60 Minutes just re-ran their piece on 100,000 Homes, a project that helps the homeless by giving them free housing. Counterintuitively, this turns out to be a significant cost saver: the worst of the homeless cost the taxpayers a lot. For example, a night in the hospital costs as much as several months rent. But homeless folks don't have insurance: The hospital has to cover this somehow--ultimately taxpayers and other patients and their insurance companies. 100,000 Homes focuses on the most threatened homeless, the ones who are most at risk of hospitalization, or committing a desperate act. Remarkably, a majority of the recently homeless, when given safe, clean housing, get themselves cleaned up very quickly, and with a little help, are able to get a job and before long are able to pay their rent. All they needed was a leg up.
Not all the homeless are have mental health issues, but around 30% do. A surprising number of them have minor, easily treatable problems that become debilitating or worse if left to fester. Desperate for food, they steal, or confused, they commit violence. A few hours of counseling a month, or a few dollars of medicine, are all it takes to prevent this in a great many cases.
The homeless and the mentally ill are among the most defenseless sectors of our society. The war on the mentally ill was led by Reagan and similarly inclined people, but the mentally ill themselves and their families contributed to it, by fighting what had been relatively sensible involuntary commitment laws. It's understandable why the patients would object to involuntary commitment, and many mental health facilities were horrible, but it was a system that had a chance of being fixed.
So instead, we wait for the mentally ill to commit a crime and use our remaining involuntary commitment system: the prison system. This isn't actually much cheaper than the old asylums, and it treats the "patients" just as badly as the asylums did, but a great many people with minor problems become hardened criminals in prison.
Most people who are powerless to deal with their circumstances feel anger or depression, whether they have mental health problems or not. Mental health problems only make these feelings worse, and a tiny fraction of them lash out, however they can...using a gun if it's available.
We must restore and repair the asylum system. It did many evil things as it was, but we have "thrown out the baby with the bathwater" as it were. Like prisons, we need many levels of asylum and both voluntary and involuntary commitment. They need to be decent places that keep the worst of the worst away from the vast majority, who have only minor problems. Almost half of the people now in our prisons have committed non-violent, victimless crimes like drug possession and should simply be released (upon review, of course), and a sizable fraction of those remaining (including a lot of addicts) should be moved to asylums or other places that have a better chance of dealing effectively with their problems.
I am convinced that this will save a lot of money: getting the indigent into a circumstance that helps them find work should have positive cash flow if the costs of hospitalization is factored in. Getting the mentally ill into a circumstance that doesn't make them worse has to be cheaper than the present system--the mentally ill commit a sizable fraction of crimes, and they will need a lot less security (although more medical assistance) than criminals if we house them properly. Like the non-crazy indigent, in many cases, simply treating them decently will turn them from problems to useful, or at least not harmful, members of society.
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