California Gov. Gavin Newsom has signed a bill that makes it easier for authorities to compel treatment for people with mental illness or addiction issues. The proposal is partly aimed at addressing the state’s growing homelessness crisis.
The trouble with incentives is that addiction is stronger.
Consider an emergency room, where a homeless person has arrived following a cardiac arrest in public. Thr person is revived and recuperating, but they require further help either for mental illness or subtance addiction.
Currently, the best the hospital can do is refer them to treatment, but they cannot compel a patient to seek treatment. If the person leaves the hospital and heads to their dealer, then they will continue to be a burden on society.
Treatment and getting better is the incentive. You’re not going to convince someone to give up drugs or alcohol by offering them tax breaks. Free meals work, but then people will show up just to get the meal, and won’t actually participate in treatment, because nobody can “force” them to be treated.
I honestly don’t know if this law will help with that. I understand the logic of it, but mental health and addiction is an extremely complicated problem. But to say “incentives work better than force” is to ignore the fact that we have incentives, and it’s not working.
Stress is the number one contributing factor to addiction. You know alcoholism is going up in much of the world due to climate change, and going up faster in parts of the world most affected?
Getting someone into housing is an incentive we haven’t tried. Okay, free housing if you get into treatment and take your meds? It reduces stress too, which makes treatment more likely to work. And demonstrates compassion, making therapeutic relationships easier to form and thus, makes treatment more likely to work.
Force doesn’t work. You destroy all trust in the therapupitic process before you even begin.
I agree with you, except free housing should be available without conditions. Isn’t the threat of homelessness just another form of coercion? Americans have more than enough existing housing and food production to provide for everyone. We force artificial scarcity into both markets to preserve profits, because it’s harder to raise rents when a free option exists.
Mental health and addiction are both medical problems. Trust is always an important part of medical treatment, but trust runs both ways. Can we trust people with those issues to seek treatment on their own? Doesn’t society have a compelling interest in treating their conditions?
I’m not advocating for the police to start rounding up homeless people and dumping them in overburdened psych hospitals. I’m not even advocating for this law. We need far better treatment options, healthcare in general, and economic reform before we should ever expect to address homelessness and mental health. I just don’t think we should take anything off the table when it comes to ensuring people get treatment. Force might work for some people. It might make things worse for others. The goal, however, is worthy of discussion and the methods cannot be dismissed out of hand.
In my experience force doesn’t work very well for actually treating people. It works well to protect society. And short holds can create a situation for someone needing help to seek it in the future (because they didn’t kill themselves or someone else.)
But as a means of getting people help that’s going to improve their mental capacity, it generally doesn’t help most people. It can help society and if it’s used as an alternative to prisons and jails, that’s an improvement.
My fear is that it will actually further stigmatize mental illness, and force people into the shadows. When using incentives could be a far superior option.
Plus, low income housing with a few staffed social workers is far cheaper for tax payers than prisons and jails.
You are underestimating the type of people this law is targeting. Nobody who is just stressed out is going to be forced into an institution (although I agree the law should be carefully written to guarantee that). This is meant to get people who are full-on batshit insane off the streets and in an environment where they at least have a CHANCE of getting sorted out.
For example, I have a friend who is psychotic. No, I’m not misusing the word or exaggerating, this is a person who is sincerely and obviously psychotic, diagnosed as such by a psychiatrist, sees and hears things that are not there, believes that the government is all rape-demons from hell that are out to harvest our sanity.
When unmedicated, that is.
Once medicated, she is like “holy shit clarity thank god, keep giving me the medicine.” But if there’s ever a lapse, we go right back to the rape-demons from hell trying to force pills down her throat and the only way to save her is to, essentially, violate her by being the rape-demon from hell that forces pills down her throat. Which is of course very illegal but people care enough about her to do it anyway.
It would be very nice for it to NOT be illegal to save people from the rape-demons from hell, to have a support system in place aside from what is basically a secret cabal of friends and family as a safety net should this person end up somewhere alone and unable to access their meds.
I think you’re underestimating who this law will target.
Addicts it says. Yes, people with other chronic mental health conditions too. But it sounds to me like California’s plan to deal with the opioid crisis is to start locking addicts in rehab facilities until they figure out how to be treatment wise if they’re not already (this is a term meaning, play the treatment game with therapists without doing the work).
Treatment really requires people to be willing. And unless they’re an immediate danger to themself or others, I don’t agree with forcing people into treatment. On both moral grounds and practical ones.
If this is an alternative to prison or jail, for crimes aside from drug charges, then great! But from what I could gather from the article, this isn’t really what’s going on.
It looks like they are also trying to implement funding for medical treatment as well, which is why the plan can be delayed up to two years.
But there are grey areas to being an immediate danger to themselves or others. If someone is walking into traffic because they are too high to be aware of their surroundings or a schizophrenic homeless man is randomly yelling at people in a park he lives in, there is a danger.
I would agree such people are a danger to themselves or others, but this law goes beyond that. Here’s the text of it if you’re interested. One need only be using drugs or alcohol or have a mental illness while being homeless.
Being “gravely disabled” means that someone is no longer able to provide for their own food, clothing, or shelter because of a mental health disorder. WIC § 5008(h). A person may be considered gravely disabled if, for instance, they are no longer eating enough to survive, or they have become unable to maintain housing.
So being homeless is being gravely disabled and can be used as a reason to forcibly commit the homeless if they use drugs or have a mental condition, regardless of whether they are a danger to themselves and others.
Actually it defines being unable to provide your own shelter as the litmus test for being gravely disabled.
This law is designed to force homeless people into treatment so CA can look good by getting homeless people off the streets. There’s softer and cheaper ways to do this, outlined in my many posts above. But it basically comes down to using housing as an incentive for treatment. Real housing staffed with social workers. Not locked down treatment facilities which don’t work well because patients get wise to treatment when it’s forced down their throats.
This law might do more good than harm, I’m just concerned about its potential to be abused. Certainly there are a lot of homeless people who aren’t capable, need help, and aren’t getting it.
There are no incentives you can use to entice someone under a psychotic break. You really have no idea what the situation is like. These are not people who have adhd or depression or whatever. They literally do not comprehend reality.
Yeah, if the issue is a growing homeless population, get them housed and use the housing as an incentive for treatment.
Housing first works best with homelessness.
And incentives work better than force for treatment.
But what do I know from my lived experience being homeless because of poor mental health? Or the human services classes I took after getting on my feet?
Apparently much less than people’s gut reactions.
Honestly this bill is more about cleaning up CA homeless problem (and accompanying image) than it is about helping people with mental illness. It ignores best practices, the advice of homeless advocate groups, as well as disability groups.
And you can say no to treatment by just playing games with a therapist and pretending to do the work.
Forcing people into mental health care isn’t very effective and we know this. This isn’t about helping the homeless. It’s about CA’s image. Newsom’s image im particular.
Cool. So if you’re a woman living in a red state that. And your conservative Christian psychiatrist decides you wanting to leave your husband is insane, you’d be cool with being locked up?
Attitudes like this were common in psychiatry not even 100 years ago. 50 years ago being LGB was considered insane. Today, many states would use your law to lock up trans people until they get better. Even now women struggle with medical care because of Drs with outdated views. And people of color don’t trust Drs generally, but you want to give them more power to imprison people? Do you think that would reduce or improve the stigma of mental illness? Do you think it would encourage people to get help? To trust therapists?
Incentives work better than force.
The trouble with incentives is that addiction is stronger.
Consider an emergency room, where a homeless person has arrived following a cardiac arrest in public. Thr person is revived and recuperating, but they require further help either for mental illness or subtance addiction.
Currently, the best the hospital can do is refer them to treatment, but they cannot compel a patient to seek treatment. If the person leaves the hospital and heads to their dealer, then they will continue to be a burden on society.
Treatment and getting better is the incentive. You’re not going to convince someone to give up drugs or alcohol by offering them tax breaks. Free meals work, but then people will show up just to get the meal, and won’t actually participate in treatment, because nobody can “force” them to be treated.
I honestly don’t know if this law will help with that. I understand the logic of it, but mental health and addiction is an extremely complicated problem. But to say “incentives work better than force” is to ignore the fact that we have incentives, and it’s not working.
Stress is the number one contributing factor to addiction. You know alcoholism is going up in much of the world due to climate change, and going up faster in parts of the world most affected?
Getting someone into housing is an incentive we haven’t tried. Okay, free housing if you get into treatment and take your meds? It reduces stress too, which makes treatment more likely to work. And demonstrates compassion, making therapeutic relationships easier to form and thus, makes treatment more likely to work.
Force doesn’t work. You destroy all trust in the therapupitic process before you even begin.
I agree with you, except free housing should be available without conditions. Isn’t the threat of homelessness just another form of coercion? Americans have more than enough existing housing and food production to provide for everyone. We force artificial scarcity into both markets to preserve profits, because it’s harder to raise rents when a free option exists.
Mental health and addiction are both medical problems. Trust is always an important part of medical treatment, but trust runs both ways. Can we trust people with those issues to seek treatment on their own? Doesn’t society have a compelling interest in treating their conditions?
I’m not advocating for the police to start rounding up homeless people and dumping them in overburdened psych hospitals. I’m not even advocating for this law. We need far better treatment options, healthcare in general, and economic reform before we should ever expect to address homelessness and mental health. I just don’t think we should take anything off the table when it comes to ensuring people get treatment. Force might work for some people. It might make things worse for others. The goal, however, is worthy of discussion and the methods cannot be dismissed out of hand.
I agree mostly with what you’re saying.
In my experience force doesn’t work very well for actually treating people. It works well to protect society. And short holds can create a situation for someone needing help to seek it in the future (because they didn’t kill themselves or someone else.)
But as a means of getting people help that’s going to improve their mental capacity, it generally doesn’t help most people. It can help society and if it’s used as an alternative to prisons and jails, that’s an improvement.
My fear is that it will actually further stigmatize mental illness, and force people into the shadows. When using incentives could be a far superior option.
Plus, low income housing with a few staffed social workers is far cheaper for tax payers than prisons and jails.
You are underestimating the type of people this law is targeting. Nobody who is just stressed out is going to be forced into an institution (although I agree the law should be carefully written to guarantee that). This is meant to get people who are full-on batshit insane off the streets and in an environment where they at least have a CHANCE of getting sorted out.
For example, I have a friend who is psychotic. No, I’m not misusing the word or exaggerating, this is a person who is sincerely and obviously psychotic, diagnosed as such by a psychiatrist, sees and hears things that are not there, believes that the government is all rape-demons from hell that are out to harvest our sanity.
When unmedicated, that is.
Once medicated, she is like “holy shit clarity thank god, keep giving me the medicine.” But if there’s ever a lapse, we go right back to the rape-demons from hell trying to force pills down her throat and the only way to save her is to, essentially, violate her by being the rape-demon from hell that forces pills down her throat. Which is of course very illegal but people care enough about her to do it anyway.
It would be very nice for it to NOT be illegal to save people from the rape-demons from hell, to have a support system in place aside from what is basically a secret cabal of friends and family as a safety net should this person end up somewhere alone and unable to access their meds.
I think you’re underestimating who this law will target.
Addicts it says. Yes, people with other chronic mental health conditions too. But it sounds to me like California’s plan to deal with the opioid crisis is to start locking addicts in rehab facilities until they figure out how to be treatment wise if they’re not already (this is a term meaning, play the treatment game with therapists without doing the work).
Treatment really requires people to be willing. And unless they’re an immediate danger to themself or others, I don’t agree with forcing people into treatment. On both moral grounds and practical ones.
If this is an alternative to prison or jail, for crimes aside from drug charges, then great! But from what I could gather from the article, this isn’t really what’s going on.
It looks like they are also trying to implement funding for medical treatment as well, which is why the plan can be delayed up to two years.
But there are grey areas to being an immediate danger to themselves or others. If someone is walking into traffic because they are too high to be aware of their surroundings or a schizophrenic homeless man is randomly yelling at people in a park he lives in, there is a danger.
I would agree such people are a danger to themselves or others, but this law goes beyond that. Here’s the text of it if you’re interested. One need only be using drugs or alcohol or have a mental illness while being homeless.
What is a grave disability?
So being homeless is being gravely disabled and can be used as a reason to forcibly commit the homeless if they use drugs or have a mental condition, regardless of whether they are a danger to themselves and others.
But it is along with mental health issues or substance abuse problems. It isn’t like only being homeless gets you into custody.
And custody includes putting a roof over a person’s head.
I don’t see how leaving these people in their current condition is the humane option.
Actually it defines being unable to provide your own shelter as the litmus test for being gravely disabled.
This law is designed to force homeless people into treatment so CA can look good by getting homeless people off the streets. There’s softer and cheaper ways to do this, outlined in my many posts above. But it basically comes down to using housing as an incentive for treatment. Real housing staffed with social workers. Not locked down treatment facilities which don’t work well because patients get wise to treatment when it’s forced down their throats.
This law might do more good than harm, I’m just concerned about its potential to be abused. Certainly there are a lot of homeless people who aren’t capable, need help, and aren’t getting it.
The schizoid homeless this law is targeting ARE imminent dangers to themselves and others.
Read the bullet points someone posted in these comments.
Just being homeless and having a substance use disorder is enough.
It goes way behind a psych hold.
I’d have to read the text of the bill
Always amazing to see people who know what they’re talking about getting downvoted all the time. Maybe lemmy really is becoming like that other site.
There are no incentives you can use to entice someone under a psychotic break. You really have no idea what the situation is like. These are not people who have adhd or depression or whatever. They literally do not comprehend reality.
Yeah, if the issue is a growing homeless population, get them housed and use the housing as an incentive for treatment.
Housing first works best with homelessness.
And incentives work better than force for treatment.
But what do I know from my lived experience being homeless because of poor mental health? Or the human services classes I took after getting on my feet?
Apparently much less than people’s gut reactions.
Honestly this bill is more about cleaning up CA homeless problem (and accompanying image) than it is about helping people with mental illness. It ignores best practices, the advice of homeless advocate groups, as well as disability groups.
Incentives work with sane people.
All people respond better to compassion than force
But you can also say no to compassion.
And you can say no to treatment by just playing games with a therapist and pretending to do the work.
Forcing people into mental health care isn’t very effective and we know this. This isn’t about helping the homeless. It’s about CA’s image. Newsom’s image im particular.
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It does but… how are you going to screen everyone, are you going to leave it up to police discretion?
How does that work out most of the time?
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Cool. So if you’re a woman living in a red state that. And your conservative Christian psychiatrist decides you wanting to leave your husband is insane, you’d be cool with being locked up?
Attitudes like this were common in psychiatry not even 100 years ago. 50 years ago being LGB was considered insane. Today, many states would use your law to lock up trans people until they get better. Even now women struggle with medical care because of Drs with outdated views. And people of color don’t trust Drs generally, but you want to give them more power to imprison people? Do you think that would reduce or improve the stigma of mental illness? Do you think it would encourage people to get help? To trust therapists?
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