Reddit reviews The Insanity Offense: How America's Failure to Treat the Seriously Mentally Ill Endangers Its Citizens

There is certainly a correlation between the closure of these facilities and the increase in the prison population. Rather than institutionalizing the profoundly mentally unwell before they commit a crime, we wait until after to put them in a prison that won't treat their illness.

E. Fuller Torrey wrote an excellent book on the subject a couple years ago The Insanity Offense. He goes over the whole deinstitutionalization movement, and gives a number of concrete examples of people who've committed heinous crimes who, 30 or 40 years ago, would have been in an mental institution.

> And I don't think I'm being particularly rude but I just don't get why all the people disagreeing with me keep BOLDING EVERYTHING. I think that's pretty rude.

Because in a forum like /r/mentalhealth people tend to gloss over things and get a really bad impression. People are lazy and the stigma of mental illness is so high that they don't like to get into particulars but want the gist of something. Our bolding is to ensure that THESE folks get the right info. Reddit is a public community, there are legitimate mental health professionals answering, folks with some diagnoses, relatives of individuals with MI, laypersons, psychology fans, trolls, etc. Those of us who are passionate about our work/the field take it seriously enough that we need people to get the right/accurate info.

> Anyway, my view is that her guardians letting her run amok on the streets, letting her have access to the media, and generally all the destructive behaviour she is exhibiting (lighting animals on fire?) seem to suggest she is not getting the best possible care.

I don't necessarily agree with your view. It works both ways though. For example, I often have clients who are actively ruining their lives by showing up to work/school drunk/high, who have anger management problems and blow up at their friends and family for no reason, etc. Each MI and even those without have "symptoms" that can ruin their lives. It's unfortunate but it's their reality and that's what we work on in session. That being said, it's not my job, their family's job or their friend's job or whoever's job to prevent them from ruining their lives in this way. Ultimately, they have the right to freedom, which includes the right to be self-destructive to a point.

Laws have been put in place to draw a line. That line is homicide, suicide, child abuse and elder abuse. Everything else is pretty much fair game. Some here would argue that 3 strike laws for drugs is an effort to add that to the mix and prevent people from ruining their lives from drugs/alcohol but it's not worded as such, so I'll leave it out of this discussion.

If you're very interested in this subject, I highly recommend The Insanity Offense and Mad in America for some really insightful history, opinion, etc on the subject.

> If she is getting the best possible care and is not responding to it, then clearly more serious steps should be taken rather than letting her run about.

She has the right to run about though.

> I believe legally you aren't allowed to "deny treatment" when you have progressed to this stage.

Not true. You can deny treatment. But short of suicidal or homicidal ideation, you can't get a 5150 hold for "being crazy", "acting crazy", or "denying treatment". It all comes back to freedom.

> So just because the time limit on the hold runs up, that means she should be allowed to be free and cause harm to herself and others?

I am not sure if you're using the lay or professional definitions here but just to clarify, in most cases she can self-mutilate/harm but if she doesn't present as high suicidal risk (thoughts, intent, plan, means, etc) then that isn't "harming oneself" from a professional point of view. As far as homicidal ideation, in most cases, you need to know exactly who they are intending to hurt and it cannot be a by-product situation - it's a planned, methodical intention to injure or murder someone else.

I'm not sure if that changes your thoughts but I am happy to elaborate further if you want more clarification.