Welfare in the Mental Health Sector (1 Viewer)

[KFunk]

Below is a new article with a short argument for increased welfare in the mental health sector (which has at least some degree of economic clout). Quoted with 'freedom lovers' in mind:

Philip Mangano, the former executive director of the US Interagency Council on Homelessness, spoke at a homelessness forum in Sydney on April 2 this year.

He made the point that investing in permanent supported housing -- not just emergency shelters -- was cheaper for governments and dramatically cut the chances of men and women returning to the streets

...

Case in point, a Massachusetts program targeting the mentally ill showed that 146 clients spent a total of 46,000 days in hospital over a two year period. The annual cost of this was $9.75 million -- about 42 per cent of Massachusetts' budget for this area of health.

Basically these 146 patients were walking in and out of hospital, such was their inability to hold a place in regulated society.

But when they provided a permanent housing placement for them, the hospital days and costs associated with them dropped by a staggering 93 per cent.

Whacky news source, but it had better data than some of the others I looked at:

New eyes needed on mental health - Editorial News - Gold Coast, QLD, Australia

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I always find these issues interesting given the mix of problems including the extent of autonomy, social perceptions of illness, government spending and so forth. I look forward to hearing the libertarian 'user pays' solution to this.

 

[katie tully]

It brings to mind that homeless man in Sydney who spent hundreds of thousands of dollars being admitted to hospital every second day because of self harm tendencies or whatever else homeless people face.

That more than 2000 mental health patients roamed the streets of Queensland for days, weeks, perhaps months without authorities having any clue where they were is a major concern. It is a despicable level of care for people who perhaps need it most.

Where I disagree with Libertarians is that I don't see why morality is such a bad thing. I can't understand why more able people don't have a responsibility to ensure the welfare of those less able. In this case, persons who pose a danger to themselves or others.

In my experience, they're not bad people and during moments of lucidity, they're generally acutely aware of their issues and show a willingness to improve. As it stands, our guidelines basically say that as soon as a person no longer shows a tendency towards hurting themselves or others they're out of our care. This is the biggest failing imo, because it's during these lucid moments that more should be done to ensure they continue to have housing, that they continue therapy/medication ... it's while they recognise they need help that they should be helped the most.

Now the point about the 2000 patients is scary. This poses an immediate danger to the public and themselves.

We all know where I stand in terms of user based health care (i,e, i think it's effing ridiculous) and given that our hospitals are effed up the a in terms of funding, any strategy that reduces cost in the long term will probably increase productivity and patient turn over in the hospitals. Not only that, but we're providing these people with the basic necessities for life, which imo is our responsibility.

 

[KFunk]

In my experience, they're not bad people and during moments of lucidity, they're generally acutely aware of their issues and show a willingness to improve. As it stands, our guidelines basically say that as soon as a person no longer shows a tendency towards hurting themselves or others they're out of our care. This is the biggest failing imo, because it's during these lucid moments that more should be done to ensure they continue to have housing, that they continue therapy/medication ... it's while they recognise they need help that they should be helped the most.

This also brings up the general issue of reactive, crisis-oriented services which catch problems late in the game. I agree that in mental health in particular there are strong arguments for intervening during lucid, well-functioning periods to help build coping skills, resilience, etc.

I'll have to try and find a good lit review on outcomes of residential care and other settings. It has been long enough since the initial bouts of deinstitutionalization last century for some good data to be floating around.

 

[katie tully]

We don't have 24 hour mental health facilities out here, we have a phone number for out of hours but it's centralized in a town 100+ km away. So any crisis that occurs after 5pm and weekends ends up being the problem of the police and general nursing staff at the hospital, unless someone is on call ... Usually it just results in

a. mental health staff going to the hospital 1+ days after the incident
b. patient being released from the hospital without adequate follow up. I.e. it doesn't get followed up until a referral is sent to mental health which can sometimes take days.

One thing I noticed is when we check the phones after the weekend or something, is it's not uncommon for there to be 10+ messages from people with issues ranging from 'help the voices are back' and 'help I've run out of medication lol'....

All of these then become issues of general hospitalisation with staff ill equipped to deal with mental health patients, or they get shipped off to the nearest mental hospital which is a 100km ambulance/police escorted trip...

Hahaha I could go on all day, but the last point I have ... Generally these people don't have immediate family or they do, but the family doesn't want to know/care/ill equipped to deal. So when they are released, they're released on their own.

 

[volition]

Looks like what you're really arguing for is a community effort to improve people's welfare. That doesn't necessarily mean it has to be done by the government. In market anarchism, I'm sure there will be plenty of non-profit organisations - people might get together to build/maintain the road on their street, this isn't an argument for government.

I think many road owners and store owners would have an incentive to chip in to such an effort because otherwise these people who aren't mentally well can wander around and make customers feel unsafe/uneasy.

 

[katie tully]

Um. How many people own roads

It is a government problem in that governments fund hospitals, fund staff and have an overall duty to protect us and them. Given that your probably a Libertarian, you're going to disagree eh.

 

[volition]

katie, with road ownership, I was talking from the perspective of a hypothetical market anarchist society.

 

[volition]

zimmerman8k, it's important to distinguish what you mean when you're using the words "welfare" or "public". It's possible to argue for the existence of welfare (if you mean privately funded). Also, with words like "public property", you may find this interesting: A Plea for Public Property by Roderick Long. I still agree with you overall of course, this is just something to be mindful of.

 

[banco55]

On a different note as a matter of public policy wouldn't jailing them also be cheaper then the repeat hospital visits? We always hear how too many people who are jailed are suffering from some form of mental illness and how expensive jail is etc.

 

[SylviaB]

On a different note as a matter of public policy wouldn't jailing them also be cheaper then the repeat hospital visits?

no

 

[katie tully]

On a different note as a matter of public policy wouldn't jailing them also be cheaper then the repeat hospital visits? We always hear how too many people who are jailed are suffering from some form of mental illness and how expensive jail is etc.

What the...

 

[Ben Netanyahu]

On a different note as a matter of public policy wouldn't jailing them also be cheaper then the repeat hospital visits? We always hear how too many people who are jailed are suffering from some form of mental illness and how expensive jail is etc.

You're an abhorrent human being. An outrageous example of the worst kind of person.

Looks like what you're really arguing for is a community effort to improve people's welfare. That doesn't necessarily mean it has to be done by the government. In market anarchism, I'm sure there will be plenty of non-profit organisations - people might get together to build/maintain the road on their street, this isn't an argument for government.

People getting together to maintain public services? Hmm. Surely representatives will be needed for this, yes, because most people have their own thing to get on with. Surely these representatives will appoint people to maintain the roads for the best price, to get the best possible outcome, yes? And surely there must be some kind of wider input than just a local community so that we end up with similar streets, and not with a situation like the different railway gauges between NSW and Vic. I'm supposing that there'd be some kind of...consortium that is in charge of roads to prevent chaos.

Well, this is starting to sound suspiciously like government!

 

[volition]

Ben Netanyahu, you're missing a crucial difference: If you'd rather not have a representative do the choosing for you, you would be free to do that. The freedom to choose your master every 3 years doesn't make you any less of a slave.

There may well be some kind of organisation that sets standards about things like railway gauges, but once again, there's nothing about the nature of roads or train tracks that indicates that this couldn't be done by free individuals as opposed to the state.

 

[Ben Netanyahu]

Ben Netanyahu, you're missing a crucial difference: If you'd rather not have a representative do the choosing for you, you would be free to do that. The freedom to choose your master every 3 years doesn't make you any less of a slave.

Would there be any laws in your society? Surely there would, yes? Even if they're developed by some kind of free market (aka democratic) decision making process. One might not have to vote every three years but the freedom of individuals would still be curbed and, imo, the end result would be identical.

Except there'd be a lot more suffering. The idea that individuals are willing to be charitable on a large scale without being forced to do so is a big, fat, gigantic fallacy.

 

[volition]

Ben Netanyahu

Yes there would be laws, but no, that process of law making is not necessarily democratic. The end result is not identical since you may opt out at any time, exercising your right to individual secession. Also, it's not the same as having your freedoms curbed since the laws are generally opted into, or are just a matter of someone choosing not to deal with you (which is their right if they choose)

 

[SylviaB]

Cue Lentern with his whole "Greedy liberal capitalists" rant.

 

[Ben Netanyahu]

I see, I see. This is interesting. Does your organisation have a pamphlet that I can preuse at my leisure?

Do you consider that good will on the part of most people would prevent crime (or bad things in general, say rape, murder and theft for example) from running rampant? Or is there some other force that will prevent society from collapsing in on itself, which I assume would happen. This is no longer a question of similarity to what we have now as I see that this is not the case. It now looks more like an outrageous impossibility, imo.

 

[volition]

Ben Netanyahu, you'll probably find this video series interesting

YouTube - Obliterating Statist Myths Episode One: Anarchic vs. Statist Law and Justice (Part 1 of 5)
YouTube - Obliterating Statist Myths Episode One: Anarchic vs. Statist Law and Justice (Part 2 of 5)
YouTube - Obliterating Statist Myths Episode One: Anarchic vs. Statist Law and Justice (Part 3 of 5)

mises.org will have a lot of stuff as well

 

[Lentern]

Cue Lentern with his whole "Greedy liberal capitalists" rant.

I make no apologies for caring about the single mother who works two jobs so that her seven year old son can have a set of school shoes that fit.

 

[SylviaB]

I make no apologies for caring about the single mother who works two jobs so that her seven year old son can have a set of school shoes that fit.

Lol, what fraction of a percentage of families are actually in this prediciment.

And if she needs to work two jobs to afford shoes, perhaps she should've studied a bit ahrder at school to get a half decent job instead of popping out children.