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So a Federal spending bill from 40 years ago is to blame for the droves of insane and/or drug addicted people living on the streets of San Francisco, LA, San Diego? Did it do something to prohibit the state of California from solving the problem on its own in the last four decades? And none of the other subsequent state or federal administrations that could have restored that magical problem solving funding are to blame? Or, rather, has oodles of cash been thrown at the issue by all levels of government to no avail⌠For example, The LA Homeless Service Authority spends a billion a year in city, state & federal funds with a miniscule success rate. But blame Ronald Reagan.
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Last post from me on this topic b/c Iâve already gone too far astray, but, respectfully, Iâm not quite sure what the relationship is btw what youâve stated and conservatorship.
The LPS Act is what governs involuntary hospitalization (and conservatorship is only one part of that Act). Involuntary hospitalization is technically not allowable if the only issue are substance abuse issues. But that might be clinically impactful because lengthy hospitalizations are not thought to be a particularly effective treatment for âpureâ substance abuse.
Iâve treated plenty of wealthy people, too. I can assure you that their addiction issues do not resolve anymore quickly than those who are unhoused. They just have the resources to hide the issue from others (including the general public) more easily.
Substance abuse is an extraordinarily difficult issue to treat, and anyone even implying that it would be resolvable if they (either the provider or pt) could just access the ârightâ treatment is⌠naĂŻve, at best.
Iâm not sure if you (or the doctors to whom you have spoken) are operating under the assumption that substance abuse is a major cause of homelessness?
While Iâm sure there are some homeless people for whom substance abuse is the primary issue, I think a lot of those who are homeless were using drugs to help them cope w/ the homelessness and/or whatever the primary issue was (such as psychosis). And, given the methodological problems involved in studying mental health issues in the homeless population, I would be very surprised if they were any high-quality data suggesting otherwise.
Lengthy hospitalizations might be helpful for, say, primary psychosis, but psychosocial treatments and long-acting injectables (all of which can be administered on an outpatient basis) can result in long-term stability. If someone has a strong history of being repeatedly admitted, the treatment team can apply for LPS conservatorship so that treatment such as long-acting injectables can be given involuntarily. So conservatorship laws donât really interfere with that, either.
In CA, at least, the LPS Act is written in such a way that those are âgravely disabledâ (and much of the homelessness population might match this definition) are actually eligible for the longest involuntary hospitalizations.
In short, Iâll put it this way: while Iâve frequently thought over the course of my ~15-yr career that insurance (and the financial resources of a patient, b/c of how screwy insurance is) really interfere with effective treatment, I cannot say that I have ever thought that the existence of the LPS Act greatly interferes with effective treatment.
Iâm guess Iâm trying to say that I really donât know donât quite understand what the doctors who youâve spoken to are getting at. But, again, the laws in your state might be quite different.
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Particularly in light of the following, from wikipedia:
âIn response to the ensuing homelessness crisis of the 1980s and after many years of advocacy and numerous revisions, President Reagan signed into law the McKinneyâVento Homeless Assistance Act in 1987; this remains the only piece of federal legislation that allocates funding to the direct service of homeless people. The McKinneyâVento Act paved the way for service providers in the coming years. During the 1990s homeless shelters, soup kitchens, and other supportive services sprouted up in cities and towns across the nation. However, despite these efforts and the dramatic economic growth marked by this decade, homeless numbers rose and remained high from 1990 to 1999 according to the âcoalition for the homelessâ webpage. {{[38]}} It became increasingly apparent that simply providing services to alleviate the symptoms of homelessness (i.e. shelter beds, hot meals, psychiatric counseling, etc.), although needed, were not successful at solving the root causes of homelessness. The United States Interagency Council on Homelessness (USICH), a federal agency contained in the Executive Branch, was established in 1987 as a requirement of the McKinneyâVento Act of 1987.â
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Iâm not a medical expert, so I am sure I am doing a poor job of summarizing the nuances of their points, but we donât seem to be saying much different, at least as far as root causes and the relationship to the earlier discussion here regarding housing pricing.
That is to say that mental illness and addiction is a primary factor in homelessness, treatment for those is a long term process, and the current system does not adequately provide long term solutions, but rather spits them back out on the street immediately.
Thats a medical issue, not a housing issue.
The doctors that i have heard speak on the issue are in California.
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The politicoâs answer for it is, wait for it⌠âlegal injection centersâ. How brilliant an idea that is.
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This is another one of those questions that essentially boils down to a couple simple options. For this small segment of the population state/federal government pays to house the people in a crummy apartment (and give the drug users heroin ), incarcerates them or provides them the medical care to allow them to live as independently as possible. Or of course just let them live on the street.
There is no market based solution to house drug addicts (until they are rehabilitated) or the 1% of the population that are mentally incapable of working.
Want to know what the cheapest option is to clean the streets up? Give the drug users free heroin and a crappy apartment. The Dutch figured this out years ago. Proper healthcare costs a huge amount. Putting them in prison is a $30k plus per year per person proposition.
There isnât an easy solution. Itâs pick your poison. Every option is either unpalatable or very expensive.
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I know I said I was done, but my clarification will not be as long winded as my other posts (I hope). 
And I am learning quite a bit from the thread.
Well, possibly, actually. Iâm not familiar w/ the intricacies of the Omnibus Bill from 1981, but it apparently cut funding for nursing homes that also treated people who were primary mental ill (and required that the patients have significant medical issues). States canât re-define something explicitly stated in a federal law. And if you were counting on tens of millions (if not more) per year from a source, itâs not really possible to make up that kind of windfall w/o significantly raising taxes (and we all know how popular that is) or cutting funding from other program.
And Prop 13 has really screwed up the stateâs revenue stream for about 50 yrs (and countingâŚ).
I am familiar w/ the other things mention in the thread about this sub-topic, but I was not familiar w/ this Act at all. Itâs actually rather hard to find much info about the original version that passed, since whatâs easily accessible on the internet is basically a repeat.
From the little I can find, whatever Reagan signed was apparently only a small portion of what had originally been proposed. And, assuming I correctly access the proposed bill, it doesnât do much in the way of concrete action.
Academic writings about the Act only reference its effect on public-accessible education for homeless children (most of which came from amendments in subsequent administration), so I am actually unsure that the original bill did anything at all.
I actually do not know if drug use is a primary factor is homelessness. I think it is a strong co-occurring factor, which is quite a different thing from it being a primary facator.
The system makes it more profitable to spit them back on the street more quickly. It certainly does not mandate it, and there are definitely work arounds (that are actually encoded in law and thus are not a secret) in many situations.
I guess a strong secondary point I was trying to make is that I do not know the motives of why the doctors youâve heard do not use, have not discussed, and/or do not advocate for strengthening those parts of the law.
Yes, I agree with that. Having said that, I was not under the impression that politicians (at least in LA, where I cannot escape the election ads) were strongly tying the housing crisis to homelessness specifically. I was under the impression that the some of the general public was making such associations (and I agree that association is completely stupid).
I originally found the idea of needle exchange (which is a step removed from government funded drugs) to be quite challenging.
But then you work w/ IV drug users for even a relatively short period of time and discover that the biological imperative for them to use is so strong, that you might as well help to curb the negative behaviors associated with IV drug use (b/c you really cannot stop the IV drug use itself).
I am not advocating for or against socialized medicine, but one advantage of socialized medicine is that itâs generally much easier to obtain data to help determine if such programs are effective.
[quote=âEC99, post:40, topic:436246â]
Exactly. Thatâs why I find the usual conversations about these issues to be so frustrating. I want to tell people, âFolks, the solution ainât gonna be prettyâŚâ
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If you listen to CA politicians, they will tell you that homelessness is exclusively a housing issue and that the mentally ill/addicts are an inconsequential fraction of the homeless population. To the point of actively blocking many of the medical treatment based solutions.
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Even renaming it âunhousedâ versus âhomelessâ. Words do matter, and more attention should be paid to words with an agenda behind them.
It was offered as a simple refutation against a pointless blaming, when I believe we can all agree the issues themselves are not âpartisanâ, insomuch as the solutions may be. I gather from a quick follow of your link that this act was funded for two years, established a federal advisory council which forced states to report to, and largely bolstered existing systems (possibly establishing a few along the way), but my takeaway is this is the most prominent federal legislation passed by Congress directly addressing the homeless crisis in the late 1980âs. I can confirm SRO unit occupancy exploded in the tenderloin, china town and Civic Center/upper Market areas during this time, and the City âseemedâ to be cleaning up its act. It still had a long way to go to get where it is now, as untreated wounds tend to worsen.
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Poor and on drugs.
Wtf does any of this have to do with WFH 
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Since Iâm likely the one that fully derailed the WFH topic, Iâll try to fixâŚ
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Thereâs a recycling joke in there somewhere but I wonât point it out.
Reagan was a good president, and I voted for him, but his and. Nancyâs attitude toward the homeless and mentally ill was the blight on his presidency. But if you want to deify him, have at it. The democrats have been useless as well
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Outpatient clinics are âover staffedâ? Perhaps you meant understaffed??
Yes, def meant understaffed. Thanks for the correction.
Well, there was whole AIDS things, too, but thatâs a story for a diff day.
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Never a bad time to rewatch âAnd the band played onâ or âAngels in Americaâ.
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kind of late to the game supporting soup kitchens after doing this:
" Reaganâs mass purging of mental health hospitals first began when he was the governor of California. As governor, Reagan threw more than half of the stateâs mental health patients out of hospitals and onto the streets. He abolished the hospitalsâ ability to institutionalize patients with severe mental illness. With nowhere else for these mental patients to goâmost with disabilities that prevented them from workingâthey simply became homeless.
As a result of the actions of Ronald Reagan and others like him, Americaâs mental health system as a whole deteriorated so much that Congress was compelled to act. President Jimmy Carter signed into law the Mental Health Systems Act of 1980. The legislation sought to reform and rebuild Americaâs mental health system by developing community mental health programs and provide mental health services for Americans suffering from chronic mental illnesses.
Curiously enough, one of the first major legislative actions Reagan undertook as president was to repeal this reform of Americaâs mental health system and slash federal funding for mental health care by 30 percent. As his presidency progressed, Reagan continued his former practice of throwing patients out of mental health hospitals, albeit on a much grander scale than what he undertook as Californiaâs governor. During his presidency in the 1980s, some 40,000 beds in state mental hospitals were eliminated.
During the aftermath in 1988, the National Institute of Mental Health estimated that 125,000â300,000 mental patients with chronic mental illness were homeless.
As a result of Reaganâs actions, Americaâs mental health care system remains debilitated. Despite lawsuits, states like Nevada continue to illegally empty their mental hospitals and place their mental patients on buses that take them out of state, thus avoiding the bill."
or the astrology thing. or the alzheimers/dementia thing. or the creating Al-Qaeda thing. or the Savings and Loan scandal thing. or the Keating 5 thing. or the Iran-Contra thing. or the supporting South African apartheid government thing. or the crack/cocaine epidemic thing the CIA started thing. or several of the other awful things he did that iâm too tired to bother typing out.
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Iâve discussed this recently with a buddy of mine and he heard a podcast where dealing with government assistance is way more expensive to build housing than getting private investors.
Reading all these posts makes me think that we can do better without the red tape.
I think that homelessness is a tough issue to tackle like mass shootings⌠there could be a mental health component thatâs not easily solved by more housing or gun control.
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