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Zora Margolis's avatar

The over-medication of hospitalized patients resulted, years ago, in an abhorrence for forcing people to be medicated against their will. As someone who has worked in short-term involuntary psych hospital units, I have seen how difficult it is to give meds to someone who doesn't want to take them--it is a legal and bureaucratic nightmare. Someone who is in a floridly psychotic state does not have the ability to make informed consent, but many hearings must be held and hoops jumped through before the Dr's judgement that they need meds can be accepted. The pendulum swung so far in the diretion of patients' rights, that patients sometimes need to be restrained, or in seclusion to keep them from harming themselves or others, when a shot or a pill will return them to a semblance of reality. The pendulum has to swing back to the middle. Freedom is a very elusive concept when you are trying to help, or manage the symptoms of someone who has no internal capacity for self-control.

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Zora Margolis's avatar

Your analysis of how end-stage capitalism has fueled the crisis of homelessness is excellent, but there's more to it, that stems from the closing of state mental hospitals during the Reagan administration. Not only were the community resources for medical care and housing never funded as promised. The entire premise was based on the belief that people with chonic, severe mental illness would be willing to voluntarily take medication, and live in situations where they would be required to follow rules of behavior. As a retired psychiatric social worker, I can tell you that this whole model is a fallacy. A huge percentage of the unhoused and also those housed in prison are not willing to take medications to control the symptoms of their illnesss that cause them to be unable to manage their lives, or who often turn to alcohol or street drugs instead. Nor do they want to live anywhere that requires them to take meds, abstain from alcohol or street drugs, or follow basic rules. To solve a big part of the homeless problem, and the reality that our streets and jails have become de facto psychiatric facilities, mostly unmedicated, we need to re-establish state hospitals--hopefully more humane than those of the past. If the laws were changed to make it easier for a court to require a chronic miscreant to take meds, it might be possible for some to live in the community with adequate support services, and if they refuse, they live in the hospital. Some are simply too sick or disorganized to care for themselves and need to be mandated to live in a state facility. It is less cruel to make sure that the chronic, severely mentally ill are adequately housed, fed, clothed --and required to take medication--than it is to allow them to continue to live in bedlam and befoul the streets of our communities, even if that is what they prefer to do.

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