Are Americans Just Terrible People?

[Zoupa]

That's one of the worse (worst? I never know) article I've read in a while.

And yeah it's not unique to the US, but from my limited, anecdotal experience it's more prevalent in North America compared to Europe.

[Berkut]

That's one of the worse (worst? I never know) article I've read in a while.

And yeah it's not unique to the US, but from my limited, anecdotal experience it's more prevalent in North America compared to Europe.

I wonder how much of that is simply explainable by our appalling mental healthcare system?

Or rather, the fact that unless you are wealthy, we simply do not have one - the system is, literally, to simply let them wander the streets homeless.

[chipwich]

That's one of the worse (worst? I never know) article I've read in a while.

And yeah it's not unique to the US, but from my limited, anecdotal experience it's more prevalent in North America compared to Europe.

I wonder how much of that is simply explainable by our appalling mental healthcare system?

Or rather, the fact that unless you are wealthy, we simply do not have one - the system is, literally, to simply let them wander the streets homeless.

It's illegal to treat someone who doesn't want to be treated.

[Tonitrus]

Unless that someone is Britney Spears.

[grumbler]

That's one of the worse (worst? I never know) article I've read in a while.

And yeah it's not unique to the US, but from my limited, anecdotal experience it's more prevalent in North America compared to Europe.

I wonder how much of that is simply explainable by our appalling mental healthcare system?

Or rather, the fact that unless you are wealthy, we simply do not have one - the system is, literally, to simply let them wander the streets homeless.

It's illegal to treat someone who doesn't want to be treated.

I'm not sure what you meant to say here, but what you actually said is obviously wrong.  See, for instance, https://www.ncbi.nlm.nih.gov/books/NBK557377/#:~:text=Defined%20by%20the%20United%20States,against%20his%20or%20her%20wishes.

[Berkut]

That's one of the worse (worst? I never know) article I've read in a while.

And yeah it's not unique to the US, but from my limited, anecdotal experience it's more prevalent in North America compared to Europe.

I wonder how much of that is simply explainable by our appalling mental healthcare system?

Or rather, the fact that unless you are wealthy, we simply do not have one - the system is, literally, to simply let them wander the streets homeless.

It's illegal to treat someone who doesn't want to be treated.

That is simply not true.

The first thing you have to ask is: How do you know what they want, and do you treat in the absence of knowing?

IE, if someone is in a car accident, and unconscious, do you have to wait for them to wake up and let you know they want treatment? Of course not, there is a presumption that people want treatment for serious injury or illness. Hell, even if someone was actively screaming "STOP! THAT HURTS!" while the ER doctor treats them, they are not going to stop, because we know that people in extremis often are not responding rationally to what is happening to them.

So the next question is: How do we know what they want when their injury or illness is such that it impairs their ability to communicate what they want or would want absent that injury or illness?

I am not trying to be flippant here - I fully realize the very dangerous ground we are walking on. But to pretend like we should err on the side of "Well, that mentally ill person SAYS they don't want treatment, so lets just leave them alone" in all cases is vastly more damaging then to take on the rather difficult and error prone work of evaluation and professional intervention when necessary. Road to hell and all that....

[Sheilbh]

I wonder how much of that is simply explainable by our appalling mental healthcare system?

Or rather, the fact that unless you are wealthy, we simply do not have one - the system is, literally, to simply let them wander the streets homeless.

I wonder how much that's impacted the pandemic and even the vaccine roll-out - I know the vaccine is for free and I've no doubt there's loads of publicity campaigns about that. But if your standard experience is that you have to pay for healthcare/treatment and you're not a big news consumer, it doesn't seem crazy to me that you'd worry you might get a bill for the vaccine or for covid treatment (or testing) - or it might be not a thing at all. I don't know.

I haven't read the article - I basically agree with Jake. My general view of the world - including the US - is that 95% of people are good and kind and generally want to help each other. That's certainly been my experience and it has, generally, been re-inforced by the response to the pandemic.

However my query for "are Americans x?" would be are Americans angrier than everyone else? It might just be an effect of social media - and I think it's heightened during the pandemic. But I always find the semi-regular videos of basically fully grown adults throwing a tantrum from the US really weird. It's either people having a tantrum in an airport or a shopping centre or whatever, or people being so out of control on a plane they need to be physically restrained - it seems really strange and I don't know if it's just there's more of it because of pandemic-stress or we see more of it because of social media.

And I'm coming from the UK where random violence/brawls/air rage etc exist but here it is very much linked to binge drinking - you know if you want a fight go to any provincial town in England on a Friday night and you can find one. The videos and stories from the US seem more random and just people kicking off in malls or on planes - and as I say I don't know how much is pandemic, how much is Trump, how much is social media but I see one of these videos or stories at least once or twice a week. I don't know if it's always been like that and we just see it now, or if it's new or what.

[viper37]

So the next question is: How do we know what they want when their injury or illness is such that it impairs their ability to communicate what they want or would want absent that injury or illness?

Next of kin (parent, husband, children, gardian, etc)) could well decide in their name that they do not want a specific treatment.

It is possible there is still a question of taboo in our respective societies where many families will not want to admit someone needs mental health care?

[Sheilbh]

Also the availability of mental healtch care is not great. I think as a society we have talked a lot about healthcare and I think are removing the stigma etc which is good - but I think, in the UK at least, that has outpaced the actual availiability or provision of mental healthcare on the NHS.

[Jacob]

I don't know about the whole "it's illegal to treat someone who doesn't want to be treated" thing. Makes it sound like homeless people with mental health issues are there because they refuse getting help. My understanding is that most people on the streets would like to get help, but that no such health is available.

[Razgovory]

I don't know about the whole "it's illegal to treat someone who doesn't want to be treated" thing. Makes it sound like homeless people with mental health issues are there because they refuse getting help. My understanding is that most people on the streets would like to get help, but that no such health is available.

Some will refuse to get help, but mostly that's because they are mentally ill.  The bigger problem is deinstitutionalization.  We have long since closed most of the mental hospitals in this country.

[viper37]

Also the availability of mental healtch care is not great. I think as a society we have talked a lot about healthcare and I think are removing the stigma etc which is good - but I think, in the UK at least, that has outpaced the actual availiability or provision of mental healthcare on the NHS.

Well same here.  A couple of decades ago, waiting time to see a psychologist in the public sector were around 2 years.  As of last spring, it was 7-8 years, for "urgent needs".

[Berkut]

I don't know about the whole "it's illegal to treat someone who doesn't want to be treated" thing. Makes it sound like homeless people with mental health issues are there because they refuse getting help. My understanding is that most people on the streets would like to get help, but that no such health is available.

It's a mix.

My ex-wife was a case manager for the SMI. She had plenty of clients who if given the choice would have refused her care, but in those cases that was BECAUSE they were mentally ill.

Like I said, I recognize that this really is a very difficult balancing act.

There is no question that a lot of this is lack of available care as well. Again, going back to that anecdote of my wife as a case manager for the SMI. Her contract with the state of Arizona was that her caseload was based on the severity of the client. In other words, a Severity 1 client is 3 points, a Sev 2 client is 2 points, and a Sev 3 client is 1 point.

A Sev 1 client is someone with serious issues that require AT LEAST once a week (could be as often as daily) contact, or someone with significant mental impairment within the criminal justice system. So there are really sick people who are likely a danger to themselves or others, or even people with serious mental illness that are incarcerated.

Sev 2 is someone who needs contact at least once every two weeks, up to once a week. Sev 3 someone who needs contact between 2 weeks and a month. Of course, all these are ballpark.

Her total caseload (this is for someone with a bachelors degree in social work - no actual clinical expertise, and basically little or no actual experience, she was hired right out of college to manage the cases for people with serious mental illness, once of whom was in prison for murder, as an example) was supposed to be maxed out at like....20 points. Maybe it was 25?

She *never* had a caseload of less then 50 points, and was often around 70-90.

She spent her time, at times, wandering around the streets looking for her clients to check in with them.

[Malthus]

Even with the best will in the world, our ability to treat mental illness is not good.

Certain conditions respond to drugs, others do not. For those that do not, there are a bunch of available therapies, but they do not appear to be terribly effective. It doesn't help that mental illness often goes hand in hand with other conditions, such as alcohol and drug addiction. Which are heavily stigmatized.

In the past, as a society we used to basically warehouse the mentally ill that could not easily be treated in prison-like mental institutions. This was open to all sorts of abuses and the pendulum swung firmly against this option, which is now open only to those who have demonstrated harm to selves or others.

We replaced this option with ... doing nothing. Non drug treatments (expensive and not very effective) are heavily rationed and so in practice available to either the wealthy or those who have families capable of providing home treatment until a slot becomes available. The alternatives are medication (which doesn't work for everyone) or the street.

For families with a mentally ill member, it's a nightmare for both those ill and those dealing with it who are not ill. I've seen it a few times. Those who aren't ill spend their time chasing down resources, while trying to keep home life together, not an easy task by any means.

[Razgovory]

Is homelessness a big problem in Canada?