The above video was from seven years ago. Perhaps the public streets will now cease to be insane asylums. The concept that psychotropic drugs could allow us to dispense with insane asylums has proven itself to be an insane delusion. What institutions we have tend to be jokes. People are put into them, put on drugs, and immediately released, the problem “solved” by the drugs. An unholy alliance of budget cutters and civil libertarians have caused the ignoring of a salient fact: for many severely mentally ill, there is no good solution but for institutionalization. Often this is a bad solution, but better than allowing them to roam the streets, a threat to themselves and those who come into contact with them. Good family care is often the best solution, but too many families are unable or unwilling to provide such care, and for the violent mentally ill this not a safe solution.
I’m wagering only an odd minority of vagrants will be candidates for 24 hour care.
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You have regulatory regimes which generated artificial constraints on the quantum of available housing, regulatory regimes and changes in effective demand which have largely eliminated housing types common 80 years ago, and the recent idiot social experiment in drug legalization. You also have gobs of public expenditure in certain loci. In blue jurisdictions, you can wager gobs of public expenditure means gobs of money squandered on grift and graft.
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The prevalence of schizophrenia does vary from one country to another, but I doubt you’re going to find that at point of onset it varies inter-regionally or varies much by social stratum. Where do you have masses of vagrants? Toronto, i.e. in a country where the political class has imposed on the populace wildly excessive immigration rates. Los Angeles, where you have warm weather, the proximity of the southern border, bad regulatory regimes, and welfare grift. Seattle, where you have bad regulatory regimes and drug legalization &c.
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Add more asylum beds and take away the toys given the har-de-har ‘public interest bar’. But work on your planning and zoning regime, your landlord-tenant law, the quantum and distribution of police services, your drug laws, &c. Vagrancy is part of the human condition. Failure to contain the problem and ameliorate its effects is an exercise in learned helplessness.
As a young man I worked in a state hospital that included patients who had been judged criminally insane. I can testify that none of the people that I came in contact with there should be out on the streets. My father the psychiatrist used to say that if you can’t or won’t control yourself, someone else will control you. The vast majority of people in the hospital I worked in we’re not capable of controlling themselves, often even with drugs. A major part of our dysfunction as a society right now is because no one controls those who can’t or won’t control themselves.
My concern would be a lack of systematic due process for isolated individuals with no family or community to advocate for their rights and leaving a lot of power in the hands of the most subjective and (currently) most politically-woke branch of medicine i.e. psychology. The horrors depicted in “The Snake Pit” and “One Flew over the Cuckoo’s Nest” were no doubt exaggerated, but they were not invented. Bedlam within walls is hardly an improvement on the current Bedlam without walls (except that we wouldn’t have to look at it).
Psychology is not a branch of medicine. Psychology has an academic side and a professional side and both are variegated. North of 20% are post-secondary teachers and they’re seldom specialists in psychopathology. (The department I’ve been most acquainted with had about a dozen slots, one of which was allocated to abnormal psychology). Shy of 40% work in the clinical / counseling sector; these commonly have master’s or first professional degrees rather than research degrees. If I’m not mistaken, clinical psychologists seldom have schizophrenics on their patient roll because treating schizophrenics is outside their skill set.
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Psychiatrists and people who work for them in inpatient settings are the professionals supposedly trained to supervise schizophrenics. Forty years ago, Fuller Torrey offered that gp’s with an interest in schizophrenia could do about as well as psychiatrists in outpatient supervision as psychiatry had largely abandoned the schizophrenic population. Doubt that’s the case today. Psychiatrists are trained in residency programs after medical school and seldom have much background in psychology. There are about 25,000 psychiatrists in the United States v. >60,000 clinical psychologists, v. 475,000 counselors and social workers who specialize in dispositional and behavioral issues.
Art:
Sorry for the confusion of professions. If there are clear, scientific and public standards for institutionalization, and a due process I have no problem. I am aware of the sad case of a family friend, whose brother needed help but could not get it in the SF Bay Area in the 80s and 90s, even though the family had money set aside for him. Every time the authorities took him in hand for erratic behavior, some “rights” lawyer got him released, and he died on the streets.
But it concerns me that the mental health profession connived with the courts and “progressives” to sterilize the “unfit” for half the last century, and now calls gay OK and “trans” normal, and long opined that religious belief was a “neurosis”. The politics of the guy taking out my appendix wouldn’t faze me, but if he’s eying me for Bellevue, history suggests I should be asking questions. I would hope by now psychiatry was as scientific as internal medicine, but I’m not seeing it.
We’re talking about the power of the state to take people in hand, and the state has big feet. Let’s take care where we let it step.
I agree with you generally. I think as a practical matter the problem is less pronounced than it is in other areas, as we’re talking about people who have issues manifest to the layman which take the form of violence and / or disorderly conduct.
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About 0.5% of the population was billeted in state asylums in 1955. The population who would be a candidate for that would be much lower today because people who are impaired due to perinatal accidents and the like are commonly in group homes or with their families, those who are senile have the option of assisted living or state-financed nursing homes, those with tertiary syphilis and post-encephalitis have disappeared from the population, much of the schizophrenic population can be cared for by family, and the manic-depressive population generally benefits only from short-term inpatient care. (Fuller Torrey in 1985 estimated that about 0.25% of the population consisted of schizophrenics in hopeless condition).
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In 1990, the Urban Institute estimated the vagrant population at 0.25% of the whole. In 2010, the Census Bureau estimated that about 0.17% of the population was homeless at any one time. You’ve had an explosion in drug use in the intervening years. You have quite a mess of those in that category who are suffering interstitial issues and will have found a place within weeks.
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I suppose a high proportion of the residue might be schizophrenics or otherwise demented, but my wager is that they’re mostly generically incompetent people. There isn’t a solution for such people, just charitable efforts to operate soup kitchens, community food cupboards, emergency shelters, &c and removal of tax and regulatory impediments to accommodations for the sketchy and / or destitute: flop houses, SRO hotels, boarding houses, apartments with shared kitchens, &c. Local police can provide enhanced patrols in neighborhoods containing such facilities, roust people caught sleeping in public places and harassing passers by, arresting and jailing people for public order offenses, and suppressing the drug trade.
Don, there isn’t enough hospitals to take care of the mentally ill in Illinois. I have a relative who failed to take her medicine, and she had to be taken up to Ottowa because Peoria didn’t have good facilities for longer term care. We used to have a hospital called the Zeller Zone Center, but the state decided in its great wisdom to close it down because they claimed there wasn’t enough patients to justify keeping it open. Well, there must have been a population boom in mentally ill people since then, because Peoria is getting a 100 bed mental health facility in a year of two. I hope that will have enough beds to handle the number of patients that will come in.
Art:
A “manifest to the layman” standard is exactly what is needed for the law to take someone in hand, allow for reasonable habeas corpus challenges and minimize abuse, not just “let’s all trust Dr. Wanmug over there”.
As for the rest, as Freud might put it: sometimes a bum is just bum. Not much you can do except charitable palliation for the cooperative, rigorous rousting for the recalcitrant.
@“Lead Kindly Light:” “ My father the psychiatrist used to say that if you can’t or won’t control yourself, someone else will control you.”
Very, very wise words.
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