RobWipond

This is a complex topic, but a few issues that don't often get mentioned... Every study that looked at deinstitutionalization found that virtually none of those people ended up homeless or imprisoned. Other factors account for rising homelessness. Very few people refuse decent permanent housing. But another problem is, much housing being offered requires compliance with treatments. "Housing First" -- housing without treatment compliance, but voluntary supports, is a better approach, and more effective. "Care", unfortunately, is not what forced treatment typically involves -- it's often very aggressive and many people want to escape it.

I would not mind it if they also openly disclosed: "Please be aware that, if you call this phone number, your call may be traced and you could be subjected to a police visit and forced psychiatric hospitalization. The policies and circumstances under which this might occur are unfortunately broad and vague." It bothers me even more immensely that, on the contrary, many news stories deliberately lie and mislead about this issue -- I've tried to get some corrected by contacting the journalists and editors with the evidence, but I've only rarely succeeded.

Yes, I read that book, and I talked with people from NAMI, I examine the issue of the role of involuntary treatment amid family conflicts at some length. And yes, I show in the book that it's often relatively easy to get people detained--and that's part of the problem, because then there aren't beds left for those who might really benefit. The whole process is very unscientific, and legally vague, and so people on all sides become frustrated. More voluntary options and supports would help a lot.

Oh, yes, this happens A LOT. And I discuss it in my book, yes, with examples. It's so common it even has a name in the scientific literature "diagnostic overshadowing." The American Association of Emergency Physicians issued a couple of massive reports not long ago reviewing the extent of the problem, and calling for some sort of standards to ensure doctors and nurses actually test people for physical conditions before diagnosing them with mental illnesses, because many common (and uncommon) physical diseases and problems create "symptoms" like depression, extreme anxiety, hallucinations, and more, and many studies show they're missed. As in, the MAJORITY are being missed, and people are getting labeled and forcibly treated with psychiatric treatments, sometimes for years, never getting the actual physical cause identified and addressed until much too late. I have some tragic cases like these in my book, too.

And actual studies have consistently found that Housing First maximizes how many people stay housed. Canada did it across five cities. The VA has instituted it. European countries have had success. I have yet to see a single "abject failure" identified in formal studies. Even knowledgeable critics often just criticize that it does not increase treatment participation a lot--but it does keep 80-90% housed.