Homeless mentally ill in the U.S.

[Math Is Hard]

In large cities in the U.S., it is not uncommon to see homeless people in the streets who are obviously suffering from severe psychiatric disorders. I wondered if this was also common in large cities of other countries. I have been trying to figure out why the U.S. seems to have given up the social responsibility (and I feel that there is one) of caring for these people.

Any thoughts?

 

[hypatia]

Well the answer here in Michigan is, money. The state closed all the doors to state funded mental hospitals, except for the criminals who are mentally ill.
The few who had families, or people who care about them were lucky. They got help with the extensive paper work for social aid, and were put into group homes. The others, some who couldn't even walk, were dumped onto the streets.
The Salvation Army scooped some up, and housed them for a while, and others simply vanished. It was the states contention that the public/not for profit groups should handle this.
Its been a nightmare.

 

[Math Is Hard]

I seem to remember someone telling me that a similar thing happened in California in the late 1970's. The funding was cut off and the mental hospitals were emptied.

I work very near one of the best neuropsychiatric research centers and hospitals in the state. It always strikes me as ironic that just outside the building you'll see homeless schizophrenic people wandering around, eating out of trash-cans, urinating on the sidewalks, and sleeping in the bushes. The people who desperately need help are separated from the people who know best how to help them by only a pair of glass doors.

I am amazed that state governments expect groups like the Salvation Army to handle this burden on their own. I am sure these organizations do their best to feed and shelter these people, but they also need psychiatric care. The expense for the medication alone would be enormous I imagine.

 

[pallidin]

I would agree that there is a social responsibility to care for the mentally ill. After all, is mental illness a "choice"? No, it is a disease, be it a biological or emotionally cognitive "disorder"
Speaking for myself, I would have no problem with financially assisting in the care and hopeful remediation of these people. They do not want to live that life, they are victims, in my opinion.

 

[Smurf]

In large cities in the U.S., it is not uncommon to see homeless people in the streets who are obviously suffering from severe psychiatric disorders. I wondered if this was also common in large cities of other countries. I have been trying to figure out why the U.S. seems to have given up the social responsibility (and I feel that there is one) of caring for these people.

Any thoughts?

That would require raising taxes. I think this is the main deterrent.

 

[Math Is Hard]

pallidin, I agree with you. I feel the same way. I'm a person who is very skeptical of any new social programs (and the existing ones) but I think this is something that needs attention.

smurf, what is the situation like in Canada? Of the homeless people there, do you think a significant number are severely mentally ill? Or are they just "street people" who are, for the most part, there by their own choice?

 

[Smurf]

Well, the rare times that I do see a homeless person they're usually quite polite and very normal with the exception of being rather dirty. Usually able-bodied too, I believe they could work if they wanted to. Doubt it's drugs either, or they're just really good at hiding it. They're great if you need directions though!

Having said that, I live in a town of several thousand (maybe as low as 6?). I imagine Vancouver (and even Nanaimo - where I'm moving) would be worse. Especially with the drugs, none of the heavy stuff is in town here, so I wouldn't expect to see any with the homeless!

 

[honestrosewater]

Some information about problems and proposed solutions in the US can be found at http://www.mentalhealthcommission.gov/ looks like a pretty easy read. The commission identified 6 goals:
Goal 1: Americans Understand that Mental Health Is Essential to Overall Health.
Goal 2: Mental Health Care Is Consumer and Family Driven.
Goal 3: Disparities in Mental Health Services Are Eliminated.
Goal 4: Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice
Goal 5: Excellent Mental Health Care Is Delivered and Research Is Accelerated.
Goal 6: Technology Is Used to Access Mental Health Care and Information.
and made several recommendations for reaching them. Comments from the APA et al regarding the commission's recommendations:

In keeping with your request, we have identified the three Commission recommendations that, in our judgment, offer the most promise for achieving the desired transformation of our nation's mental health system. The following list, in order of priority with explanatory comment, reflects the combined input of our APA Task Force on SMI/SED and four of our Public Interest Directorate committees and task forces that focus on special populations across the lifespan:

Recommendation 2.3: Align relevant Federal programs to improve access and accountability for mental health services. As the Commission noted, this recommendation addresses critical needs in our service delivery system, including: flexibility in funding, supportive employment and housing, an end to the Institutions for Mental Diseases (IMD) exclusion, and access to mental health services for individuals through our educational and justice systems. The creation of flexible funding streams enables agencies to commingle funds to provide the most appropriate services to an individual over time, including access to a comprehensive system of care.

- http://www.apa.org/ppo/issues/pcmhltr1103.html

I wanted to see what the situation is in Florida and found this:

The primary blame lies not in Tallahassee, however, but in Washington. Because their illness prevents them from obtaining private insurance through employment, many people with severe mental illness rely on Medicaid to pay for their treatment. For every dollar Florida spends on Medicaid, the federal government reimburses more than 56 cents -- unless the patient is between the ages of 21 and 65 and treatment is in a psychiatric hospital or other "Institution for Mental Diseases" (IMD).

- http://www.psychlaws.org/GeneralResources/article27.htm

(More info is available on their site, http://www.psychlaws.org/default.htm.) This is the same explanation I see other places. I found many medical and mental health organizations that think the "Medicaid IMD Exclusion" should be repealed- in fact, every one I found agreed. For an example of their arguments, which I happen to agree with, see http://www.nasmhpd.org/general_files/position_statement/exclusion.htm .
More info about the exclusion: An Analysis of the Medicaid IMD Exclusion.
According to http://www.mhamd.org/policy/alert.030805.html, Maryland, Arizona, Delaware, Hawaii, Iowa, Massachusetts, Oregon, Rhode Island, Tennessee and Vermont have had IMD Exclusion Waivers but risk losing them. I'm not sure how much of a problem it really is- apparently there are ways to get around it if you really try- but it still seems ridiculous to have the exclusion in the first place. The US has already made a commitment to helping people receive medically necessary treatment, and I think doctors should decide what constitutes medically necessary treatment.

 

[Math Is Hard]

Thanks for those excellent links, hrw. One of the things I became very interested in while reading them was the renewal of something called "Kendra's Law" in New York. Under this law, severely mentally ill people can be court ordered to remain in outpatient treatment

It seems to be working:
http://www.psychlaws.org/BriefingPapers/BP18.htm

During the course of court-ordered treatment, when compared to the three years prior to participation in the program, AOT recipients experienced far less hospitalization, homelessness, arrest, and incarceration. Specifically, for those in the AOT program:

74 percent fewer experienced homelessness;

77 percent fewer experienced psychiatric hospitalization;

83 percent fewer experienced arrest; and

87 percent fewer experienced incarceration.

 

[Astronuc]

My wife worked as a drug and alcohol counselor at a local mental health clinic in Texas. Deinstitutionalization began during the Reagan administration when they decided to reduce social services in order to cut taxes, although the official excuse (justification) was to put people in a less restrictive environment, i.e. give them liberty. States jumped on the bandwagon and basically decided to shift responsibility to local governments, which were not set up to treat the severely mentally ill. There were local programs that were euphemistically termed "community-based" health care - but no funding!

The net effect was to take the mentally ill and put them on the streets. But it saved taxes!

Local jurisdictions in Texas and across the nation dealt with the problem by arresting the mentally ill and putting them in jail. Sometimes as was the case in our community, mentally ill people (no longer patients) showed up in the community with a one-way bus ticket from elsewhere (both from in Texas and out-of-state).

Mistreating the mentally ill editorial by Rich Lowry, editor of National Review, a TownHall.com member group.

The devil in deinstitutionalizing by Sean Paige, Treatment Advocacy Center (TAC).

 

[honestrosewater]

Wow, http://www.psychlaws.org/BriefingPapers/BP4.htm says "Forty-two states permit the use of assisted outpatient treatment (AOT), also called outpatient commitment. The eight states that do not have assisted outpatient treatment are Connecticut, Maine, Maryland, Massachusetts, New Jersey, New Mexico, Nevada and Tennessee. Florida adopted an AOT law on June 30, 2004."
I guess if someone refuses treatment as a result of their disease or poses an immediate danger to themselves or others, forcing them to receive treatment may be justified in some of those cases. Are you guys comfortable with the government forcing people to receive treatment?

 

[pallidin]

Wow, http://www.psychlaws.org/BriefingPapers/BP4.htm says "Forty-two states permit the use of assisted outpatient treatment (AOT), also called outpatient commitment. The eight states that do not have assisted outpatient treatment are Connecticut, Maine, Maryland, Massachusetts, New Jersey, New Mexico, Nevada and Tennessee. Florida adopted an AOT law on June 30, 2004."
I guess if someone refuses treatment as a result of their disease or poses an immediate danger to themselves or others, forcing them to receive treatment may be justified in some of those cases. Are you guys comfortable with the government forcing people to receive treatment?

Good question. My opinion is that such a determination should NOT be in the governments hand. Where it should reside is within an impartial non-governmental psychiatric review board, which itself is monitored by a public advocacy group.
That the government might make defined legal guidelines is somewhat OK, but the adjudication on a case-by-case basis should be done by non-government entities with serious public oversight.

 

[devil-fire]

apparently a lot of the mentally ill homeless turn up in the prisons system. a big problem with that is that the majority of the prison system is not set up to deal with mentally ill. in the following link, there is a guy who has been in the system for over 10 years for stealing a purse.

this link is to a TV program on PBS that is also published on the internet called frontline

"Fewer than 55,000 Americans currently receive treatment in psychiatric hospitals. Meanwhile, almost 10 times that number -- nearly 500,000 -- mentally ill men and women are serving time in U.S. jails and prisons. As sheriffs and prison wardens become the unexpected and often ill-equipped caretakers of this burgeoning population, they raise a troubling new concern: Have America's jails and prisons become its new asylums?"

http://www.pbs.org/wgbh/pages/frontline/shows/asylums/view/


iv posted this link before on another thread but i think the content is closely related to this topic

 

[Kerrie]

interesting this topic came to light at this time in my life...currently, i am dealing with someone who has possible mental illness. it's very easy for society to have no compassion for those dealing with illnesses because they are "strong minded" and can't understand why they can't move with society.

i hope that someday, societies can open their hearts and arms for those who suffer. many of them want help.

 

[pallidin]

i hope that someday, societies can open their hearts and arms for those who suffer. many of them want help.

Indeed, and if one looks deep into their eyes, or listens to their private screams at night, most of them sense that there is something wrong with them and would love to change but don't know how. On that realization comes more tears from them in the middle of the night.

 

[Math Is Hard]

My friend's brother suffers from severe schizophrenia and for many years he was cared for by elderly parents. When he is on his meds he is one of the nicest guys you'd ever want to meet, but when he slips up and stops taking them he is completely out of control. He's destroyed furniture and even injured his frail parents on several occasions. He lives in a group home now where they make sure he takes his meds. He has done well in this situation.

I think some people might be nervous about the government forcing treatment on people because it would violate their freedom, but I feel that when you see someone with such severe mental problems having an "episode", you know that it is when they are off the meds that they are not free. They are imprisoned by the disease, unable to control their thought and actions.

Of course, this sort of enforcement should only apply to the extremely sick, the non-functioning - the absolute worst cases.

 

[Kerrie]

but I feel that when you see someone with such severe mental problems having an "episode", you know that it is when they are off the meds that they are not free. They are imprisoned by the disease, unable to control their thought and actions.

this is absolutely true...they are not in control of the disease, but rather it is in control of them...

 

[zoobyshoe]

I think some people might be nervous about the government forcing treatment on people because it would violate their freedom, but I feel that when you see someone with such severe mental problems having an "episode", you know that it is when they are off the meds that they are not free. They are imprisoned by the disease, unable to control their thought and actions.

Astronuc is absolutely right. The Reagan administration killed what used to be a reasonably workable solution to this problem. There used to always be funding for state mental hospitals and the majority of the inmates preferred to be there, and stayed voluntarily, rather than choose the alternative of life on the streets. They might complain from dawn till dusk that they weren't crazy, and didn't belong in a mental hospital, but the food was free three times a day, the beds were warm, and they realized they were safe there in basic ways they wouldn't be on the street.

That whole system was stupidly dismantled and now no one seems to have a clue how it ever worked or how to fund it, and there is the erroneous notion that it is an impossible goal, when, in fact, it was in place and working fairly well until Reagan got into office.

 

[Dooga Blackrazor]

Mental health is a serious issue. In Canada, we still have problems with how we deal with mental problems. I applied for mental health assistance because I was not depressed, but indifferent - I was rarely happy or sad. I didn't get any help until I was verbally abusive and suicidal, and, even though I have medication, I am not always treated properly. I get rewarded by our government if I exploit my illness and act out. As soon as you start applying yourself and recovering, you lose out on benefits or are pushed down a list. The triage system is abhorrent here, in my opinion.

Mental illness is definitely a disease that can be difficult to deal with. I have a hard time explaining to people how I feel sometimes. If I don't do my homework, I am asked why I didn't do it. I might have watched t.v. instead - but not because I wanted to watch t.v. I can't even explain it now. Sometimes I just get depressed and feel like I'm not in control of my own body. I just become a traveller on a unpredictable ship. Luckily, I'm getting better.

However, you're definitely correct that people should be forced to get help; however, there should be strick controls. It's cruel to force a severely depressed person to get help then, after years of treatment, find they are still no better. Suicide, as taboo as it is, needs to be made avaliable to even the mentally ill - perhaps after a certain time. Imagine being tortured indefinately and drugged - that could happen if such action was legislated improperly. Despite that risk and others that may exist, something definitely needs to be done to ensure that people are forced into getting assistance when necessary.

 

[SOS2008]

In response to this and the earlier thread on the topic, my own view is that the homeless are a result of different factors.

Arctic Fox mentioned those who are anti-establishment (or so they will say). I was watching a program on MSNBC this last weekend about run-aways in Portland. On one side of the coin, most have a home, but the home life is dysfunctional, often abusive. In addition to emotional problems, many use drugs, most migrating to harder drugs over time. To solve this problem we must improve family services and address the issue during childhood.

On the other side of the coin, it was amazing how quickly they could raise $40 from pan handling spare change, usually for a heroin fix. They would complain about people who would tell them to get a job, and when people would give them groceries instead of money. They seem to get by, and they seem to choose this way of life. In general, I know folks who contribute time to the Salvation Army, and they say most are alcoholic and/or addicts who game the system as best they can.

Then there is the "bag lady" with psychological problems--often the family searches for her, finds her, takes her home only for her to run away again. These types of homeless people usually don't seek services at all. Like MIH says, these kinds of people need to be on meds, and really should be supervised/institutionalized in some way. Currently people can only qualify if they are a danger to others or themselves.

Many people experience homelessness for at least brief periods of time due to loss of job or medical bills. Many Americans live beyond their means or month-to-month with no savings, family network, etc. and can fall through the cracks more easily than we all realize. Despite what people think, it is difficult for these folks to get Access health assistance, food stamps, welfare, etc. because you have to be destitute, not just struggling. The people who obtain these benefits are those who know how to game the system and have no intention of "getting back on their feet" if they ever were.

It all comes down to government programs and how these are administrated. And in the meantime, those who lack understanding or empathy may find themselves homeless as well one day.

 

[Loren Booda]

The Treatment Advocacy Center, at www.psychlaws.org, advocates nationally to change laws that allow "the right to be psychotic."

The Treatment Advocacy Center is a national nonprofit organization working to eliminate barriers to timely treatment of severe mental illness.

Noncompliance is perhaps the most confounding paradox of caring for brain diseases - it pits families against the ill, visits serious social and medical maladies upon those sick, and costs in poor quality of lives and billions of dollars of real human value.

 

[Loren Booda]

Deinstitutionalization and the absence of social support in the community started with a Democratic administration (Kennedy) and has continued mostly unabated and unaddressed by every one since then. Homelessness is a product of the space age. G. W. Bush has a mom with depression, and for a conservative seems genuinely concerned for people with mental illness.

 

[SOS2008]

The topic is a can of worms in that a single related issue, such as treatment for the mentally ill can be just the tip of the iceberg -- most notably misdiagnosis, including institutionalization of the deaf not so long ago. Much of this problem is simply a lack of understanding, not just political in nature.

With regard to the needy, my position is that government should not reward those who game the system, and should instead do a better job at preventing good Americans from falling through the cracks or below poverty levels by providing incentives, such as tax breaks for savings, less debt (especially credit card debt), etc.

There have been various efforts in this direction, for example I believe Senator Dodds pushing for legislation against credit card abuses. Unfortunately there aren't enough members in congress who get behind such things; I don't care what administration or party

 

[Math Is Hard]

I've been thinking a great deal on the subject and I decided to make the controversy of Assisted Outpatient Treatment programs the subject of my research paper for a class. I did a great deal of research at the psychlaws.org site that Loren mentioned. Your comments are welcomed and appreciated. My argument abstract follows:

Summary of the Controversy: Assisted Outpatient Treatment (AOT) programs featuring court-ordered psychiatric medication have been adopted in 42 states across the union. Intended to ease the burden of untreated mental illness on society and the misery imposed by mental illness on the individuals affected, the laws are troublesome to civil libertarians who fear the potential for the laws' misuse. If medication can be mandated to control potentially dangerous behavior, some worry that it may be extended to control behavior that is merely disruptive. AOT programs were designed to protect the individual and protect the community by reducing the risk of harmful behavior in people with severe and persistent psychiatric disorders. Several AOT laws, such as Kendra’s Law in New York and Laura’s Law in California sprang up in swift reaction to acts of homicide committed by severely mentally ill individuals during psychotic episodes. Supporters of AOT laws claim that the community has a right to impose measures of restraint, medication or otherwise when it comes to protecting the lives of its citizens from potential danger. Opponents say that forcing individuals into involuntary treatment is too high a price to pay for the statistically low-risk of actual harm.

Thesis statement: AOT programs both reduce harmful behavior and improve the quality of life for severely mentally ill people who have a history of treatment non-compliance resulting in repeated hospitalization, arrests, or acts of violent behavior. Court ordered treatment, including medication, is at the heart of these programs, and it has significantly increased adherence to treatment and decreased many of the problems associated with severe mental illness including homelessness, hospitalization and incarceration. Diseases such as schizophrenia and bipolar disorder interfere with an individual’s judgment in adhering to treatment. According to one study by the Rockland Psychiatric Center in New York, the largest reason that people abandon medication is a result of disease-based decisions. Reasons for refusal include delusional paranoia, denial of illness, or in the case of bipolar patients, a preference for the euphoric symptoms of the manic cycle of the disease. Court-ordered medication forces a person to take the treatment seriously and “stay on the meds."

AOT laws give us a safer community. Studies are showing that these programs have significantly decreased harmful behavior in the participants. Suicide attempts and incidents of physical harm to others have been reduced by half. AOT programs give mentally ill people control over their minds and bodies. For individuals suffering from severe psychiatric disorders, staying on medication is their only hope of living a normal life. Research suggests that these programs are also cost-effective. The reduction of hospitalization and incarceration, which comes as a result of AOT programs, provides relief to already overstretched state budgets. Most importantly, the recipients themselves report a high-level of satisfaction from AOT programs. AOT laws should stay, and they must be reinforced by careful monitoring of the programs and adequate access to medication for the patients.

Personality profile of the adversarial audience: Opponents of AOT programs are individualists, concerned more with individual liberties than the collectivist needs of the state. Those who oppose AOT programs see Kendra’s Law and other AOT laws as a drastic overreaction to a small number of cases of violence involving the mentally ill. They believe that an individual has the right to make their own choices about their mental health treatment options; that he has as much a right to be sick as to be well. They are also concerned that involuntary treatment will be extended and enforced on people who are merely disruptive as opposed to extremely sick. There is a concern that AOT laws and programs were pushed through to benefit large pharmaceutical corporations and doctors by forcing a demand for expensive medication.

Points of Agreement: Severely mentally ill people are too sick to understand that they are sick. Losing touch with reality and the inability to reason are part and parcel of severe psychiatric problems such as schizophrenia and bipolar disorder. Medication has proven effective in controlling delusions, hallucinations, and other mental dysfunctions caused by psychiatric disorders. Individuals suffering from severe psychotic episodes (in some cases) are a danger to themselves and others. The greatest violation of individual rights is unnecessary injury and death for victims of violently mentally ill people. We can reduce such occurrences with AOT.

Evidence: A recent report by the New York State Office of Mental Health (March 2005) shows that court-ordered medication delivers dramatic results. Compared with 3 years prior to the beginning of the AOT program in New York, 74 percent fewer severely mentally ill individuals experienced homelessness, 77 percent fewer experienced psychiatric hospitalization, 83 percent fewer experienced arrest, and 87 percent fewer experienced incarceration.

Evidence strongly suggests that AOT programs not only protect mentally ill individuals from themselves, but also decrease their danger to the community. In New York, comparison studies contrasting incidents of harmful behavior of individuals in court-ordered treatment with the number of incidences among the group six-months prior show 55 percent fewer recipients engaged in suicide attempts or physical harm to self, 47 percent fewer physically harmed others, 46 percent fewer damaged or destroyed property, and 43 percent fewer threatened physical harm to others.

 

[zoobyshoe]

Here's two arguments:, a pro and con:

E.Fuller Torrey & Mary T Zdanowicz
Address:http://www.m-power.org/GlobeDebate.htm

 

[honestrosewater]

MIH,
Just curious- did you come across anything discussing the side effects of these drugs?

I think it would be interesting to compare AOT with mandatory vaccinations. I imagine most Americans are already familiar with vaccinations. Society's motives and benefits seem similar in both cases and both involve the issue of an individual's rights regarding their medical treatment and concerns about ulterior motives (benefiting pharmaceutical corporations).
But the differences between them would bring out what concerns me the most: the impact on the individual. Just guessing at some things on the list...
Mandatory Vaccination:

• applies to everyone
• requires occasional shots
• affects the immune system

AOT:

• applies only to some
• requires regular, long-term treatment
• affects the brain and nervous system

I don't know how the potential side effects compare, but that would be another point to consider. Do you see what I'm getting at? It's not that they're being forced into treatment but the specific type of treatment that they're being forced into that makes AOT more alarming.

 

[zoobyshoe]

MIH,
Just curious- did you come across anything discussing the side effects of these drugs?

Google Search: tardive dyskinesia
Address:http://www.google.com/search?hl=en&ie=UTF-8&q=tardive+dyskinesia&spell=1

Do you see what I'm getting at? It's not that they're being forced into treatment but the specific type of treatment that they're being forced into that makes AOT more alarming.

I'm trying to find an article that describes a psychiatrists shocking experience when he took a drug similar to haldol in an experimental effort by a small group of doctors to see what the side effects were like. Ivan posted it last year, but I can't find the thread.

edit: I found the article but it requires buying a subscription to read.

Here's a different one that discusses the common unpleasant side effects (that lead many patients to drop their meds):

Schizophrenia Leading Drugs for Psychosis
Address:http://www.schizophrenia-help.com/Schizophrenia_Editions/Schizophrenia__Leading_Drugs_f/schizophrenia__leading_drugs_f.htm

 

[honestrosewater]

Google Search: tardive dyskinesia
Address:http://www.google.com/search?hl=en&ie=UTF-8&q=tardive+dyskinesia&spell=1

Thanks. I was just asking because she didn't mention it in the abstract, and I've heard that the side effects of some drugs can be quite bad and make finding the right medication, combination of medications, doses, etc. for each patient complicated.

I'm trying to find an article that describes a psychiatrists shocking experience when he took a drug similar to haldol in an experimental effort by a small group of doctors to see what the side effects were like. Ivan posted it last year, but I can find the thread.

Just to be clear, I didn't mean to imply that treatment won't or can't work, but that treating mental disorders, and singling people out for treatment, is more complicated than a simple shot in the arm for everyone.

 

[zoobyshoe]

Just to be clear, I didn't mean to imply that treatment won't or can't work, but that treating mental disorders, and singling people out for treatment, is more complicated than a simple shot in the arm for everyone.

Exactly.

According to one study by the Rockland Psychiatric Center in New York, the largest reason that people abandon medication is a result of disease-based decisions. Reasons for refusal include delusional paranoia, denial of illness...

In cases like this it doesn't make much sense to force someone to take a drug that isn't giving them insight into their disease or alleviating their paranoia. The meds are clearly not working, so why force them to take them?

There is a difference between this kind of patient, though, and someone who's fine on meds and sick off them.

 

[Math Is Hard]

Thanks for the feedback. That is an interesting idea about the comparison to vaccinations, honestrosewater. I've been reading a little bit about the new generation of drugs and while there still are side effects, they seem to be a vast improvement over the previous generation of psychotropic meds.

Thanks for that link, Zooby. I noticed the comparison to Alzheimer's that was made. I've been working on a similar line of reasoning in my paper.

In cases like this it doesn't make much sense to force someone to take a drug that isn't giving them insight into their disease or alleviating their paranoia. The meds are clearly not working, so why force them to take them?

If the drugs are not working then I agree, they shouldn't be taking them. Like all medications, individuals are going to respond differently. It is the physician's responsibility to try to find the one that helps.

The side effects may be bad, but are they worse than the symptoms of the disease? There's a homeless man near my house who appears to suffer from severe schizophrenia. He's been having bad episodes for a couple of days now. He behaves as if something is attacking him. Whatever he thinks is happening to him, he's obviously terrified. It's like he's trapped in a waking nightmare.

Last night I was reading about cases of violent behavior in people suffering from severe bipolar disorder and schizophrenia. The saddest cases were of mothers who killed and maimed their children. Too horrific to go into it here. I just kept thinking - these incidents did not have to happen.

 

[Loren Booda]

I believe that the incidence of rape in mental institutions is relatively high, but even more so for (especially attractive) homeless women on the street and the mentally ill in prison.

The Los Angeles County Jail and Riker's Island (NY) are the largest de facto mental institutions in the country.

 

[zoobyshoe]

The side effects may be bad, but are they worse than the symptoms of the disease?

The way you can tell is if the person is willing to put up with the side effects for the relative peace the meds give them. Some people are on three different meds at once: A psychotropic, an antidepressent, and and anti-anxiety drug, and are still hearing abusive voices.

There's a homeless man near my house who appears to suffer from severe schizophrenia. He's been having bad episodes for a couple of days now. He behaves as if something is attacking him.Whatever he thinks is happening to him, he's obviously terrified. It's like he's trapped in a waking nightmare.

Could be schizophrenia, could be mania with psychotic features, could be something organic: a dementia, could be street drugs. He ought to be looked at, yes.

Last night I was reading about cases of violent behavior in people suffering from severe bipolar disorder and schizophrenia. The saddest cases were of mothers who killed and maimed their children. Too horrific to go into it here. I just kept thinking - these incidents did not have to happen.

You're right, and in the cases of mentally ill parents there should probably be much more than policing their meds: weekly group meetings on parenting skills, and meetings with psychologists to make sure they aren't teaching their kids things like the President is Satan's puppet. I'm not concerned about this required med taking in the cases of people who are dangerous.

 

[Math Is Hard]

You're right, and in the cases of mentally ill parents there should probably be much more than policing their meds: weekly group meetings on parenting skills, and meetings with psychologists to make sure they aren't teaching their kids things like the President is Satan's puppet. I'm not concerned about this required med taking in the cases of people who are dangerous.

I'm glad you brought that up. This is something that's missing from my paper. There needs to be monitoring, not just dosing. Services should include counseling for the whole family as well as the individual.

Three weeks ago, one of our local homeless guys in Westwood was passed out on the sidewalk. I stopped a patrol car and asked them to go check on him. I honestly wasn't sure if he was even breathing. They agreed to go over but their attitude was just "yeah, he does that all the time."
Why won't someone help him?

The Los Angeles County Jail and Riker's Island (NY) are the largest de facto mental institutions in the country.

I agree. Deinstitutionalization was nothing more than the swapping of one facility for another. If I did the math right, the numbers look like this:

1973: for every person incarcerated by the New York State Department of Corrections(DOC), there were approximately 7 in New York State psychiatric hospitals.

2000: For every patient in a NY State Hospital, there were approximately 14 inmates housed by the New York DOC

http://www.prisonpolicy.org/articles/massdissent040100.shtml

 

[SOS2008]

MIH - Very interesting.

It seems there is always argumentation of misuse/abuse against scientific progress. With correct systems in place for ethical usage and plenty of testing of drugs, then it would be just a matter of diagnosis and treatment. As you mentioned earlier in the thread, the mentally ill (once properly diagnosed) tend to go off their meds, so they need supervision of some kind.

If you are interested in comparing meds to vaccination and in regard to side effects, you may want to research autism from flu shots.

 

[honestrosewater]

If you're interested in the legal side of things, cases about mandatory vaccinations have already made their way through the system and the broader parts of those decisions may be relevant to AOT. Vaccinations: Precedent and
Current Laws[/url] (Updated January 18, 2005) may give you some leads. For instance, from the JACOBSON v. COM. OF MASSACHUSETTS decision:

We come, then, to inquire whether any right given or secured by the Constitution is invaded by the statute as [197 U.S. 11, 26] interpreted by the state court. The defendant insists that his liberty is invaded when the state subjects him to fine or imprisonment for neglecting or refusing to submit to vaccination; that a compulsory vaccination law is unreasonable, arbitrary, and oppressive, and, therefore, hostile to the inherent right of every freeman to care for his own body and health in such way as to him seems best; and that the execution of such a law against one who objects to vaccination, no matter for what reason, is nothing short of an assault upon his person. But the liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good. On any other basis organized society could not exist with safety to its members. Society based on the rule that each one is a law unto himself would soon be confronted with disorder and anarchy. Real liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own, whether in respect of his person or his property, regardless of the injury that may be done to others. This court has more than once recognized it as a fundamental principle that 'persons and property are subjected to all kinds of restraints and burdens in order to secure the general comfort, health, and prosperity of the state; of the perfect right of the legislature to do which no question ever was, or upon acknowledged general principles ever can be, made, so far as natural persons are concerned.'
- http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=us&vol=197&invol=11