Monday, January 7, 2013

Politics And Mental Health

A few weeks ago, Indigo Red left the comment below to this thread here at Always On Watch (emphases mine):

The roots of the current problem go all the way back to the Eugenics Movement that spawned the Holocaust and Planned Parenthood.

"It is true Gov Reagan did gut funding for state mental hospitals, but was forced to do so by court decisions ruling that the mental health patients could not be confined without patient consent or due process. Previously, people could be detained and institutionalized for any number of reasons and often for no good reason.

In an attempt to find alternatives to the eugenics movement that contributed so much to the Holocaust, a federal mental health study was begun in 1955 resulting in the 1963 Mental Health Act as part of John Kennedy's New Frontier. From this came multiple court decisions emancipating the mentally ill from the vagaries of the law and the shame of families with mentally ill members. Because the decisions were Federal and states are always trying to save local money, the Federal gov't then became the funding agency of first resort while states cut back on local funding. The Federal budget was not large enough to cover all the new fiscal demands of the new found mental health gold mine limited the resources to the states. (Lesson for ObamaCare.)

While Reagan was governor (1967-75), a Federal court ruled in Jackson v. Indiana (1972) that due process required the commitment for mental health treatment also required adequate and appropriate treatment must be provided - the mentally ill could no longer be warehoused for the safety of themselves and society, they must be treated in preparation for release to the general population and several lower courts recognized the due process right of the mentally ill. In that same year, Gov Reagan signed the Lanterman–Petris–Short Act effectively doing what the O'Connor v. Donaldson ruling would do nationwide in 1975. The LPS bill had bipartisan support and was widely lauded by the left as a civil rights masterpiece. The ACLU argued for the end of forced institutionalization of harmless insane people. Ronald Reagan argued just the opposite, but was compelled by the courts to release the harmless mentally ill without any guidance on what harmless meant after hospitalization and medication. It was, in fact, assumed that the mentally ill, when returned to sanity, lucidity, and reality, would voluntarily continue their treatment and medications never wanting to go back to crazy. Boy, were the experts ever wrong.

As President, Ronald Reagan repealed the Mental Health Systems Act by signing the Omnibus Budget Reconciliation Act of 1981 consolidating ADAMHA's treatment and rehabilitation programs into a single block grant enabling each State to administer its own allocated funds. The repeal of the community mental health legislation and the establishment of block grants, the Federal role in mental health services changed once again from funding to providing technical assistance in increasing the local providers capacity for mental health services to a population of growing mental health concerns because of the continued redefining of and addition to mental health disorders.

Once the funding responsibilities of States had been taken up by the Federal government and the States having found other uses for the money formerly used for the mentally ill, States were reluctant and loathe to finding new State funding or dropping other programs to re-fund moribund mental health programs. And now we're stuck with mentally ill people without help, without the wherewithal to request help, and a society so increasingly frightened of the mentally ill they are threatening to disarm in the face of danger and at the same time take to the streets with pitchforks and torches to chase down and slay the monsters among us. What a fine mess good intentions have left us."

AOW, I have a cousin not much younger than myself who has been mentally ill for as long as I can recall. As a child he would beat his head against walls and his family thought it was cute as did schools and doctors. Eventually after many years in and out of prison and mental hospitals, and not being able to find adequate help, he took control of his life the only way he knew how - with a screw driver in his hand, he faced two police officers in an alley who shot him 7 times. He survived, but since that time almost 30 yrs ago, he has been in prison for psychiatric care. It's where he wanted to be -- or dead. He's been diagnosed as autistic and schizophrenic and had been before such diagnoses had been possible.

As the above words by Indigo Red indicate, the law of unintended consequences has reverberating effects that can direly affect society — effects that reap the whirlwind.

Now, how do we remedy this mess? Or CAN we remedy this mess and, at the same time, safeguard individuals' rights?

49 comments:

  1. IMO, it's not the federal government's job to "remedy" this problem. If the State's want to tackle it (or not), THAT is their prerogative.

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  2. ps - Federal funding of "civilian" health care needs to end. This includes the USPHS, Medicare and Medicaid.

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  3. Regardless, money for Health Care should flow through the states and private organizations. If the states want to "pool" their money and establish a CDC equivalent, that's THEIR business, not the federal government's.

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  4. I thought this post was going to be about how politics and mental health are mutually exclusive...

    Yes, our feral government is the king of unintended consequences.

    Anyone see the article about how cash for clunkers was an environmental disaster?

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  5. "Now, how do we remedy this mess? Or CAN we remedy this mess and, at the same time, safeguard individuals' rights?"

    We cannot solve this mess and safe guard individual rights. There is too much art and not enough science in the mental health field. As long as there is any subjectivity in a diagnosis, individual rights can not be protected.

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  6. People who have proved themselves to at least ten witnesses incompetent to live as non-violent, self -sustaining, contributing members of the community should not have any "rights" other than the right not to be subjected to cruel, abusive policies in the institutions to which they ought to be confined.

    In other words the Nurse Ratched's of this world ought, themselves, to be put out of circulation.

    Those who want to harm THEMSELVES should be permitted to do so without interference.

    Those who want to harm OTHERS should be confined and frankly would be better off dead.

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  7. My friend, Emily, as usual, covers it neatly, elegantly and succinctly:


    The Brain, within its Groove
    Runs evenly — and true —
    But let a Splinter swerve —
    'Twere easier for You —

    To put a Current back —
    When Floods have slit the Hills —
    And scooped a Turnpike for Themselves —
    And trodden out the Mills —


    ~ Emily Dickinson (1830-1886)

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  8. I watched a good program on Discovery about mental health in Spain and how they care for those with mental health issues.

    Basically it is divided into three responsibilities but with a national mandated provision regarding danger to others (and themselves).

    Basically the law says that the National Government must provide a minimum standard to mental health and yes they have a quasi-socialist sytle of health-care funding rather like Obamacare. That means diagnosis and basic medicine coverage BUT no institutions.

    The Regions (our equivelant of States) takes care of institutions and care BUT not diagnosis or medicines. The problem is that the States have differing standards and basically it is poor in quality in most cases.

    The third option is private or non-profit organisations. In that case there is the best hospitals that money can buy or, as in most cases, run by the Catholic Church and thus subject to their standards, policies and opinions to what is good health care treatment.

    The National Mandated Provision though is the benefit that Spain has and I think a critical solution.

    Regardless of the conditions and who is caring, every person who has been deemed to have a mental health condition (even temporary) must be valued by a tribunal (a judge, a member of the ministry of health and the professional caring for that person) to deem how much that person is a danger to that society. If they are a constant danger they will be instutionalised and to varying degrees up to being sent home. The level of access to weapons, prescriptive drugs and even curfews and access to public transport all can be controlled. It is automatically reviewed annually. The National government pays for it.

    Steve M

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  9. The problem is that even if you wanted to do something about it, you don't have any money to do it.

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  10. It's always the unintended consequences, when government steps in (where they have no right stepping in), then everyone wants the government to do something else, to fix what they broke in the first place, there is no end to it.

    Daniel Greenfield has a great article (all of his are great) today, THE CIVILIZED SAVAGE, below is the link and a quote. Worth the time to read it all.



    QUOTE

    Most contradictory of all, he believes that the sum of civilization lies in dismantling the military and industrial infrastructure that makes civilization possible and replacing it with a trillion dollar social organization that will reproduce some natural primitive order, as defined by the proverb, it takes a village to raise a child, a proverb that like the rest of his ersatz savagery he invented himself.

    END QUOTE

    http://sultanknish.blogspot.com/2013/01/the-civilized-savage.html

    Debbie
    Right Truth
    http://www.righttruth.typepad.com

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  11. The job of our government is to protect and serve the people. This is why it's in charge of military matters and why we have a National Guard.

    Mentally ill people cause a lot of harm to others, and either they get locked up and treated whether they want to be or not, or they end up being shot dead.

    Dealing with the mentally ill is part of our government's duties. Who else will do it? States do it according to their own views, which are generally in conflict with the views of other states and our Federal government, as well as the views of private treatment practicioners. Our government is inept about most things, undeniably, but at least there should be a central place to turn to when someone's growing instability is threatening those around them. State agencies can be helpless to intervene, or even unwilling to do so, in spite of an obvious need.

    It's either have our Federal government take on the job and prevent a lot of carnage, or wait on the really disturbed ones to get violent and kill, then shoot them dead in the streets or warehouse them as usual in our prisons.

    No one has any problem with police arresting people, the courts trying them and deciding who goes to prison. Why then would anyone get all puffed up over civil rights issues in the effort to keep nuts off the streets and into treatment facilities? We would all be better off for it, including those being treated.

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  12. By the way, that Emily Dickinson quote is total jabberwocky and utterly inappropriate to the subject at hand.

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  13. This comment has been removed by a blog administrator.

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  14. Debbie, do you want to go back to the days of lobotomies and shock therapy?

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  15. For what it's worth:

    ...[I]t is simply indisputable that most perpetrators of school shootings and similar mass murders in our modern era were either on – or just recently coming off of – psychiatric medications....

    More information at the above link.

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  16. TO ALL:

    Pardon my lack of participation in this thread. I had a day filled with doctors' appointments yesterday and got somewhat disquieting news from my neurologist and didn't feel much like blogging. When I'm ready, I'll post about what the neurologist said and the upcoming diagnostic tests.

    Anyway....

    The classes I teach resume today. I'll be back to this thread late this afternoon. In the meantime, discuss the topic of this blog post as much as you like.

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  17. what struck me is the reason Reagan acted as he did to the mental hospitals, etc. He has a terrible rap here in LA, or did until we got the homeless pretty much off the streets in the last few years; and the truth gets ignored. I didn't know that about being forced to by the courts, etc. This is another typical leftwing misrepresentation which usually goes uncorrected and people learn that as history.

    I don't know how we remedy this mess; having no funding ANYWHERE anymore because we've been driven into being broke as a country, we have no funding for much of anything but entitlement seekers and bailing out companies which then fail but once supported obama, so...
    well, it's the truth!

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  18. Lets step back a bit so we can look at the issue without bringing "government" into it.

    When we use terms like "mental illness" we obviously think "sickness" and naturally expect a pill to make things better.

    When we talk about something called "the autism spectrum of disorders" does anyone have any idea how broad that spectrum is?

    Like my sister says (she has a son who is non verbal autistic) anyone can get a diagnosis of aspergers.

    One of the hardest things to understand is that once the brain is damaged, and this is true even for people who overdose on prescription drugs, its damaged forever.

    Yes, medical professionals love to push the belief that there is a drug, or a combination of drugs that make a difference. Then they rely on observations of the caregiver to determine if there has been an improvement (like the caregiver is an objective source).

    The reality is we need to develop a system for mental health as we have none right now. A system that allows for at home care, assisted living care, nursing homes, and then psych wards.

    Something more in line with our system for senior living.

    If we think along these lines, then we can jump to the discussion of freedoms, government, and costs.




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  19. I'm not a fan of Geraldo but he did an extraordinary thing by looking into what was going on at WillowBrook State School, a state-run institution in NY for people with mental disabilities. He pressed government officials to look into the disturbing reports or accusations of what was happening inside the institution. Through Geraldo's live broadcast expose of Willowbrook institution he was able to get the place shutdown.

    Here is a preview of the documentary.
    http://www.youtube.com/watch?v=k_sYn8DnlH4

    Here are two clips from the documentary.

    http://www.youtube.com/watch?v=dbiYJkiX-Dg


    I'm not sure closing these institutions down was the correct course of action. Obviously the mistreatment of these individuals needed to be addressed, and those responsible be prosecuted, and major changes needed to be made to the way that these individuals were cared for but I'm not sure closing the institution down was the right way to go.

    There has to be a way to get an individual evaluated if you suspect they'll do harm to another or themselves, or even if they just need serious help but are not quite to the point of hurting others or themselves without getting them committed to an institution. There has to be a way for these people to get help without violating their rights at the same time. But the safety of persons in our society does also need to be considered but it must respect the rights of individuals.

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  20. Most mental illness is an extreme form of self-centeredness. Ether spoiled children who never grew up wanting to remain spoiled and acting outraged when society fails to roll over and play dead to serve their needs, or else neglected or abused children who can't think of anything but their desire to take revenge on a society that failed them.

    Being mentally ill became fashionable after Freud.

    ------------> Katharine Heartburn

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  21. Excellent article, AOW. Back in the day, it seemed ridiculously easy to have someone institutionalized. It was a shameful time, and in the last thirty or so years, there has been no improvement in the care of the mentally ill as I can see.

    I don't think Reagan did the right thing. Also, I think that in the case of the mentally ill, as a society we need to take care of them. Conversely, if the involved family is well off, they need to support their family members, too.

    In the specific case of Newtown, we knew who the killer was years before the event. We just didn't know he was a real killer. There are literally thousands of these kids in the public school system, and they are in and out of trouble all the time.

    Private schools will not have them, and they are shoved off on the public systems. The public systems are legally required to care for them, even to the point of one-on-one teaching and supervision. However, these kids are shielded from the rest of the world because of privacy laws, litigious parents, and a society that doesn't want to know what is really going on.

    In most cases the public school system serves as a care system for some kids that should not be there at all. It is a publicly expensive baby-sitting service for many parents who have no other way to take care of those kids.

    Where is the mental health community on this issue? Why are we not hearing proposals from the mental health experts on ways forestall these murderous events?

    Unfortunately, it will be left to government to craft solutions. Government is the least competent institution we have.

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  22. Some people need to be institutionalized. Obviously, there should be a thorough vetting process for this, so people aren't wrongfully committed.

    That said, the facilities didn't need to go away, they needed to be reformed! Even in hospitals and nursing homes today, you can find deplorable conditions.

    With proper reformation, regulation and use, the institution is a necessity.

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  23. I had an aunt that literally went insane when her only daughter killed herself and my uncle decided to lock her up instead of getting the psychiatric help she needed to get through.

    The last time I saw that precious woman she was confined to a bed in a disgusting smelly facility and her care was minimal. She was pretty much ignored, so much that after all the electrical treatments, they fried her brain and left her a vegetable, but sadly she could still feel pain and would cry out when they did more horrible procedures on her. The last I heard, after YEARS of having a feeding tube they pulled it along with her insides.

    I actually was thankful to God when He took her home.

    This should have never happened and someone should have been taking care of her. All she needed was someone to help her through grieving process, but my uncle chose to lock her in an insane asylum instead.

    Thank you for this topic, because these are people that need help from family, friends and competent doctors and nurses.

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  24. "By the way, that Emily Dickinson quote is total jabberwocky and utterly inappropriate to the subject at hand."

    Is that so?

    I think you'd better read it again -- a little more carefully this time. Maybe it's meaning will penetrate with a little more study.

    If that doesn't work for you, perhaps you'd care to explain why you think the short poem is irrelevant? Your analysis should prove fascinating.

    ~ FreeThinke

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  25. ... or did until we got the homeless pretty much off the streets in the last few years; and the truth gets ignored.

    ---
    Where did they go? Brentwood?

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  26. ps - Federal funding of "civilian" health care needs to end. This includes the USPHS, Medicare and Medicaid.

    The logical conclusion to all the crocodile tears shed by Baby Boomers about the debt they ran up for their kids and grandkids.

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  27. Thank you, AOW. Glad you published my comment as a story. Had I put it on my blog, it wold not have been read by so many with so many excellent comments.

    I'd just like to add that I am on paroxetine, the generic Paxil, and have been for many years. Paxil was introduced in 1993 and I was prescribed 25mg 4/day in 1996 plus 10mg clonopin 1/day. In the first week, I had serious problems with suicidal and homicidal thoughts. In an extreme anxiety state, I returned the pills to the MD - actually I threw them at him. About three years later, I was represcribed Paxil by another MD who ordered 12mg 1/day. Currently I use 10mg 1/day.

    The original dosage was a massive overdose of 100mg per day and I have seen this happen several times with the users very reluctant to tell their doctors the dose is too high. A man I worked with was put on Zoloft and almost immediately wasn't able to stay awake at work or even do the work because his thinking was so clouded, but worst was that he became surley and aggressive. I convinced him to cut the pills in half for a week. He got so much better after that. He then went to his MD, explained what had happened and the dosage was halved again so he was only taking 1/4 the original dose. For the next two years we worked together, he was pleasant to be around and for the first time in his life had a stable relationship with a woman who eventually married him.

    This past several months, my mother struggled with her new diabetes medicine. In Dec, my oldest sister went to the MD with Mom where her meds were reviewed and the MD found her diabetes medication was twice the dosage it should have been and was damaging her liver, making her sick. She never thought to tell her doctor the meds were making her sick.

    Two problems are common to these experiences: doctors prescribing too large a dose without follow-up within 10 days, and reluctance of patients to question the doctor or inform them of adverse effects.

    All but one of the mass shootings in the past ten years have involved psychotropic drugs either on the drugs or not using the prescription drugs. Those who were on the meds, I'm just guessing here, were probably on much too high a dosage which can cause the very illness they're meant to alleviate. Those who weren't taking their meds, probably didn't like the zoned out, numb feeling of the high dosages and went back to the non-treated state which felt normal, but allowed the original brain chemistry defect to run free. Communication and timely response are so very important.

    The most egregious misconceptions of mental illness is that it's different from any other bodily illness. If we have a stomach illness, we involuntarily vomit. If we have a lung infection, we cough uncontrollably. But, no one thinks we should be put down pr put away, rather we treat the illness. My brain disorder is caused by a serotonin imbalance and slept for long periods when I did sleep, but seldom deeply. I was always tired and often mad, mean, and violent. From a very young age, I had thoughts of suicide, homicide, and physically harming others, but never had the means. Since the paxil prescriptions, I've sleep well, am happy, and people like to be around me now. Negative thoughts are rare usually extending to symbolic desires vis a vis Liberals and other stupid people. I just wish this drug was available when I was a child.

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  28. Tao,
    Thank you for stopping by and taking the time to comment. I appreciate it.

    When we talk about something called "the autism spectrum of disorders" does anyone have any idea how broad that spectrum is?

    I know quite a bit about the extent of that spectrum. I've done a great deal of reading on the topic.

    However, the fact remains that even the experts are in their infancy of knowledge about the human brain. Neuroscience is an ever-evolving field of expertise, and what was accepted as fact yesterday is obviously not fact today.

    The reality is we need to develop a system for mental health as we have none right now. A system that allows for at home care, assisted living care, nursing homes, and then psych wards.

    Frequent evaluations would be absolutely necessary. Just as with dementia due to old age, mental states fluctuate a great deal and sometimes very quickly. A person can seem fine and appear under control, but something else entirely is happening inside that individual's head. In the case of my mother-in-law, who has suffered from Alzheimer's for years, I've seen that rapid fluctuation for myself. Those with other mental disorders can do the same.

    A lot of "crazy people" never hurt anyone -- themselves or others. Furthermore, a lot of "crazy people" absolutely resist treatment or stop treatment.

    I have to wonder if we really have more people with mental disorders or if the medical professions are simply diagnosing more people as having mental disorders.

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  29. Indigo,
    Some mental illnesses seem to respond well to treatment, but a few do not. The problem is that the experts do not seem able to predict in advance if a person actually will become dangerous. And even in the cases in which the experts could see the danger, getting anyone involuntarily committed is a Herculean task. Meanwhile, the clock keeps ticking in the disturbed person.

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  30. Bob,
    You have made excellent points about the problems involved between mental disturbance and the education system. A lot of these kids are warehoused via education until a certain age, at which point they are "released" into and onto society.

    Why are we not hearing proposals from the mental health experts on ways forestall these murderous events?

    In my view, the mental health community needs to concentrate more on the causes of these mental disturbances. Warehousing, particularly as you described it, is a bandaid -- not a solution.

    Now, there have always been mental anomalies. I believe that Adam Lanza was one such anomaly. God help us if the numbers of such anomalies is high or continues to proliferate.

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  31. Indigo,
    BTW, Paxil can be a very effective medication. My father, who was mildly bipolar, was prescribed Paxil in his final years. The medication certainly improved his quality of life as he was less depressed and, therefore, able to participate in more family activities.

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  32. Leticia,
    Many facilities -- nursing homes and insane asylums -- are indeed as you described. Not as many are that bad now as compared to a few decades ago, but those horrible places do exist. My grandfather died in the 1940s in such a facility; he was mad as a hatter -- and homicidal -- because of dementia. But the way he was treated there! He did strapped down and screaming. That facility has been closed for many years now -- precisely because it was such a terrible place. Some 15 years later, my grandmother had to be confined in a private nursing home --a much better place, where she received the tender care and the medical care that she needed. We sometimes brought her home for the weekend, but keeping her at home was out of the question because she needed vasodilators, which, a the time, could be administered only by IV.

    It is ESSENTIAL that anyone in ANY medical-care facility have an advocate who will be aggressive in demanding proper care for a family member or loved one -- even in hospitals with top rankings.

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  33. FT,
    As a commenter above pointed out, once the brain is damaged, particularly in certain ways, the damage is permanent.

    PS: I get the relevance of Emily's words. ;^)

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  34. FJ,
    The states and private companies companies NEE to step up on this issue. The federal government is a poor manager -- that's for sure.

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  35. Steve,
    I am unfamiliar with Spain's approach. But what you have described does sound workable.

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  36. Right Wing Theocrat,
    The problem is that even if you wanted to do something about it, you don't have any money to do it.

    A valid point.

    The care of the mentally disturbed is expensive -- and labor intensive. Unless these people are confined to cages.

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  37. Katharine,
    Most mental illness is an extreme form of self-centeredness.

    I'm not sure that "most" applies, but "some" certainly does, IMO.

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  38. Black Sheep,
    at least there should be a central place to turn to when someone's growing instability is threatening those around them

    I'm not sure that the federal level can deal with the burgeoning problem. All those layers of bureaucracy! And the time factor! Wait, wait, wait. Delay after delay. One needs an expensive attorney to get much of anything done.

    In many metropolitan and suburban areas, there are social workers and adult protective services. How efficient are they? In my experience, not much.

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  39. Duck,
    It was not all sweetness and light

    Some change came for a reason


    Yes.

    Please see THIS. I am familiar with a lot of the details because my grandfather was briefly confined there because of his homicidal dementia.

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  40. Duck,
    PS: Because of the distance involved, none of us were ever sure what was done to Grandpa. **sigh**

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  41. Debbie,
    It's always the unintended consequences, when government steps in

    True.

    Clearly, SOMETHING needed to be done. However, I have to wonder what consequences still remain unrecognized.

    Let us fervently hope that Adam Lanza wasn't the tip of a terrible iceberg.

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  42. I'm glad that you refuted the old slander against Gov Reagan of California. To this day, Democrats dishonestly claim that Reagan "closed mental health facilities" and "threw mental patients out on the street."

    No, lawsuits and court decisions did that. Reagan had no choice but to comply. You can no longer "commit" someone against their will unless they have murdered someone or attempted to do so.

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  43. Z,
    We are fortunate that the vast majority of the homeless that you mentioned are not much of a danger in the way that Adam Lanza and others were.

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  44. AOW said, "It is ESSENTIAL that anyone in ANY medical-care facility have an advocate who will be aggressive in demanding proper care for a family member... "

    This is especially true when YOU are hospitalized for any reason. Make sure you have somebody watching out for you and advocating for your care. Nurses and doctors tend to respond to the loudest cries for help, and your advocate needs to make sure you get care, too.

    As far as old folks go, I have developed an opinion that the rest of the world should leave us to our Tennessee whiskey and what other drugs we want to make our days pass happily. That way we can just fade away in a cloud of euphoria on a perpetual high.

    With the Obama death panels staring us in the face, we need something else besides our guns.

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  45. "Where did they go? Brentwood?"

    They all got FEMA trailers and EBT cards.

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  46. Bob,
    One can set up a power of attorney and advance medical directive. Those documents really do work!

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  47. Thanks for the info I have a dear suffering from mental illness and its not a good look

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