A Review of the "Mental Illness" Definition Might Prevent Crime 260
An anonymous reader writes "Following a BBC report showing abnormal variation in the number of people taken into police custody with mental health problems, concerns have been raised about the legal definition of "mental illness". Prof. Steve Fuller argues that a much sharper legal distinction is required to ensure criminals with mental disorders are not released without appropriate treatment. Fuller distinguishes between two cases: a 'client', who pays a therapist and enjoys a liberal, level-playing field in face-to-face interactions, and a 'patient' who is being treated by a doctor for a particular disorder. If the former relationship cannot be established due to person's mental state, then the latter one should be enforced. Thus, Fuller calls for 'a return to institutions analogous to the asylums of the early 19th century.'"
Need more mental health centers not prisons (Score:5, Insightful)
Need more mental health centers not prisons with 23/7 lock down
The problem is... (Score:5, Insightful)
Who decides, what they can compel, and how that person's life is managed while they're institutionalized are all very, very important factors in if it's even possible to use involuntary medical-based confinement or not.
And that doesn't even begin to address costs. While I don't care for it, it's possible for prisons to get some return on their costs by using prison labor to do things that don't really pay the prisoners but do pay the prison. If someone's committed for what's supposed to be a mental illness problem, it's doubtful that using that person for profit for the institution would really be possible.
Re:Does Slashdot (Score:4, Insightful)
Until it is you being put away, Mr. Coward.
Re:Need more mental health centers not prisons (Score:5, Insightful)
Well, they easily serve the same purpose. How long until "disagreeing with the politics of the ruling party" becomes a mental illness? No, no, we're not locking up millions in prison camps, that would be fascism, we're just confining them in mental health institutions, it's really for their own good!
Re:Need more mental health centers not prisons (Score:3, Insightful)
Some mental health centers can be compared to prisons, with similar lock downs. Once admitted to a mental health facitlity, it can be harder to get out of than prison. And, depending on your location and health insurance coverage, they can be very easy to get stuck in.
Re:Need more mental health centers not prisons (Score:5, Insightful)
The trouble with mental health is that there isn't any kind of magic bullet treatment like there can be with just about any other disease.
Usually the best treatments come from medication, and if the person stops taking their medication (this is very often the case, they think they don't need it anymore, especially due to the stigma attached to it which often makes them WANT to stop taking it) then they go back to how they were before, only this time going back on the medication doesn't solve the problem and the psychologist has to keep trying different medications until one works, assuming they can ever find one.
Or they can also come from therapy (depends on the exact condition) and if you keep them in these places until they are "treated", it may as well be a prison sentence. I've seen these places, they very much remind me of a prison: The windows are barred, the doors are all locked and only visitors and/or staff are allowed through them, and visitors can't bring plastic or metal inside. The patients are forced to sit around doing nothing all day long, maybe get to play backgammon with some derp who was born without a personality, or if they're lucky he'll be a nut and somewhat entertaining to talk to.
Re:Need more mental health centers not prisons (Score:2, Insightful)
Right. Just put half of the population either into mental health centers or in prisons.
That will save you from thinking about why you've got so many criminals and people who are nuts.
Oh, Yeah? (Score:1, Insightful)
I think Prof. Fuller should be in therapy. If he disagrees, it must be because he's "not in the appropriate mental state to operate in such a relationship", in which case his need for treatment "may need to be legally enforced.”
Re:Need more mental health centers not prisons (Score:4, Insightful)
"The trouble with mental health is that there isn't any kind of magic bullet treatment like there can be with just about any other disease."
There's almost never a magic bullet treatment, for any disease, mental or physical. The problem with mental illness is that it diminishes the sufferer's ability to make decisions for himself. That doesn't mesh well with a society of individuals.
Prevent crimes? What about justice? (Score:4, Insightful)
"Preventing" crimes is not justice. Locking up innocents to "prevent" them from committing crimes is essentially the opposite of justice.
Also, note what they're preventing: "crimes". Not violence or any action that harms anyone. "Crimes" encompasses all manner of disobedience toward authority, regardless of whether that authority is legitimate. Example: Man faces felony charge over trimming shrubs [utsandiego.com]. Not a crime: DEA locks up a student, forgets about him for 4 days with no food or water [nydailynews.com].
Re:Need more mental health centers not prisons (Score:5, Insightful)
It's exacerbated by a society that doesn't take it seriously.
No, really, no one takes the fact you have a mental illness seriously until you do something completely batshit crazy like shoot up a school. If I had a nickel for every time someone told me I didn't have a reason to feel depressed...
You are ignored, basically, until you commit a crime. THEN people care. Until then you're not ill, you're just a lazy loafer.
Comment removed (Score:5, Insightful)
Re:Foundation question (Score:5, Insightful)
I, unfortunately, have had far too much exposure to the mental health system, due to mental illness in my immediate family. I'll give you my perspective on your questions, based primarily on my anecdotal experience, plus some research-based discussions with practitioners.
I think the answer is a qualified yes, people can be made better, though "cured" may be too strong.
Mental health treatment is, I think, much where medicine was shortly after the discovery of the germ theory of disease. It's beginning to become a capable, scientific endeavor, and it is very useful within the areas that it works, but there's lots we don't understand, about what goes wrong, about why it goes wrong, about what will and won't work to fix it, and even about why the stuff that does work, works.
My daughter's condition is a good example. She has Borderline Personality Disorder (which is a really terrible, inaccurate name, and everyone knows it, but that's the label that got stuck on it). There is no cure but time; most BPD sufferers eventually achieve fairly normal functioning by their mid 30s. There are some treatments that help, though. Sometimes. The best one is a particular form of psychotherapy called Dialectical Behavioral Therapy, which is at root mindfulness training. It's effectiveness is definitely better than nothing, but whether or not it will help a person become a functional member of society is very hit or miss. My daughter's doing okay, but has real challenges.
My sister's son, on the other hand, has Bipolar Disorder. There are great meds that almost completely fix the problem for a large percentage of sufferers, including him. In addition, it appears that specific dietary restrictions can do just as much as the meds. I understand that schizophrenia is eminently treatable with medication, though the severe side effects often discourage its use.
I have ADD, and so do all three of my sons. There are very effective medications for it, but there are also learned habits that can be used to work around it. My older sons and I use the latter plus a little self-medication with caffeine. My youngest takes Concerta.
Depending on the disorder, sometime diagnoses are clear and incontrovertible, and proof of "cure" (or management) is equally incontrovertible. Sometimes it's really fuzzy. Sometimes treatment is effective and well-understood. Sometimes it isn't.
The answer, I think, is to be very clear about what we can and cannot do, and to do what we can. And, of course, to continue research into improving our ability to understand and treat.
Re:Need more mental health centers not prisons (Score:4, Insightful)
mental health centers ARE prisons.
They are calling for a return of the bad old days of 19th century asylums.
Re:Need more mental health centers not prisons (Score:4, Insightful)
This is about false diagnosis used as a shadow justice system for malcontents, and bringing back torture and abuse.
we're not talking about people who actually need help. we are talking about people who are about to be rammed through the system because the system wants them gone, without too much of a fuss if they were ordinary criminals
Re:Need more mental health centers not prisons (Score:5, Insightful)
I have to disagree... If I get strep or pneumonia, they give me a z-pack and bam, it magically goes away. If I have a broken finger, they give me vicodin and bam, I magically don't care about the pain (though yes, the finger itself just takes time to heal). If I have insomnia, they give me ambien and bam, I can magically sleep again. When my knees or hips eventually wear out, they give me new ones and bam, I magically get to walk for another 20-30 years. And keep in mind that many of our "magic bullets" work on a larger scale and longer term scale - Vaccination, water sterilization, sewage treatment, annual physicals, etc.
Even for the things that still tend to kill us, like cancer and heart disease, we have a lot of magic bullets that let us live far, far longer than we would have a century ago. Case in point, we wouldn't have various religiots arguing over their "right" to murder (as in the case from last week) their 10YO daughter by refusing treatment for a 95% survivable form of leukemia. She would simply have died, no moral issues involved.
But for mental diseases, it gets a lot messier. There, I would have to at least partially agree with you. We have plenty of ammo, but precious few we would dare call "magically" effective. Perhaps more like "napalm", where they might get the job done, but with so much collateral damage that you have people going off their meds because the cure sucks almost as much as the symptoms (to give my metaphors a good stir there).
Perhaps more to the point of TFA, I would have to agree with its author. We need to get over this societal PC BS that every sociopath and drooler can, with the right care, grow up and lead a productive life as a rocket surgeon. Some people will never manage more than wiping their own ass, and some people will never grasp why they can't "earn" their living pointing a gun at convenience store clerks. Simple as that. Best for us, and best for them, to keep them off the streets until such time as we can cure "criminal" with a magic bullet - Preferably starting the process before they take a real bullet from an armed victim or a cop or a partner crossed.
Re:Need more mental health centers not prisons (Score:5, Insightful)
We stopped being vigilant a long time ago. We stopped being honest citizens a long time ago. Many will sing the last line of our national anthem without a hint of irony, despite the fact that we imprison more people than any country in the world.
The crimes we need to be afraid of are not the crimes committed by people behind bars. They are the crimes committed by men in suits, in government or corporate board rooms. Most people in prison are victims, either of unjust laws, or an economy deliberately engineered to work against the common man. We need to focus on the real problem. It's not the schizophrenics on the street corner, it's the sociopaths in DC and NYC.
Re:Need more mental health centers not prisons (Score:3, Insightful)
No, because "protecting people" from their mental illness is a more sanitized, less outrageous aim, at least on the surface. If you're looking to stigmatize opposing points of view with a slow boil, it's an intermediate point. Just long enough to collect statistics "proving" that such people are often criminal, and regrettably must be incarcerated in some cases.
Disclaimer: I don't believe in some large conspiracy attempting to do this. I am afraid that certain segments really believe this, though, and would do it if they could, which terrifies me. The agreeable laughter I hear in my liberal area when a scientific study claims conservatives brains are different can be unsettling at times.
Re:Need more mental health centers not prisons (Score:5, Insightful)
You do realize that until the 60's, the U.S. had a fair number of asylums. Then it was determined that the mentally ill had rights and they were promptly discharged with many finding the street life fit them better than anything else. It turned out the mentally ill had a right to be homeless.
What is needed is a more sane approach to mental illness, especially now with so many vets suffering from PTSD. The discrimination should stop, but for that to stop people would need to be educated about mental illness....well, I guess the mentally ill are screwed then.
The prisons are filled with people that simply run into the law enforcement system before they run into a mental health system. The law enforcement system cannot force one onto meds, so the poor souls get warehoused in the prisons. When they are let out, their neuroses are that much worse because mental illness frequently does not get better on its own. Left untreated, it gets worse. By that time, the mentally ill think of prison as a refuge, so they commit another crime to back.
Did anyone read the article itself? (Score:4, Insightful)
I know, on /. we don't need to. But it seems to me that the point that the Fuller appears to be making is that the current environment (presumably in the UK where he practices) is that a very large number of people are diagnosed with "mental illness" which is fine if they are continuing to be largely functional, seeing a therapist of their choosing, etc. The problem is that when someone is arrested the question of "mental illness" has two different dimensions ... is the person legally responsible for their actions (the legal dimension) vs. is the person undergoing treatment (or has ever undergone treatment).
People who are not responsible for their actions are a tiny minority. But IF someone has been identified as not responsible for their actions, why are they left roaming the streets? That isn't fair to them or to society.
Admittedly, there is always the question of "who is to say" and that begs the question to appropriate due process (clearly, it shouldn't just be some random doctor or family member has nominated them for commitment). And clearly there were abuses in the past. I don't think Fuller is the first to notice that the current situation is arguably worse (fraction of homeless people who are seriously ill ... of course, that begs the question of whether their mental condition caused the homelessness or the other way around :).
I'm far from sure that I agree with Fuller, but the vast majority of the comments seem to be missing his core argument.
medical model (Score:4, Insightful)
Re:Need more mental health centers not prisons (Score:2, Insightful)
Then it was determined that the mentally ill had rights and they were promptly discharged with many finding the street life fit them better than anything else. It turned out the mentally ill had a right to be homeless.
The USA operates on a policy of Social Darwinism because anything else would be pinko-commie.
If you're ill and or poor in the USA, the sacred Market will remove you from the human race if you are not sufficiently fit.
Re:Need more mental health centers not prisons (Score:2, Insightful)
That's an impossible fantasy - since healthcare resources are not infinite, rationing must happen somewhere. The open issue is: who does the cost-benefit analysis? Both history and basic economic theory say the person most affected usually has the best information to make that call. Healthcare is less obvious, because sometimes you're unable to make the decision precisely because of the condition you need help for. Even so, the consumer should be the one making that cost-benefit analysis wherever practical, and where not the doctor is perhaps the best choice - never the government ruling from afar, deciding what's best for the peons.
Re: Need more mental health centers not prisons (Score:0, Insightful)
The call of the socialist, summing up virtually all of the problems in the US right there.
Talking about "put away" ... (Score:2, Insightful)
Yes, rebels without a clue that should be put away
... of the many (former )criminals in the West that have been released back to the society, some of them were released solely based on the political reasons ~ such as they were of the "under privileged group" and so on
And once they were released back to the society they commit crimes again, and again, and again
Although I've been an American citizen for more than 3 decades, as a person whose origin was not from the Western nation, I can NOT understand why on earth the Western society is more willing to put more innocent people on the harm's way than locking up those crazy fuckers?
I mean, who cares if they were from the "under-privileged groups"? Who cares if they were from "broken family" ? Who cares if they were being "abused" before they commit their crime ?
Why is the human rights of the criminals that MUCH MORE IMPORTANT than that of their victims ?
That is the ONE THING that I can never understand, despite having to live in the West since the early 1970's.
Re:Need more mental health centers not prisons (Score:5, Insightful)
Many of the asylums were horrible and without hope, due to longstanding medical orders for which there was no effective treatment. The advent of effective psychopharmacology changed that: people with bipolar depression, for example, devastating post-traumatic stress based depression,, devastating post-trautmatic stress, and numerous other problems became treatable and could be treated as outpatients or with short stays to stabilize their medication, then released. Care really did improve in the 1960's and early 1970's, when the psychoactive medications were better understood and seized upon with great joy by doctors and patients who'd before felt quite hopeless. Unfortunately, this became coupled with cost-saving "return to the community" programs and policies, and we wound up with _enormous_ numbers of ill people who could not safely live on their own, turned out without structure to remember to take their medication by themselves.
The results have been predictable: numerous confused, somewhat insane people were left without the help they needed because their smaller, modern, fragmented families could not possibly fill in the gap of providing residential care. When coupled with the strain on the prison systems from the "war on drugs", the threshold for providing residential care has been raised so high that facilities willing to work with modest mental disorders have been overwhelmed by even more profound cases, an. And the quality of care for both has dropped, harshly.
I'm afraid that I'm old enough to know relatives and colleagues with such members. When their need for treatment leads them to self-medicate with illegal drugs, they then wind up snared in the "war on drugs" and "zero tolerance" policies, and become even more difficult to help.
Re:Need more mental health centers not prisons (Score:5, Insightful)
Most people in prison are victims, either of unjust laws, or an economy deliberately engineered to work against the common man.
[citation needed] times infinity. this is an extraordinary claim that is false on its face.