Better here?

This prompted by the article at reference 1. A long article about what happened when most of the mental hospitals in New York were closed down in favour of care in the community, starting in the 1960s - as they were here. A change prompted, in part, by the poor state and bad reputation of some of these hospitals. A change made possible, in part, by the arrival of medicines which could control the symptoms at least of mental disorder. Provided, that is, that they were taken.

In the article there are several references to the right not to take medicine, the right not to be admitted to a shelter or a hospital and to the data privacy/data protection barriers to sharing patient data across the various agencies and organisations involved. With one result of this last being that care, such as it is, is not as joined up as it might be.

One complaint one often hears here is that care in the community was never properly funded. In New York we are told: '... Before deinstitutionalization, New York spent about $400 million a year on its psychiatric institutions, according to one estimate cited in congressional testimony in 1963 - the equivalent of about $4 billion today. The assertive community treatment teams, by comparison, have received, on average, about $120 million a year in state and federal funding in recent years...'.

But then there are 600 homeless shelters, said to cost another $250 million a year, with a total of around 80,000 places, including 37 specialising in supporting those with mental disorders. A lot of the homeless have mental disorders and a lot of the homeless are either black or Hispanic. The story seems to be that these shelters are run by contractors and there is pressure to keep costs down - with the result that, as here, there are not enough front line staff and they are not very well paid. And, all too often, vulnerable people are directed to the wrong sort of shelter. '... Some teams spent just 15 minutes per visit with patients - the minimum amount of time required to bill Medicaid for services...'.

I assume that the article refers to New York City, with a population of something under 9 million, about the same as London and something under half the population of the state as a whole. While I learn that 40% of the population of London were born overseas - including here a modest contingent from Ireland. And according to the BBC at reference 6, there are around 150,000 homeless people in London, with around 6,000 of them sleeping rough. Does homeless here mean the same as homeless there?

And then there is the network of 11 municipal, general hospitals, which treat, as well as their general patients, near 50,000 psychiatric patients a year, and costing of the order of $11 billion a year. The private hospitals are not too keen on such patients, partly because they get a much better return on medical patients. Perhaps these last get through more operations, more interventions and more medicines.

So it would take a while to work out what the comparable spend now to the $400 million then was. Similarly, it would take a while to work out where the responsibilities lie, given that there are at least three outfits with a finger in the pie. See references 3, 4 and 5. It would also take a while to produce some decent statistics, never mind a proper comparison between New York and London.

So while the individual cases cited by the article are bad, it is hard to put them in context. And as regards the 94 cases turned up by the NYT investigation, just how bad is 94 cases in 10 years? What if the real figures is nearer 500? How many drug deaths were there over the same period? How many murders? How many road traffic deaths?

References

Reference 1: Behind 94 Acts of Shocking Violence, Years of Glaring Mistakes: New York officials have escaped scrutiny for repeated failures to help homeless mentally ill people, a New York Times investigation has found - Amy Julia Harris, Jan Ransom, José A. Alvarado Jr (photographs), New York Times - 2023.

Reference 2: https://en.wikipedia.org/wiki/Whitchurch_Hospital. The Cardiff hospital snapped above, finally closed in 2016. The hospitals of the Epsom cluster also sported water towers, one of which became home, at least for a while, to a peregrine falcon.

Reference 3: https://omh.ny.gov/. The responsible public body for New York State.

Reference 4: https://www.nyc.gov/site/doh/about/about-doh.page. NYC Department of Health and Mental Hygiene

Reference 5: https://mentalhealth.cityofnewyork.us/. 'The Mayor’s Office of Community Mental Health promotes mental health for all New Yorkers'.

Reference 6: https://www.bbc.co.uk/news/uk-england-london-64224529.