No one is talking about the very big risk associated with this, that mental health professionals can commit you against your will with no trial, which is an erosion of civil liberties (incarceration without trial). Having known several friends who got committed and held against their will in psych wards when there was no good reason to, because their insurance was good, this is an issue.
Notice they don't give any stats about outcomes, but the primary cited issue is "mental health" which is very vague and a subjective assessment.
We should not create an extra judicial system that has no checks and balances. Otherwise we will head towards medical authoritarianism which could easily be abused by those in power (psychiatrists and others) for their own personal gain.
This isn't changed by an arrest being the first step. As an EMT I frequently transported people to hospitals (or from hospitals to psychiatric facilities) following their arrest. This just avoids the extraordinary cost to both society and the individual that comes along with an arrest being part of the process.
The medical authoritarian system you're worried about already exists and frankly I saw no evidence of its abuse. Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released - which is a far cry from having healed or become functioning members of society.
> Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released.
Having personally had family members and friends in such places, I can tell you this is false. It has often been the case they are 'magically' healed and capable when the insurance money runs dry.
it's true that one anecdote does not invalidate another, but assuming truthfulness of both anecdotes the first anecdote seems more wide ranging and likely to give a better view of problems in the system.
How is that the case? The first anecdote is someone with only glancing knowledge of the people taken to the mental health facility. They pick them up, probably on a very bad day, and drop them off without seeing evidence of wrongdoing. What evidence would they see? A mustachioed doctor twirling his mustache and laughing maniacally? By contrast, the other anecdote has intimate knowledge of an individual affected by the system for the course of their involvement with it.
I don't think either anecdote is compelling, but I do think it is wrong to weigh one as greater than the other.
To be fair, one anecdote is the viewpoint from the eyes of someone in the "system" while the other is a viewpoint of those affected by the system. Its essentially recreating the initial conversation of police vs people. One side says all good in the neighborhood, the other says corruption is still a problem.
Not to mention the fact that neither comment says which country or region they're based in. I suspect these things can vary a lot by geography, yet both are making very generalized statements.
True. Further complicating matters, I believe there is a correlation between misunderstanding and willingness to share anecdotes (across the general population, not specific to this thread).
Which may be indicative there is not enough data available to support a conclusion, so a person operates with the information most available to them, which may count as a contribution to that data ultimately.
For one thing, we frequently see many of the same patients again, back on the street or in their communities, which is pretty definitive reason to think they're not locked up indefinitely.
In your experience, do they get better after their stint in the psych ward, or are they pretty much the same, or are they worse?
My experience dealing with the homeless on the streets of Seattle is they seemed to either stay the same or get worse. I never saw one person get better from a stay in the psych ward, it seems at best a place to keep them locked up for a little bit and then turf them back out on the street.
Notice how psychiatrists and psych hospitals don't really advertise much anything about "cure rates" or percentages cured. You compare that to any other field of medicine which often talks about percentages of outcomes, especially for fields like surgery, infectious diseases, oncology, etc... and you find the primary reason why I personally (and many others) do not find the field of psychiatry to offer much beyond "medicate and manage" while syphoning insurance money and government funding, and while also causing potentially horrible side effects.
If the primary exploit is siphoning insurance money, is it possible that your frequent fliers have worse insurance than the subjects in the contra anecdote?
But it's not especially relevant to the point I was responding to: this program, where police are replaced by healthcare professionals, primarily deals with people who lack housing or income, which makes the commenter's concern a lot less relevant to this particular discussion.
Then I could counter argue with another anecdote that I visited thousands of such facilities and in all of them cases of magic healing once the insurance money dried up happened.
Merely extending the scope of an anecdote does not change the fact that it is an anecdote and does not provide greater power to convince.
I think it's more along the lines of one anecdote doesn't invalidate Occam's razor, and the Occam's razor in this scenario is that psych facilities are acting in good faith.
There is plenty of evidence of inhumane treatment in psych facilities over decades, including human experimentation, drug trials, debilitating brain surgeries, electroshock therapy etc. Psychiatry is probably the single medical field that has caused more harm than it has cured.
Yes I know and there are some people in permanent psychiatric care without any perspective for improvement with current known methods, some are kept almost like animals or permanently sedated.
Its not unique to the US. Just a few years ago a high profile case happened in portugal where a man had a dispute with his parents and was forcibly committed for 2 years without the doctor his parents went to ever seeing him.
That's not really an example of the issue mentioned:
> "Having known several friends who got committed and held against their will in psych wards when there was no good reason to, because their insurance was good, this is an issue."
This is pretty much specific to the US (in developed countries). It would be impossible in Portugal.
Basically, the only advantage of American healthcare is that if pays for innovation better than others. The world benefits from it, Americans suffer due to it. As long as they're happy, good for them.
If the government is paying the facility to continue holding/treating the “patient”, I don’t see how it’s in any meaningful way different nor impossible in Portugal.
The way the fraud works is different. In the US it is their insurance is good, keep them in. In Portugal everyone has the same insurance so it is keep our faucility as full as possible, only releasing just enough people to make it appear like we are doing something.
I have no idea what fraud occurs. In either system. I know enough humans to know that some are honest and some are not. Thus if it is possible to get away with fraud odds are someone is.
Number of hospitals are not a relevant measure, since all the major hospitals are public. Here are more relevant measures: 70% of the hospitalizations and 73% of urgent care occur in public hospitals.
I don't have the numbers for psychiatric hospitalizations, but I would guess the number is higher than 70%.
The American part seems to be that our penny-pinching private insurance companies finally provide a benefit in protecting us from being committed forever?
Because plenty countries have private hospitals who can keep billing the govt as long as they can keep you there.
Raoul Wallenberg was allegedly thrown into a psychiatric ward in Russia when he came on a political visit, and held there till the end of his life.
The incentives may change by country, but it is pretty common to setup wards like prisons, for practical reasons. And that can be abused, as every form of power will eventually be.
He was arrested in Hungary during the siege of Budapest. Everything after that is pure speculation. When he went to meet General Malinovsky he famously said he didn't know if he'd be a guest or a prisoner.
I've never heard any of this about a psychiatric ward before and he was definitely not arrested in Russia on a visit.He was also an OSS asset - and there is a more than decent chance that the Russians knew it. I do not see any way this very special case with this very special man can be used to make a statement about broader issues to do with mental health. I walk by a memorial to him near Deák ter on a regular basis and think of him often.
USSR had a long history of putting disidents in psychiatric wards. Those who dared to criticize communism ("the greatest system ever") would be labeled as crazy and locked in a hospital.
Raoul Wallenberg wasn't what you'd call a dissident criticizing communism, and was mostly known for saving Jews from the Nazis by offering them Swedish protected passports.
Officially he was arrested by the Russians for espionage in Budapest in 1945, during the war, with later reports suggesting he was actually involved in an espionage effort. He allegedly died in prison a few years later. There were claims that he was sighted in prisons and psychiatric hospitals as late as the '80s but if they're true then this certainly wasn't used as a cover, he was already claimed dead. The psychiatric ward angle doesn't really make sense in these circumstances, there's no need for a cover story when the official story already sounds like a cover, and even presumably legitimate.
In my experience such facilities aren’t any better in some “nice” northern European countries.
The incentives might be slightly different, end results the same.
For example in Finland involuntary commitment is somewhat frequently used as an impossible-to-appeal alternative to investigative detention. You’d have to be crazy to do crimes, right?
Involuntary commitment is just inherently suspectible to abuse, I’m not sure anyone should have that power.
Indeed, no such incentives (e.g. financial) are in place in the country in which I am in Eastern Europe, thus, no one is really interested in abusing those things. Were they given financial incentives to do so, they most likely would.
This often veered into straight-up torture, including electric shocks and drugs that caused pain as a means to "cure" people from not believing in communism.
Did you know Electric shock is still a very lucrative business in the USA, while the United Nations has deemed involuntary ECT (which is allowed if court-ordered in the US) as torture?
Meanwhile the FDA recently re-classified ECT as Category 2 "Safe and effective" devices, even though there are hundreds of studies showing they cause long term memory loss.
I'm not even sure why we still haven't reformed the FDA, but it is long overdue.
I used to work in health care for years, and I have an understanding of our health care system. Make no mistake, it still sucks in many areas, and there is some cover up between cops and health care workers when it comes to drug users, or anyone who goes to the detox room (alcoholics, mostly). They treat people inhumanly there.
Before I became a health care worker, I spent some time at the psychiatric ward, and at the detox room (voluntarily). I liked the psychiatric ward, the staff and roommates were nice, and I made some pleasant memories with a girl in there. :)
In any case, you are typically an inconvenience and they do not want you there, especially at the detox room.
Why would this be the case? Do healthcare facilities not receive "insurance money" based on patients in the rest of the world? Because I'm pretty sure they do. Whether is abused or not is a different matter.
Your experiences may be not contradicting each other. These facilities may release both healthy-enough people and those people whose insurance ran dry (i.e. underhealing them). But it doesn’t mean that they forcefully detain healthy ones until their insurance ends.
To the extent that our experiences differ, I'd bet that things resolve in my favor for these cases. In other words, the vast vast majority of encounters that this article describes are ones involving people with very low incomes or without housing (68% of calls were in this category) rather than people who have private insurance.
It does seem like a bit of a contradiction to use a market-based Homo economicus model of patient qua consumer behavior to motivate the widespread use of private insurance for the same individuals who are supposed to be institutionalized because they can't care for themselves! Single-payer may not always be the best model but at least it avoids this particular absurdity — of course Medicaid wouldn't stand for this.
Of course, when you absolutely need indefinite care, the situation changes and you get our monstrous nursing home ecosystem.
While those are the types of people most likely as a group to commit crimes, that doesn't means any individual does. Many of them are harmless, and know how to survive, and even take pride in their independence.
While I'm sure it is in your favor, if those who are harmless are taken off the street in addition to those who are harmful overall it is a loss.
> Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released - which is a far cry from having healed or become functioning members of society.
The problem of wrongful involuntary commitment (especially for insurance fraud reasons) is more rampant and widespread than one might initially guess.
I've only skimmed the paper at present, but are all of their examples based around minors being involuntarily committed by their parents? Because that seems like a separate, if related, issue.
See the article at the bottom of my original comment for the Buzzfeed investigation into UnitedHealthCare psych wards. That was targeting adults, not children.
However, involuntary commitment of children (and subsequent rape too many of the girls who end up there, tragically) is a huge problem. Look up abuses of the "Baker Act" in Florida for example.
>Look up abuses of the "Baker Act" in Florida for example.
I have a friend who was involuntarily committed under the Baker act when she was in 9th grade. She was never suicidal, never threatened anyone, and was held for 2 days to evaluate her. A bully lied and claimed my friend made suicidal statements and thought it would be hilarious to tell the school administration that they were "concerned for another student". Rather than just a call to her parents and a long chat with a guidance counselor the school administration decided that clearly she was just lying and even though she denied everything and never showed any indication to any of them that she was a risk to herself or others they had her committed. The bully that lied to the school administration even went on to brag about doing it.
I think the real travesty here is that misuse is completely unchecked and the timeframe is absurd. If someone is being held against their will, without commiting a crime, why on earth is it considered fine to just hold them for days at a time before even being evaluated by a mental health professional? They already have to transport them to a mental health treatment center so why can't hospitals figure out an on call schedule for psychiatrists?
It's a farce that the standard of proof is so low supposedly in the name of safety and urgency and yet even while the situation is urgent enough to hold someone against their will it's not urgent enough to get a psychiatrist on the phone on a Sunday.
To throw on the anecdote pile... my brother was committed due to overreaction of an LSD trip. He had been up for days and was almost incoherent after being brought in to the emergency room by the police. They said it would be 2 days, then 5 days, then another week. I called and told them that his insurance had contacted me and said they weren't going to be paying for any additional time. He was released the same day.
I was about to comment with a similar anecdote. Situations will be different depending on the psychiatric facilities, but there are some, usually the most expensive ones (and being expensive is not at all an indicator of being a good one), in which some physicians have no issue keeping people in there as long as there is money to be drained from the family. Worse, the psychiatric state of the patient has not necessarily improved during that costly stay.
> Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released
Penitentiary system is overburdened and has no interest in keeping people around once they're safe enough to be released.
Makes equal amount of sense to me.
In USSR, punitive psychiatry was the tool of choice for the government in the times of wide international information dissemination.
I don't mean to ridicule the American struggle for fixing community policing - I understand that defunding and disbanding the police comes out of a desperate situation, and I admire this kind of courage for radical changes. But it's a mistake to think that one step is a complete solution.
(I’m reading The Gulag Archipelago, and I haven’t gotten far enough yet to find out the exact procedures that were used for dealing with political dissidents via mental health charges.)
> As an EMT I frequently transported people to hospitals (or from hospitals to psychiatric facilities) following their arrest.
> I saw no evidence of its abuse.
Unless your EMT services is responsible for 100% of the patients that enter the psych facility, the set of patients you see is probably affected by survivorship bias[1]. The people you see may be biased towards people with a legitimate problem severe enough for someone to call an EMT.
> Most psych facilities are over-enrolled and have no interest in keeping people around once they're stable enough to be released
About 8 years ago had an experience with a facility (in the SF Bay Area). A psych I had seen once for <5 min had me arrested and sent for a 3 day hold. The justification fabricated; a few sentences of vague nonsense. After finally seeing a doctor on day 2 for about 1 minute, he upgraded the 3 day hold into a 2 week hold at a psych facility (supposedly on the suggestion of the original psych).
The facility was over-enrolled; the staff often complained about having to deny admission due to lack of room. Everyone at the facility that wasn't a doctor thought I obviously should be released immediately. I didn't see a doctor again until day 5 (I explained the situation for q few minutes, meeting over, nothing happened), while the facility was somehow able to justify to Medi-Cal why they should pay several thousand dollars to keep me there for another day. On day 10, I guess Medi-Cal stopped paying. The doctor showed up for a 2nd meeting, insisted I take a shitty SRNI and finally let me leave.
Psychiatry does not know how to cure mental illness. At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects.
Investing more money into this doesn't solve the societal issues which come from drug addiction, lack of economic opportunity, a failing education system, etc
I would rather see us focus on fixing schools and the economy than spend billions on these programs that have dubious outcomes
Fine. In the meantime, any objection to taking billions from a program that has dubious outcomes and involves violence and a permanent criminal record, and shifting it toward one that has dubious outcomes but doesn't?
You seriously cannot neither compare the two or shift calls from one to another. They should live in their own sphere like they do in many countries. There are problems in both (massively so in the US) but if you look in journals, books and magazine-articles by well respected psychiatrists you will see many saying that what we do today with medicine will likely be seen in the future as a medicinal/chemical lobotomy. People's lives aren't just ruined but people are ruined permanently by treatments.
Luckily I don't live in the US where there's a high risk of being shot by police if you call for help for mental problems or getting put away because of good insurance, but if I did I would pick the police over the risk of getting medicated by overworked and poorly educated hospital-workers. The police might pass you on but that is still a risk I'd willingly take if I had to pick Police or direct to the social-system in the US. Of course I would rather take a loved one to someone I knew would give them proper care in the first place but most that call the police does not have that option or we wouldn't have this problem in the first place.
In other words, the problem isn't as black and white as you appear to make it. The solution is educated police working with a better social system, not sending social-workers to do a job they aren't educated or prepared for. If you look at much better (but still not perfect) systems you will mostly see that even when mentally sick people that are already in the hospital get violent they still call the police as it isn't their job to pacify dangerous individuals. That is the job of a well educated, not over-worked, police-force.
I'm willing to make a pretty safe bet that there are far more people in the US who have criminal records than have been committed to institutions against their will. I doubt it's even a contest, I'm seeing rough estimations online as high as 1/4 of the entire adult male population in the US.
And I'm also willing to make a pretty safe bet that the proportion of those criminal records that actually get expunged is a lot lower than you're making it sound like.
And lastly, I'm willing to make a bet that overall, the long-term effects of even a short criminal record are roughly comparable to the long-term effects of involuntary commitment. Yes, we can have a conversation about firearm privileges, that's worth talking about. But let's also not forget that the most immediate effects of a criminal record are things like loss of income, housing, and the ability to find employment, which can have an extremely significant effect on your entire future. In comparison, most employers will not ask you questions about your mental history.
And again -- you can still get involuntarily committed to an institution after you're arrested. The only difference is that now you have two problems instead of one, both a mental health record and a criminal record.
> And again -- you can still get involuntarily committed to an institution after you're arrested. The only difference is that now you have two problems instead of one, both a mental health record and a criminal record.
There are tens of thousands of serious sex offenders who, after serving their prison terms, are civilly committed to a prison-like treatment facility until the state decides they are safe. Only the most dangerous 2-4% of sex offenders are committed, and in some states it's rare that anyone is fully released. (Minnesota didn't fully release a single person in a two-decade period[0] In Texas, "only one person has been released from the program on a provisional basis since it was created 16 years ago."[1]). It's very expensive because the states do have to provide professional treatment, but apparently the states feel that the cost is worth it. In many cases being convicted of murder would be better than being civilly committed, since one would have a much better chance of eventually seeing freedom.
You're talking about a situation that is almost always going to be accompanied by jail time. Even under this program, the top 2-4% of sex offenders are going to go through the justice system and see jail time. Look at the stuff you're citing (emphasis mine):
> This type of law grants Minnesota courts the ability to deem someone an ongoing threat
> here are tens of thousands of serious sex offenders who, after serving their prison terms, are civilly committed
If anything, this seems to lend credence to the idea that having more police officers is not a deterrent for involuntary commitment. Literally all of these people were committed after being arrested and going through the justice system.
----
Add to that the fact that you're talking about a relatively tiny proportion of a very specific crime. Doesn't mean that it's not a problem, but as a point of comparison, there are currently ~200,000 people in the US serving lifetime sentences in prison.
So I still don't see how I'm expected to treat those numbers like they're the same. Of course treatment facilities can be problematic, but I'm not seeing numbers that make me think they're a worse problem than our current incarceration system.
And I especially don't see how the current initiative is going to affect the numbers you're talking about. Is Denver planning to stop prosecuting sex offenders? Why does the first responder being a mental health professional or a police officer matter in that instance? I mean, on both sides here it's wild to be talking about the top 2-4% of sex offenders or prison life sentences in regards to a program that is bragging in press releases about how they handled a low-level trespassing case. You're looking at a different category of crime than this program is designed to address.
I have no idea why you're interpreting my post as an adversary. My post seems to support your position. I was giving an example of the situation you stipulated, where having both a mental health record and a criminal record is much worse than merely having a mental health record. It's the combination of the two that gets one locked away for life. If there were a mental health program that could address these problems before they become a criminal justice issue (granted, a huge if), then everyone would be far better off.
Not everything is a debate to win, and I'm not your opponent.
You still seem to be missing the fact that there is no additionality here. If the current system would put you in a psych ward, the prior system would arrest you then put you in a psych ward, which most folks would agree is strictly worse.
> Seems like a great avenue for disarming the populace
You say that like it's a priori a bad thing?
Coming from a county where the populace was never as heavily armed as yours, and in which we did "disarm the populace" fairly severely in response to a mass shooting, your gun violence problem is certainly one of the big big downsides to "living in America" for people I know.
> ... if the government needed to turn dictatorship.
And even this "reason we all need to own guns" seems kinda pointless? Do you honestly think what passes for "a well armed militia" in the United States these days stands _any_ chance of prevailing against the American Military and Law Enforcement? Your _cops_ drive tanks!!!
I totally get that America has a level of gun ownership and a legal marketer and blackmarket for guns that we in Australia don't even comprehend, and that any attempt to change that is not only seemingly politically impossible but that even if the political will to change it existed it'd be a multi generation program to reduce the sheer number of guns in circulation. But I'm nt at all convinced by any of the arguments claiming it would be a bad thing for sociality...
Consider how many people would need to be incarcerated against their will to make this work. Disarming the American populace would be nearly impossible by far more effective means. Taking this approach would be incredibly ineffective.
> Psychiatry does not know how to cure mental illness
Law enforcement doesn't know how to cure criminality, either. And it's much worse when it comes to mental illness.
> At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects.
Law enforcement isn't even that effective, at criminality or mental illness.
> Investing more money into this doesn't solve the societal issues which come from drug addiction, lack of economic opportunity, a failing education system, etc
Shifting resources into this from law enforcement responses to mental health issues does solve the societal issues that come from law enforcement’s egregious mishandling of mental health issues, plus saves money that can be used to deal with those other problems because it's cheaper per call handled. Also, alleviating mental health symptoms does mitigate many of those problems, which are, in many cases, direct consequences of mental health symptoms.
> I would rather see us focus on fixing schools
As if anyone knows how to do that.
> and the economy
Wasting less money on sending police to encounters where police presence is actively harmful is, among other things, fixing the economy.
That isn't true: We don't police rich neighborhoods like we do poor ones, so there isn't as much opportunity to catch people doing crime, not to mention that crimes of poverty or opportunity are less when folks aren't needing to steal things. (yes, I realize that not everything people steal are things like food, but mental health is important, and things often fill these needs). In addition, poor people are more likely to get caught for some things simply because of living conditions. A decently middle class person can find a private place to smoke a joint or do drugs. Just go camping, for instance, or out in the backyard. City living plus lack of resources means you can't just go out in the courtyard of the apartments.
I'll also mention that rural places tend to have fewer cops and are seen as having a generally lower crime rate. (I didn't look up the numbers, but this is the stereotype).
> Psychiatry does not know how to cure mental illness. At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects.
I realize this is just a sidenote, but I just want to address this point for anyone who's struggling with problems like depression or other serious mental issues. Getting help can be a lifesaver, and sometimes medication is part of it.
Properly prescribed by a professional who knows what they're doing, medication to treat depression can in some cases literally change your life. It's not the only way to address mental issues, you absolutely should couple it with therapy. It's not for everyone. That's why a professional is involved. But stigmatizing people who take medication to help manage their problems is incredibly harmful.
Absolutely correct, it can be a life-saver, but patients should also be aware that many people get permanently ruined by the medication prescribed by so-called professionals - especially antipsychotics and antidepressants - so to try it is to take a big gamble. Medicine should be the very last thing tried to help people with mental problems. Not the first as it is today and likely not the second either. It is, in many many cases, incredibly harmful or totally superfluous. I'd go so far as to say that IMO at least 9 out of 10 in the psychiatric system is over-medicated and/or misdiagnosed. Most people I have seen that get medication end up in one of three situations being either life-long medicinal dependency, polypharmacy or misdiagnosis. All could be prevented by a working psychiatric system without close ties to Big Pharma.
Most people that get antidepressive medicine isn't heavily depressed and shouldn't get medicine at all:
>Conclusions: The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.
>My guess is that future generations of psychologists will look back at our over-prescribing of psychotropic drugs with incredulity too, amazed at our blind enthusiasm for largely ineffective and damaging treatments, and at how such barbaric methods could become so widespread.
If you go in with a headache and get prescribed an antipsychotic, sure. If you have severe depression that just goes away with the right drug, isn't that solving the problem?
The problem with overmedication is when the drugs don't work, or don't work properly. A competent professional would work with you to find the drugs that work for you, not say “here, take this, not interested in hearing your symptoms”. It's usually possible to know when you've got a bad doctor, and usually possible to seek a second opinion.
> If you go in with a headache and get prescribed an antipsychotic, sure. If you have severe depression that just goes away with the right drug, isn't that solving the problem?
The problem is that often medication is prescribed very quickly and virtually no supervision happens. This is a very bad combination in general, but especially if the patient is suffering from a mental illness. These drugs literally list things like suicide among their side effects and it is extremely irresponsible to prescribe them to someone and then tell them to check back in 3-6 months or so. But this represents standard practice.
Take a depressed person who wants to commit suicide, but is too depressed to do it. Put thing on an anti-depressant that raises their mood and improves them over the course of a few weeks. There risk for a period in there where a patient has not exited self-harm territory, but now has energy to do things - including self-harm.
The drug isn't causing suicide. It's just unfortunately taking a patient through a risky period.
Many people do not understand that anti-depressants don't work instantaneously. They take time. That is where the risk comes from.
I agree with the supervision part but imagine you're a doctor, you have these meds at your disposal and someone comes to you suffering with what you assess to be a condition that you know a certain med is 90% effective. Wouldn't you give it to them and simply risk that they might be in the 10% that it doesn't work or maybe the 0.1% that it'd cause a bad effect? Should we eliminate medication because it isn't 100% effective for everyone and sometimes has adverse effects?
If medication A is 80% effective, 10% useless and 10% major side-effecty, and medication B is 5% effective (half of the A-useless people), 90% useless and 5% “causes headaches”, which do you try first?
That's why there is a profession, to make these kinds of judgements. But what is the alternative? People that are going for medication don't usually have many choices. If it wasn't too taboo and there wasn't so much misinformation around this then people wouldn't have to end up in situations where you just need to take something asap because you've been catatonic for the past 4 months and/or you're having paranoia and delusions and your life is going to hell. These are real life struggles, we can't be theoretical and aim for the ideal. Science improves and it's certainly better than it was in the past.
> Medicine should be the very last thing tried to help people with mental problems
Really? They should just keep on suffering and do what? Snap out of it by the power of their will?
> Most people that get antidepressive medicine isn't heavily depressed
And let it evolve to chronic "mild" depression and possibly more severe mental illness, instead of treating it with an off the shelf anti-depressant today..
Medication helps lots of people and it's very effective, very quickly. If someone is suffering a lot of the time they don't need to be and this narrative of "only meds when it's severe" is why so many people go undiagnosed, untreated and later develop worse conditions in which they may not have a chance of full recovery.
Treat it when it's early, meds in moderation and with supervision.
It does however start to solve the issue of having people who don't belong in prison being sent to prison. A part of a complex set of issues that have led to the US having the largest prison population in the world despite being nowhere near the most populated country.
In the US in particular it seems bizarre that this discussion has descended into worry over being locked up in mental health facilities given a prison population so large it compares unfavourably to most authoritarian dictatorships.
>I would rather see us focus on fixing schools and the economy than spend billions on these programs that have dubious outcomes
I couldn't find an exact number in the five minutes of searching I was willing to put in, but the budget seems to be in the single digit millions, a far cry from billions.
And it also ignores that the alternative here is not "do nothing" but "send police instead", which also costs. And if it leads to arrests it costs even more. And if people end up getting a criminal record, it tends to reduce their long term employment prospect, and as a result reduce tax revenue/increase welfare costs. There seems to be plenty of potential for this to save money over time.
There are many physical illnesses that we can't cure. That doesn't stop people from going to the doctor for treatment for them. Just because the illness will be there doesn't mean we can't significantly improve someone's quality of life.
But we can usually objectively tell what is wrong. A test can be administered by different doctors and they're almost certainly going to arrive at the same conclusion. Mental illness has so much overlap and comorbidity that we can't really do that. Even for something like ADHD we don't really have an objective test for.
We can tell folks what is wrong if you have a common and fairly well understood disease that has indicators that we can test for. People sometimes wait years to be diagnosed with an autoimmune disorder, though, and these have medicines that can significantly improve life. We find cancer, but sometimes treat everything as aggressive (though it is starting to change). And so on.
Heck, we are still slowly discovering body parts.
The brain is one of those things we still don't know a lot about despite the seemingly broad knowledge we have. Some of the knowledge we have is fairly recent and can be thanked, in part, to modern scanning. I don't know how we can expect folks to have a definite test for this when there is so much we don't know.
>Psychiatry does not know how to cure mental illness
Psychiatry doesn't know how to cure mental illness and oncology doesn't know how to cure cancer, but they both work a lot better than the supplement aisle.
Agree for the case of oncology. Disagree for psychiatry.
The evidence is mounting that vitamins may actually be just as good a treatment for most people with mild depression or other similar ailments vs SSRIs and other psychiatric drugs.
While this is partially true, it is important to realize that most of these papers are talking about mild to moderate depression (not severe depression or any other mental illness). There is a ton of evidence that medication helps in more severe cases (https://www.psychiatrist.com/JCP/article/Pages/efficacy-ssri...) the main debate is whether depression meds are being over-prescribed in mild cases.
My late father is a psychiatrist. My wife is a medical resident. What you said is fairly accurate. Both my wife and late father say if someone shows up with acute mental problem, you prescribe lithium-based meds, sleep-inducing meds and/or in extreme scenarios, shock (ECT) therapy. For mild forms, it's one-on-one therapy (most listening what the patient says). Psychiatry, as it is now, is more of an experimentation than it is a science.
> Psychiatry does not know how to cure mental illness. At best it knows how to medicate it and alleviate symptoms while causing very serious or deadly side effects.
I whole-heartedly agree with this. I was on anti-depressants at some point of my life. At that time I did something very stupid that jeopardized my life. I was lucky enough to get out of it unscathed. Although I am still traumatized by the incident.
It is well known that antidepressants, especially SSRIs and SNRIs, will often make the depression symptoms worse during the onboarding period (~2-6 weeks) before the symptoms become alleviated. I'd say this was a failure on your doctor's part for not indicating and emphasizing that.
It also depends on the medication as people have different reactions to different medications, even if they're in the same family of drugs (e.g. SSRI, SNRI, etc.). Some people will have the side effect you mentioned (e.g. suicidal ideation), but feel much better than before the medication after a few weeks. Those same people may not feel any difference on a different medication, even on the highest dosage, and never feel any improvements. Then there's a wide range of reactions in between. Unfortunately, it often takes a while to find the right medication for someone and the journey to do so is rarely pleasant.
This is one of the hardest things about psychiatric pharmacology. There's no go-to medication because you're trying to alleviate symptoms for something that you don't know the exact mechanisms involved (i.e. everyone's brain is different and a "chemical imbalance" or the cause of it in one person isn't the same as another's, even if their symptoms are the same).
With all of that said, I'd definitely recommend attempting cognitive-behavioral therapy before going to medication as a supplement or alternative to CBT, especially if the depression is mild/moderate. For those with severe depression (like me), however, they may not have the motivation/drive/confidence to consistently see a therapist. In those cases, medication might alleviate the symptoms enough for them to do so, which is what happened in my case. Although I don't continue CBT, mostly due to time constraints, I still take anti-depressants to maintain what I've climbed out of so far.
None of this even mentions those with severe, treatment-resistant depression in which the only relief they get is maybe from electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS). The former sometimes doesn't work and the latter's effectiveness tends to range from months to weeks and dependent on specific pulse train protocols for those cases.
I've been treated by multiple psychiatrists (the drugs did not work, as far as I can tell, and one made me significantly sicker) and never had a psychiatrist tell me the drug they gave me may make me feel worse at first. In fact since this warning is in my experience unheard of, I question whether you are confused about the above claim. (Though it's possible things have changed since a I was last treated, I suppose)
Since a lot of the benefits of these drugs may be the placebo effect, that would be a pretty odd thing to say since they could undermine their treatment.
Psychiatry is like a science that hasn't been invented yet. If someone is seriously depressed it may be worth a shot to try drugs but the psychiatrist will have no real clue what the drugs will do, just educated guesses based on flawed studies.
You can do both, and indeed they are both required. Fixing schools and the economy are the long term solution but we can’t let people be subjected to the inhumanity of our criminal justice system that exists today (especially if they’re part of a minority).
Being a minority tends to mean in America that you have a higher chance of growing up in areas with bad education, poor economic situations, and higher crime rates.
These are all factors that lead people to poor mental health, to drug abuse, and subsequently to committing crimes (often to feed the addiction or due to poor education/limited opportunities).
These problems aren't necessarily just problems minorities experience, white communities in poverty-stricken areas of the US have exactly the same issues (See Detroit for instance). It's just that there's more poor minority communities than there are white communities.
We need to fix it for everyone, regardless of race.
>>Being a minority tends to mean in America that you have a higher chance of growing up in areas with bad education, poor economic situations, and higher crime rates.
So I guess that would change once the majority of minorities are Asian.
I think your focus should be socioeconomic status, not race.
tl;dr police were 25 times less likely to shoot an unarmed suspect in a simulation, if that suspect was black instead of white.
A little bit of common sense explains why. It would simply be inconceivable that the officer who shot Daniel Shaver to death would have been acquitted had Shaver been black instead of white. The kind of social backlash that an acquittal in such a case would elicit would ensure the political and judicial system punish the officer.
First of all, you and the person you responded to are giving examples that covers wildly different types of interactions, so it's not "counter-evidence". It does provide additional evidence for a certain type of interactions, however.
With that said, there's a massive caveat here: This is based on simulations
For it to be generally applicable you also need to then demonstrate that this matched real-world observed behaviour. On its own it is not at all obvious whether or not this accurately reflects anything at all.
There are many possible confounding issues here. E.g. for starters a typical excuse in shootings is that the officers claim to have feared for their safety. You then need to account for whether or not the simulation accurate trigger the same fear, otherwise someone with a racial bias in what makes them scared in "real life" could be expected to act differently in a simulation where they know they're safe.
I don't know whether that is the case or not, but there are many enough possible issues like this that a simulation only allow us to draw very limited conclusions here without a far more complicated experiment. Without understanding why.
Yes, data from real cases has significant advantages over a controlled experiment using simulations, but also significant disadvantages.
Still, a 25 times lower likelihood of shooting a suspect if they are black in the simulation-based experiment..
That is entirely corroborated by what common sense would predict given the backlash a typical police officer would expect in the event that they shoot and kill a black suspect versus a white one.
I assign zero value to "common sense". "Common sense" to me would also suggest that people would reveal less of their real biases and more of their concern of what those observing them might think when in an artificial setting where they know their actions will be scrutinised. We can come up with all kinds of "common sense" ideas about what might happen to explain this, and they're all nothing more than wild guesses.
Common sense informs what hypothesis to test and what axioms to accept.
Putting common sense aside, a 25X lower likelihood of shooting unarmed black suspects in the experiment suggests massive bias in favor of black suspects.
Assuming it suggests bias in favor of black suspects is assuming a hell of a lot about the accuracy of the simulation relative to real life and whether or not it captures bias or peoples beliefs about how they are expected to act or changes to e.g. fear levels, that are not supported (it's also not contradicted - there's as far as I can tell no data either way) by the experiment in question.
All it tells us in isolation is that this is how a set of people in current society acts in a simulation of that kind. It does not tell us why, and trying to draw conclusions about why without further experiments is irresponsible.
The experiment would have to be flawed to an absurd degree for the findings to not be an indication of bias in favor of black suspects.
Even multiple minor/medium sized flaws in the experimental design that produce black favoritism not reflected in real world behavior wouldn't in the aggregate account for producing a 25 times exaggeration of bias.
> It would simply be inconceivable that the officer who shot Daniel Shaver to death would have been acquitted had Shaver been black instead of white
Why is that inconceivable? The officers in the Breonna Taylor shooting weren't even charged. At least this officer went to trial and was found not guilty by a jury of his peers.
Because there is a video of Shaver crying for 2 minutes, while displaying zero defiance and total willingness to cooperate, before the officers shot him.
I cannot even imagine the kind of nation-wide riots that scenario would generate as the video of the shooting, which would be attributed to racial bias, circulated on social media.
The real life data we have is not obviously indicative of racism. Men are more than 10X more likely to be shot by police than women. Asians are less likely to be shot by police than whites. This doesn't prove police are sexist against men, or racially biased in favor of Asians.
> Most psych facilities are over-enrolled and have no interest in keeping people around
Seems you didn't read the linked buzzfeednews article.
If you read it you'll notice that many hospitals work fine -- but there's one particular psych facility company that abuses the system, Universal Health Services, or UHS.
No need to make accusations. It's just that the problem the article describes is with UHS, not with taking police out of the response to mental health issues and homelessness.
It's not that avoiding an arrest or other police involvement isn't an improvement. It is. But it's easy to assume anyone committed to a psychiatric facility ought to be rehabilitated to society. Often you could just as justifiably argue the other way around.
I could be wrong, but I believe this is what the parent is saying:
a) that people assume anyone committed to a mental institution should be rehabilitated and
b) one could argue that this assumption is often false and that they shouldn't be rehabilitated.
It sounds like they're saying that if someone is committed to a mental institution, rehabilitation could be a bad idea because it's just as likely that they're not fit for society.
note: not agreeing with the above points, simply trying to interpret them.
> It sounds like they're saying that if someone is committed to a mental institution, rehabilitation could be a bad idea because it's just as likely that they're not fit for society.
I'm saying if we make unexamined assumptions about who's "fit for society" it's easy to sacrifice non-normative people on the alter of social harmony.
What is viewed as requiring rehabilitation can reflect neuroses endemic to the broader cultural context, not merely or necessarily the dysfunction of the institutionalized individual. It's a two-way mirror.
Except then they're not going to be released on account of demonstratably being an ongoing risk to society.
Of course this concern runs exactly contra to the "medical authoritarian" one further up. Frankly, which is it that means a successful program as the article notes shouldn't be continued?
That the social body might learn to accommodate some ways of being which defy initial expectations, rather than altering individuals to conform to rigid norms.
When certain behaviors are thought worthy of institutionalization, it may reflect a narrowness of heart and mind in the majority rather than a social danger.
> No one is talking about the very big risk associated with this, that mental health professionals can commit you against your will with no trial
Increasing cop presence won't fix that problem. In multiple jurisdictions, cops can also refer you to be involuntarily committed.
So we're not creating an extra judicial system that has no checks and balances, that system already exists and cops are a part of it. We're talking about the potential benefits of removing one harmful part of the equation. If you want to also talk about the negatives of involuntary commitment and make progress in that area, that's totally worth examining as well, but it's not an argument for flooding the streets with more cops.
Getting arrested doesn't mean you can't be involuntarily committed afterwards.
Also note that in some cases, getting arrested and thrown in a holding cell can on its own be just as traumatic of an event as being held for an involuntary mental evaluation -- particularly if someone is genuinely suffering from a mental attack. And arrests don't require trials either. A sizable portion of the people in our jails have never been convicted of crimes, they're just stuck there because they can't pay cash bail.
> If you send a mental health professional to all sorts of situations, their solutions will be mental health related
Can you even say that with a straight face? Do you really think if these guys got sent to a robbery, they'd be all "the thief obviously needs Xanax!" instead of saying "This ain't one of ours, send a cop here please".
Cops have, for whatever reason, ended top being sent not just to criminal justice related incidents, but everything else as well, including mental health related incidents which they're manifestly untrained for and incapable of dealing with. But they "deal" in those situations anyway, in ways we're all tired of seeing from body cam footage and in the live crosses of news stories about police violence protests.
> One of these has a long history of strong checks and balances and improving itself over time
And yet "Some of those who work forces, are the same who burn crosses" is just as heavily quoted and relevant to 2021/01/06 as it was when it was written over 20 years ago... I do not agree with your claims about the relative track records of the two groups involved here.
Because there are a lot of cops, and they are on-call at all hours, they need training in all emergency situations.
That means they need to know enough first aid to deal with a heart attack until the EMTs get there. Likewise they should have enough psychology training to deal with the mentally ill until the experts can take over.
This is not reasonable. Everybody should know enough first aid to deal with a heart attack until EMTs get there. It's not that hard, the course only takes a couple of long days. Dealing with every variety of mental illness is orders of magnitude harder. Social workers have master's degrees, not a certificate from a 2-day course.
Just let cops figure out how to do their regular jobs right, rather than making them the first responders to an embarrassingly terrible social safety net.
We don't have a choice, cops will be first on the scene. If nothing else because until they arrive nobody even knows to call in someone else.
The police have more complete first aid kits than the average person, including such things as an AED. They also get a bit more than your standard firstly aid course.
>One of these has a long history of strong checks and balances and improving itself over time.
Sorry, it's hard to take you seriously if you make such a statement. It betrays serious ignorance of the background for why they started sending health care professionals over officers.
> Difference is, if your only tool is a hammer, everything is a nail.
Seems this program has a hammer and a screw driver for nails and screws.
> Can you guess which one is now being touted as the "new solution for all our societal ills" despite having no track record of actually being able to fix any of these ills?
Hyperbolic, no? One can certainly find people shouting from the halls on any issue. Doesn’t every startup need time and opportunity to create a track record.
> primarily fueled by giant corporate lobbies who spend a lot on every single political campaign (read: Big Pharma).
I wouldn’t be surprised if police unions and big pharma are within the same order of magnitude in political lobbying.
1. You have a pretty high opinion of our police if you think that police unions, donations, and endorsements don't have effects on political campaigns, that towns don't use both police fines and public prisons as a revenue source, and that the criminal justice system can't have comparably (or even greater) negative effects as involuntary mental health interventions.
2. You have a pretty low opinion of our current medical industry if you think that it hasn't improved itself over time. Our country used to lobotomize people and commit them for being gay. Things can and do get better over time. That doesn't mean there aren't still problems, there definitely are, but even in just my lifetime, the way the medical profession approaches mental illness has gotten much, much better. Absent some kind of better data, I am skeptical of the claim that our medical industry's problems are being solved significantly slower than our (also numerous) criminal justice problems.
3. It's possible that this will lead to more medical involvement, but I would be cautious about making strong claims about how much that will be the case and what changes that will have in people's outcomes. It's important to remember that prison is really bad. As just one example, being convicted of a felony removes 13th amendment protections, which is regularly exploited for both private and state revenue -- even in public prisons! What data do we have that indicates that mental interventions will increase at a drastic rate because of this, and what data do we have that says that involuntary incarceration is worse than our current prison system?
4. Denver hasn't gotten rid of its police, it's merely changed how it's using them and how quickly they respond to problems. So it's not that the only tool is a hammer, police officers can still respond to situations. I think it's early to jump to the conclusion that the city is going to start thinking that involuntary mental interventions are the only tool at its disposal. I don't see strong data that backs that conclusion up; in fact 35% of the calls to the STAR program came from police officers. Another way of looking at the data might just as plausibly be that the city was treating police officers as its only tool, and now it's striking a better balance and realizing that arrests weren't the only way to deal with every problem. That's the kind of thing that'll get revealed one way or another as we get more data.
----
> despite having no track record of actually being able to fix any of these ills?
Finally, again, just an unrelated side note, but I know people who are extremely grateful to both psychological therapy and psychiatric help in managing conditions. If you're struggling with this, you don't need to do it alone. Professionals can help. The idea that the only thing a psychiatrist is ever going to do is turn you into a zombie with drugs is bullcrap. And it also ignores that non-psychiatrist interventions don't always need to involve drugs. Cognitive behavioral therapy can have amazing outcomes.
I get that you don't have a high opinion of psychologists or psychiatrists, but they do help people. I just want to make that point very clear.
Have you even read the article? This does not send psychiatrists or doctors but social workers with mental health education.
I don't know about the US, but I highly doubt that these people would have the authority to involuntarily commit someone. Apart from the fact that you have yet to demonstrate that increased health workers lead to increase involuntary commitment, as if that's the only thing psychiatrists etc do.
It's also ironic that you somehow think that sending someone whose only tool is a gun (I know this is somewhat over the top, but much less so then saying involuntary commitment is the only tool of mental health professionals) is the better solution.
The suicide rate measures death from mental illness. The death rate from mental illness has been steadily increasing. Therefore we are doing a bad job at treating and preventing mental illness. What other statistic would you like to use to measure how good of a job the mental health profession is doing? There have been several prominent speeches from professionals in the field who don't handwave away problems talking about the need for more analysis of what's gone wrong.
Literally every individual thing you wrote is wrong.
1. Suicide rate doesn’t “measure death from mental illness.”
2. The suicide rate isn’t “the death rate from mental illness.” (See #1)
3. What do you even mean by “we are doing a bad job”? Who is “we” there? Also, this “conclusion” you’re drawing is supported only by nonsense predicates (see #1 & #2).
4. The “mental health profession” isn’t responsible for moderating the suicide rate. Also literally every mention you make of “mental health profession” is fallacious because the suicide rate is not an actual metric for evaluating the efficacy of the “mental health profession”, so even addressing anything you’re saying about “measuring how good of a job the mental health profession is doing” would be legitimizing a nonsensical claim. This one covers how pretty much everything else you wrote here is wrong.
You just say the first proposition is false without any reasoning to back up why and without providing any better alternative. You're sticking your head in the sand and trying to ignore the problem by saying ignorance is better than any empirical approach to measuring the quality of the mental health profession.
It seems, by failing to provide any alternative, that you're saying that it is impossible to measure the effectiveness of the mental health profession as a whole? This decline is similar to how the economics profession has concluded that it is impossible to measure the success of any economic policy vs. any other because of all the confounding factors as Paul Romer has commented on extensively. This leads to methodological poverty. You can make up whatever policy or treatment you want. It's as good as any other whether it causes people to kill themselves at a higher rate or not or leads to lower or higher economic performance. It's all the same without metrics.
You’re ignoring the material conditions of people since 2000. The steady decline of that is more likely to do with suicide rates than failures of psychiatry.
While it might be valid to frame suicide as death from mental illness, how can you say that the death rate from mental illness has been increasing when we don't even really know the size of the population with mental illness. A lot of mental illness goes unrecognized.
I would argue that the problem is in recognizing mental illness and connecting those affected to the appropriate mental health professionals.
There are more ways to harm a life than there are guns in the world. Just because a health professional gets a diploma and makes a promise doesn’t mean that worker will take good care of you or your loved one. There are plenty of cases all around the world where some health professionals killed tens of innocent people.
>> His final victim said that a "sneaky male nurse" had injected her as she slept, but family members and healthcare providers at the hospital dismissed her comments as unfounded.
>There are plenty of cases all around the world where some health professionals killed tens of innocent people.
But this article is about US doctors vs US cops. And US doctors murder at a far lower rate. The argument isn't that doctors are perfect. The argument is that they are better than cops.
Health professionals are no different than cops or any other worker. There are good and bad professionals working in pretty much any domain. Good luck generalizing and classifying people into groups. That has always worked great throughout human history.
> If you send a mental health professional to all sorts of situations, their solutions will be mental health related (medication, treatment, commitment, etc...).
> If you send a cop, their solutions will involve the criminal justice system (citation, fines, arrest, jail time, etc...).
The fact you list both of these out then say policing is the one with a "long history of strong checks and balances" (what does this even mean?) is appalling. It reads like authoritarian propaganda.
You're taking the classist and racist position, that force employed by agents of the state should be deployed against the poor & otherwise marginalized to prevent them from being a "burden to society." Also that employing people who are tasked with _helping_ instead of _enforcing laws_ should NOT be allowed to do that.
To be clear, you're not really making any falsifiable claims. It's just an endless appeal to emotion. "a long history of strong checks and balances and improving itself over time" is a bold claim about municipal agencies with their own regulations, city, and state laws to adhere to. Not to mention different missions, run by different organizations with different lines of reporting. Totally different cultures, etc. It's so vague but that's the beauty of it: you can make it mean whatever you want under scrutiny.
This is a miserable top comment. I also have a low opinion of the field of psychology, but cops can have you committed (and do) by bringing you to be evaluated by mental health professionals. Medical professionals can't shoot you.
There's nothing in the article about creating a shadow mental health justice system. What they have is a van containing blankets and food, driven by two social workers.
No disrespect intended to parent posters (i appreciate them sharing their anecdotal experience), but def sobering to see that at the top, and realize "oh, this is the common view of hivemind i'm participating in"
I have this vague hope that maybe the 'top comment' position is also based on number of replies, not necessarily upvotes, but then... the discussion itself is pretty sobering. The current program cost relative pennies, proved to be effective at both helping people and freeing up police workers to focus on crime/traffic-related issues. More effective use of city tax $$$$ through targeted spending of $. Seems like a win win win. Anyway, I agree with this particular branch of the discussion-tree.
The FAQ doesn't have a specific entry about comment rankings, but I'd guess it's based off a similar system as the Stories rankings:
"How are stories ranked?
The basic algorithm divides points by a power of the time since a story was submitted. Comments in threads are ranked the same way.
Other factors affecting rank include user flags, anti-abuse software, software which demotes overheated discussions, account or site weighting, and moderator action."
It's very surprising to me how a personal anecdote is used to argue against any kind of social service, no matter how benign and that arresting these people will somehow be better.
Uh, citation needed? Getting committed 'because their insurance was good' is likely not an issue here, as ~70% of the interventions were with homeless people.
"[T]he STAR van provided transportation to 41% of its calls for service where an individual's information was recorded. Of those incidents (107), the most common locations were a shelter or homeless services (30), the walk-in crisis center (24), or a hospital (18)."
It's unclear how many of these would involve an involuntary commit, and similarly unclear how the outcome would compare to a police encounter, which often comes with its own special brand of involuntary commit. One of the report recommendations is to create a longitudinal study to assess outcomes.
> No one is talking about the very big risk associated with this, that mental health professionals can commit you against your will with no trial,
We've had a program like this for years here in Eugene Oregon. It's called CAHOOTS.
One of the cornerstones of the program is it's all voluntary. There is no use of force, no dragging people off anywhere. People show up with a van and some basic medical supplies and help people. If the people don't want help and the only alternative is some form of restraint, they call the police.
They almost never end up calling the police because most people just want a little help and a patient person talking to them gets it done.
The fact that these people never themselves do anything against people's will is what makes this work so well.
Is the risk alone a "very big" risk? Or are you saying the difference in risk of this happening with a cop vs. a medical person is a "very big" difference? Are cops not also able to commit someone involuntarily? Why are you talking about objective "very big risk" without comparing it to the current situation and what is different about this?
I'd rather take my chances with a medical person than an amped-up dude carrying a firearm with basically no chance of getting fired (let alone imprisoned) if he shoots me.
This is what I was looking for or I was going to post myself.
Why is the risk of being involuntarily committed so much greater than having a cop do the same. Or a cop just throwing you in jail? The anecdotes of peoples loved ones being 'committed and only getting released when the money runs dry', seems far more preferable than their loved ones being thrown in jail and released when they can pay the bond. Or sit in jail and wait for a judge.
When most people can't afford to go to trial (both financially, and because they'd be insane to not take a plea), the checks and balances of the judiciary are, in practice, only available to a privileged few.
When you piss off a cop, get arrested, and are released a few days later, without any charges, you also have exactly zero recourse through those checks and balances.
When you piss off a cop, and he brutalizes you, you may get some recourse (through a lawsuit, unlikely as your case may be), but it does not serve as a deterrent to subsequent police misbehaviour. (As we have seen over the past summer.)
People sue for unlawful arrest and bad police behavior and win all the time. Check out this YouTube channel dedicated to covering just that... https://youtube.com/c/AuditTheAudit
The bar that needs to be met for proving that you were subjected to an 'unlawful arrest' is so incredibly high, it's farcical. Ten times out of ten, you're better off moving on with your life, and forgetting it ever happened.
Are there a lot of minimum wage, single parent type people that do that?
As an upper-middle-class office worker with flexible hours and cash to spare, even pursuing a small-claims case was a major PITA for me. Took a ton of time, effort, and money.
I'm not sure this point is relevant unless you're implying that because the system is imperfect we should introduce more systems in place that can be just as easily imperfect in the same ways.
The point though is that change is useless unless it’s change in a good direction. If something is going to be changed, it should be shown to be better in some way.
No one would claim that the existing system is perfect, but there is a great deal of difference between the assessment of a physician or magistrate and trial by a jury of one's peers. A jury of twelve is standard; I know of no requirement that twelve physicians deem someone a threat to himself or others. Furthermore, there are stronger protections for habeas corpus than there are for people involuntarily committed. Those who are accused are guaranteed a lawyer; those who are committed have no right to an advocate, which is doubly bad considering that they are often drugged in ways that dull their mental faculties.
The great majority of cases don't go to trial. Instead people are threatened with punishments vastly disproportionate to their purported crimes, and thereby intimidated in to pleading guilty irrespective of their guilt. Defendants without the financial/social resources to mount a solid defense don’t want to take their chances when faced with a 20 year prison term or whatever, not to mention a slow process that leaves their life in limbo for months or years even if they do eventually prevail. A NYT story a few years ago claimed 97% of federal cases and 94% of state cases end via plea bargain.
For those who do go to trial, the right to a lawyer is often pretty weak support. Public defenders are grossly underfunded and overworked, and there is no guarantee that they will be competent or committed to the case.
A jury of ones 'peers' is rarely the case either. Yes, they are citizens, but they are rarely of the same background, ethnicity, or social status. They are hand selected by lawyers to remove people that might be sympathetic to your plight.
I've never heard that jurors are the best and brightest among us. Often the highly educated and analytical are removed from jury pool.
Police suspects you have committed a crime, holds you in jail until trial or until you pay bail and may never end up releasing you even if you are innocent.
There are a large number of people who take a plea just because they can't afford the bail and it would take a year or two to get to trial. Or because lawyers are expensive and it's cheaper to plead guilty than to defend your innocence.
I've recently had an issue with an incompetent trooper (1 successful complaint and one pending) and incompetent magistrate (complaint pending). It will cost between $100 (win) and $650 (lose) to go through the legal process and defend our innocence. It's been more than 6 months too. All this is over "leash law" violation. But it's great to see both the trooper and magistrate commit civil rights violations, and have the civil rights lawyer tell you that they are violations but that the system doesn't care unless you suffer serious financial damages. So much for a justice system.
I once had a cop issue me a moving violation for Jay walking. So I understand that there can be pettiness from certain cops.
But that's a far cry from a cop being violent against someone or killing someone wrongfully. The justice system also acknowledges it cannot right every wrong, but hopefully when there's a major wrong it should be able to right it every time.
I don't believe there's any room for misconduct or gross incompetence. It's one thing to not be able to fix every wrong, it's another when the system itself creates those wrongs.
If you have a trooper lying to a judge or continuing to hold a charge against you they know is false, they should be fired.
If a magistrate doesn't know the basics of the law (like due process and dismissing with prejudice), then how can they be qualified to rule on it?
Not only are magistrates elected in my state, but they aren't required to have a law degree nor pass the bar. They take a short training course and test. In this case the original magistrate was arrested for gambling with campaign money, perjury, etc. The second magistrate was a retired cop and former police chief. Needless to say he was hostile to the defense the entire time while not questioning anything the trooper said, even stuff that was blatantly false.
Just because it is a far cry from direct violence or murder doesn't mean that it shouldn't be taken care of. You can harass folks with "minor" civil rights violations and make life hell for someone. I'd argue that being lenient on "minor" civil rights makes the violent ones more likely because of the lenience towards other ones.
If you want to be in law enforcement, don't commit civil rights violations. Period. You might not be able to right every wrong, but once a wrong comes to light, you can very well do something about it.
This claim disregards those who take a plea deal because they believe they cannot win a federal criminal case, which is a superset of those who are actually innocent of their accused crimes.
> No one is talking about the very big risk associated with this, that mental health professionals can commit you against your will with no trial
Police can arrest you and hold you against your will with no trial, for a limited period of time (e.g., 48 hours excluding Sundays and holidays is a common tule, IIRC), on the premise that it is pending charges for criminal behavior (which may or may not be filed.)
Mental health professionals (and, in many jurisdictions, law enforcement officers and others, too, can initiate this) can hold you against your will and with no trial, on the premise that it is for emergency psychiatric evaluation, for a limited time (72 hours is common.)
Further involuntary detention, in either case, requires judicial process.
I'm not seeing a particular additional danger here.
> No one is talking about the very big risk associated with this, that mental health professionals can commit you against your will with no trial, which is an erosion of civil liberties (incarceration without trial). Having known several friends who got committed and held against their will in psych wards when there was no good reason to, because their insurance was good, this is an issue.
In California, this doesn't seem to be true. I got to see this in action from the sidelines. Within 24 hours of being committed, the patient will have an advocate appointed for them and within 72 hours the patient will be released unless the health team can put up justifications that pass the advocate AND then judicial scrutiny. The doctors can kick up a fuss, but 7 days is the limit before it MUST pass a judge.
I got to watch this in action, and the advocate was MUCH more aggressive on behalf of the patient than if the same person had been arrested and was relying on a public defender.
The police have the authority to place a person on a 48 hour medical hold, and will threaten to use that authority if you don't do what they tell you. They'll use it for something like a person who passes out not wanting to go to the hospital, even if they are with a friend who can take care of them if there is really an issue. I'd probably trust this crew in Denver more than I would a random police officer in making that assessment.
Absolutely, I don't think the level of experience or training with mental health issues is consistent among police. Innocent people have died because of officers refusal to commit an individual that was having a mental health crisis. I think a team like this (with police present to execute a 5150) would have been successful in this instance.
Maybe the 3-4 people in Denver are fine. The issues come with scaling this up nation wide to where you have tens of thousands of variously trained "health professionals" where outcomes will not necessarily match what you're seeing in a pilot where they obviously handpicked competent people to run it...
We already have this in the form of child protective services. Social workers are plentiful and paid quite poorly for a degreed professional. Cops with GEDs and social workers with bachelors degrees make very comparable salaries. For an extra 5 grand or so you can get one with a masters degree. So there's no sane reason to hire variously trained "health professionals" with scare quotes. The really tough part is getting tens of thousands of independent, ossified bureaucracies onboard with the idea of and giving up/redirecting some of their responsibilities/power/budget.
Simply require a healthy percentage of staff be program successes. People who have been there and have come back.
Those people will know how this all needs to work in order to do the healthy, hard, very human work required.
They know stuff, hard earned, rough miles type stuff, that is both necessary and not taught effectively in any school other than when the bell rings at the fine school of hard knocks.
Naysayers should work at, or observe one of these programs in action before coming to conclusions. I have this experience and know those people and what they can do. Think of them as the immune system to defend against the potential disease discussed above.
It varies by state. In California, it’s essentially impossible to commit someone (source: I tried and failed, despite written permission from the person pre-episode, the blessing of their doctor, and the blessing of their family, multiple police reports from third parties, a divorce, eviction, repos, etc, etc.)
In CA if you do somehow manage to maliciously commit someone, they’re held for up to 24 hours, and an independent doctor assesses them. Also, there can be civil penalties (as in the article you cite, where the victim successfully sued the hospital).
If I had to choose between the two ridiculous extremes, I’d choose the Texas model.
I was going to come to say something similar. At least in CA or the part I am in (very liberal) getting someone committed for a longer period (3 months + etc) - I think may be pretty much impossible? This can be despite a whole host of criminal and self harming behavior. Pre pandemic I think it was probably easier to get folks in at least for a few days at a time to jail pending disposition of whatever the latest case was - which was time enough to fix locks / windows / doors etc or move.
In Michigan you can petition that someone be involuntarily committed for treatment and then they get a hearing in front of a judge. It has to happen within a few days.
Interesting. I wonder if that requires a lawyer or not. (Legal fees for this sort of thing are exorbitant in California, and the cases tend to be a stretch.)
It’s an odd (broken?) process if the judge would ascertain the person’s mental health. Hopefully, most judges would call in professionals.
Do you live in an area with high homeless rates? As in, "there's a homeless camp of tents consuming multiple city blocks"-level of homelessness?
It's horrible for everyone in the city--most of all for the homeless.
These people suffer from mental health or drug issues and need help. The status quo of "leave them to fend for themselves" is simply an unacceptable outcome.
The system launched by the DPD may not be perfect, but it's a whole lot better than what existed before. It's a huge step in the right direction.
People need to remember that perfection is the enemy. Better to step forward in the right direction now than be paralysed by the fear it will never come to pass — obviously, the latter is a self fulfilling prophecy.
> People need to remember that perfection is the enemy.
Yeah I'm getting real sick of the stance that if something only fixes 80% of a problem and doesn't perfectly resolve every issue every person might ever encounter, it is a failure and should never be implemented.
If it is not causing more harm, and especially if there is a way to address unforeseen harm that might arise, awesome! Let's give it a go.
Because sending armed officers out to deal with any little thing that happens is demonstrably not working well right now.
Yeah, there seems to be a real sense that we are scared to try anything or do anything anymore and an army of people ready to bite off the head of anyone who does.
A lot of interventions have "disparate impact" - we had that locally - so a big outcry. So yeah, "trying things" can be somewhat high risk. I think some police departments are trying to be proactive by reducing overall contacts (ie, don't pull folks over for things like missing plates / bad registrations etc, delay or avoid responding to certain other erratic behavior type calls).
Slippery slope fallacies, concern trolling, whataboutism, pearl clutching, feinting spells, Copenhagen Effect (blame anyone who tries to help for the original problem), Alistair Cockburn's wisdom about organizational change (tldr: people really, really hate change, of any kind, for any reason).
There is a lot of evidence that housing the homeless is not only more humane, it's also smart economics. By the time you sum up all the costs of homelessness, it's a pretty nasty toll.
The biggest actual expense is the massive medical bills from exposure and neglect. Police and ambulance services are likely a close second, chasing around town and dealing with random mentally ill people in dire straits.
The other costs are less obvious. As homeless clutter your public spaces, your city starts to rot. Parks become open areas of blight as the homeless overwhelm them and destroy the services they offer. This means much of the money your city invests in parks and public spaces ends up going to waste. Unless you spend more money on police.
The final big expense is clean up and sanitation... unless your city doesn't clean up after homeless people in which case you just end up with actual shit in alleys on big piles of garbage on street corners.
Putting up housing isn't a perfect solution, but it certainly eliminates some significant parts of that.
PS- I just cleaned up after an encampment. After the city cleaned. 20 used needles (mostly insulin) and dozens of other sharps, human waste, soiled diapers, everything else you can imagine. I'm just so pissed off. No one should have to live like that. Just put people in homes. Safe, clean, access to services. Even triage with microhouses along with honeybuckets and potable water would be better.
> Universal housing like SLC is doing is cheaper, more humane, and lightyears more effective.
I read about that program and it sounds amazing.
Decent public housing is pretty common in Europe as well.
I forgot to mention one major cost savings for a city. It is much easier for someone housed to get a job and recover financially than a homeless person.
>Have you worked with the homeless? Yes there is a lot of mental illness, but there is a large number of people who choose to live this way.
Having been homeless myself many years ago, I can tell you from experience that not having money to pay rent or anyone to take you in is the reason people "choose" to be homeless.
And once you are homeless, it's very difficult to work yourself out of it, for many reasons.
I assume you haven't considered that it's very hard to keep (or even get) a job if you have no place to bathe or store your stuff while you're working.
I've worked in shelters and offered people food and a place to get cleaned up and they decline.
I grant you many are not like this and perhaps you're more knowledgable with your first hand experience. I know I personally, also from trying to offer people shelters or even free room-and-board, they don't take it. I don't know why in all cases, but many wanted to do things "their own way". I find it commendable and I respect those who choose to refuse handouts.
That's my point, they may not choose to be in that situation. However, forcefully detaining them for "mental illness" for not wanting "assistance" is a different discussion.
Some shelters are pretty horrible. Sometimes, folks just don't want the shelter's help.
Horrible, as in: you can't stay here if you are a male with children. A female with children will have a curfew and need special permission if they happen to have part-time work that keeps them out after curfew. The children's father can't visit because it is technically for abused women. You can't make sure your medications are safe and you might not keep your belongings. You might be forced to go to AA meetings, church services, or to work in the thrift store. You might be turned away if you are trans or gay - I'm not sure that is supposed to happen legally, but it does nonetheless.
We should house folks, period. In actual housing. Shelters should always be a very, very temporary solution.
If you still get folks that insist on living on the street even though they have basically free housing, then surely, we can do better and create spaces for folks to live. You know, with showers and toilets available for use.
>That's my point, they may not choose to be in that situation. However, forcefully detaining them for "mental illness" for not wanting "assistance" is a different discussion.
That's a rather bold assertion -- can you cite any statistics or surveys?
In some limited sense, they may "choose" homelessness over poor shelter conditions or unaffordable housing, but that can hardly be considered a choice.
>but there is a large number of people who choose to live this way.
Well, if they aren't mentally ill and thus able to act rationally and it's a mass phenomenon then doesn't that point towards an underlying cause that makes it rational for a large number of people to choose homelessness?
In my observation a lot of the homeless in the camps with mental health issues are on medication or have been through mental health facilities several times and it just made things worse for them
Source: working on the streets of Seattle a couple years ago every weekend.
My own belief is that there isn't a single simple issue, but rather a web of many simple things that have complex interactions.
Nearly all of those are political issues though. Technology can help with better communications and tools for debunking falsehoods in those communications.
It might also eventually help with strong AI that's smarter and better than humans at offering a set of solutions and then letting people debate the ones that we agree are also emotionally the correct answers.
Exactly, the people who will be committed against their will would still be committed against their will if police respond. I know this for a fact because the one guy I know who encountered police during a mental health episode ended up commitment.
The difference here is taking away the addition of police to the incidents. No handcuffs or jail holdings, no being roughed up or killed.
Hopefully the mental health person knows how to de-escalate the situation - I think this is huge. I think the friend I mentioned above could have avoided impatient treatment if he had a qualified mental health person respond instead of the police, due to the situation around his incident/arrest.
Right. So the improvement is that health care workers who are actually qualified to make that determination show up and don’t escalate the situation with violence or legal trouble. That’s a whole lot of improvement. And sounds like very little downside since the risk associated is identical otherwise.
A cop in Seattle was found to have involuntarily committed multiple people because he had a crush on the EMT who had to come transport them.
I don't think keeping police involved is going to improve any of the things you care about.
Civilians can end your life "without trial" if its in the right circumstance just like a police officer can. These are the the rules the courts put into place. And just to be clear I have no issue with self defense. A reminder we are not talking about police doing things against the law or if they get away with it more often.
Civilians aren't universally armed with firearms and both formal and informal legal immunity. They aren't called upon to put an end tension situations.
If the worst a health professional can do is commit you to a mental institution, it's still likely to be an improvement over being shot to death.
you have a vanishingly small chance of being killed by a police officer if you are unarmed. this is on the order of tens every year in a country of 300m+ people.
I'm not sure what the proportion of citizens armed with firearms has to do with this. Its about rights of citizens in the country, all of whom can defend themselves and end life without trial in the correct circumstance, being self-defence (as it should be).
And nobody in the country should have the right to detain you without trial. If you really believe this I'm afraid that is quite short sighted.
I understand the media loves to hype these things when they happen, and they are all tragic incidents, but when you take a look at how often that actually happens compared to other things that can end your life, you realize it's really not actually that big a problem, compared to say... Murders or violent crime.
"Among men of all races, ages 25 to 29, police killings are the sixth-leading cause of death, according to a study led by Frank Edwards of Rutgers University, with a total annual mortality risk of 1.8 deaths per 100,000 people. Accidental death, a category that includes automotive accidents and drug overdoses, was the biggest cause at 76.6 deaths per 100,000, and followed by suicide (26.7), other homicides (22.0), heart disease (7.0), and cancer (6.3)."
So for every man killed by police (note that this is all police killings including those of armed suspects fighting the police) there's 42 people killed in accidents, 13 people commit suicide, 11 murdered by normal people's, 3.5 that die of heart disease, and 2 that die of cancer. And this is specifically for the demographic most likely to commit violent crime: young men.
Another way of phrasing this is, "even among the gender and age group most likely to be killed by police, people are an order of magnitude more likely to die of accidents, at the hands of non-police, or by their own hand than at the hands of a police officer."
That includes violent criminals being shot out of self defense. I wonder what the stat is for murder by cops when the victim didn’t have a deadly weapon.
It says "police killings are the sixth-leading cause of death".
"Police killings" by definition includes shootouts, when they were fired at fist, seriously threatened with firearms etc.
Sure, police interaction can and should be strongly looked-at and there have been much too much unwarranted deaths by police but just attributing some cause-of-death ranking to police killings without justified/unjustified contextualization is downright misleading.
> Our results show that people of color face a higher likelihood of being killed by police than do white men and women, that risk peaks in young adulthood, and that men of color face a nontrivial lifetime risk of being killed by police.
This is a problem. Whether you believe it is due to racial discrimination, societal pressures, or something else, the fact that BIPOC are being killed by police at a higher rate is a problem worth solving.
Sorry you have an issue with statistical facts and that equates to "white supremacy" to you. The rest of us are not going to dodge reality because its uncomfortable to discuss.
I'm confused why you are comparing risk of death to police action versus other causes. The linked research shows that of all deaths attributed to police action, people of color are extremely over-represented for their proportion of the population subject to police action. What does risk of death from other causes have to do with this conversation, and why do you think the research contradicts the results presented in the article?
Taking your numbers at face value, it seems we have an inequity problem regardless of police involvement. The question becomes, why are Black people committing over 50% of homicides, and what impact does our current policing strategy have on that number?
I'm not sure what the scope of the conversation is, then. The article is a report on a novel mechanism to reduce crime (novel in the US, that is). Your claim, as I understand it, is that the absolute number of excess deaths from police action in the Black population correlates with the outsized representation of the Black population in homicides, and you don't see a problem with this (please correct me if I misunderstand). I hypothesize, admittedly through leading questions, that addressing said outsized representation through means other than policing may have a beneficial effect on the overall crime rate, which seems to align with the reporting in the article. Is there something I'm missing?
So you believe that there are a significant amount of non-African-American murderers who managed to escape prosecution, and that these law enforcement agencies framed random African-Americans for murders they didn't commit? And you believe this happens across the country at rates high enough to change these numbers?
TL;DR: looking at numbers killed by police in absolute is meaningless. You also need to consider how many of these deaths occurred while the person who was killed by cops was also armed with a gun or deadly weapon. Hint: most of the people who get shot and killed by cops were trying to harm those same cops.
And this is the hyperbolic, overdramatic society we live in today, with no nuance or potential to see another side.
Qualified immunity -- qualified meaning limited. Yes it is easy to abuse and has been abused, but rest assured cops have gone to jail for murder and involuntary manslaughter.
I don't think they mean qualified immunity. I think they mean juries acquitting officers, judges throwing out cases, grand juries declining to indict, and D.A.'s deciding not to bring charges.
This happens all the time for officers and not for officers. It depends on what the political agenda is of the mayor and DA. Counterexample: look at what is happening in Portland right now. The DA is flat out refusing to bring charges against criminals.
(Also for a longer history of counter examples, see what happens to people who are criminal finaceers. Spoiler alert: nothing.)
What people fail to realize time and time again is so many of our contemporary issues come down to power struggles. It all has to do with power dynamics and how one set of grifters is vying to keep it over another set.
My answer has always been limitations. Limited powers, limited government, limited terms. But happy to hear of other realistic solutions that don't resemble an anarcharist approach.
Never fails IME people who say they favor “limited government” really mean “government for thee, not for me.” They want laws enforced, sure, but mostly just the ones about keeping the rabble from getting in the way of the fReE mArKeT.
It’s painfully obvious to me, now, after everything, that pursuing a “limited government” requires making it harder for certain groups to vote and gerrymandering. Can’t have the rabble voting in their own welfare; that means higher tax rates on top earners —- aka “getting in the way of the fReE mArKeT” —- to pay for it.
It’s the inevitable conclusion, as we are seeing in the United States.
No, when I say "limited government" I mean just that. A government that has certain powers, but not others.
This is not just about enforcement of laws, it's about which laws are allowed to exist in the first place, and about government procedures adhering to those laws.
To give you concrete examples:
* I don't think "the government" (broadly defined) should have the power to stick some poor kid in Riker's Island for a few years while they think about getting around to trying them on a trumped-up charge.
* I feel like there is significant value in a number of protections enshrined in the US constitution (starting with the prohibition on ex post facto laws, as a pretty major one).
* I feel that asset forfeiture is a complete travesty and should never have been allowed under any sort of "limited government" approach.
That sort of thing. Of course then we have to have some debate about which powers governments should or should not have. And revisit that every so often as the situation (society, world power balance, technology) changes. But we should revisit it in a reasonable way, where everyone is clear that we are revisiting it, instead of the government just grabbing more power for itself unilaterally, whether it's through abuse of executive orders, pretending like everything is "interstate commerce", setting up secret courts, doing parallel construction, passing unconstitutional legislation and hoping no one notices, or whatever other things various governments in the US have tried over the last century or two.
This is sarcasm, right? There haven't been this many broad-as-daylight examples of "Laws for thee and not for me" than the authoritarian, wanna-be tiny-emperor governors and mayors, and representatives of a certain political ideology all across the country with their draconian, unscientific lockdowns.
> It’s painfully obvious to me, now, after everything, that pursuing a “limited government” requires making it harder for certain groups to vote and gerrymandering.
You have been reading way too much propaganda. First of all, Gerrymandering is enjoyed by each side of our ruling class. So that invalidates the rest of your nonsensical point.
one "certain political ideology" stormed the capitol and murdered a police officer. maybe you saw it, it was led by a centaur furry right through them beating a cop to death on the steps of the capitol building. But sure, yeah, absolutely, it's the libs who are destroying america. Give me a break.
You're not a serious person. Go back to qanon or whatever new conspiracy theories you "liberatarians" are on to next.
edit: But since you're obviously struggling with a social life, I'll give you some help.
> I can't get people I am close with to even consider engaging in conversations about firmly held beliefs they have if I even remotely present myself as possibly holding a different opinion.
Yeah because you're an annoying asshole my guy. All you do is cast yourself as the victim. Gee whiz I wonder if you're a mediocre white-passing guy in tech, it's really a whole mystery. Have fun responding, I'll see you in 6 months when I check this account again.
Nancy Pelosi, Maxine Waters, et all all called for similar insurrections during their favorite completely debunked conspiracy theory that we've heard about incessantly for the last 4 years. When businesses were being burned and looted during the summer, and 24 people died, they complicity supported it, and used it as an opportunity to advanced their political talking points, and attack their political foes.
Ok so how does this risk compare to the risk of being involuntarily committed, which you say is a high risk. Moreover, how many of those are permanent like you are claiming. Put numbers behind your arguments.
This comment expressing support & encouragement for state-sanctioned violence against its citizens is authoritarian propaganda employing classist and racist tropes.
Nobody talks about how difficult it actually is to commit mentally ill people in many places.
Case in point, San Francisco, where severely mentally ill homeless people abound, many of whom who cannot look after themselves, and are left to suffer and die in the street out of respect for their civil liberties. Or those who terrorize neighborhoods for years on end, and everyone looks the other way out of respect for their civil liberties.
Civil liberties are important, but prioritizing civil liberties to an extreme, above all else, is often harmful for the individuals they’re supposedly serving.
> No one is talking about the very big risk associated with this, that mental health professionals can commit you against your will with no trial, which is an erosion of civil liberties (incarceration without trial). Having known several friends who got committed and held against their will in psych wards when there was no good reason to, because their insurance was good, this is an issue.
Do you have a citation for this being a real side effect of the type of program listed here? The program as described in this piece seems novel and this article certainly makes it sound like a success.
I know engineers and programmers like to poke holes and look for edge cases that might break any potential solution, but hopefully we can allow ourselves to celebrate the victories when we see them without letting the perfect become the enemy of the good.
What you're worried about is reasonable but it doesn't seem to have much to do with the article.
There's no mention of the mental health clinician and EMT in the van grabbing people, throwing them in the van, and hauling them off to be committed.
Instead they seem to be sympathetic listeners who can help with problems. Not solve, probably, and probably not permanently but anything that helps keep people from getting shot or locked up in jail is good.
I had a friend who was essentially committed against her will. She was never grabbed violently or thrown into a van. She was calmly told they would be committing her, then asked to strip and change into a gown, told to take the medication or it would be administered forcefully, etc...
You have a very "Hollywood" idea of how this stuff happens. Reality is a lot more insidious.
No idea what your friend went through, but that's not what this program does. The people in these programs can't commit anyone, or take them anywhere they don't want to go.
The service works much much better that way because when the van rolls up, there is no fight or flee reaction.
In these situations the Police basically have 2 options.
- Take into custody (Which could mean being committed)
- Shoot
I'll take my chances with trained health/mental health professionals who can understand "I took too much", or I'm having a mental health crisis and while I might seem "out of control" I'm really harmless. Frankly if those health professionals think I need to be committed I probably should be committed.
The police can take you into custody and commit you as well, but if you are having a mental health crisis, and can't really follow the rigid police directions more than likely it's going to end poorly, because the police will do what's necessary to take you into custody, including killing you.
If you’re high on drugs, yelling scary stuff, acting violently without technically doing anything illegal. and threatening to kill yourself, I’d restrain you myself if I could. What’s the alternative to locking you up or waiting until you hurt someone & shooting you dead? You’re out of your mind, ruining everyone’s day, and you need a timeout to get your shit together, so if you wanna act like a child with no regard for the well-being of those around you, I’d have zero problems with sending you to your room until you cool down. It just so happens your room is a padded cell at the local mental health facility.
Not everyone has many friends, and if your one or two friends (literally 1 or 2) aren't there, there is no one. Your family might live out of town, too.
When my ex attempted suicide, he'd have succeeded if he lived alone. Few people would notice my own absence for some time if I lived alone, honestly.
I don't see how that risk has increased. It's pretty normal for police officers to call paramedics and mental health professionals in when subjects show signs of mental issues and substance abuse (there are even laws requiring them in some places). If the subject is in lockup or on the street by the time they arrive makes no difference since they have the exact same power to involuntarily commit them.
Now, whether that power is something that should be more regulated is a different question entirely. I believe there is an appeal process for being committed and it can go to trial, so it's not like it's entirely authoritarian. If signs of abusing this power are found, then of course, something should be done about it, but again, who was the first respondent really doesn't matter in that discussion.
EDIT: I read the linked article and holy shit, the US health system really is fucked. Honestly, when the incentives are that misaligned, I can see why you were worried (I was looking at this from a 1st world perspective; mild offense at the US intended). Maybe it would be smart to add an additional sanity check to the STAR system, but of course, until your healthcare mess is sorted, that's like putting a bandaid over a stab wound.
There are a few issues with your statements. The first being that the staff of this program have no incentive to "commit you against your will". Why would they do that? I work in healthcare and have met people that work in these types of programs. By and large they do it because they care, the stress and risk you get from working with these populations isn't worth the money.
I work in Canada, so perhaps it's different in your country, but to be commited to a mental health facility here, a trained physician needs to "form" you, basically sign forms stating that you are a danger to society if not treated. There are strict laws surrounding this, it's not just some random decision.
Lastly, you say this will lead to some "medical authoritarianism". Programs like these, as well as the ability to commit people to mental health facilities has been around forever, yet I see no evidence of this medical authoritarianism you speak of.
"Mollath's forensic incarceration for seven years and the surrounding legal judgments became the basis of a public controversy in Bavaria and the whole of Germany when at least some underlying elements of his supposedly fabricated paranoid story about money-laundering activities at a major bank turned out to be true after all. Mollath himself had consistently claimed there was a conspiracy to have him locked up in a psychiatric care ward because of his incriminating knowledge; evidence that turned up in 2012 made his claims appear plausible."
I would be shocked if the social workers riding around in vans are allowed to commit people. Social workers are kind of like nurses in that very few of them hold a PHD and they generally aren't allowed to diagnose or prescribe(varies by state and education level). They can provide all sorts of support, advice, counseling, etc to people in crisis, but when it comes to people who need to be committed, social workers mostly call 911 and hand it off to the cops, same as the rest of us. They can refer you for a voluntary psyc eval with a psychologist, or advise the judge that it might be a good idea to send you for an involuntary one rather than just sending you to prison, but they have very little power to decide anything for you. And if they're even remotely competent and you're not a blatant menace to society, then they're generally trying to keep you safe, stable, and out of institutions as much as reasonably possible. The whole ethos of social work is very different than psychology or law enforcement. It's very much focused on what concrete, practical things can be done to improve your health, happiness, safety, and quality of life. A lot of times it's simply hooking people up with services that they aren't savvy enough to find or access without help, or helping them get through stressful situation without falling apart and going to jail, using drugs, etc.
This is a dangerously bad take. Real progress is being made by this change and the assumptions you’re making risk taking wind out of its sails over essentially a non-issue.
If anything, I wouldn't worry about this given the article. The majority of the incidents shown are homeless people berating retail staff over welfare card issues; technically they would be charged with trespassing because the police have to be called to make them leave the store.
The example given was a mentally ill woman who had issues buying food with her debit card.
If anything, it looks more like a crew of people handling nuisances committed by "regulars" as they pop up. The danger is probably they DON'T commit as much as they could, and put out fires rather than secure help. That is, they just keep enabling the nuisance calls.
I'd be worried too about overreliance on this. If the guy suddenly pulls a gun or a knife on what was just being a public nuisance, you are having more or less medical workers in danger of their lives.
First, that seems needlessly absolutist. We're literally talking about upending decades of emergency response practice here, surely it should be reasonable to talk about tweaks to the process (mandatory judicial hearings within N days of mental health detentions seem very reasonable to me) without demanding that a change be thrown out because of a theoretical problem.
Second, is there data here? I mean, the article lists 748 tracked incidents. Did any even lead to an involuntary hospital admission? Shouldn't we figure this out first?
Inventing terms like "medical authoritarianism" seems like more noise than signal, basically. Surely the fourth amendment as it stands can speak to the needs of mental health cases just as it can accused criminals.
Indeed. It went the way Thomas Szasz described when he wrote The Therapeutic State [0].
It's a common trend in covertly authoritarian governments, but not only, to be able to remove people from the public without a fair trial: just question their sanity and have a doctor sign them in. Sometimes it isn't even the government, but someone well connected who needs someone else removed.
Yet neither you or op seem concerned of being killed by the police for no reason, like it happened to many. Perhaps you are in the demographic that wouldn't be shot by a cop but could still be judged unstable by a medical professional.
That's funny[0]. I'm not American, so don't pull the white guilt card on me.
I've spent a total of 12 days in the US in my life, and I was pointed a gun by the police once. That's infinity percent more than in any other country I've lived visited or lived in, and I've traveled my fair share off the beaten path.
When they saw their mistake, they spouted the generic excuse that I matched a description, something that wouldn't fly in any other first world country, but is somehow accepted in the US.
Anyway, I'm white and I did nothing wrong, so I guess that officer just pointed that gun as joke with no intention to kill,[1] right?
US police kills citizens at a rate seen only in developing countries. According to the wiki[2], US police kills 10 times as often per capita as the worst European offender of significant population (France), and ranks higher than places like Angola, Colombia or Rwanda, that have insanely higher crime rates. Let that sink in, and think whether the problem is race based or not.
But don't worry, Biden won, the rates will remain the same but it will no longer be an issue worth being reported in the media ;)
Not at all, demographic doesn't relate only to race but other factors, like where do you live, etc.
I don't have data to back this up, but in every country, people living in middle/high class areas have to worry much less about being stopped on the streets by the police than others.
For the rest of your comment, I totally agree with you. I don't think Biden is going to change anything significantly here, considering both his and Harris history.
> Not at all, demographic doesn't relate only to race but other factors, like where do you live, etc.
My bad, too many arguments in that direction lately :)
> people living in middle/high class areas have to worry much less about being stopped on the streets by the police than others
Indeed. Another correlation I see interesting is, regardless of income, the urban/rural/suburban breakdown, with rural populations getting the short end of the stick here.
I see your point, but it’s worth considering that the tradeoff is potentially seeing said people shot by an armed officer, or thrown into jail where they’re likely to be hurt, abused, and otherwise suffer.
Portland had a similar program. It worked GREAT. (I am out of the city and have not kept up. Some form of it may still be a thing.)
Now, in that program they could hold you for 72 hours tops. No criminal record, no arrest, just a record private to that program for maintaining patient history. No attorneys, no bail, nothing. Outreach staff were deputies well trained in deescalation and conflict resolution as well as EMT and other related first responder skills. They do not perform law enforcement and need their status to execute the program tasks only.
We used to do that with law enforcement. We don't today. Some say we should. Some say we can't. No judgement from me. That is just the current lay of the land we all live with today.
These programs offer a strong, effective, humane option and they save a lot of money.
It saw a lot of use dealing with the following:
Drugs and alcohol inebriation, violence and general inability to do self care.
Homeless
Mentally Ill
Temporary mental distress.
Say one ends up there flat out hammered. Ok, you stay, until you aren't. Same for most drug scenarios.
The primary criteria for release? Not being hammered and or not being an asshole. This was the right thing to do almost every time too.
Worked great as a more serious crime prevention, and self harm reduction.
They could escalate to the court system, or a hospital, and or begin treatment at the integrated detox facility. All anyone need do was ask.
For homelessness, it typically required something be going on, like people going to die, or who were otherwise at some grave risk.
Those people could also just reach out. A ride in the van later, they can clean up, sober up, and then tap social services, or get into a shelter, temp housing, depending, or detox.
Police could DEescalate to this program as well and did so frequently.
People served by this program did not get criminal records, nor did they get a mental health record.
What they did get was help, and where it made sense, some tough love, and hard, lucid talk.
A significant percentage of the staff were former street people who had entered the program, got themselves good and then stuck around to help others. These people really matter. They have been there and are highly effective.
At the time, it was nationally recognized as a strong alternative to the typical judicial system grinder chewing lives up rather than lifting them out.
Here is something one of those people told me, and before I write it, I have in depth knowledge of the program via my spouse who worked front line outreach for many years:
Help buys time. Real help is sans judgement too. Time is what people in trouble need. When they get it, they have an opportunity to make different choices, and when they do, they are no longer people in trouble.
They become people getting out of trouble, improving. This is what they, and everyone else really need.
Nobody knows what reaches people. We only know when we continue to try some of them are reached and when we try harder, with genuine concern and zeal, more are reached.
Just reaching someone often is not enough. They fall back, need more time.
This is as good as it all gets.
Being human can really suck. Us lucky ones, who do not currently experience that suckage can count ourselves lucky and also for the help we may one day, ourselves need.
That, at the core, is what these programs and others like them are, or need to be about. When they are, they work.
The problem you describe is real, but this program is a net positive (even in terms of the problem you're concerned about). Cops escalate mental health related scenes, which leads to people getting arrested and then put in a hold (which often gets extended).
If a social worker is able to resolve the situation without getting the cops involved, a cop isn't going to get personally offended that someone in crisis isn't "complying" and feel the need to punish them.
This is actually a big issue with child/family services as well. A lot of what they do is extra-judicial, though in theory there is often judicial review... eventually. This is coming from a foster parent. Don't get me wrong, a lot of these services are needed, but you would hear stories of abuse by the system.
Extra-judicial threats are something everyone should be on guard against.
If you don't mind, what country do you live in and/or what thought process led you to "medical authoritarianism"? I would like more background on this, because it seems relatively absurd for the United States, where we struggle to even get a doctor involved when they clearly should be.
Agreed. It’s worth noting that your concerns absolutely have precedent.
In the USSR and other 20th century states, committing people against their will to mental health asylums was a very common way of dealing with political and religious dissidents.
Presumably no arrests made though means people didn't fight the medical professionals trying to incarcerate them? So I assume most of them went voluntarily.
Private insurance often pays providers better rates than Medicaid, so patients with private insurance are on paper more "desirable" than patients without. The commenter is suggesting that translates into kidnapping, essentially.
If the arrest record is warranted, I fail to see your point. The outcome of not having a record when you probably should have one is probably net worse for society, given it won't show up later on a background check, for example.
It’s the same point as - if a person needs to be committed they should be. We are in this position because cops have not been shown to be fully trustworthy in a lot of these situations. It is infinitely better to not have the cops involved at all unless they are absolutely needed at which point the medical care workers can send for them. This new way is a win-win for everyone involved.
Assuming the cops don't just turn them off or "lose" the footage, which "mysteriously" seems to happen every time there's an incident (unless the cop is too stupid to cover their tracks).
What is the difference between a psych ward and a jail? No difference in tv shows, except they also drug you, do weird experiments, and you could get killed by fellow inmates without a problem. If getting committed to a psych ward replaces prison it sounds much worse.
Yes, from the title I had expected it to be about health officials ignoring the law in instituting covid related restrictions. We definitely don't need more power in the hands of unaccountable technocrats.
They handle most non-violent 911 calls which cops would end up handling. Things like people walking into a business naked or sleeping in the doorway of a business, these guys get called. It's a big percentage of 911 calls in any city where you have homeless people.
Usually they can help people out, but if people do get violent or belligerent, they call for police backup. That's pretty rare.
Overdoses, sick homeless people, people shouting random shit at people in front of businesses, pretty much anything non violent, these guys talk them down give them a little help, drive them to a clinic, or whatever they need. It's a lot cheaper and more humane than arresting them.
While I support the approach I'm not sure Eugene is the best example. There is a huge homeless problem here and police don't respond, including when I wake up in the middle of the night to someone sticking their flashlight in my window (from my locked back yard and they came right up to my back door) nor the homeless man that was sleeping against my bedroom wall and yelling all night about the CIA's listening device in his teeth. I've also had them break into my backyard and turn off my electricity (fun way to wake up freezing). But then again, I'm not sure police should be responding because they think it is appropriate to shoot down Peal (Toshi's towards Safeway) when some dude steals their vehicle and is driving *away* from them (I'd get it if they were driving towards the cops but that's not what happened).
The program is good and I'm glad less people are dying from it, but the problem is very messy and there's still a lot that needs to be done to build upon it. My issue is that many times people make these first steps and then just stop. The homeless problem has only seem to grow since I've been here and covid has made it far worse. Living in Eugene it doesn't feel like the city or state is doing what they can to appropriately fix things. It more feels like people are patting themselves on the back and calling themselves woke while making near meaningless improvements. I don't blame the homeless people for these actions as much as the people that have the power to fix the issues. People do the above actions when desperate. No one wants to live in a tent under the bridge when it is rainy and cold. We can be humane and solve the problem and that's what I want to see my taxes go to. After all, I pay more taxes here than I do in California.
Throwaway because I want to keep my main account somewhat anonymous.
I agree with a lot of what you are saying, but I don't think any of that has much to do with CAHOOTS. If it weren't for them, those same calls would be filled with police... I can't imagine there would be a better result.
Ultimately homelessness is the problem, it's not just worse here, it's worse in a lot of places. Opening up better and safer shelters I think is the only long term solution, but I'm not sure Eugene has the resources to do that. Federal and State collect all the income tax, Eugene's budget is small potatoes.
> After all, I pay more taxes here than I do in California.
Really? I pay about the same income tax, a bit higher property taxes, and zero sales tax. I haven't done the math, but I'm pretty sure the sales tax savings more than makes up for the difference in property tax.
>No one wants to live in a tent under the bridge when it is rainy and cold.
Not to deride from the rest of your comment which I thought was solid commentary but this particular line is not true. Yes it is true the over whelming majority of people have no intention of doing this. But it only takes one or a few people to transform a space. Stuff like boondocking, stealth camping, vagrancy, and alternative living is relatively speaking more popular than people would think and really only kept in check by the threat of the justice system and active policing.
> Stuff like boondocking, stealth camping, vagrancy, and alternative living is relatively speaking more popular than people would think and really only kept in check by the threat of the justice system and active policing.
I really hate when people feel the need to interject this kind of statement into a discussion about homelessness. Unless we had viable alternatives, it's impossible to know what percentage of people on the streets are just out there for a lark. My gut feeling is, it's an extremely low percentage. When it's sub freezing and I rider my bike past a 55 year old trying to sleep on a concrete bike path under a bridge with nothing but a couple of shitty blankets, I don't think he's a tourist. If I was going to do hobo tourism, I'd head for Florida or California, not Seattle or Portland.
But lets assume some number of these guys really, genuinely want to have sleep in half frozen mud puddles. We can still put up housing for the people who don't want that. Give people the option to get a decent roof over them.
Then once we're sure the people still sleeping on Main Street are doing it because they genuinely enjoy being outdoors, you can talk about active policing and the justice system on whoever is left.
Land use (especially in regards public access property) and homelessness go hand in hand. Most people don't care if someone can check off a box that says they have a home address, they care what people are doing in their parks, libraries, roadways, sidewalks, right of ways, etc.
>Then once we're sure the people still sleeping on Main Street are doing it because they genuinely enjoy being outdoors, you can talk about active policing and the justice system on whoever is left.
There are classes of people who have the means to be helped but choose not to. Which are still going to be there regardless of how much resources you throw at the issue, unless you think the future is a dystopian society where people no longer have free will.
Eugene Oregon is bit of an outlier. They have a very dense anti-police/anti-government community and are big participants in the clashes we see in Portland against the Federal Courthouse there.
There's an old CBS interview with them from 1999...
Really big fan of this approach. I'm often afraid to call the cops because I don't want them stepping into places where they aren't going to be helpful. Especially in more tense situations that may involve illegal substances or other grey area activities.
We usually don't want anyone getting in trouble, we just want a tough situation sorted out in a healthy way.
Eugene gets a fair number of things right for being a fairly backwater city. I do wish they had a better solution for homelessness in general, but we do as well as most cities on that and CAHOOTS treats the homeless far more humanely than most cities. (Plus it saves the city money!)
>Eugene gets a fair number of things right for being a fairly backwater city
Well of course. They don't have seemingly unlimited money to piss away. They have a defined amount of resources and a problem to solve so they figure it out the best they can.
It's never the SFs, NYCs, Austins or Bostons on the world that come up with novel ways to tackle problems. They're rich enough to afford bad government and to try and spend their way out of their problems. It's the Clevelands and the Buffalos and the Newarks of the world that innovate. They don't have a choice because they have to figure out how to do more with less.
Saw a dude sleeping on the street in -13°C today. My friend called the police. They told us to call the ambulance. We called the ambulace. They told us to call the police. We called the police. They said they'd call the ambulance........ Shortly after he was called up by the ambulance, who said the police was on their way. Well, it's good to know you get help over here, eventually.
I feel like most communities could really use a city-government-backed non-emergency medical dispatch. Not the ambulance/EMS (which is for emergencies and/or for bringing people to the hospital); not the police (who are armed and trained to respond with violence); just medical-ish people who could be called out to those in need of some important-but-not-urgent medical attention.
It could even just be a volunteer service of community members with good upper-arm strength, first-aid training, and an extended form of Good Samaritan-law protections. Semi-professional first responders, with no other qualification than being a first responder.
So basically, lifeguards. For places other than pools.
Some communities that don't have many fires dispatch their firefighters for this, and that works pretty well. But most fire units don't have enough downtime for that to be workable.
I'm a recently minted volunteer firefighter in northern Solano county (about 1hr north of SF). What you're describing is pretty much how it works here, and as I understand it, most other rural areas.
90% of our staff are volunteers. Some of the guys have EMT training (and some are EMTs in their day job) but most of us have just enough training to take vitals and do CPR until the pros arrive. Outside of fire season, maybe half the calls are medical? We're pretty remote so we get on scene faster than the ambulance. If you call 911, we show up.
Fun fact, this is largely a consequence of the reduction in house fires since building codes were improved in the mid to late 20th century. As house fires got rarer, cities had a conundrum; you obviously still need firefighters when fires cropped up, but the reduced rate of them made them sit idle a lot. The shift of medical duties into firefighters was a solution to that problem; give them something productive to do between increasingly rare house fires.
To add a data point, that's basically one of the roles of firefighters in France. You can learn a bit more in here [1]. The highlights: " In addition to providing fire protection and rescue, the French fire service is also one of the providers of emergency medical services.", and "As of December 2015, there were 246,900 firefighters in France [with] 78% voluntary/call firefighters."
It’s the same in much of the US- the majority of services rendered by fire stations are medical in nature. Most fire stations I’m aware of require all professionals firefighters to be EMTs (emergency medical technicians) and include at least one paramedic per shift/station.
I think this can vary though, as I’ve heard places like New Haven Connecticut rely heavily on private ambulance services.
I live in a small town that has the same dispatch for all those services (police/fire/EMS). Covers a couple counties if I understand correctly. I guess we are weird in that police and fire are "public safety" instead of separate.
As far as 911 dispatch goes, this is fairly common. In my experience, it's not uncommon to get an ambulance and a police officer for the same call, even if only one is needed. This seems to be the norm for calls where a neighbor has fallen ill (or, in the case of the elderly, literally fallen over and can't get up).
In technical terms, "serious medical emergency" means "a person is heavily injured and at risk of loss of life or permanent disability without expert medical intervention".
A homeless person generally does not need a doctor's / EMT's attention to survive, a cab to the nearest shelter is sufficient.
In Germany, we have both of this. The phone number 116117 connects you to the non-emergency (defined as: you don't need an ambulance crew to pick you up) medical hotline, and semi-professional first responders called "Helfer vor Ort" in some of our states (https://de.wikipedia.org/wiki/Helfer_vor_Ort).
And just to clarify for the non-Germans: this is a nationwide number which connects you to your local service, much like 112/911 does.
In big cities it generally goes to a call centre staffed by nurses or EMTs, who will do basic triage over the phone and can dispatch an ambulance or on-call family doctor to your home if necessary. Or they may just tell you to take some paracetamol and go to your regular doctor during their opening hours.
In smaller towns it may go to a local doctor/nurse/pharmacist who is rostered to take the calls.
Here in Berlin we have a service for exactly this called the Wärmebus (warm bus) run by Red Cross and the city. Social workers come out in a van, talk to the person, help them however possible.
If they're willing to go to a shelter, they'll take them there. If not, they'll give them a cup of hot tea/coffee and whatever they need to stay warm: a jacket, sleeping bag, blankets, etc.
This is also my experience with the police. I've had to call them 5 times in my life, and not once did those calls result in any sort of action being taken. In fact, in the most recent one, the operator forgot to hang up the call and openly mocked me to her coworker while I sat there listening. It's maddening.
Especially in a country where the police kill so many people every year, I can't help but wonder what the purpose of this system even is if they can literally lie to your face saying they'll send someone and just not.
> I can't help but wonder what the purpose of this system
Some words I live by: The purpose of a system is what it does. The purpose of the police is to protect private property, especially if it's owned by corporations. They're not there to protect you or keep your community safe. They are there to keep private property and capital private.
Correlation / causation problem here. Of course arrests will go down in that circumstance, by definition. You need other metrics beyond 'arrests' to properly measure effectiveness of the policy, though.
Right, but they're also arresting fewer people. People that likely would otherwise have been arrested. Broadly speaking i'm supportive of this initiative, but it's important that its outcomes actually be measured, and just number of arrests is not a good metric. Not arresting people is easy, it's hard to not arrest them without increasing crime. I hope it works though.
> People that likely would otherwise have been arrested.
But that's... that's the point, right?
I get what you're saying, but the outcome people wanted was "conflicts that don't need to result in arrests should stop resulting in arrests." The goal was to reduce needless arrests and only have arrests in situations that couldn't be handled in other ways.
I mean, we can measure other things like long-term impacts on people's health, prevalence of crime, etc... but one of the questions I was hearing when this idea was first floated was actually, "can these situations be resolved without arrests, or are the police just going to need to be eventually called anyway?" And it does seem like this outcome goes some way towards answering that question.
Just as an analogy: if I introduce script changes in a support center with the goal of solving customer problems faster and having fewer calls escalated up the chain to upper management, and at the end of 6 months, way fewer calls are being escalated up the chain to upper management, then that's a statistic I care about. It's not the only stat I care about when figuring out if my changes were successful, I might also look at things like customer satisfaction and call time, but it is on its own a pretty important outcome for me to measure.
If a homeless guy is wandering around with no pants on, do the police really need to be there? Do they need to arrest him? Why? Is jail going to teach him wearing pants is a good idea?
Likewise:
- Overdoses
- Random shouting
- Sleeping in a Denny's parking lot
This doesn't fix the long term issues behind why these people are running around doing crazy things. But neither does having the police take care of the issue.
It works well because fundamentally it's less expensive, more humane, and less likely to turn violent. Let the police handle the situations where they are needed to protect people.
What is the value in putting a person through forced rehab when the reasons they are drinking/ on drugs hasn't gone away?
Most successful rehab is voluntary. People need to first admit they have a problem. Simply making drug rehab programs more widely available without court intercession is likely to have a much bigger impact.
If people are released from rehab right back on the street, the chances rehab will be effective are even less.
Unless you at least attempt to fix the underlying issues, you are just pouring tax money out the door.
> I mean, we can measure other things like long-term impacts on people's health, prevalence of crime, etc... but one of the questions I was hearing when this idea was first floated was actually, "can these situations be resolved without arrests, or are the police just going to need to be eventually called anyway?" And it does seem like this outcome goes some way towards answering that quest
Yes, but this is exactly the question. Were these situations 'resolved'? We don't know. The article doesn't say. All it says is that nobody was arrested. You can just as easily achieve zero arrests by doing absolutely nothing at all.
Unless we arm our police forces with time machines, I would expect homicides to increase during a crisis or uncertain times regardless of the police force.
Exactly this. I hope that this program works, but we need to be measuring the actual outcomes here, not just saying "no arrests". It's easy not to arrest anyone. What's hard is not to arrest anyone without the crime rate going up.
Jail can be a horrible traumatizing experience and/or a bad influence. You don't need a conviction and a prison sentence to be subject to the harms of incarceration.
I’ve done a fair bit of contract work with a few law enforcement organisations. One department I was working with was getting a lot of pressure because emergency callers were waiting on the phone for way too long. The commissioner hired an outside agency to triage emergency calls. They’d basically just answer the phone and put you back on hold. They started tracking the time the call was answered from when the triage call center picked up. Reported a huge improvement back up the chain. I read a news paper article about how successful they’d been in reducing wait time a little while later.
All the derision we give KPIs in software development applies just as equally to other areas of society too.
The police don't want to have to attend to calls with "emotionally disturbed persons" as they term them. I know a few officers in the NYPD and unfortunately they aren't given many tools in order to deal with these people. They either have to dump them off at a hospital (who often also doesn't want them) or arrest them for whatever they did. It is really not what they want to be doing.
In NY long ago there were very large institutions where they'd ship mentally ill people off to. This was not a good thing at all but the police did not have to deal with habitual people that stop taking their medication. Now there is not much they can do.
The US used to have more of that. The men in the white coats would come to take crazies away.
In the SF bay area, they were sent to Agnews Insane Asylum in Santa Clara, which gradually closed down and is now an Oracle facility. When that institution was active, homeless people were rarely seen.
This trend will be interesting. We mainly abandoned the practice in the late 1960’s and turned more towards policing by the 1980’s. Mental institutions got a really bad reputation and some of it justified as we were committing people for things like being gay. Lobotomies became unbelievably common. The whole concept was scary.
So today there’s a general distaste for policing tactics which although very effective, people seem to be souring on the costs - high prison populations, a feeling of profiling, and suspected unfair treatment of certain demographics. Criminal justice is in a crisis right now and people demand change.
So things like this have been becoming popular. I wonder how long it will be before it’s widespread and prison budgets are rerouted to mental health facilities?
I’m most curious about what will be considered a mental health issue and how politicized that will be.
I’m very cautiously optimistic that it could be a change for the better if administrated well.
Can we not learn from the several dozen other democracies with both lower prison populations and lower overall crime rates? I'm curious how the US is so unique in this regard.
> I'm curious how the US is so unique in this regard.
Culture, policing attitude, guns and the fact that the only thing lesser than the training US police officers receive is the bar to becoming one.
In most western countries becoming a police officer is a multi-year selective process, with lots and lots of training for conflict resolution, lessons on psychology, and of course the law. In the US you can be let loose on the streets in as little as 3 months.
Then once you're past the street level, the US also imposes much higher sentences on average, and punishment continues even after your sentence is served - by marking you as a felon for the rest of your life and locking you out of many opportunities for leading a normal life. Hello to high recidivism rates.
The prison term itself, the punishment, is also just that: punishment. Prison conditions are inhumane. If you treat humans as something lesser, they will behave accordingly.
The “guns” thing is annoying, because they are so easily accessible that means collective punishment of escalating force for the rest of us at all times because we could have a gun
In my world it would not be rare for people to not have a gun
It should be obvious that I wouldn’t know with concealed carry
But on the legal concealed carry side, getting that approved is extremely rare. All the densely populated counties are like that, in the whole country.
> "The US used to have more of that. The men in the white coats would come to take crazies away."
The nice young men in their clean white coats are coming to take me away Haha!
Don't know if you intended a song reference there, but I did enjoy it.
That said. This isn't what the people in this program do. They help people. Give them a ride to a shelter, give them a little food and some water. Give them a little mental support and somewhere quiet and safe to be for a little while.
They don't take them away unless they want to go somewhere.
I fully support using the proper resources to tackle these non-violent problems instead of sending cops which could very easily turn into someone dead.
What I do not support is completely decriminalization or disincarceration like the current DA of San Francisco is doing. He has turned SF into a dangerous place where criminals are no longer worried about stealing into cars, burglarizing homes, etc. This will only escalate and I really hope the recall effort to get rid of him hastens.
According to the linked progress report [1], they peeled off about 2.8% of incidents for this program. The second largest type of incident was Welfare Check, which I believe means "I need to check on X person whom I haven't heard from and isn't answering their phone". [2]
Welfare Checks made up about 20% of the total incidents they handled, and of course these wouldn't result in arrests. The other leading incident types were Trespass, Assist, Follow-Up, and Suicide.
Of these, only Trespass (the leading incident type) would seem to have the potential for an arrest. But as other commenters have mentioned, it is perhaps not great to never arrest trespassers because they would be more likely to continue trespassing.
Overall, these five incident types make up 75% of the total incidents handled. Four of the categories pretty much have no way of leading to arrests, and the fifth category is one where it's not clear that never arresting people will lead to the best outcome.
There are many good reasons to consider having non-police respond to some calls that are currently routed to police. But I'm not sure that looking at this program only through the lens of "there were no arrests" is the right way to measure success. They should look at other factors (do police make arrests when they go out on calls like these? Is the lack of arrests causing people to become less inhibited about trespassing, for example?) before heralding the program as a success.
I believe you are mistaken about welfare checks being unlikely to end in arrest. It's not uncommon for police to find reasons, or create them, to arrest people in the course of conducting one.
A quick Google search for "wrongful arrest welfare check" finds numerous results, including a woman who was arrested when the police entered the wrong address, and a Black woman who was killed when the police officer failed to identify himself.
The unfortunate truth is that anytime a police officer is involved in a situation in the US, it can escalate into a wrongful arrest or worse.
I'm intimately aware of the service. I don't hold out much hope for mental health engagements that begin forcefully under immediate threat of arrest for not playing along. The anti-social/anti-authority person should only be encouraged to seek moral guidance voluntarily from an authority they trust, some things in a community need to be kept sacred and honest.
The title is the worst part of the story. It seems tautological that a person will not be arrested when the police hand off that person to people who don't carry out arrests. It'd be a bit like saying that in the first six months of marijuana legalization, there were zero arrests for marijuana possession.
The more interesting (and heartening) aspect is that the police and the white van brigade appear to be working together and helping each other do what they do best, with benefits to the community.
The white van has the right and ability to call the police to make an arrest.
In the past, these 750 incidents, which did not require police intervention would have likely led to a police squad wasting time on these 750 incidents as opposed to spending time on other real crime issues.
The problem is that such white vans don’t exist in other police forces.
If the mental health personnel can't resolve the issue on their own they call for police backup to make arrests. The fact there were zero arrests means the mental health personnel were able to handle every case they encountered.
Whether no arrests is a good thing depends on the crimes.
Only the most ideologically blinded would defend having a social worker team like this respond to car break-ins and the other broad daylight petty theft that has plagued California since they passed that ballot measure awhile back (and a couple other specific cities with similiar legislation).
If using this program as an alternative to police response for drunk and disorderly conduct, teenagers doing teenager things, homeless person trespassing and other "no immediate victim" type crime (which is what it sounds like from TFA) then it's a good thing.
You're assuming that every time the police are called, there is a crime. You can scroll up in this post to see examples of people calling police when they are concerned for someone's welfare, and no crime has been committed. It happens regulary for want of other options.
If the breakins are people who need food and shelter, maybe they can help. Or if they can convince people to switch from crime to legitimate income.
In other words I'd be okay with lesser penalties for someone smashing my window if in exchange there was a very high likelihood of getting caught, and of that event leading to reformed lives.
Anecdotally, I can confirm this by seeing someone who made one very real but economically insignificant mistake have their career ruined for years over a misdemeanor charge. They needed financial and emotional help. Instead they got a plea bargain steamroller, no chance to talk to counsel, etc.
Agreed, the "but" in the bolded text[1] further confuses, but the article highlights some great progress.
>> STAR, has responded to 748 incidents."
>> about 3 percent of calls for DPD service, or over 2,500 incidents, were worthy of the alternative approach
[1] "Chief Pazen is thrilled with the success of STAR, but the time and money it saves will go toward fighting crime, he said."
I start from a place of wanting this program to be successful, but I have to ask- what do they do if the subject becomes violent or dangerous? The disturbed person suddenly pulls a knife, or attacks the respondents? It seems unrealistic to not have someone armed & prepared for violence, even if they're just armed with pepper spray
It can take a long time for the police to show up, and a very short time to be stabbed. Arming STAR members is probably a step in the wrong direction, but I agree that they need to be able to handle these situations on their own.
This program deals specifically with nonviolent people, they presumably have some sense of what they're getting into and understand that violence, while not impossible, is very unlikely.
I agree. There are many comments here saying, "what if they turn violent?" as though that is a deal breaker for this kind of program. I think EMTs are a good model for this. If the situation escalates then the health professionals can disengage and call the police.
It isn't a risk free profession just like firefighting, policing and logging aren't risk free professions. But the risk of violence does not mean we should do away with the program if it proves to be successful.
EMTs have a helmet and ballistic vest in the ambulance in quite a few cases, though I'm not sure having the closest "health care professional" looking like a 90s ATF agent would help with the public perception.
How is it different than any situation when somebody turns violent and the police aren't already there? At least in this scenario there are people there who are presumably the most equipped to de-escalate the situation without further violence.
> Per self-reported data, CAHOOTS workers responded to 24,000 calls in 2019 -- about 20% of total dispatches. About 150 of those required police backup.
Ten percent of police calls are about mental illness, but only 2% of attacks on officers occur during responses to incidents involving a person with a mental illness. This role is probably much safer than being a police officer, which is already only the 13th most dangerous job. When an incident occurs, it will almost certainly be used as an excuse to criticize the program when in reality the job is safe compared to many others.
That's why most programs like this send both a social worker and police officer. The social worker initially takes the lead but if things escalate past the point that the social worker is able to de-escalate the police are there to intervene.
They’re professionals. I think they’re aware that there are risks involved on this job.
The brutal truth is that social services for the dysfunctional elements of society will almost certainly involve more risk than what “regular” people will face. I hope that they’re compensation reflects that additional risk.
Compensation for risk occurs through the same mechanism as compensation for everything: the supply and demand curves. This creates outcomes where the compensation for risk occurs at a deeper level, co-mingled in with many other factors.
I'm sure many people don't agree with this and think the absolute riskiness of a job should factor into compensation irrespective of the risk preferences of the labor market as a whole.
I don't really agree and generally contend that markets (labor or otherwise) are the most efficient and elegant solution for pricing anything. At the very least, if a better and more robust system exists, it hasn't been discovered as of yet.
When the government is the one doing the hiring, they don’t have to pay market rates. They can decide add on hazard pay.
This system already exists - it’s why police get better pay and benefits compared to jobs with similar education requirements and levels of danger in the private sector (e.g. delivery drivers). Why couldn’t that hazard pay be extended to these psychiatric responders?
Suppose they don't. They declare the job to be worth $2/hour, which they can do because minimum wage is just a law the government can change. Nobody takes the job. Now what?
Those job openings go unfilled forever, literally forever, until the government decides to pay market rate.
The only way to pay below market rate is conscription. The government could draft people, forcing them to do the job. If people are free to leave, they are getting market rate.
> traveled around the city in a white van handling low-level incidents, like trespassing and mental health episodes
In many (most?) other countries, the police may not even get called in for such cases; and anyway, an arrest would not be made. At most, the police officer might demand the trespasser vacate the premises, escort them out, then give them a threatening talking-to.
Given that they are being dispatched to those incidents that cops probably wouldn't have responded with an arrest anyways, it's hard to compare.
If they or cops were dispatched entirely randomly to incidents, it would be possible to do a fair comparison so long as the number of incidents the both groups respond to were numerous enough to be statistically significant.
Considering the DPD boss supported this method precisely because he was having police officers wasted at situations that didn't need them, the fact that there were no arrests means perfect specificity on the test for "Should I choose STAR over PD?".
Why would you randomly dispatch them? That would defeat the purpose entirely of this unit.
Yeah, I'm curious about their protocol and organization. So:
* Org chart - which city dept they report in to
* Dispatch Protocol - It says a third of the time they're called in by police officers. Is the only other way to get them to call 911 and ask for them?
* Emergency Protocol - What is their stated approach to dealing with the situation if it goes pear shaped, who do they call, how do they make sure they're not around to get hurt.
there is something laughably grim in how a new initiative does a better job in handling types of cases than police, but the money they save is funneled right back into the police - the institution that is responsible for mishandling so many of these cases in the first place
Can I take this comment to mean you are a proponent of No Child Left Behind? Because when an organization isn't doing well, clearly the answer is to give them _less_ money.
As someone who works in EMS, I don't understand this concern... Obviously this is not a zero risk activity (welcome to emergency services), but trained professionals are aware of the risk, and have the skills to assess and react as needed (including leaving the area and calling police).
This is not some new problem no one has encountered before. EMS has been dealing with it for decades.
You're not being sent to deal with people who are more or less physically healthy though, or who aren't already agitated in a threatening way. And even if you "disengage," you still have the original crime; the homeless guy is still yelling obscentities and trespassing in some place, now he's just violent.
It's a different clientele, and ems is not there for conflict resolution at all.
We routinely get sent to agitated individuals. Whether that's someone experiencing a mental health crisis, under the influence, or experiencing a medical issue (diabetics can get extremely belligerent). Deescalation and conflict resolution are absolutely thing we do, pretty much every shift.
I fail to see how this is any different from the STAR program. The people involved are not actively violent, but have the potential to become violent, and the staff involved certainly have the appropriate training to deal with that and keep themselves safe (to the extent that's possible, emergency services are never going to be zero-risk).
EMS is dispatched to calls with a similar likelihood of violence as the program described above (i.e. low, but certainly not zero). This program isn't dispatching mental health professionals to "violent individuals".
Right... just like in EMS... Which was my point above. We don't expect our scenes to turn violent, but we're aware of the fact that there is always a risk of that happening, and we're prepared to react appropriately if it does. I assume the same is true for the STAR program.
I don't think there's anything wrong with him, but it's a weird assumption that people should not be armed in general conditions. In my opinion, it should not be a special or notable thing at all.
This program has the potential to be major net gain for our society. We have the largest incarcerated population in the world. We have mental health and opioid crises. Our current models of policing are ineffective and inhumane.
I hope that these health professionals become far more widespread and are held in as high regard as firefighters who also risk being seriously injured or worse.
'THE policy that led to the release of most of the nation's mentally ill patients from the hospital to the community is now widely regarded as a major failure. Sweeping critiques of the policy, notably the recent report of the American Psychiatric Association, have spread the blame everywhere, faulting politicians, civil libertarian lawyers and psychiatrists....'
This is encouraging in Denver but we need a much more serious nationwide approach IMO
'Many of the psychiatrists involved as practitioners and policy makers in the 1950's and 1960's said in the interviews that heavy responsibility lay on a sometimes neglected aspect of the problem: the overreliance on drugs to do the work of society.
The records show that the politicians were dogged by the image and financial problems posed by the state hospitals and that the scientific and medical establishment sold Congress and the state legislatures a quick fix for a complicated problem that was bought sight unseen.'
Unless you're making your money on private prisons this program seems like a win for every actor in the system: the police, the distressed person, tax payers, society as a whole.
I’m sure it’s more complex than this, but why isn’t the federal government jumping at this as a massive employment opportunity. You could train a wide variety of people for these jobs, and the way the jobs could be structured, support roles might not require college degrees in a lot of cases. Award grants or conditional extra city funding to cities that grow the program and make it work. People get to feel good about giving back, the country can feel good about reducing needless arrests, we can make bigger strides to solving homelessness, we can make good on various social justice reform items not only without necessarily massively defunding police, but also by freeing police up to actually do the much harder job they are trained for and stop treating police like they need to also be an arbitrary mental health issue handler.
There’s a lot of complexity for sure. This idea will hit a lot of roadblocks. But it seems like the potential upside across a dozen or so dimensions is super high.
Of course this is the same country that shuts out widespread nuclear power, so maybe this is the last we’ll hear about it when some police equipment manufacturer starts lobbying against it the minute one of these workers is involved in a violent encounter or significant arrest or something.
You have to understand how the federal government works.
Now that something like this has been implemented and has been successful, it’s likely that it will be adopted more widely, perhaps at the state level. An enterprising congressperson (most likely one of their aides) will notice this opportunity and pick it up as a policy/platform to run on at which point legislation would be introduced that would allocate funds or direct the federal government and/or all states to implement this.
Another way is that a Federal agency gets wind of it and pilots it and then proposes to adopt it more widely.
For starters, a lot of people have negative productivity. Think of someone intensely anti-social who drags down the productivity of people around them.
Presumably that would be true of any possible intervention and if we overcome that risk in every endeavor reliant on human productivity then it’s not particularly important to call it out as a risk here.
Underlying energy of why it works - people are actually afraid of psych facility even more than police department and think if they get there they would have even less chance to get out.
Also medical personnel is trained for everyday kind of violence, they can just beat the shit out of you where police would maybe wait until one more step of escalation.
That free hands give them authority that police doesn't have.
Just give police permission to beat people on a whim and you would instantly see the same effect with nobody risking to mess with police again and so no need for arrest.
These programs aren't like that. A van shows up, a medic and someone with experience dealing with mental health issues. They talk to people help them with some basic needs, drive them to a clinic if they need detox (and want to go) or otherwise just get them to stop doing whatever it was that caused someone to call 911.
The STARS people have no authority to cart people off, and are trained to avoid physical confrontation. If people get violent or need to be physically removed, they protect themselves and call the police.
It works in the sense that the stats look good initially until the clients get bored and say the magic words "I DON'T WANT TO TALK TO YOU".
These mental episodes are thinly veiled threats, they want to be pampered or antagonism will follow. You can pamper them with attention but it will only encourage that person to escalate next time when not pampered as much. A self-fulfilling cycle that keeps the health care professionals in high demand. The stats about non-violent incident success conceal what kinds of incentive structure they offer the offender and the professional who won't always report violent outbursts.
Notice they don't give any stats about outcomes, but the primary cited issue is "mental health" which is very vague and a subjective assessment.
We should not create an extra judicial system that has no checks and balances. Otherwise we will head towards medical authoritarianism which could easily be abused by those in power (psychiatrists and others) for their own personal gain.
See https://www.buzzfeednews.com/article/rosalindadams/intake for an example of what I mean.