Canadian Politics Today

The trouble with all that is who decides who is "incipient"

De-institutionalization was a well-intentioned program. It was supposed to convert inhumane and, for the patient ineffective confinement into treatment in the community. This April 2, 1972 article, which I remembered reading, The Patients Can Walk Out At Any Time at Bronx State Mental Hospital (link) made the case for de-institutionalization. Unfortunately few were as motivated as Israel Zwerling, and most looked at the process as a way of saving money.

It saved money, and it allowed mentally ill people to rejoin the community.

Calculated risk is part of life - do you want to be one of those nanny-types who accept no risk at all ?  If so you belong on the CBC. 

I said in another thread, quoting an author, we live in the richest, greatest time in history, and we've never been more heavily medicated.  How many people are under psychiaric help, or need it? Millions. You simply cannot lock them all up, or even more than a tiny fraction. Be nice to have them offered treatment, though...

Approximately 1 in 5 adults in the U.S.—43.8 million, or 18.5%—experiences mental illness in a given year.1
Approximately 1 in 25 adults in the U.S.—9.8 million, or 4.0%—experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities.2
Approximately 1 in 5 youth aged 13–18 (21.4%) experiences a severe mental disorder at some point during their life. For children aged 8–15, the estimate is 13%.3
1.1% of adults in the U.S. live with schizophrenia.4
2.6% of adults in the U.S. live with bipolar disorder.5
6.9% of adults in the U.S.—16 million—had at least one major depressive episode in the past year.6
18.1% of adults in the U.S. experienced an anxiety disorder such as posttraumatic stress disorder, obsessive-compulsive disorder and specific phobias.7
Among the 20.2 million adults in the U.S. who experienced a substance use disorder, 50.5%—10.2 million adults—had a co-occurring mental illness.8


https://www.nami.org/learn-more/mental-health-by-the-numbers

The trouble with all that is who decides who is "incipient"

That is the key point. It has legal, medical and ethical components with none easy to answer. Its one of those things
where in hindsight, we second guess and come up with pat answers and what appears to be cause and effect situations
that seem predictable and controllable.

The bottom line is they are not predictable and controllable, looking at a bad event after it happens creates an illusion of
predictability and certainty and therefore controllability.

I am concerned about an abuse of the legal and mental health processes in incarcerating the wrong people. Its a fine line.

I have worked in the damn system. There are days I have seen sick people released and can't believe it and other days people forced into hospitals who don't belong there.

Some psychiatrists are helpful, others over-worked and so misdiagnose and screw up.

Emergency rooms in hospitals are swamped as it is making psychiatric admissions problematic.

The Charter of Rights n Canada makes it all but impossible to force medication or treatment on anyone.

Likewise costly civil law suits now mean doctors will not expose themselves to law suits for forcing people into psychiatric hold without the patient's consent.

Bottom line is as well, most violent people are not contrary to belief as predictable as we think they are. They don't give out signs or warnings as many think they do. I know people who can turn on you and bite and attack you with no warning. They have a range of neurological and psychiatric conditions that mask their emotions and appearance.

Ask anyone who works in an old age home how unpredictable people with dementia or Alzhiemer's can be.

90 to 95% of schizophrenics are not violent.  Drugs such as meta-amphetamine, crack ****, can make people get 10 to 100 times their strength when they rage.

Some kinds of disassociated states can make people appear possessed by demons-their eyes bulge, they scream out babble and they bite, kick, attack and even zapping them may not slow them down.

Under the circumstances, I tend to have a lot of respect for prison guards, police, fire, paramedicspsychiatric nurses and attendants, people who work front line when people go ballistic. Interestingly those front line responders are a lot more tolerant than we pedestrians and by-standers. They are a lot more sympathetic to the mentally ill than you would expect for what they have seen.

I have facilitated groups with violent men in prison and in court programs. I wish I could tell you they are predictable and putting them in jail would help. Putting a violent angry man in prison may only serve to make him worse on the way out.

I am sorry for all the failures in my job over the years but I can tell you the system tries to do its best juggling individual legal rights with the right of a society to remain safe. It just aint easy.

Maybe the solution isn't incarceration/institutionalization but a much improved mental health system.  It's almost impossible to predict a person behaving violently before they're violent, but you can sometimes see warning signs and act, maybe we should be more aware of that.  Problem is mental health problems are often invisible and people suffer in silence, especially with the taboos still out there.

It is easy to see the warning signs with hindsight, the question is can we see them as unique to these individuals ahead of time. Just reading Internet opinion boards would lead me to believe there are millions of unhinged people out there.

Yeah, even on this board and the other one, I assume none of the posters ate.or would be violent .... But sometimes I wonder.

Don't make me come over there!

We all knew it was you that would crack.