Lock Them Up! Lock Them Up!
No no, not them; the distressed people
Links are at the end, in solitary.
I climbed to the top of that thing pretending all the while that my legs weren’t saying Jesus, man, give us a break. On the way down, stepping off the very last step, one of my legs gave out, I sat down abruptly, and my backpack pulled me over and left me looking every foreshortened inch the turtled gaijin fool.
But that’s cool. It’ll make a good story to pass down through generations, how my son-in-law tried to kill me.
“The United States has barely any public mental health infrastructure, and as a result people with mental illnesses are often shunted into the prisons or onto the sidewalks.”
There’s a bi-coastal move afoot to restart wholesale involuntary commitments of people suffering from mental disease.
People across the political spectrum understand that our current system is ineffective, though they bring different levels of compassion to their analyses of the situation. Conservatives are primarily concerned with disappearing populations that they consider to be a nuisance and a menace. Most liberals understand that leaving people to suffer on the streets is inhumane, while treating people in jail is more expensive than simply doing so in a hospital — and both are profoundly traumatizing. But despite their differences, conservatives and liberals are increasingly united in their calls to return to the bygone era of mass involuntary hospitalization.
This is a mistake. In cyclical fashion, mental health reformers have promised that, due to the advent of some new technology or modality, mental illness could be cured, or even prevented from occurring in the first place. When these hopes are inevitably dashed, society falls back on warehousing people and keeping them out of sight. We now find ourselves close to a bipartisan embrace of the latter option.1
Zeb Larson’s Jacobin story offers a decent abbreviated history of mental hospitals and asylums and the horrors they often bred, and notes the good faith generally underlying both the establishment of the institutions—although he perforce doesn’t touch on the London hospital responsible for the addition of “bedlam” to our dictionaries.2—and the eventual emptying of most of them.
He also notes that although the drug store truck driving man3 is most often held responsible for the expulsion of mental hospital inmates into the general population with inadequate resources for ongoing care, other governors including Mike Dukakis enacted similar programs.
The practices of discharging people who need mental health care or substance abuse treatment or both onto the streets, or warehousing them in jails and prisons, are widespread and inadequately challenged or addressed.
Reformers who advocated for the closure of hospitals in good faith believed that people, once discharged, could quickly and easily integrate into the rest of society. Setting up any kind of social safety net never seems to have been a priority, and the ramshackle network of group homes and supported housing that exists has never been adequately funded. Architects of this system like Robert Felix conceded that they had oversold how easily it could be accomplished.
Instead of returning to mass forced hospitalization, we need to revise what we expect from deinstitutionalization. The deinstitutionalization framework is flawed because it has never incorporated the need for a broad social safety net. Proponents of deinstitutionalization dramatically underestimated even the medical care that would be available to people once they were discharged — let alone supportive housing, employment, and access to welfare.
Yr. editor has had the extreme good fortune, to some extent self-directed, to be funneled from the street into adequate-to-excellent mental health care and social welfare benefits. Housing, medication, therapy, an extremely modest but very helpful federal income stipend and other benefits are what keep me functional enough to write this stuff. I sometimes feel guilty for the help I’ve received because I’ve seen the consequences for people who don’t get it, either because there’s not enough of it to go around or because they’re unable to take full advantage of what is available.
Hospitalization might have been a good option for me on some occasions, but either it wasn’t available or I resisted the notion. (I did wind up in a 23-hour care facility a few times, but it had only had one room (with four extremely comfortable recliners because beds were statutorily forbidden) and one psychiatrist, and was often fully occupied. Still, the relief from being off the street—and the care of sympathetic nurses—when it did have room sometimes made me cry.)
To break out of this rut, especially as our society seems to be moving even further toward a disastrous carceral care model, requires building up systems of long-term care, as well as systems of housing and employment. This means no longer hiding the problem or warehousing it, but it also means moving away from optimistic hopes for quick-fixes and cures.
The shortfall in supportive resources for people who need them is obviously a matter of policy. (People will argue it’s a lack of money, but the money is determined by policy.) We can either spend the money to provide such resources, or maintain the unconscionable status quo, or return to wholesale involuntary commitments into hospitals or community clinics which will undoubtedly be themselves underfunded, as state and federal governments bicker about who shells out.
Dignity has been enshrined as a fundamental human right in other countries; nobody fully enables it, but we’re the most distant from it among developed nations.4
“Labor should never support privatizing public health care.”
The New York Daily News has a story on the efforts by New York City mayor Eric Adam’s and others' attempts to force city retirees into a Medicare Advantage plan.5
Adams and the heads of two large city employee unions say the move will save the city hundreds of millions of dollars while providing the same level of care as the current medical retirement benefits, while opponents argue that the private plan to be administered by Aetna will increase retiree medication costs and force them into limited insurance company provider networks.
The latter argument has the benefit of accuracy, in addition to which CVS-owned Aetna is among the majority of Medicare Advantage providers routinely found to be overbilling for services, although they’re not yet among the majority accused by the government of fraud.6
You know what would save the city a boatload of money on retiree health care benefits? Why yes: yes you do.7
Another money-saving scheme is subsidizing public medical schools, as France (about $500 in tuition annually, depending on currency exchange rates) and some other countries do for citizens. Although the U.S. has programs which will pay off medical student loans if doctors agree to a period of years working in underserved areas (see: Exposure, Northern), the large majority of doctors graduate with albatross-sized debt which not only drives them into pursuing higher-paid specialties, but influences their positions on whether universal health care is worth pursuing.
One has to think money in some form or another, from CVS writ large or Aetna in specific, has changed hands in New York City, and likely among some of the city’s elected congressional representatives as well.
Ah well.
Women beating the hell out of the drums
With one rule-proving exception, I think, the musical selections in the newsletter the past month or two have all been groups either fronted or dominated by women. Most of the bands have been new to me, as is the case today, when we have a lot of contemporary punk mixed with ethereal balladeering, sometimes in the same tune. The instrumentation in one of the bands includes a Farfisa organ, which automatically conveys acceptance in these quarters.
Tacocat, “This Mess Is a Place;”8 The Coathangers, "The Devil You Know;"9 Shilpa Ray, "Portrait of a Lady;"10 Skating Polly, "The Make It All Show;"11 The Darts (U.S.), "I Like You But Not Like That;"12 L.A. Witch, "Play With Fire;"13
That, Comrades, is all there is
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Be well, take care.
Even if it's a question of policy, it's still a matter of money. Getting the money, assuming the policy wants it, requires taxation of someone or something. Aye, there's the rub. You've noticed, no doubt, the ongoing dispute about the debt limit. I'm not disagreeing with you about what ought to happen; just noticing the obstacle and being of the opinion that the obstacle is not easily overcome.