Unlike some here, I came away with a deep sense of empathy, and today’s HN snark and frustration bounced off me pretty hard. The public order issues - homelessness in parks, the challenges of shared spaces—have certainly impacted me. But more than that, I struggle with how to translate the state of the world to my boys. I always remind them: every unhoused person was once a little boy or girl. We might be older now, but we’re still kids inside, and nobody dreams of growing up in these circumstances.
What struck me most was the balance of compassion and pragmatism that Amanda brings to her work. It’s easy to be frustrated with the policies and bureaucratic inefficiencies that slow down real solutions - but they are, in some ways, understandable.
The biggest frustration for me is the gap between the mental state of many unhoused individuals and the requirements needed to secure housing. The city surely understands the long-term costs of its policies, and it’s run by highly pragmatic people with limited budgets. But rules are rules, and at some point, top-down accommodations (including medical interventions...) are necessary to bridge this gap.
Nothing about this article strikes me as pragmatic. She's spending all her energy attempting to help people with the least likelihood of success and then gets angry at the system when they inevitably fail. The city didn't kick Morrisette out of the hotel because they like zero-tolerance policies, but because other people deserve a chance a chance to live in a free hotel room as well.
There are those that do succeed but those are certainly the most motivated to do so. Others are in transition: know they should get indoors but know their difficulties.
Rather than kicking them out, maybe they are required to attend some mandatory psych sessions. Maybe they go maybe they don’t but at least there support to help them work thru their issues of why they blew up at the staff (as in this instance).
According to the social workers I know who work with this population, there is a persistent fear that any form of offered mental health help is a trap for institutionalizing people.
By and large, people who are chronically homeless due to mental health issues will prefer to remain homeless over being required to see a psychiatrist and having to take medicine, or so I'm told.
Barring other factors, of course.
The drugs are administered first to foster obedience, credulity, and fidelity. The patient learns to keep their appointments, lest the drugs be withdrawn. The patient becomes a regular customer at the pharmacy, which must also be done on precise schedules. The drugs must be taken as directed, and the patient learns how to read and understand and follow intricate rubrics for rituals at home, and what foods to avoid, how to coordinate meals with the drugs, etc.
The patient, having demonstrated obedience and fidelity is well-supervised now by the clinic and provider. The drugs are "virtual shackles" that stand in for actual restraints and confinement methods. Just as "chemical castration" substitutes for surgical mutilation, any patient who's on drugs and making regular appointments can be let loose, a feral in the human population, often undetected and blending in.
https://en.wikipedia.org/wiki/History_of_psychiatry#/media/F...
https://en.wikipedia.org/wiki/Philippe_Pinel
It's important to consider that Mental/BH has never been a medical discipline, and while today's scrubs and white coats are the priestly raiment of BHT, NP-LPN-RPh-BH, and M.D.s alike, they take blood pressure and do labs, and they prescribe drugs and work in clinical systems, even Western-style BH is, fundamentally, a religious temple cult of profound spirituality. In order to fit the mold of modernist secularism, the BH temple must array itself in trappings of science and respectable, professional jargon. The BH orthodox profession is that mental illness begins and ends in the body, somewhere, hopefully the brain, or at least where the neurotransmitters flow, to be manipulated by sacramental means. Because if mental illness is not bound or subject to the body, or the secret HIPAA-protected rites and liturgies are not concrete and high-tech, then treatments become subjective, outcomes are unpredictable, and evidence cedes ground to superstition or faith in deities and the intangible world of spirit, which must be ignored in order to promote and foster D.E.I.
Ramp up drug regimes trying to blunt aggression, anxiety, restlessness, independent thought and reason, resistance to authority, and other compulsions to harm others, or sometimes the drugs magnify those compulsions and homicidal ideations, and the patient just goes totally apeshit, until the hospital can get to billing their insurance in earnest. But since President Reagan "closed the asylums" the paradigm shifted to keeping people out and free and at-liberty. Because institutionalization is an excessive burden on taxpayers, families, and insurance carriers, and it's labor-intensive: this is recapitulated in the past 5 years because the "Flatten the Curve" mantra was promulgated because there are widespread staff shortages and a lack of skilled, certified HCPs, especially for Defence Against the Dark Arts. I recommend viewing the critically acclaimed, award-winning film "Ladybird" starring Saorsie Ronan; her mother is a psychiatric nurse played by Laurie Metcalf, and see how Ladybird herself turned out
Even for the HCPs on staff, BH facilities are closer to meat-grinders than revolving-doors, as they burn out, train up, move up, drink their own Flavor-Aid, circulate within the system. So those homeless psychos meet a new team of strangers every month or so. Over 25 years, I personally witnessed one clinic that changed its name/brand/ownership 5-6 times, expanded/moved at least 3 times, and there are literally dozens of BH systems that didn't exist 10 years ago, including 8-story hospitals with no 6th floor.
https://www.azahcccs.gov/Fraud/Downloads/ProviderSuspensions...
Would you believe dozens of New Religious Movements operating under auspices of BH services? You may find yourself in a shotgun shack, worshipping Shiva or Kali, or I don't know, in a UFO cult, or practicing tantric yoga with authentic Punjabi Guru, because Medicaid funding. BH Funding for Treatment is Public Safety and a National Security concern: every time a mass shooting is reported on the news, Congress acts to bolster BH funding and services, and so "every time a shell casing pings, someone's clinic builds a wing!"
Ask anyone working in hospice/palliative care and they may confide that drugs are administered when family or staff are irritated or vexed by the patient, rather than basing it on the needs of patient herself. An incoherent or insane patient may be unable to articulate their needs, but when they act out, or become criminally dangerous, they must needs smacked down. "The Squeaky Wheel Gets the Grease" indeed.
https://en.wikipedia.org/wiki/Rosemary_Kennedy#Lobotomy
The patient works with the provider to identify and treat more and more conditions. The drugs layer-up, and sometimes extra drugs are shoveled on top, to complement really debilitating effects. But in general, the drugs are exacerbating and magnifying the patient's sins and proclivities. The drugs are interacting and the patient is increasingly entangled in the intricate ritual of provider->pharmacy->daily pill rituals->pharmacy->provider->pills.
It's impossible to know whether recovery is attributable to a true underlying change or whether the drugs have papered over the worst symptoms. Therefore, it's never advisable to stop those drugs or titrate off them, because they don't get labeled with maximums or limits like the OTC stuff can be (this guy once OD'd on fiber supplements).
In the case of "lunatics" and other folks who just had a temporary nervous breakdown or trauma-based freakout, they certainly can recover and exit the system--anyone can exit the system until they're court-ordered or incarcerated, anyway.
There's plenty of other non-drug treatment for outpatients on the streets; counseling/therapy can be done 1:1 or in groups and other supports in the clinic for building life skills, etc. The homeless nutjob population can typically get benefits from us taxpayers to keep them in the clinic 3-5 days a week, just doin' stuff, because the clinic is pretty much a church, and the mentally ill need a religion with structure, rituals, priests, and sacraments like Prozac.
