Mental hospitals of the type I worked at when writing that post only keep patients for a few days, maybe a few weeks at tops. This means there's no long-term constituency for fighting them, and the cost of errors is (comparatively) low.
The procedures for these hospitals would be hard to change. It's hard to have a law like "you need a judge to approve sending someone to a mental hospital", because maybe someone's trying to kill themselves right now and the soonest a judge has an opening is three days from now. So the standard rule is "use your own judgment and a judge will review it in a week or two", but most psychiatric cases resolve before then and never have to see a judge. In theory patients can sue doctors if they think they were being held improperly, but they almost never get around to doing this and when they do they almost never win, for a combination of "they're usually wrong about the law and sometimes obviously insane" and "judges are biased towards doctors because they seem to know what they're talking about". Also, the law just got done instituting extremely severe and unpredictable punishments to any doctor who doesn't commit someone to a mental hospital and then that person does anything bad ever, and the law has kindly decided not to be extremely severe on both sides.
There are other mental hospitals that keep people for months or years, but these do have very strict requirements for getting someone into them and are much more careful.
The procedures for these hospitals would be hard to change.
Hard in the sense that there's a lot of lobbying power behind the legacy system but that's not for lack of alternatives.
Prediction-based medicine where one doctor makes predictions about what's likely to happen when the patient doesn't get hospitalized and what happens with them when they are hospitalized and then letting another doctor make the decision to hospitalize or not hospitalize isn't very hard.
Then you fire those people who make bad predictions because they are unqualifi...
People, by default, do not care very much about the suffering of the powerless. This is a very general pattern: De facto torture of the old and dying (Who by Very Slow Decay), Animal in factory farms, prisoners in solitary, Scott's rant about school being child prison, etc.
There is no real need to explain a specific example of a very general trend. In fact it is the opposite that needs explanation. We actually have made progress in various ways (for example slavery is greatly reduced, though the USA still has prisoner slaves). But compassion toward the powerless is a deviation from the default. We need to fight for it. The fight has not been won in the USA.
There are a lot of people who care about animals in factory farms, a lot of grant money and many organizations. Prison reform is similar. Both causes are clearly part of the modern left coalition.
There aren't similarly powerful organizations that care about the rights of patients in psychiatric hospitals.
From my Nordic perspective being ok to standby when other groups fail to powergrab decent conditions seems like an outlier.
To be at first glance but not actually contrarian: we are not putting enough people (who should be there) into psychiatric hospitals. This is not exclusionary of the idea that people are winding up in mental asylum who should not be there. Rather, the two are complimentary: poor diagnostics and lack of accountability, as well as limited resources, ensure that there are likely large amounts of both "should not be institutionalized but are institutionalized" and "should be institonalized but are not."
I do not live in the United States, but in a similar Western democracy and worked for a year in a health bureaucracy that contracted psychiatrists to work in mental hospitals. The doctors were under great pressure, due to lack of funding, to release people as soon as possible, whether or not mental health support was available in the community they would be returning to (in most cases, this meant "the street/homeless shelter"). As a result, relapse/readmission was near constant.
As to what prevents them from becoming a constituency for the modern left - even when many of them are ethnic minorities - the reasons identified below are cogent, and I would add, to judge from the people we dealt with in my job, the mentally ill are unpleasant/unsettling to deal with. I know many people who will talk about their grad school depressions as a major mental illness, but they have nothing on the cases the psychiatrists I worked with handled. Serial arsonists, people who habitually ate glass and metal, others convinced that all indigenous people were possessed by the devils and lashed out at them at every opportunity.
The mentally ill are also often the cause of many other (politically preferred) social problems. Recently, in my city, there were a string of verbal assaults and physical intimidations of Muslim women at transit stations. After widespread condemnation of these attacks and community groups talking about the need to "raise awareness" , with an implicit assumption that the actors were many, the police figured out the attacks were the work of two mentally ill men with long histories of on again/off again institutionalization. The attacks stopped and the issue disappeares from the news. To be blunt, no one gains anything from directing attention at the mentally ill.
Mental health in general in the US (and around the world) is poorly understood. Pop-psychology spreads myth, misinformation, and disinformation and Big Pharma preaches advancements in medication over advancements in therapy and counseling models. Money talks, and no one can argue with Big Pharma in this arena. Unless you are a professional in the field of mental health or a client or friend or family member of one, most people don't care to know how the sausage gets made in terms of keeping 'mentally ill' people under control, and even fewer people care whether keeping them under control is an actual solution to the very real problems they face.
I've been living in a mental health institution for the last 2 years, and have been in the public mental health system practically from birth. We're deemed scapegoats of the society, like criminals and often treated just as bad or worse. This society only knows itself by creating false dichotomies: classifying 'these people' as mentally ill, and 'these people' as not, based on a somewhat circular logic which allows for the unfair division of resources and diversion of those resources to those who are deemed 'able' to use them.
The way the authorities tell the difference between the 2 groups is way too often archaic and systemically discriminatory, and mental health has become so enmeshed with the criminal justice system so as to almost become indistinguishable from it at the Public level. Society needs people on the bottom so that others can be on top. Wish it were otherwise.
In some way we treat mental patients even worse then prisoners. Prisoners don't get medicated against there will.
Being inside the system I expect you to understand it well. Given the suggestion in other comments that the problem might be due to a lack of obvious policy proposals it would be valuable to have easy to understand proposals. Do you have one? I think it would be valuable to have it spelled out.
There's some sort of "out of sight, out of [their] minds" pun here.
That aside, isn't this the actual purpose of mental institutions? Like the attics of previous generations, they are where we stow people we prefer not to think about. And you have to admit they do that job very well indeed.
I remember when there was a lot of attention being given to Amanda Knox here on LW. Someone asked a similar question as you...something along the lines of "Why aren't more people up in arms about this?"
The answer for me at that time was that I have a certain number of Attention Dollars to spend. People are wrongfully imprisoned all over the world every day. New video cards are too expensive. Kids are being tortured. McDonald's stopped serving salads during the pandemic. There's all sorts of things to spend my AD's on.
Attention to causes and injustices costs AD and there is a high transaction cost to switching which injustices are important to me. I hypothesize that the complex system that is the-attention-of-public-discourse suffers from the same. There's only so much capacity for giving attention to different causes, and switching those causes carries a high price.
That's not to say Cause X is wrong or less important, only that I (and, hypothetically, public discourse) can only focus on a limited number of things, there's costs to switching attention, and other things beat Cause X in the race to capture attention.
Different things probably come to the forefront through quirks of zeitgeist, personal relevance, effective messaging, attentional resources available at the time, and a dozen other subtle and not-so-subtle factors.
Of course, this doesn't really answer your question (and here I am submitting it as an answer)! It only pushes the "why's" to another level. Why can public discourse only focus on a limited number of things? Why, exactly, is it currently focusing on the things it is? Why are the transaction costs to switching attention high? I suspect that the answers are very complicated and unknown.
There is an economy of public attention. The amount of noise is high, and information asymmetries abound. If you think Cause X is not getting the amount of attention it should then you should work on lowering the information asymmetries and noise level...and recognize that if Cause X gets more attention it'll mean Cause Y that everyone is currently paying attention to will get less attention. (At least if my model holds.)
Also, you say "...suggests that a lot of abuse of power is going on." I think that this conclusion depends a lot on your priors. One type of person is going to see a bad seed when they see this story, another type of person is going to see a corrupt institution. This feeds into this hypothetical economy of public attention.
How confident are you in this being the main reason and not other suggested reasons provided in this thread?
One type of person is going to see a bad seed when they see this story, another type of person is going to see a corrupt institution.
The fact that the story exists and there doesn't seem to be a follow up and some agency felt it's responsible for fixing the issue is part of the story.
You can argue that something is a bad apple when the bad apple gets removed by the owner when attention comes to it.
...I remember when there was a lot of
I see a difference in that burocrazy is not allowed to interfere with peoples treatment but it is allowed to interfere research.
Given that SCREENING ONLY labels are not followed having more of those guidelines would not alter patients care. By making such requirements it might give raise to an illusion or image that the care has certain properties.
The doctors ar effectively operating under the collar of science without actually applying science. With greater adherence we would either get pushpack to follow less scientific advice to the level where it is practical or treatment would grind to a halt.
With some other processss we don't only care that they are possible, we want them to be smooth. Having high rigour and high practicability is a big value conflict. Most conditions are mysterious to most people so being able to justifiably know is more concretely valuable. This would predict that if general awareness of the existence of mental health conditions increases then efficiency of care could start to outshine rigour.
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It's just a general pattern of overlooking certain kinds of terrible suffering that is not very visible. My go-to example is that, even by the most conservative estimates, at least 1% of children go through severe physical, emotional and sexual abuse growing up, which means that, if you live in the city, there is a high chance that there a girl being raped by her brother/uncle/father within a mile of you right now and no one would hear about it or pay attention, until it's too late. A decade or two or three down the road she will end up in a psych ward with incurable CPTSD manifesting as a host of personality disorders, only to be marginalized and often abused and neglected there, as well.
Omelas was so much better, even for the one suffering child, compared to our society. At least everyone there knew about the suffering child, and it was not completely in vain. And there is nowhere to walk away, it's no better anywhere else.
There's an enormous amount of work into fighting child-hood abuse in the last decades. We criminalized hitting children and have see-something-say-something as a paradigm for whole of of different policies. While those policies don't bring childhood abuse to zero society tries very hard. The LGBT community that used to ally with pedophiles stopped doing so and people who are advocating for the marginalized group of pedophiles are now clearly out of the coalition because caring about children not being abused is central to the modern left.
incurable
That's such a strange word. The word incurable is a license to avoid accountability for not curing illnesses. It's a class of illnesses for which psychiatric hospitals lack the skills to cure them at this point in time. It's a feature of the psychatristic community and not an inherent feature of the disease.
As the Schizophrenia Research Project suggests it's plausible that for a good portion of them the drugs that the psychologists give them inhibits the natural healing process.
A cynical guess is that in politics you only fight for rights of people when it is profitable -- if you expect that in turn they become your voters. You care about minorities either if they are large enough, or if other groups feel like they are in the same reference class.
Apparently, psychiatric patients are not numerous enough (to vote for you in return for your help), and other groups of people do not identify with them enough (to vote for you in return for your help to them).
Other possibilities that spring to mind are:
I think "why doesn't it get more attention" is the wrong question to ask. "What's the better solution" and "what should I do to improve things" are likely to get more traction here.
I think "why doesn't it get more attention" is the wrong question to ask. "What's the better solution" and "what should I do to improve things" are likely to get more traction here.
This looks to me like it comes from a mindkilled point of view, that discount the value of knowledge.
"How should we solve X?" is a different question from "Why is the current political coalition the way it is?"
The first question is about solving a political cause. The second question is about understanding.
In the model that deluks917 proposes animal rights, prisoners and psychatric patients should have similar amount of backing for their cause. In our world that's not the case. There's something wrong in the model. The rational way to deal with unexplained derivations from models is to try to understand them to update the model.
The fact that people like shminux and deluks917 mistakenly put it in the same reference class as problems that the modern left cares about is interesting and suggest a broken model.
This looks to me like it comes from a mindkilled point of view
Quite possibly. I did and do make the inference that the post was targeted at the question as a political issue (with the intent to change it, not as an academic exploration). That form of question is so commonly used that way, that it requires disclaimers and multiple examples for me to even consider that it might be otherwise.
I also skipped a step, in failing to state that I do not actually know whether it's a problem, nor if so, whether it's significant enough to put much attention on. Compared to general human poverty and wasted potential, the short lifespans of humans, and the significant existential risks that face intelligent life in this corner of the universe, I think it may be correct to spend less effort on specific marginal cases.
Scott writes in My IRB nightmare about how his colleague took people freedom away and justified it with tests that aren't validated for the purpose of diagnosis and that have a warning THIS IS JUST A SCREENING TEST IT IS NOT INTENDED FOR DIAGNOSIS.
This can only happen because there's very little public accountability and suggests that a lot of abuse of power is going on. While the US has a lower psychiatric hospitals bed count then many other OECD countries, there are still ~80,000 people in those institutions. A lot of them effective have very little rights and have to endure medical procedures without them consenting such as taking various drugs.
Mental health people seem to me like they should be classified as a marginalized group by the ideals of modern left. On the other hand the modern left put very little attention on fighting for the their rights as evidenced by Scott's colleague getting away with major abuse of power.
Why is the state of affairs like it is? Why don't they get more attention?