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Deinstitutionalisation happened more or less everywhere but the outcomes you describe occurring in America with respect to people with serious mental illness (SMI) didn’t happen everywhere, ergo, deinstitutionalisation is not the problem nor re-institutionalisation the answer. In the UK we have community treatment orders (CTO) for non-compliant (and potentially risky) SMI patients and such patients are usually prescribed long-acting intra-muscular anti-psychotics. If they disengage and become non-compliant with treatment, they can be recalled to hospital.

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The issue is that the US may not have the ability for all kinds of reasons to manage deinstitutionalization as well as other countries, so re-institutionalization may be a good solution for us. Especially given the lack of anything resembling stable community support for so many patients.

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Why would America not have the ability to do what many other countries have done? America is the richest country in the world, so this cant simply be due to financial constraints, not to mention the fact that re-institutionalisation would actually be more expensive than community-based alternatives anyway.

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deletedJul 21
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NIMBYism isn’t just an American thing. As for civil liberties, the type of conservatorship that Britney Spears was famously on indicates that America can enact laws which are quite authoritarian, as regards mental illness, when it wants too.

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It is easier when the state has no financial liabilities. Remember, no one gets elected on this. Our largest, old cities are like walking advertisements for Republican Party extremism, with programs claiming to help everyone, yet never helping anyone. They are jobs programs for connected jerks. I should know, as I work in such an agency. Much of public transit in large corrupt cities suffers from this as well. The schools are literally a corruption all-you-can-eat with overpaid consultants who not only steal from poor children, but ruin their educational experience as well (the best sign of this is to see easy-to-game metrics such as "How many students go on to college").

I love the American city, but corruption is so deep that I am not sure they can reform anymore. My Chicago neighborhood is full of pot holes, but the city staff reliably water the flower pots hanging off of light posts every week. It is insane. Chicago has a forestry service, but they are clearly not doing anything, save for removing dangerous trees, but even there, not very well. The department is well-staffed, but what do they do?

It is terrifying. In another era we could hope that the Republicans would come around, but they apparently are too concerned with tax cuts and silly social issues that have no bearing on people's lives. It is easy to feel helpless.

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Reading these kind of articles makes me thankful for the UK mental health system, despite its faults

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My thoughts exactly

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As the UK is getting more like the US (in policies and atomization), the UK mental health system is getting there too, don't worry

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You are incorrect. It did happen everywhere. Those who with this new found "freedom" rationally converged on better locations with homeless services and good drugs. I can always tell people who have never known anyone who is homeless, or been homeless, because they make these kinds of statements. Homeless people go where it is better. Furthermore, many municipalities will buy them a bus ticket there. For some reason, journalists refuse to write about this, but plenty of places literally buy a bus ticket and often will give cash or a VISA gift card to local homeless to get them out. It is the standard municipal policy in most of the US.

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deletedJul 21
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If someone with SMI was NFA and was on a CTO and needed to be recalled to hospital but refused to comply then its likely that the Police would need to be involved in apprehending the individual and conveying them

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