It's not just emergency rooms, example of a food store in San Francisco:
'...When I sit down with Desaulniers, he's tired and stressed and the deep creases between his brow are furrowed.
In our brief meeting, I get an up-close look at how much he's juggling by the number of people who approach him as we're talking at one of the tables in the grocery store's cafe.
For starters, there's the worker who has arrived to fix the $4,000 broken window due to a robbery early that morning. There's also an investigator from the District Attorney's office who drops by to share that a customer who bit Desaulniers in the arm is being subpoenaed (This is the second customer who bit him). And there's the employee who asks him to deal with an uncontrollable customer who is shoplifting and hollering that he needs to use the bathroom'.
The US used to have places to send those people. Santa Clara, CA had "The Great Asylum for the Insane".[1] Later "Agnews State Mental Hospital", then "Agnews Developmental Center", and finally demolished for a Sun Microsystems facility. It was the classic "funny farm" in a rural area, with impressive architecture.
This was the early 20th century solution to homeless crazies. Was it better than what we have now?
The "state hospital" in my area was shut down in the eighties. It turns out that many of their treatments were ineffective and inhumane. I believe there is still a support group for former patients that is active.
I don't know how much truth there is to it, but people I've known that worked in metal health institutions have complained that they're systemically being shut down with no where for the patients to go. They say that often patients end up being handled by police, EMTs, and medical workers. None of which are particularly expert in dealing with mental health issues.
That happened in the US a long time ago, starting in the 1960s.[1] "By 2000, the number of state psychiatric hospital beds per 100,000 people was 22, down from 339 in 1955." During this period, prison populations went way up.
I think that is true, this is a population that has been historically under-served. In my opinion, lack of funding was at least part of the problem with these institutions; one common thread seems to be a lack of staff.
Frankly, I don't trust healthcare leadership to people who call a suffering human "a crazy", and that's why those places were shut down. Society reaps what it sows.
This isn't limited to ERs. I have a close friend that works as a nurse at Stanford (not in the ER) and the treatment they have to endure there is insane. Patients have punched her, spit on her, asked her for sexual favors, massages, and the list goes on. Worse, Stanford wants their nurses to treat patients like hotel guests which makes matters worse. The staff has no recourse when patients act this way. Seeing all of the sexual harassment backlash in Silicon Valley makes me wonder why it hasn't applied to places like hospitals - it's as if this treatment is expected and hospitals are immune because they're seen as a last resort for sick people. Where else do you send them?
The one thing that I find hard to believe in our society these days is the amount of violence shown to medical teams in hospital emergency rooms and also first responders and paramedics who are trying to save lives in the field. It is endemic here in Australia too, not just the US.
I grew up in South East Asia, where I and my friends were taught to pretty much revere the people in this line of work. I guess it is still that way in those countries too, highlighted by a recent video of the protests in Hong Kong where huge crowds of protesters would willingly make way for ambulances to get to casualties in the crowd.
Is it something that we need to ingrain to our kids as they are growing up, so that they have more empathy? It astounds me that a paramedic friend of mine was recently kicked and punched by 2 "friends" of an unconscious person as she tried to save his life on the street. She says it is a really common thing nowadays. Where is your mindset at when you try to prevent someone from saving your friend's life?
“I have seen a colleague kicked in the face; I’ve seen a nurse kicked in the chest and have to get medical treatment. I’ve seen patients spit on people and throw urine across the room,” he added
Why is our society so tolerant of this? Why should anyone, let alone an educated, working professional have to put up with this?
Come on. Let's take the definition of mental illness in this article:
"declining communities must respond to drug abuse, homelessness, and antisocial behavior"
A significant cause of drug abuse is chronic untreated pain, another significant cause is addiction CAUSED by medical treatment (the so-called opioid crisis), and of course neither homelessness nor antisocial behavior are even remotely mental problems. In short, VERY few of these people have mental illnesses other than being poor.
In other words what this article is complaining about are ... economic problems that cause people to become more desperate, less willing to compromise and all of those economic problems must of course be mental illnesses. Futurama put it best:
All of this of course means that the vast majority of "mentally ill" do not have any problem responding rationally. Their rational responses are simply not what the clinic and/or other people want to see. For example panicked responses to not receiving treatment for a child because they have no alternative. The article reports that ERs let some people wait for weeks before any actual medical care was provided, then complain these people protest, and at some point protest strongly, even violently.
The average mentally ill person does not attack staff. Clearly i was refering to a subset, the violent mentally ill for who rational debate is not a strong point.
Since 99% of those "mentally ill" are merely poor, it would be very nice of you to stop referring to them as "mentally ill". Even in the article you can clearly read that the real issue is that substandard care is provided for poor people. This is what leads to these issues.
It is not "mental illness" that makes people unwilling to accept this, and it is not irrational. And, of course, there is a point where people decide violence is more likely to get them somewhere than acting nice. That, too, is not irrational.
If a doctor refused care for your daughter who, say, has an epileptic seizure. How long would you accept waiting in an emergency room before you would start shouting? How long before you'd turn violent?
Because in all honesty, it wouldn't be weeks.
The solution is better medical care, and LESS mental health "help", of course.
The root problem is not a lack of security it is a social problem that no amount of 'immediate corrective action' will correct.
Some other countries have similar problems and yet others have little or no trouble. In the long run the social conditions that cause the violence have to addressed, adding security protects people in the moment but does not fix the root cause.
I realize that this is cold comfort to those affected right now.
Like there isn't enough gatekeeping going on with US "healthcare" already? Which is very likely one of the causes of this in the very first place.
I live in a country with universal healthcare. When I get sick or have an accident that requires urgent medical treatment, I'm wasting literally zero thought on "Can I actually afford this?", I just get the help I need and it won't leave me with massive debt.
I can't even imagine how depressing, and for some probably enraging, it must be to be in a situation of distress and pain, while having to consider if one can actually afford to get professional help, without having to pay off crushing debt for the rest of one's life.
The surprise here is how few people snap from this very apparent inhumanity going on.
I can't tolerate the concept that people don't "deserve" basic things like health treatment based on their behavior. It's sick to me, and a hallmark of a sick society.
Health treatment isn't really a basic thing. I find it really bizarre how people keep trying to write in more and more luxury goods as god-given rights.
Whenever I think of rights, it is things that society and other people must not do, rather than something that other people must provide for me.
You are saying people deserve a certain level of care regardless of their harassing behavior while waiting for such care and that you are utterly intolerant of any disagreement.
A sick society is one that cannot handle minor disagreements.
Ultimately, you're not going to completely keep out all the people banned all the time. Duty to treat exists for a reason: in an emergency, it's better for society if people get emergency treatment and sometimes the other bits (e.g. money) don't work out.
However, most people who consume emergency services, don't do so unconscious. Hospitals, EMS, etc. want to get paid, so you're going to be asked for an ID sooner than later.
Some people might not want to give ID, or just not have it on them. I don't know what hospitals do in this case currently, but it doesn't seem like a huge stretch to just make those people give fingerprints to continue treatment.
This[1] claims that 4 finger IDs from fingerprints are 99.9% accurate, which isn't perfect, but it's pretty good.
You prosecute someone that's mentally ill and send them to jail. Now the jail has to deal with violent outbursts and is generally not equipped to handle people on a medical level like that. Our prison system is designed to punish people, so those people if they get out of jail fall back into the same issues.
The answer to solve these problems is better preventative care. Meaning better healthcare for vulnerable populations, better solutions to housing for the homeless and so forth. Unfortunately solutions like this require things like increased taxes or recognizing the problem exists and many would prefer to just sweep it under the rug for people in emergency rooms and jails to deal with.
Except, again, that doesn't solve the problem. They go to jail for a year or two, become a handful for people in prison to handle (whom are not equipped to handle people with severe mental illness), are released and then the cycle continues. Or even then, those inmates are admitted to those same hospitals because where else do you think people get proper treatment?
None of this discussion solves the actual problem at hand, it just deals with the symptoms. Eventually the problem will become uncontrollable if you just ignore the actual damn reasons why people with said issues end up becoming homeless or violent in the first place.
When the symptoms include unacceptable impacts on other people, they still have to be dealt with.
We can and should chip away at risk factors, but the human brain is wickedly complex and we're never going to get 100% health and behavior within norms. Just like we can and should encourage exercise and healthy diets, but we're still going to need the medical system.
Instead they person is battering inmates or police and getting punished for it, while potentially being recruited to criminal activity instead of being treated.
There's 3 main factors talked about in deterrence theory - severity, certainty, and speed.
The US generally has severe enough punishments, and increases do little to add deterrence (and the downsides then take over).
Certainty and speed are weak though. People drive in a civilised manner because if you don't, a cop will write you out a ticket. But if people behave in an uncivilised manner in a more criminal way, it's actually unconstitutional to have swift and certain penalties.
People are fine arguing that the 2nd amendment was more appropriate for the era of muskets. Maybe the 5th is more appropriate for an era where overly harsh sentences were applied to political prisoners through the use of torture.
You really shouldn't incarcerate an animal unless you're prepared to accept the responsibility of taking care of that animal. A human needs food, water, shelter, clothing, medical services. If you're holding a bunch of humans in one place, against their will, you're gonna need to use force which means you're also buying weapons, guards, training for the guards, facilities for the guards. In order to coordinate all this spending you need computers, administrators, office spaces.
Because insanity is usually incurable, you would be taking care of these people from the date of their incarceration, for the rest of their natural lives. Are you ready for that responsibility? Is anybody? My community has been routinely fucking this up for decades and they have a couple hundred-million dollars to play with. What about yours?
You don't. But after a certain number of violent interactions that point to a mental health, I wager to say it does not take a rocket scientist to draw a conclusion.
It can be dangerous to give governments carte blanche to do this...
> Sluggish schizophrenia or slow progressive schizophrenia was a diagnostic category used in the Soviet Union to describe what was claimed to be a form of schizophrenia characterized by a slowly progressive course; it was diagnosed even in patients who showed no symptoms of schizophrenia or other psychotic disorders, on the assumption that these symptoms would appear later. The diagnosis has long been discredited because of its scientific inadequacy and its use as a means of confining dissenters. It is considered a prime example of the political abuse of psychiatry in the Soviet Union.
I'm talking about after they've already broken the law - not just when some doctor declares they are ill. I assumed intentionally, violently kicking a person in the chest to the point where they medical intervention is illegal.
Under the UN Declaration on the Rights of Disabled Persons, that's unethical. Also historically "Involuntary mental health treatment" in the US has not been humane.
We should strive to have compassion for the homeless and ill, not imprison them.
You can give people a choice between either being prosecuted as a mentally healthy person, or getting mental health treatment. It's not involuntary but gives mentally disabled people a way to get help.
It's a nice thought, and should probably be an option, but it won't be sufficient on its own, I don't think.
Would it surprise you to learn that many with severe mental illnesses do not voluntarily undergo treatment? A friend worked in a job training and support program, first with chronically homeless, and then with mentally disabled specifically. The single biggest obstacle most faced was their own unwillingness to accept or stick with treatment.
The homeless in particular that this friend worked with were untrusting of any program that might potentially hinder their autonomy- so they would show up for the free bus cards, food and job training, but any hint of medical support and they would disappear for fear of being taken off the street and locked up.
Most, given the choice between jail or treatment, would choose jail, simply because there was a defined time period that they would get their freedom back, plus no pills.
How about some compassion for the victims, too? They get spit at, insulted, their belongings stolen, and their property vandalized. And we mostly guilt them for not turning the other cheek more gracefully.
You're not giving them involuntary mental health treatment because you deem them ill - you do it because they are mentally ill AND have kicked a nurse in the chest and threw feces at others.
This article fails to mention that ER departments tend to be underfunded; hospitals typically do not generate much revenue through ER departments and they are often blamed for losing money. There are many articles out there, this is just the first one I grabbed.
Less staff means higher wait times, long wait times lead to frustrated and angry patients. People with mental health issues might be less able to manage a longer and more stressful visit. Exhausted providers might me less effective managing upset patients. And so on.
This article calls out people with mental health or drug addiciton specifically.
"As doctors and nurses administer care, they risk physical assaults from drug-addicted or emotionally disturbed persons"
Mental illness exacerbated by drug use that leads to ER visits is a pretty disordered state of affairs to begin with.
There are plenty of legitimate reasons that would make sense for a person to wait an hour or so in an ER once they have been stablised/triaged, such a for observation, further diagnostic tests, or the attention of a particular specialist.
An otherwise-healthy person can generally deal with this without getting violent, even if they're feeling a bit stressed, but if someone's tripping balls and being chased by robotic dinosaurs, then it's no wonder that people are acting out and behaving in ways that transgress social norms.
No the underlying causes are different. Social tensions, budget cuts, inadequate management... all these leads to delays and mishaps in emergency rooms. To a level we've never seen before (forgotten elder died after too many hours unattended).
Well...doctors and nurses are some of the highest paid people in the US and these problems are directly caused by a lack of a social safety net and mental health care. It's like they took the Hippocratic oath and didn't think it applied to not bankrupting people for getting sick.
You misunderstand how the system works. Doctors don't have that much influence over how billing works. It's actually also more inconvenience for them the way it's fragmented now. They don't decide the amount country spends on mental health care, or economic rules which influence the social safety net. It's still a high risk job they're doing. The mental health care issues impact them too - see doctor suicide rates.
So you may want to direct that lack of sympathy towards people who created the system as it exists now instead of those working in it.
I see you don't know many doctors. Sure, some of them have that motivation, but that's a bad generalisation. (on the other extreme, you know that Doctors Without Borders exists, right?) There are also easier ways to get rich where you don't have to spend years training and working crazy hours.
There's also a big difference in required skills between doctors, fire fighters, and social workers.
Full stop doctors are profiting off the sickness and suffering of others, when they take an oath to do no harm.
Yes, I agree, the Doctors Without Borders people are saints (no sarcasm here - there are truly good people in this world). That is not the rule in the US - the rule is that we have greedy evil people who are making money off of cruelty.
Again, if that's what you think, if recommend taking to actual doctors. It's really not a "get rich quick" job.
Sure, the pay is very high, and they could live a good life with less. But it's not the biggest expense in the system overall - ie it doesn't really impact your bill that much. Other countries also have high doctor pay and don't suffer the same issues with healthcare billing, so concentrating your anger on people who actually do the work to help you is a bit misguided.
A few years back, my wife had to go to the ER due to sudden life-threatening illness. They were getting ready to stabilize her (barely) and turf her out because of an issue with health insurance (my employer was happy enough to take the premium out of the paycheck but never informed the insurance). It took a lot of pleading to keep her that night. A young black guy might well have been arrested.
Right now I am dealing with fantasy bills from an ER visit a few months ago.
The whole medical-industrial complex can die right now. I have no sympathies for anyone in it. If they get assaulted in the course of work, they earned it many times over.
I can totally see being upset with the people in administration and billing. But how can you be that upset with the doctors and nurses, when your whole complaint is that you wanted more of their attention?
The physicians and nurses are the public face of the healthcare mess. It's only natural that they would attract ire. You go to the physician and you know they'll overbill you. It's sickening. You get angry the moment you walk through the door.
The dude hates doctors and nurses so much that he thinks they deserve to be physically attacked. And yet he is desperate for their services. This is a contradiction. I’m attempting to point this out.
You can look at it the other way: you need physicians and nurses, and because you have no alternative they fleece you by any means possible, and the rule of law doesn't apply to them.
A couple of years ago I fell for the high-complexity drug testing scam at the intake visit. It goes like this: you pee in a jar, and they send it to an out-of-network lab. A few weeks later the 4.5 kUSD bill arrives, which isn't covered by insurance. Everyone denies responsibility: the physician says you gave us the sample, the insurance says out-of-network, and the lab says services rendered. The charges eventually went away, after several afternoons on the phone.
Civil society offers no solution. It's no surprise that people give way to their anger. There isn't even a contradiction.
Ridiculous. The best part about paying for a drug test is that it literally offers no benefit to the patient. He or she knows firsthand whether they took any drugs. (Excepting cases where something is slipped into a drink but that accounts for ~0% of tests performed.)
I can see that but suggesting a course of action that is absurd on its face doesn’t do anything to refute his stance. Medical treatment for a severe injury isn’t optional.
'...When I sit down with Desaulniers, he's tired and stressed and the deep creases between his brow are furrowed.
In our brief meeting, I get an up-close look at how much he's juggling by the number of people who approach him as we're talking at one of the tables in the grocery store's cafe.
For starters, there's the worker who has arrived to fix the $4,000 broken window due to a robbery early that morning. There's also an investigator from the District Attorney's office who drops by to share that a customer who bit Desaulniers in the arm is being subpoenaed (This is the second customer who bit him). And there's the employee who asks him to deal with an uncontrollable customer who is shoplifting and hollering that he needs to use the bathroom'.
https://www.sfgate.com/bayarea/article/SoMa-San-Francisco-Ha...