Without a well designed universal health care system, the costs for these types of public programs will just keep skyrocketing. Seems to me with the current state of U.S. health care, we wouldn't be able to afford the medication and oversight. Even if such a thing passed, the facilities would probably be deregulated and privatized leaving tax payers to play a bunch of money to private entities who may very well end up abusing the patients (like what has happened with prisons and schools). I think it would end up like the stereotypical nightmare asylums we have had in the past.

Anyway, I think it would have to be part of a universal health care package, or something added afterwards, that provided very strong public oversight and plenty of money for research into addiction and psychiatric treatment. I would want such facilities to be more than hospitals, a place where people can retain their dignity and not feel like prisoners.

I think some other changes in our legal system would help a great deal too. Decriminalizing drug possession in general, and making marijuana fully legal could help keep people out of the dehumanizing prison system and keep them from being taken advantage of by hardcore criminals. Perhaps someone who would turn to drugs would be less likely to get hooked on the hard stuff if something like marijuana was legally available?

I know little about the state of our psychiatric and drug rehab institutions, or drug legality issues though so I'm looking forward to seeing how others respond to let me know if I'm off base on my comments

The obvious pointlessness of criminalizing mental illness. The causes of many of those illnesses. The waste and moral bankruptcy of inserting a profit motive into social programs that are supposed to help those in need. The lack of sufficient/appropriate resources to deal with these problems.

I believe that all of these issues spring from this most basic issue, we have a fundamentally dysfunctional social structure. There is no room, no accommodation in our social structures for those of us that cannot or will not conform to its demands. In the past, it was possible for them to leave, to "go west" or to later to simply "tune in, turn on, and drop out". That release no longer exists and it was never a solution in any case, it just made it possible for the rest of us to more easily ignore them.

I don't see any solutions that don't involve complete restructuring and that just isn't going to happen. We have to remember that there are large numbers of us that have adapted to this dysfunction and deeply resent it when they perceive that other people are getting assistance that they want for themselves.

A friend of mine has a 30 year old son with several mental health issues that are exacerbated by modern culture. A little over a century ago he could have found a place - he's strong, has a knack for fixing larger mechanical things, and works hard - and would likely have been able to homestead a place or work in the rough and tumble towns that sprang up in mining areas.

Instead he simply can't function in today's society. He is always angry - a byproduct of refusing to take his meds and his inablilty to have a space of his own and to work. In a previous time he might have headed west and avoided people, or been able to fit in to a much more physical society. But those aren't possibilities, and instead he spends his days and nights playing video games, drinking, and occasionally doing odd jobs...very sad.

We're not that country anymore, but we don't change our systems and perceptions to accommodate how we have changed. Rather we keep trying to force the people that don't fit and for whom we no longer have a role into a place that only makes things worse until it becomes unbearable. Then we blame the person for failing to conform.

because I think the compassionate consciousness of
humanity is on the rise. But it will take time.

Institutions have helped people, but also have become dead
end prisons for too many, with poor nutrition and inadequate care,
abuse in many cases.

It comes down to individuals, especially those who choose
care-giving professions, to raise the bar on treatment of others,
quality of life, understanding the whole person and treating
the whole person, including the broken child inside.

A woman like that with the right care could get well.

Institutions could be wonderful places, if well designed and
maintained, So many of us, left entirely to ourselves -- even with
the best intentions to make changes, usually default to what is
most familiar. A place that provides healthy structure is
probably essential for most people like that. A chance to heal,
a chance to find out who she is without the drugs, the
desperation, and the aloneness.

It's gonna take a lot of love to change the way things are,
to make things work out right.

We have the love. We have the wisdom, we have the
solutions, and the generosity of spirit. It's here, it's already
inside every one of us. We must tap into it, every single one of us.
That's the only way.

can support nor call compassionate. Revoking liberty from harmless people for the sake of one's asthetics is not a good thing.

but we need a better solution to what we have now. I really don't know what could work, which is why I'm asking.

No offense, but you say you only speak to her to say 'don't pick our flowers'. So that makes me wonder if you really know what her health problems are? The assumption that it is just a meth problem could be just an assumption. Some say speaking to people about them helps them. Have you asked how she is?
I just wonder about the 'meth' thing. If her health is all drug related, and law enforcment and rescue come so very often, why is she never arrested for possession of meth or paraphanalia? That is what makes me think it might be something more than or other than just drugs.
Not trying to judge you or her. Just wondering....it is nice that you think of her and have hope for her betterment. That's what good people do although we usually have more questions than solutions.
Thanks for caring about her.

I'm an old woman and in my old age don't try to reach out to help any more because I can't. All I can do is care about, but I can't help care for. This is why we need social programs so people like me, who can't take on the burden, can help out though.

On edit: I didn't answer all your questions. We know through the sheriffs she is a meth user. They have spoken to my family about her trespassing, the flowers again. I don't know why she's not arrested. If she's taken to the hospital because she's in OD and we know for a fact that is the problem, maybe they don't consider that a crime. I assume they confiscate the drug paraphernalia each time they come into contact with her. Since meth is made from stuff you can buy in the drugstore or hardware store, maybe it's not really illegal.

Florida. Also, Shreveport, La. In clinics (I believe faith-based) addicts were allowed to use even opiates, sometimes on a daily basis. Other clinics tried to wean addicts off of drugs, but failed.

"Clinic sites included New York City, Los Angeles, New Haven (Connecticut), Jacksonville (Florida), and Shreveport (Louisiana).
Most of these morphine clinics managed to curtail illicit drug use, although patient's lives still revolved around their need for multiple daily
self-administered doses. The New York City clinic attempted to detoxify and rehabilitate patients; this program was considered a failure (
Musto, 1997)"

http://www.westbridge.org/assets/enc%20of%20neuroscience%20-%20methadone.pdf

This doesn't directly answer your question, but in this day and age such radical examples of what to do with drug addicts and their mind-altered ways may not fly. I read another hard copy source which indicated that "patients" in these two Southern clinics were for the most part able to keep a job down, maintain families and stay out of jail. That went to "pot" when the WOD became nationalized in 1913.

Jacksonville. Shreveport. A hundred years ago. Jeez.

mentally ill and mentally retarded people in the '70's in Alabama and in the '80's in Massachusetts. These institutions were horrific and the living conditions were inhuman. Based on what I saw, I think community based treatment is a much better option.

From what I can see in Cecile's case the only help she gets is from the first responders and frankly, I don't know if she made it today. It's the first time the ambulance left without sirens blazing.

evaluated them and placed most of them in group homes that were appropriate for their needs. In Alabama there were some people who were not retarded or mentally ill...they were just poor or orphaned and ended up in institutions because the state had no other place for them. Those people we trained in life skills and they eventually went out on their own. In Cecile's case I would think she would be hospitalized for a while so she could be evaluated and treated and, if possible, placed in a community group home with a lot of support and supervision. I had clients in Alabama who had never seen a toothbrush and who peed in tin cans that they kept under their beds. One boy who ultimately became the plaintiff in a federal law suit was kept in a straight jacket for years because the institution couldn't be bothered dealing with his behavioral problems. Pretty grim.

to result in those people being cared for in their own communities. Trouble was, no money was set aside for that. So, quality of care or even availability of care for those put out on the street by the state varied widely from county to county. The counties got the job, but no money to accomplish the job. Local county government didn't allocate funds, so in a lot of California counties, only a token effort was ever made. There would be a County Department of Mental Health, but getting treatment there was almost impossible.

The state emptied out its public mental hospitals, bad as they were, and just put people out on the street and told them to get care in the community. The result was even worse than the horrible hospitals.

The state of mental care for the uninsured and/or poor, in Texas, is deplorable.

Instead of building on an established framework of institutions to broaden a transitional plan from institutional care, rehab programs, living skills programs and community based support systems - when feasible - he simply walked away from it all. Counties and cities weren't equipped to meet the needs of people.

The fall back option that was the result - the street, County jail, 24-72 hour hold at limited County mental health facilities, etc. Some non-profits stepped up to help out. They've been fairly successful for those who can rebuild a life with professional, family and social support. For others the options were, and remain, severely limited.

And the psych-techs, etc., are having to work in environments where security isn't always sufficient. We've had a couple of killings, and several serious assaults at Napa State in the last couple of years.

But unfortunately... help for the mentally ill doesn't have billion dollar lobbying firms.

The state hospital outside of New Orleans was a wonderful community.

Some had lived there their whole lives. They had farming, were often involved in a significant way in the running of the place and many had specific jobs that utilized their talents (like the organist).

I saw many of these patients come completely apart when they were deinstitutionalized. While community based treatment can be much better in theory for many reasons, the reality was that there was not community based resources to accommodate these people.

It remains a problem to this day.

One last thing is that the rate of recovery for patients with chemical dependency is positively correlated with residential treatment and virtually nothing else. The sad irony is that residential treatment is the least accessible treatment in the system in most places.

...had its own farm, dairy, shops, etc., and substantially reduced the cost of operating the place.

I would think being involved in some kind of productive enterprise would be far more humane and beneficial than being confined to the wards all day.

I remember the first time I met the organist. He had not had access to an organ since they discharged him. It was the one thing that gave him peace and joy, and he was simply lost without it.

It was then that I reevaluated my position on deinstitutionalization.

has got to be better than eating out of garbage cans, sleeping out in the elements, and dying under an overpass somewhere.

It is our national shame that we treat the most vulnerable portion of our population the worst.

And little to nothing is being done.

than treated. Before today's psychiatric medications, there weren't a lot of choices of how to treat people with serious mental illnesses. Now there are, but we don't have programs available to actually get those medications and care to those who need them, but can't afford them. The old-style public mental hospitals were horrid places, almost universally. Underfunded and understaffed, they simply sedated the patients there and herded them around and tried to keep them quiet. That wasn't treatment.

What's needed isn't institutionalization but actual treatment by qualified professionals and provision of the required medications, even if the patient cannot afford them. There's also a need for inpatient facilities, also available regardless of the ability to pay, where people can be moved from crisis to stability. We also need adequate housing in the community for people who cannot reliably maintain employment due to their illness.

The old style of institutionalization was cruel, inhumane, and should never be brought back to life. We need a new way to help people that actually helps them, not just keeps them out of sight.

meds, but need supervision to see that they take them as prescribed. They have a tendency to quit taking them when they feel better.

I don't have any suggestions for that. However, if medications are affordable or provided without charge, people are more likely to continue taking them. Also, medication management by professionals should always be looking for non-compliance due to negative side effects and work on adjustments or changes that will help with those.

There are many, many issues involved with care of mental illnesses. A caring, intelligent family is the best thing, but that's not always available.

to make them. Unless a crime is committed, and compulsory meds are given. But even here, once the sentence/probation ends, the patient falls back to the same routine of refusal. I've seen this first hand.

Mental patients got a much needed boost in constitutional rights; it was a liberal issue 50 years ago. But perhaps there are consequences when such notions as institutionalization, taking meds, orders, etc. are contingent upon committing crimes. And if the crime is bad enough, you get "institutionalized" in a big way.

My grandma lived alone. She owned her home and had a good pension. But she also had very serious mental health issues. The police and paramedics were her most frequent visitors. She never wanted family around and was quite vicious to my mom. Every couple of weeks she'd create some disturbance, or she'd go out looking like a deranged and dirty bag lady (which she was) and somebody would call 911. Eventually she became extremely combative whenever the police and paramedics showed up. One day they'd had enough so they dragged her out of her house kicking and screaming and biting all the way, strapped her to a board and dropped her off at the hospital.

Her house was unbelievably foul and the health department declared it uninhabitable. One of the first things my mom had to do was find and drag out my grandma's cat, a wild creature which was just as bad tempered as my grandma. (I still have scars from that cat...)

My grandma never did go back to her house. My mom would find care facilities for her, but eventually she'd get kicked out, or the staff would start returning the abuse my grandma dished out. Then grandma would have to come back and live with us. The only living creature happy in our house whenever grandma was there was the cat who'd happily leap off grandma's lap and attack anyone grandma couldn't hit or kick from her wheelchair. Grandma did have occasional moments when she was "grandmotherly," and I try to remember those, but her cat was always trouble.

Setting up social services to deal with people like my grandma is a difficult problem. But when you look at all the resources we throw into the military it doesn't seem to be an impossible problem. We could train social workers to deal with the mentally ill and the drug addicted, and we could build comfortable community facilities where they could live under appropriate and humane levels of supervision. As a society we simply have to commit ourselves to doing that.

Napa State Hospital used to have a dairy, farm, and some other enterprises designed to help provide for the material needs of patients.

This approach might very well assist in recovery, as long as the work was voluntary.

be treated like a human being in a hospital, not parked in some god awful institution as in days of old.

Deinstitutionalization had it's heart in the right place but never did make accommodations for those who were released.

Many were just dumped into communities where they had not the first clue how to survive.

And the problem remains.

There are lots of mentally ill people who have been helped greatly with therapy and medication, and do just fine in normal society.

Even addicts to hard-core opiates or stimulants can live normal lives if they were given access to injection clinics. Give them the opportunity to break the addiction, but if they can't do that, then I'm for giving them maintenance doses under medical supervision.

Injection clinics have been tried in the UK, Switzerland, Canada, and they work! Crime dries up, the addicts, though still shooting up, get clean needles and pharmaceutically pure drugs in controlled doses, and they can hold down jobs and be productive members of society.

I'd say keep institutionalization as an option, but only as a last resort. What these people need is in-community support. Injection clinics for people with addictions, community-based mental health care and medication for those with other mental illnesses. Most of the time, if they get that kind of support, they'll be just fine. The problem is they don't get that support. They just get dumped on the streets with no access to proper care.

I'm an RN and work in a city-hospital. We have LOTS & LOTS of drug addicts & alcoholics who come in. If they're in for an illness & need their DT's treated, I feel like we owe it to them to give them whatever they need to avoid a crisis while they're here.

HOWEVER, some patients come in for an appendectomy, for example, and they go into DT's or drug withdrawal while they're here. They have NO intention of stopping their alcohol use or their drug use upon discharge. It is our responsibility to keep them safe while they're here, but we can't be their nannies and hold them forever because they "may" use upon discharge. They must want treatment for it to work. Simply drying them out and holding on to them doesn't do them any good. They'll use as soon as they can escape.

Am I saying we shouldn't treat patients, based on their ability to pay? Absolutely NOT. I feel like healthcare is a fundamental right. What I AM saying is that SOME patients do NOT want their addictions treated, and it is a waste of precious time & resources that we, a state-run facility, do NOT have.

For health insurance companies.

My son had inpatient treatment in 2005.

At first we didn't know what to do. (He was huffing duster among other things)


Fortunately, we were able to find resources very quickly.


Also many substance abuse cases are often given treatment options via the court systems.

We support a harm reduction continuum - from safer use, limited use, to abstinence and all points in between. We aren't professionals in the chemical dependency field, though. Our primary role is limiting spread of HIV/HCV infections at the transmission source - the syringe. It's a clear, simple focus.

Yet the question of treatment routinely comes up among our clients. We do our best. Often refer to the STD clinic across the street. There's a Public Health nurse we work with there who's keen on connecting people with resources. She'll do a screen, per the regs, but will go a bit further to help link her patients with some other options.

In-patient referrals are almost non-existent. You need money to get in to those well known facilities. So we refer to local resources - County mental health, County drug & alcohol services, AA, NA, etc.

And we all work and build on a bottom line of trust. It's been hard to establish among us all. Trust is a thing often overlooked in this situation.

Historically housing for chronic alcoholics has been contingent upon sobriety. This often left these folks out on the streets when they relapsed or ineligible for services if they refused to comply with sober living. Some studies are now indicating that these kinds of housing options are quite effective in decreasing alcohol use

http://healthland.time.com/2012/01/20/the-wet-house-homeless-people-with-alcoholism-drink-less-when-booze-is-allowed/

As far as individuals with Chronic Mental Illness, housing should be a key in providing adequate wrap around community based treatment. Alas there is never enough money to provide the kind of services and actual housing for those who are difficult to treat. In addition to community opposition to housing in residential communities, the reality is that "recovery" from mental health issues is a complicated and very individualized process that involves the kind of support systems that are hard to develop and fund.

As an ex-bartender, I always felt some of my more alcoholic customers would have done better if they could have had something a little less strident as their rehab when circumstances forced them to sober up.

HUD housing is supposed to be inspected annually, to prevent just this kind of situation.

Sounds like what she needs is some heavy-duty detox rather than prolonged or repeated institutionalization.

however I definitely think that some of them are incapable of caring for themselves and they need to be taken in and cared for.

(I do not want to see the hell-hole type institutions that we used to have in this country though.) My grandmother had 2 sisters who were placed in those they had epilepsy which was not understood in those days. Very sweet loving and beautiful little girls who were put in a hellish institution where they died because no one understood how to treat their seizures

However, what is happening now which is no care whatsoever other than what happens in the ER isn't a solution either.