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Comment by cneurotic | Hacker News Reader

I don't think the issue is so much that cities are too lenient on these people. It's more that the resources available to them are both inappropriate and inadequate.

My wife works at in-patient psych unit in my town.

Granted, we experience nothing near the scale of problems in cities like Seattle. But even here, our city can't cope with the sheer number of folks with these mental health / substance abuse problems.

Many of my wife's patients are dangerous to themselves or to other people. They can only stay on an in-patient unit for so long. After that, the stopwatch starts ticking. How long until the next violent offense?

If there were more institutions for these people, somewhere between Hospital and Jail, at least the stopwatch would STOP more often.

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"Somewhere between Hospital and Jail" was supposed to exist. When mental institutions were essentially dismantled in the 70s and 80s, the promise was to move towards a more community-oriented system of specialized housing, counseling, and in-and-out-of-home mental care.

To the surprise of no one who knew better, funding for those initiatives was never put to those uses, and instead was funneled into law enforcement activities. When we treat mental health and drug addiction as criminal matters instead of public health matters, we get the sorts of outcomes we are seeing today.

Is there evidence that money wasn't put into "specialized housing, counselling and in and out home mental care"?

I'm sure a disproportionate amount went into law enforcement and arresting drug dealers instead of helping anyone. I'm just curious if there's data to back that up.

The resources are likely there already, just waiting to be redirected. I highly doubt the end of the war on drugs would significantly increase the supply than what it already is.

I think part of the problem, though, is that any individual city (or even state) that attempts to solve this problem by giving more resources is doomed to fail, because it ends up attracting more homeless people and making the problem worse.

This is not hypothetical. In Texas there was an exposé done recently about how churches in a bunch of small rural towns were buying 1-way bus tickets to Austin for their homeless people, as Austin has generally better services for the public (and just passed, extremely unwisely in my opinion, a city ordinance making it legal to camp in any public place as long as you aren't fully obstructing a sidewalk.)

The obvious solution is to do it at a federal level but there doesn't seem to be much will for it even in heavily urban states - let alone the Senate.

How does Europe deal with this? I'm not aware of wide-spread forced institutionalisation. Are the problems dealt with before spiralling to full-blown homelessness and mental health issues?

Europe didn't get the opioid crisis. It is a "uniquely American problem" that we created by over-prescribing highly addictive opioids and then kicking them off the prescriptions once it became clear that they were addictive. That drove many people onto illegal drugs like heroin.

As of 2019, we have 4% of the world's population, and 81% of its opioid consumption.

Do you have a source for this? Thanks.

I can try to find something canonical. I heard it from our County's Medical Program Director (the physician who oversees EMS).

I think that was more or less the conclusion of the article. The "tough on crime" contingent wants to lock people up and get them out of sight, but the alternative - getting them mental health assistance - is hard to do because we lack the range and depth of resources needed to address their issues.

And since we're reasonably sure that increased incarceration isn't the answer, that leaves us in our current situation.

Perhaps one more option: Lower the standard for involuntarily forcing them into mental health treatment.

Look, the standard needs to be fairly high. But don't these people need to be in treatment for long enough that it actually changes things for them? Is anything else going to work?

Or do we say that their right to not be forced into something they don't want supercedes both their need and the need of society?

I think that's a good point, and for the most part I'd say I agree. If someone meets the criminal threshold of incarceration, it should be possible to divert them to treatment for at least the same length of time as a prison sentence. Along the same lines, maybe blur the lines between incarceration and treatment a little more. Incarceration should ideally be more therapeutic than punitive.

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