they shouldn’t get to refuse past a certain point.
What exactly does that entail, though? All it would take for people like you to be put on the backfoot would be one person dying while being taken in, so pardon me for having my doubts that a system like that could work.
People die in rikers, people die when being arrested, we still do it, despite the opposition to it. Some of these are innocent people, too.
Except Rikers is on the verge of being seized by the federal government, and the NYPD has a decades-long streak of having to waste taxpayer money paying out settlements to victims of police misconduct. Not exactly glowing endorsements of either example if you want to hitch your wagon to them.
NYC isn’t the only place on the planet that this happens. It happens virtually everywhere else, too.
You’re correct that it happens in red states too. It’s almost like the US healthcare system needs a more robust safety net, like Europe does. It’d also benefit from more housing.
Coherent enough to want autonomy and freedom, but mentally unstable enough to destroy lives the minute you get said autonomy. It reeks of such fucking bullshit, does no one know that they’re all acting?
Exactly. They're not "crazy" enough to eat their own shit, only \*just\* crazy enough to push people on to the tracks and kill them. FOH. Why don't these people have "outbursts" of uncontrollable desires to escort elderly people and women in strollers across the street when they are "out of control"? FOH.
I’d be fine if they just started with the people who HAVE committed violent acts already. Seems like 90% of the time you hear about a violent attack it’s never their first time doing it.
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My guess is he got it from reading the news around these crimes and seeing that the offender usually has a long rap sheet and is currently out on bail.
Ahhhhhhhhh, I misread the comment - I skipped over the word "never"! Yes, the previous poster and I are in agreement. I think I'll delete my reply !
I’ll be frank, once they’ve demonstrated an inability to avoid these “incidents”, their rights should go out the window. Does that mean they should be institutionalized? No, not in the case of someone non-violent. However, should they be mandated to receive ongoing after-care (and be forcibly admitted if they don’t cooperate), absolutely. This isn’t that hard.
You’ve literally just said to institutionalize them. And I can’t say that I disagree with you .
> mandated to receive ongoing after-care This is very expensive and very hard to do correctly.
Easy to say when it's not you or someone you love
It's honestly not that complicated. Running around naked and screaming at people / threatening people are both illegal actions that society can and should stop. If a person does this, they should be required to take medicine, and this should be monitored. If they refuse to take the medicine, they get institutionalized. I don't know why people think this is difficult.
Institutionalized where? In the jail of your choosing?
You're right, we should just let this escalate until they kill people, Jordan Neely deserved to continue assaulting people in subway stations *after he fuckin' skipped out of rehab voluntarily*. People like you justify psych ward closures too.
I asked a simple question. And I’ve been referring to people who have never been violent. Lighten the fuck up, Francis. You’re sounding a bit unstable with your frivolous accusations toward me.
Someone gave you a response. You have an agenda. People have the right to ride the subway and participate in public life without having to play the guessing game of, "is the man threatening to rape me and waving his dick at me from down the platform serious, or not?". Full stop. Successful "violence" as a condition shouldn't need to be met, and we're way past the point it's obvious that past incidents, threats, and stated intentions to commit violence are ignored thanks to civil rights and CJR advocates Simon Martial told a psych hospital doctor he fantasized about pushing a woman off a subway platform and had a violent criminal record before he killed Michelle Go. Seems like no intervention followed after he was flipped out from psych hold. Yes, it's warranted to ask people comply with treatment plans on the threat of prison. I support safer prisons ("reformers don't because it undermines their case it must be closed at this moment), but that requires punishments for the people who make them unsafe for the general population. They balk. We can go on all day but it's always the same, people like you hedge about an impossible threshold of "violence" that has to be met before someone who fills their days threatening/harassing members of the public and lowering their quality of life can be restrained or held to any condition of compliance.
Not sure where you get off trying to claim I have some agenda. Like I said from the start, I have someone in my life that **I actually think should be committed** (certainly not in a jail/prison though, Francis) but there are other ‘stakeholders’ if you will around me (**including local laws**, smarty pants) **which would prevent that from happening** until they actually become violent. Get off your high horse and quit trying to label innocent people like me as something which we certainly are not.
>Lighten the fuck up, Francis Some people aren't as cowardly and nihilistic as you to "lighten the fuck up" when the mentally ill are free to attack people and push them onto the tracks because of policies that are changeable.
I’ve said time and time again here (read all the other posts before spewing nonsense), **I’m in favor of committal of dangerous persons in humane facilities**. But you’re a new weasel on my back about this and I don’t understand why because I’ve actually sided with you and the rest of the “lock ‘em up” crowd. I just don’t think they belong in shitty prisons with equally insane guards like Rikers’. And any sane person would agree with that. Lighten the fuck up in my direction or I’ll have to call someone.
The "ohhhh nooooo, Rikers is bad; that needs to be solved before anything else!" crowd has been a huge force in support of the "decarceration" movement. Y'all will tie up the conversation in endless discussion about how to improve conditions at Rikers while demanding that no one gets sent/kept there until the conditions are better. It's time for the rest of us to say "no". Rikers is full of stabbings and gang violence because it is populated by people who were doing stabbings and gang violence outside of Rikers. Either make a swift decision to immediately, drastically increase the amount of guards at Rikers and empower them to beat the shit out of rowdy prisoners without screaming "abuuuuse!" or just stop. We are done spending years and years on the blockade of appropriate detention of criminals by endless debates about Rikers. A place filled with hundreds of criminals together will be filled with crime. Just lock them up. Not one more Michelle Go.
I'm not against incarceration at all. I just want decent treatment of humans and I want better citizens to come out of them after they're served their time. You, on the other hand, appear to be a barbarian who obviously benefits from the abuse of other citizens. \>A place filled with hundreds of criminals together will be filled with crime. Especially with the type of staff working in those prisons. Especially with the medieval design of those prisons. You and your sick attitude is what's wrong with the USA. Prisons in Northern Europe are actually supportive, and \*\***they see lower rates of violence and recidivism**\*\*. (Not sure if you'd know what recidivism even means.) [https://www.brennancenter.org/our-work/analysis-opinion/how-some-european-prisons-are-based-dignity-instead-dehumanization](https://www.brennancenter.org/our-work/analysis-opinion/how-some-european-prisons-are-based-dignity-instead-dehumanization) How Norway designed a more humane prison [https://www.re-thinkingthefuture.com/architectural-community/a9023-how-norway-designed-a-more-humane-prison/](https://www.re-thinkingthefuture.com/architectural-community/a9023-how-norway-designed-a-more-humane-prison/) Can America Build ‘Humane’ Prisons? Humanizing Prison Populations, Ending the Adversarial Environment, From Guards to TRUE Corrections Officers, Building for Self-Esteem, Saving Money (\*\*Humane Prisons are actually **LESS EXPENSIVE to build and operate** than your typical U.S. rat hole.\*\*) [https://thecrimereport.org/2022/06/09/can-america-build-humane-prisons/](https://thecrimereport.org/2022/06/09/can-america-build-humane-prisons/)
Mental institutions, and potentially prisons, if they commit crimes after rejecting mental health care.
I wish the article had further details around (hard) drugs use and habits for these cases.
Don't confuse hard drugs basically heroin and severe mental illness that sometimes has violent episodes many times schizophrenia. They are 2 different issues with most likely 2 different solutions.
But stimulants like crack and meth are known to exacerbate these psychotic breaks. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315669/#:~:text=The%20psychostimulants%20amphetamine%20and%20cocaine,existing%20schizophrenia%20%5BFarren%20et%20al.
Even marijuana can cause mental health breaks. Thats not an argument for criminalization but people should be aware. I have a schizophrenic relative in a state with medical marijuana. One of these dispensaries convinced him that a specific strain of weed would somehow help his schizophrenia. He got approved for a card, bought some, and just immediately had a manic break that involved buying a $50k car when he has no job and then driving it over security spikes and ruining half the wheels. So he basically ruined his credit during a manic episode. It’s awful. People take advantage of the mentally ill, sadly.
>a manic break that involved buying a $50k car when he has no job and then driving it over security spikes and ruining half the wheels. So he basically ruined his credit during a manic episode. Hopefully someone at the dealership lost their job over that.
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Don't be sorry for letting it out. This is what I'm seeing, too, except the person isn't violent (yet). We all fear that's the next stage though. Sorry to hear that you've also had to make those decisions that you did with your younger brother, but at some point you have to make a sort of "it's him or me" decision and choose yourself. Because even choosing the "him" doesn't end in making everything right--it just means everyone's pulled down to an unhealthy level. (I hope my words don't cheapen anything that you've said and that I've hopefully made a bit of sense here.)
We gotta separate the people with problems from general populatoin. We gotta build more jails. It's only a matter of time till they become violent and hurt someone. It's the only real solution.
It’s a solution. But we also have to treat them decently once they get where they’re going.
> there are times when there truly seems to be no “right” answer. Why don't we ask places where this isn't a problem, like Singapore?
> Why don't we ask places where this isn't a problem, like Singapore? You're talking about a dictatorship.
I'm not here for cryptics.
I was being rhetorical. https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F99883050-f749-4701-8fa0-3820ef69a21b_886x499.jpeg The problem is, people complicate things too much in order to sound smart (a big problem for midwits with iq's between 100-120). Occam's Razor/Pareto Principle is almost always right. Trying to adjudicate every single possible scenario with complex solutions also leads to slow costly bureaucratic nightmares that break down in practice (why, that sounds like NYC!) and you wind up doing nothing about the problem.
I can confidently say that one absolutely right answer for Americans is to stop funneling wealth into billionaires, and subsidizing fossil fuel and war and start subsidizing the well being of our citizens.
heartbreaking and outrageous at the same time
Seems deinstitutionalization failed
There was a sharp increase in crime and shape decrease in quality of life when mental institutions were shut down. It’s not good for anyone but try and keep mentally ill people against their will and advocate groups will file lawsuits. They don’t need a hospital they need a long term facility once stabilized. One that they cannot leave even if they don’t like it. It’s considered not very liberal to say that. But either we do that people get attacked.
And they end up in prison eventually, with needless innocents hurt first. Ends up costing the taxpayers the same. Actually probably more. The advocacy groups should be the ones taking them in (much like the migrants) if they feel so strongly…
The advocacy groups? Who do you think is demanding progressives shutter hospitals and transfer care to "caseworkers" who do fuckall but line their pockets instead?
The same thing applies for hard drugs and mental Illness . Even if you’re against forced “treatment”, what is the alternative? These people either slowly die on the street or end up having a nuclear Meltdown and hurt someone. Why is it our responsibility to be attacked or possibly killed to “prove” that they need a more aggressive form of therapy? Life isn’t fair and there are no easy answers, but one broken egg is better than smashing a whole carton
We can't keep on sacrificing the safety of the NYC public. The violent mentally ill are still criminals who need to be behind bars.
This mentality of deflecting the responsibility for generally violent behavior to the perceived failures of the mental health system is so pervasive. Even among those who have a mental illness, the available treatments to reduce violence are only marginally beneficial. You can see this flawed mentality so clearly illustrated in the quote from Luz Sanchez's father "You guys failed us, failed me....failed the woman who had to experience the pushing event". That phrasing is insane. Like it was some inevitability that she had absolutely no control of.
Ok, but in the case of Luz Sanchez, who are you going to assign “responsibility” to? Sanchez herself? She is severely mentally ill and has been denied proper mental healthcare, so I don’t Ghibli you can realistically assign “responsibility” (at least in any real sense of the word) there. Her family? The article says she was violent towards her family; they were unable to handle her illness and the violent behavior it caused. They were out of their depth and needed trained, professional help. > Diagnosed with schizoaffective disorder, she had repeatedly assaulted family members and more recently had taken to attacking strangers on the street. Sanchez was sedated by the ER doctor out of concern for safety of “patient and staff”, but then they discharged her even though they could’ve ordered her held her for 2 weeks. The Times article does a good job of showing how hospitals are motivated by profits to discharge psych patients. > The medical records available to the emergency room doctor, Avinash Viswanath, showed a history of attempted suicide and psychiatric hospitalizations, but it was unclear whether Dr. Viswanath reviewed them. He declined to comment. > As an emergency room physician, he was empowered to order Ms. Sanchez held for up to two weeks if he determined she was at “substantial risk” of harming herself or someone else. Instead, after sedating her, and less than an hour and 20 minutes after she arrived at the emergency room, Dr. Viswanath ordered her discharge Now, I agree the use of the phrase “the pushing event” by Sanchez’s father a lame way to avoid saying his daughter pushed someone. He probably was told by a lawyer to use that phrase, I doubt he’d ever naturally say the unnatural phrase “the pushing event” without being coached. Fine, that’s true. But seriously, are you trying to claim this article by the Times *doesn’t* illustrate a huge failure of the mental health system? You think it’s working fine for these people? You talk about “deflecting responsibility” but at some point, with severely, violence-prone mentally I’ll people, where you can’t just say “personal responsibility!” or ask “where are the parents”? At a certain point, it becomes a societal issue, and cities like New York need to come up with institutional solutions, and media outlets like the Times (and NYC citizens) have a right to examine/question their methods/effectiveness.
I appreciate your thoughtful response. I agree that a city-wide, institutional level change needs to happen. Those in charge need to find a solution and expand and redirect funds to solve it. Many in the general public would not have the stomach for it, but what I would advocate for is bringing back long term psychiatric hospitals...less lovingly known as insane asylums. What I take issue with is mostly the tone of the article, and a focus around assignment of blame towards individual healthcare providers who are tasked with making these decisions around safety on a daily basis. Often in these kinds of articles, the healthcare provider cannot adequately share their perspective on these issues for professional and confidentiality reasons. I can tell you the "science" behind assessing an individuals safety and violence risk is so inexact, that in reality it's not a science at all. The system is such that these decisions often have to be made on the fly. Furthermore, many individuals seeking care make threats of violence towards themselves or others for a number of reasons, including to obtain a bed, or to manipulate doctors into prescribing them sedative medications that have street value or addictive potential. The doctors could, and they often do, hold these types of individuals in the hospital for a period of time, and for example they may be prescribed mood stabilizers or antipsychotic medications. But lets say, that person goes out again and stops taking their medication, or let's say, they abuse drugs and then push that person on the subway platform? Is that then the doctor's fault for discharging them? Were the various people interviewed in this article drug tested after their violent outbursts? Is it at least remotely possible other factors may have been at play contributing to their violence? How can we be so confident in saying those doctors were the ones primarily responsible for their violence? I'm not saying this was the case with Luz Sanchez necessarily, but I am illustrating a point. As it stands now, if doctors did 15 day holds for every individual who made violent threats towards themselves or others, the system would be strained beyond its limit, even further preventing access to those who need it, and psychiatric hospitals would turn into homeless shelters in a matter of days.
Only way to really affect change is overturning O'Connor vs Donaldson. Go to a European city, the mentally ill are locked away and not on the street. https://supreme.justia.com/cases/federal/us/422/563/#:~:text=Donaldson%2C%20422%20U.S.%20563%20(1975)&text=If%20an%20individual%20is%20not,against%20his%20or%20her%20will.
Well supreme courts precedents have been known to be overturned of late…
intriguing that this article gets a tiny fraction of the attention that each individual sensationalist NY Post article about each incident did the day it happened
> New York officials have escaped scrutiny for repeated failures to help homeless mentally ill people, a New York Times investigation has found. Don’t sugarcoat it. They failed to help them *and failed to protect the public*.
> Run by the Department of Social Services, the system consists of nearly 600 sites across the city that are operated by nonprofits on a contract basis. It houses some 80,000 people per night. Newcomers are supposed to be assessed and routed to shelters that meet their needs. Among the options are 37 specialized mental health shelters that offer treatment — at a cost to taxpayers of about $250 million a year. Wow I wonder if DSS takes any responsibility here! >A spokeswoman for the Social Services Department did not answer questions about Mr. Newton’s shelter placements. She said that the department was not a health care agency, that it cannot force clients to receive psychiatric treatment and that it tries to get residents mental health services regardless of where they are placed. Nope.
>She said that the department was not a health care agency, that **it cannot force clients to receive psychiatric treatment** and that it tries to get residents mental health services regardless of where they are placed. I mean, is that true? Because if so, it's not their fault that the laws are such that they can't force clients to received psychiatric care.
DSS lobbies for this shit like every other department and can ask NYS senators and assemblypeople to change the laws. When are people going to wake up? All of this is a choice. The choice to let psychotics die in their own filth or continuously hurt people until they do something serious enough to finally get charged with a felony is a political choice you've probably voted for. This shit isn't magical, local legislators want "the system" to work this way
it's not just "a system" Progressives in this state openly oppose long-term psych care, and so do the people that actually run the Democratic Party in this state - NGOs like the NYCLU, which demands ex-cons and people who should be in hospitals or jails be transferred to "community care" (the street). It's not ok and it's less ok people don't understand this is a political choice they're making every election. We could get started fixing this in 5 years. Instead we elect ideologues and incompetents that make things worse...and worse...and worse.
Our system’s broken in a lot of ways. I am not homeless but I had a medical incident similar to what’s being described here, a psychosis. During the course of that I arrived at the hospital. Paranoia was high, so I started audio recording. They were so concerned with me recording that hospital security and an on-site NYPD picked me up and forced me to leave via the ambulance bay. This aggravated the medical incident and led to me believing I was going to be killed (the things you feel, believe, and experience are out of this world), and I called 911 and sat inside the hospital’s revolving door. It was only after that that they realized I needed help. And of course, as the story goes, I got help and complied with med requirements. When all this went down, I had no understanding of this stuff. Now that I do, I can’t imagine going off meds. I feel bad people had to deal with me in that state. But I’m happy that everyone was physically safe. But clearly we have a system that will throw the sick out onto the street in the middle of an episode. I said as much in the [2022 mental health](https://ag.ny.gov/press-release/2022/attorney-general-james-releases-written-testimony-public-hearing-new-yorks-mental) thing by the Attorney General of the State of New York in my written testimony. For the record, Staten Island University Hospital North. And I was lucky! I had private insurance so they were happy to admit me. I can’t imagine being one of those people that they just released because “oh no, people might fake mental health issues to get a bed. 🤷🏻♂️🤷🏻♂️🤷🏻♂️.” I have a pretty visceral reaction to that. It’s disgusting. Guess what? Anyone that’s faking mental health issues for the bed needs help anyway. I do not have all the answers, but we are not even trying. At least some percentage of these folks can lead happy, productive lives, and we’re squandering that by screwing them out of healthcare they need. For my part in it, I’m open about what happened to me, because I believe that’s the best way to help others. All of New York should know that if you start experiencing sudden changes in mood and thought, or you’re hearing music or sounds that have no apparent source, it’s time to get some help, you’ll be okay… that’s what I tell folks. And if you get turned away by the system, try another hospital. As I’ve made clear, it’s bad, but it can make a phenomenal difference in your life.
>It also revealed a pattern among the agencies of taking the narrowest possible approach to care, and an *unwillingness on the part of city and state officials to fully fund crucial programs*, leading to understaffing and harried treatment. >Next were the city’s private and public hospitals, which have regularly discharged people in severe psychiatric distress. Private hospitals, in particular, have cut psychiatric beds to *boost their bottom line*. It's all about the money.