Trying to understand...

[dualstow]

In other words, what if we peel back one more layer on this onion and consider the possibility that the increased rate of untreated mental illness is yet another symptom but not the ultimate cause?

Makes me want to reread 'Ishmael'.

[WiseOne]

I suspect that there is also a "copy-cat" factor.  Once mass shootings become first well publicized and then commonplace, the idea will occur to someone who is emotionally disturbed much more readily than it would have pre-Columbine.

There is no doubt that the steadily decreasing mental health coverage, on the part of both state Medicaid programs and private insurance, and the increased barriers to psychiatric hospitalization that started after "One that Flew over the Cuckoo's Nest", have played a role.  You pretty much can't see a psychiatrist or counselor nowadays unless you can pay cash.  I deal with a lot of Medicaid patients who need psychiatric care for one reason or another, and about all we can do is point them in the direction of pastoral counseling at their church.  This won't change unless there is a conscious decision to increase both public and private funding for psychiatric care.

Regarding gun laws restricting sales to the mentally ill...great idea in principle, but how do you decide who is mentally ill?  Psychiatric treatment records are tightly safeguarded, like HIV tests, and we have all these information privacy laws that would make it illegal for even the fact of psychiatric treatment to become public record.

[stone]

WiseOne, it is interesting that the US system puts a low public priority on treating psychosis. In the UK it seems one aspect of medicine where medical attention is very prompt. I was taken aback a few years ago as a visitor to the US, at seeing the number of people shuffling about in San Franscico obviously suffering from psychosis and in a total mess. As much as anything doesn't that spoil things for other San Franscico residents, leaving aside what it is like for the crazy people themselves? 

[MachineGhost]

There is no doubt that the steadily decreasing mental health coverage, on the part of both state Medicaid programs and private insurance, and the increased barriers to psychiatric hospitalization that started after "One that Flew over the Cuckoo's Nest", have played a role.  You pretty much can't see a psychiatrist or counselor nowadays unless you can pay cash.  I deal with a lot of Medicaid patients who need psychiatric care for one reason or another, and about all we can do is point them in the direction of pastoral counseling at their church.  This won't change unless there is a conscious decision to increase both public and private funding for psychiatric care.

Let us all not forget Geraldo Riveria was the man responsible for spearheading the mentally insane out onto the streets with his shock journalism.

[WiseOne]

WiseOne, it is interesting that the US system puts a low public priority on treating psychosis. In the UK it seems one aspect of medicine where medical attention is very prompt. I was taken aback a few years ago as a visitor to the US, at seeing the number of people shuffling about in San Franscico obviously suffering from psychosis and in a total mess. As much as anything doesn't that spoil things for other San Franscico residents, leaving aside what it is like for the crazy people themselves? 

Low, and getting lower.  On the surface it is a financial decision, but there is also social stigma involved.  And MG you're right about shock journalism playing its part.  Despite what you might read about homeless people simply being down on their luck, nearly all of them are untreated disorganized schizophrenics.  Their lives would clearly be better (and longer) if they were institutionalized.

I suspect also, given the age of most of the shooters, that their condition was developing rapidly at the time.  Schizophrenia is genetic, and symptoms develop at some point in late teens or early twenties, sometimes very suddenly.    A system that is easy to negotiate and that responds quickly is what's needed, and we just don't have it.

[dualstow]

...
  Despite what you might read about homeless people simply being down on their luck, nearly all of them are untreated disorganized schizophrenics.  Their lives would clearly be better (and longer) if they were institutionalized.

As a resident of an extremely large city with no short supply of unpredictable homeless people, I know that the lives of all citizens would be better.
It really is a serious and tremendous problem.

[stone]

In the UK they have also largely phased out large long stay asylums (apart from for the criminally insane) but we do seem to have replaced them with some (somewhat) effective sheltered housing and home visits by psychiatric nurses. I think home visits by psychiatric nurses are a tremendously effective and relatively low cost way to deal with this. A psychiatric nurse stopping by for 30 minutes every couple of days can make a massive difference.

[Storm]

In the UK they have also largely phased out large long stay asylums (apart from for the criminally insane) but we do seem to have replaced them with some (somewhat) effective sheltered housing and home visits by psychiatric nurses. I think home visits by psychiatric nurses are a tremendously effective and relatively low cost way to deal with this. A psychiatric nurse stopping by for 30 minutes every couple of days can make a massive difference.

For all the talk of the evils of socialized medicine, the UK seems to be doing this very right.  I would be willing to bet that subsidized housing and psychiatric nurses are less expensive overall than letting homeless people get treated at the ER on a regular basis.  In this case, it seems an ounce of prevention is worth a pound of cure.

[MediumTex]

In the UK they have also largely phased out large long stay asylums (apart from for the criminally insane) but we do seem to have replaced them with some (somewhat) effective sheltered housing and home visits by psychiatric nurses. I think home visits by psychiatric nurses are a tremendously effective and relatively low cost way to deal with this. A psychiatric nurse stopping by for 30 minutes every couple of days can make a massive difference.

In the U.S. we have been engaged in a massive multi-decade asylum building project.

We call these asylums penitentiaries.

[WiseOne]

In the UK they have also largely phased out large long stay asylums (apart from for the criminally insane) but we do seem to have replaced them with some (somewhat) effective sheltered housing and home visits by psychiatric nurses. I think home visits by psychiatric nurses are a tremendously effective and relatively low cost way to deal with this. A psychiatric nurse stopping by for 30 minutes every couple of days can make a massive difference.

In the U.S. we have been engaged in a massive multi-decade asylum building project.

We call these asylums penitentiaries.

That is indeed one way to get medical care, food and shelter if you're otherwise unable to work.  Of course, the guy who hangs out around the corner from my front door is on his own.

If we took just 10% of the money that goes to build and staff jails, not to mention handle all the court cases that fill them up, and paid for those psychiatric NP home visits, we'd all come out way ahead.  This is why you saw the UK Olympic opening ceremonies highlighting the NHS - it is something to be proud of.

[stone]

WiseOne, although I'm a big fan of the psychiatric home visit set up that the UK NHS provides, I think on a wider  level the NHS does have some big problems. Other countries in europe seem to be able to provide better outcomes than the NHS at no more cost for many disease classes such as cancer, diabetes and heart disease. To my mind the fact that the US and the UK systems always get mentioned in debates about health care politics is a bad reflection on both those systems. The systems to be admired IMO are those that no one ever mentions because they quietly work well with no drama eg in Germany, Netherlands, Spain etc.
The NHS does have immense public support in the UK and to be honest I'm always baffled by that. People say we must support the NHS or we will end up with a US style mess. Why don't we look to what is done on continental Europe? I was also very struck by the Olympic 2012 NHS display. At the time I remarked that we were celebrating the fact that we have a health service that is only slightly worse than that in the rest of Europe at a similar price and yet with far greater Leninist purity .

[MachineGhost]

WiseOne, although I'm a big fan of the psychiatric home visit set up that the UK NHS provides, I think on a wider  level the NHS does have some big problems. Other countries in europe seem to be able to provide better outcomes than the NHS at no more cost for many disease classes such as cancer, diabetes and heart disease. To my mind the fact that the US and the UK systems always get mentioned in debates about health care politics is a bad reflection on both those systems. The systems to be admired IMO are those that no one ever mentions because they quietly work well with no drama eg in Germany, Netherlands, Spain etc.
The NHS does have immense public support in the UK and to be honest I'm always baffled by that. People say we must support the NHS or we will end up with a US style mess. Why don't we look to what is done on continental Europe? I was also very struck by the Olympic 2012 NHS display. At the time I remarked that we were celebrating the fact that we have a health service that is only slightly worse than that in the rest of Europe at a similar price and yet with far greater Leninist purity .

The nationalistic NHS display was bizarre and doesn't even belong in the Olympics, but I digress.

I suspect one reason there may be better outcomes in other countries is because they have a more skeptical attitude towards Anglo-Saxon capitalism, so they evaluate pharmacueticals and surgical techniques with a much more jaundiced and cynical eye.  So less people wind up being abused and killed for the sake of crony corporate profit under the the salve of doing good.  Very little in the way of major medical advances have been accomplished in the areas of the major killers and very little breakthroughs filter down to the practice level anyway.  So by not killing as many people through "the grind machine", the disease outcomes are better through relatively "poorer treatment".

Again, this may simply reflect that the vast majority of patients with the major diseases are currently The Greatest Generation who kowtow completely to medical authority.  I do not think the same submissiveness can applied to the other generations.  The transparency of Internet is changing everything.

[stone]

Machine ghost, I think the better outcomes are because things are done on schedule on continental europe. The NHS does delay many procedures. If someone needs a hip replacement or cancer treatment, then delays often just add to the ultimate cost. On the continent they have a grip on the logistics of providing everything in a timely manner. It is like the difference between the fresh produce supply system at a good supermarket and a floundering supermarket due to go bust. Why does the NHS act like that? I think it is because the NHS is so big it can't get a grip. Imagine if there were a "national food service" that had to provide all of the food for a country. Would anyone expect that to work? It is a miracle that the NHS works as well as it does. Its a testiment to the dedication of the NHS employees in the face of the impossible odds of that organisational structure IMO.

I don't think the NHS adopts novel therapies before other european countries.

[MachineGhost]

Machine ghost, I think the better outcomes are because things are done on schedule on continental europe. The NHS does delay many procedures. If someone needs a hip replacement or cancer treatment, then delays often just add to the ultimate cost. On the continent they have a grip on the logistics of providing everything in a timely manner. It is like the difference between the fresh produce supply system at a good supermarket and a floundering supermarket due to go bust. Why does the NHS act like that? I think it is because the NHS is so big it can't get a grip. Imagine if there were a "national food service" that had to provide all of the food for a country. Would anyone expect that to work? It is a miracle that the NHS works as well as it does. Its a testiment to the dedication of the NHS employees in the face of the impossible odds of that organisational structure IMO.

If things are done on schedule, that would imply a free enterprise approach and not a bloated bureaucracy like the NHS or USA.  Yet, I've never heard of Europe referred to as being a free market bastion of health care.

Maybe the NHS is simply just too good at its job as the Sovet Union was too efficient at expropriating society's resources.

I do think providing health care needs to switch to a non-governmental, non-profit voluntary cooperative form though.  The profit motive being the primary motivation seems to engender tragic conflicts of interest throughout the entire system.  Innovators do not need the allure of getting rich to be passionate about finding cures for humanity's ills.  In fact, I would argue the existing system actually marginalizes them, especially any of their novel, non-profitable approaches.

I hope biohacking makes the whole stupid mess irrelevant some day.  It's pretty obvious we'll never have any true reform via the political system.  It will have to be bottom up.

[stone]

Machine Ghost, I think the european aproach to health care is a bit like the UK's approach to Universities. Basically european hospitals etc get government money and get government inspections to ensure standards but run themselves as they see fit.