I sympathize with the terrible situation you were in with your sister.
But I want to point out one thing: you yourself have said that your family put her through treatment, through rehab, a whopping 12 times.
What do you expect the state to do that your family has not already tried?
Is it that you think, somehow, the state will be able to procure some kind of "better" rehab that will finally be effective, that would have saved your sister?
Or is it that you all want to pass the buck, financially and emotionally, and place the responsibility somewhere else?
You tried. Many times. Are you advocating for treatment options, which your sister already had access to by your own admission? Or is there some bigger aim you're really arguing for? By all means, I think we should fund treatment programs and mental health facilities; what Reagan did to this country by removing those options is an atrocity.
But I genuinely do not know why you're using your sister's case to vilify the city of Seattle for not having the resources to do what you've already tried and has already failed. You did everything you could, and it was not enough. I agree that treatment is necessary, but your argument does not make sense. Treatment did not save your sister.
"She was left to die and we called it freedom". But she wasn't. She literally wasn't. You rescued her and put her through treatment, again, 12 times. Why are you blaming the city and state? Where did your sister's responsibility and autonomy begin and end?
ETA: the fact that you, a private wealth manager, are propping up Sara Nelson here, of all people, does not help your case. Neither does the fact that you initially posted in SeattleWA, which all Seattle-area residents know as a deeply right-wing subreddit that routinely advocates for draconian and punitive conservative policies. Frankly, this sounds like propaganda, written to justify sweeps and imprisonment as a response to homelessness.
I'll also note that your sister died in Idaho. Again, why are you using Seattle and the state of Washington as an example of failure here when the fact is that a rural town in Idaho is where she died? Are you weaponizing your sister's death because you don't like to see homeless people on the streets? Is that what this comes down to? Disguising a right-wing agenda and dressing it up as empathy? Anti-Wilson propaganda, perhaps? This is more on the city council members who have failed to make any meaningful changes (like Sara Nelson) than it is on her.
My brother is in similar circumstances (minus the rehab stints, because he flat refuses to go.) He is college educated, used to have a wife and kids and a nice middle class home and job, and now he is an unrepentant, toothless meth-head. My parents have offered all of the supportive things you're supposed to do and he will. not. take. it. Short of putting these people who refuse help in jail I'm not sure what other solution there is.
We absolutely need a comprehensive safety net to give the opportunity for healing to anyone who needs it. I'm not sure that using as an example someone who had every advantage at their disposal and still refused help is going to convince the regular taxpayer to open their hearts or wallets.
And telling a story about a person who was offered substance abuse programs and mental health counseling multiple times without it sticking, and claiming that this is the true face of homelessness in Seattle, is more likely to shut hearts and wallets.
As a recovering alcoholic, let me just say that I have endless sympathy for people caught in the cycle of addiction, including people who did not escape it, like OP's sister. But believing that the housing crisis and poverty are just smoke screens for people with advanced degrees who "chose" addiction is a fundamentally conservative position.
I agree with this. Majority of homeless people in NYC, where I live, are not on the street. Most of them are in shelters or in informal temporary living arrangements (living with family or friends). Many of them work jobs that don’t pay enough to pay for rent and food.
Private Wealth Managers are the type of folks who vote to ensure social safety nets and regulations are non existent for everyone else, but then cry that they’d like social safety nets & regulations for them only. Cause they only care about themselves!
Thank you for reading. I’m new to Reddit and not partisan. Perhaps read again, I lived through this for many years, and one of my main points is that we don’t have correct laws in place when someone has lost their mind and will to severe addiction. We need to protect them, treat them, not let them die on the streets. We don’t do this to Alzheimer’s patents or young children. California, Oregon and BC have already passed laws to address this. Yes 12 rehabs, but while totally out of her mind and a danger to herself there was nothing that could hold her. No laws, systems in place. That needs to change.
oh, I think it's coming. Republicans have been talking about it, and once it happens, we'll hear screams and laments from the opposition about "autonomy". This is a catch-22 if ever I saw one.
So you ARE advocating, more or less, for imprisonment to keep people in treatment. Again I ask, where did your sister's responsibility and autonomy begin and end?
I would also add that it's unclear to what end we would be detaining these individuals. Yes, they could be kept alive in a restrictive environment where they are denied access to drugs. However, to make involuntary treatment morally defensible, there needs to be a reasonable possibility of successful long-term rehabilitation and reintegration into the community. OP writes that meaningful relationships and family are crucial to recovery. Many individuals in OP's sister's position are not going to have her innate capacity to form these connections and will not have supportive loved ones who are ready and willing to engage in the process.
Governments and rehab facilities can't assign someone a family, or give them the ability to build one from nothing. Realistically, the most they could do is confine unwilling people for a longer duration than the law currently allows while administering the same addiction treatments that are available to those who seek help willingly and have the means to access it. They could facilitate the transition back into society by providing stable housing and job placement. But then what? It isn't ethical for the government to just have custody of recovering addicts in perpetuity to ensure they don't relapse. If the root cause is a permanent biological change that overrides free will as OP suggests, I'm not convinced that forcing long-term treatment would do anything more than delay the inevitable.
Personally I believe that in some cases yes, institutionalization for treatment and care is better than letting these people die in the street of an OD, or of sepsis, or of starving to death in an isolated farmhouse because of their schizophrenic solutions.
Even you say in one of your comments that Reagan's dissolution of the state hospital system was a mistake, because anyone with eyes and ears and the ability to read has heard these stories time and again.
Why you come so hard and nastily at this guy who was directly and personally harmed by the system you yourself admit is inadequate is bewildering.
“Ate her will is not a figure of speech. It is, increasingly, a description of tissue. The National Institute on Drug Abuse and its longtime director, the neuroscientist Nora Volkow, have spent two decades establishing what is now the mainstream medical understanding: addiction is a chronic disease of the brain.
Sustained use floods and then exhausts the reward system, hijacking the circuitry that evolved to make food and family and safety feel good and rerouting all of it toward the drug, while the same disease erodes the prefrontal machinery that is supposed to weigh consequences and apply the brakes. The craving is widened into a superhighway; the off-ramp of judgment is paved over. By the time the disease is advanced, the organ that does the choosing has been physically remodeled to choose the one thing that is killing it. This is why willpower is the wrong word, and why my sister’s doctorate could not save her. You cannot reason your way out of a rewired brain any more than you can will a tumor to shrink.”
Alzheimer’s patients can’t take themselves out of treatment multiple times. Young children can’t take themselves out of treatment multiple times. Your sister was provided with the resources and chose to not take advantage of them.
If Alzheimer’s patients and children were allowed to choose whether or not to continue medical treatment, you can bet they would not. We have determined as a society that they are not capable of making decisions for themselves due to their mental capacity. OP is arguing that the way we frame addiction as a choice, as you have here, is not supported by medical experts and researchers who study addiction.
As a caregiver to my dad with Alzheimer’s - what the fuck protection are “we” offering Alzheimer’s patients? I would love to know and get in on some of this protection. Get a grip.
I’m sorry your sister died, but you say “we need to protect them, treat them”. Uh, what do you think 12 stints in rehab is if not treatment? If she decided not to participate and really work towards sobriety, there’s nothing any law or “protection” could do to save her. Look, I also lost my sister to addiction in 2021. Myself and my parents contributed financially to 3 rehab stints before she died. Ultimately, addicts need to want to get better. If you think locking addicts up and controlling them via conservatorship is the answer, then you know way less about addiction than you claim.
I also cared for an elder with Alzheimer’s, and I had exactly the same question.
How many doctors did I ask for a capacity letter? In the face of ridiculous (and dangerous) situations? How many times did I seek inpatient psychiatric care for behavior disturbance and was denied because she wouldn’t agree? Her memory care threatened to evict her without treatment (she was violently striking people), and I had the facility nursing notes documenting the episodes. Yet MDs considered this “not a danger to herself or others.”
Alzheimer’s patients have a lot of “autonomy “ to refuse care. It’s a massive headache for caregivers. Depending on their DPoA, managing their financial affairs can be a nightmare as well.
Ugh your comment gave me the chills. I’m so sorry you went through all of that. Of course your family member didn’t agree to go to inpatient psych care! She wasn’t in any position to make those kinds of decisions, and look how that turns out. You must have been so stressed when memory care was threatening to evict. Because then WTF are you supposed to do??? THERE. IS. NO. SAFETY. NET. I finally found a memory care facility and persuaded my mom to let me move him there. It took a year to convince her. Guess what? The facility evaluated him and he “wasn’t a good fit” aka too much to handle. I don’t have it in me to go through the process again and potentially get denied again.
I’m my dad’s POA, and my mom is still in decent shape, so financial affairs have only been a slight headache so far compared to everything else. But now my mom is trying to push more of their financial stuff onto my plate and I’m just maxed out. Our ONLY saving grace is that he’s a service disabled veteran, so the VA pays for an aide to come to the house 10 hours a week. Otherwise, everywhere I turn to for help, I get rejected in some way shape or form. And don’t think we didn’t have to fight with the VA for the 10 hours a week!
Besides the Alzheimer’s and Parkinson’s, he’s healthy. I am scared this is going to be my life for a very long time. I’m really scared. I hope you have peace and are doing well. I’m really sorry that you dealt with all of that. Sorry for the long rant.
Great read, so sorry for your loss. I work with people who are at the intersection of mental health issues, substance issues and homelessness and this is something I struggle with as well. Of course we want people to have autonomy but what is autonomy when they are not in their right mind. Our legal system (I am in Minnesota) of course wants to honor someone's choice but what is choice when the addiction is calling the shots? Our systems don't have a great history when given full power over people but this huge swing the other way has been incredibly damaging. A doctor who has worked with the Boston Healthcare for the Homeless program described knowing a person who lived rough for a decade and he always honored her choices of not wanting treatment. A few years passed and he sees her again at a dinner looking amazing and he compliments her progress and she asked why he let her suffer in the streets all those years. I think about that a lot.
> A few years passed and he sees her again at a dinner looking amazing and he compliments her progress and she asked why he let her suffer in the streets all those years. I think about that a lot.
Any public health intervention needs to be evaluated by the sum of its effects.
E.g. Someone goes to the doctor and says they have an unusually bad cold, with an unusually bad cough and they do an exam and nothing is unusual, they get sent home with tylenol. If they come back a week later with no improvement, they get an x-ray or maybe just straight antibiotics for pneumonia treatment.
That person can say "Why didn't you give me an x-ray and antibiotics when I first showed up"? And the answer is "Because that would be incredibly costly for little benefit, and promote antibiotic resistant infections if we did it for every such case".
Same for this story. Let's go with the unprovable hypothetical that if this woman had earlier been forced in to treatment she would have recovered.
For her to receive that, hundreds of people would have had to receive useless involuntary treatment, and many of them would have been traumatized by it. It's not worth it and there's no research that firmly suggests that it is.
If someone invents a crystal ball so we can know who will benefit from involuntary treatment and who won't, then we can consider shifting our attitude away from patient rights, but it doesn't exist.
Can you compare the predominant US system relative to some of the European countries in terms of policies, involuntary hospitalization/treatment, and the results thereof? I’m curious if any of those countries have more conservatorship and involuntary hospitalization/treatment. And whether they have less loss of life due to addiction. I assume many of those countries have better funded housing for the homeless, so I doubt citing a lowered number of homeless population as a barometer of success. Just curious if you can opine on what happens on other developed countries. Many thanks.
I do agree that mental healthcare and addiction treatment are sorely lacking in America. Where I disagree is that I think
your family's wealth has kept you from understanding poverty's role in homelessness.
Most Americans are squeezed between low wages and high rent. The cost of everything is going up dramatically, but jobs pay the same. Federal minimum wage is still less than $8 an hour. Many homeless people work jobs, but they still can't afford housing.
Corporate greed is limitless right now. Congress has been bribed by campaign donations, so they're currently as useful as a steer's nuts. America's safety nets have been ripped to shreds, and anyone can fall through the gaping holes into homelessness. All it takes is a few missed paychecks.
Jobs hire and fire at will. It's so easy for someone to be fired because they missed a few days of work due to illness, car problems, or needing childcare. It's a cruel irony that health insurance is tied to your job but you can be fired for being sick.
I understand that people are uncomfortable with mandatory treatment and hospitalizing people against their will. It's a fair position, given the history and the fact that taking away people's autonomy is something to be weighed very heavily.
But the alternative is to let them wander the street? Talking to themselves? Shitting in the street, sleeping under bridges, and eventually dying?
Bring back rehab, bring back the mental hospitals. Make them really nice. They can hang out in the garden, play video games, go swimming when they aren't going to therapy and all the other treatment activities. And slowly phase them back into society. Not a 30 day trip, or a 3 month trip. Keep them until they are ready to go back out. Hook them up with a therapist and psychiatrist on the outside, a support group, a social worker to check in weekly. Give them housing in a small apartment complex or triplex for other people just like them so they can have a sense of community and not feel judged. Hook them up with classes so they can get their associate's degree or a certificate. Have them go out into the community and socialize and go to bowling or karaoke night so they can build their own support network. Help them find a job or apply for disability. And they just stay at that house until they're ready to move out on their own or find roommates and when they do that, still give them support so they don't get overwhelmed. And over time, they can stand on their own two feet.
And if they fuck up, just take them back and start over.
The reality is that some people are going to have to be taken care of for the rest of their life. For whatever reason, they are just wounded and we either let them die on the side of the road or we step in and help them.
We also need to fight NIMBYism, decriminalize drug use, and offer needle exchanges and safe injection sites.
I have a cousin who is schizophrenic and he's been homeless for years. We try to help him, but we can't because he doesn't want the help. And he's not a threat to himself or others so there's nothing to be done. A bright and kind person lost to mental illness and all the good he could for society is lost as well.
People should look up wet houses. A lot of models right now come with the assumption than addiction can be treated but for some like my uncle they just can’t beat it and having them housed is better than letting them die in the street. It is also less of a civil liberty hazard though nimbys typically hate them.
> Bring back rehab, bring back the mental hospitals. Make them really nice. They can hang out in the garden, play video games, go swimming when they aren't going to therapy and all the other treatment activities. And slowly phase them back into society.
A few things:
There is no political appetite for the taxes needed for "very nice" involuntary rehab facilities, which as you describe them, will be housing A LOT of people. Taxpayers mostly want these folks to disappear, just like in to the asylums, which also never really worked.
There's no good evidence that what you're suggesting will work, which means it's based on wishes and desires.
You can dress up a prison any way you want, but you're describing prison and a half-way house system.
Amazing read that hit home for me. There's clearly no easy solution for the addiction crisis, and all too often it really feels like there's no solution at all. It fucking sucks. Wish I had something better to contribute.
I threw it in the first ai checker on google. The fact that the poster is just throwing it all over reddit, the em-dashes and phrasing, all suggest it's just dross.
The flowery language when discussing the neurological impacts of long term drug abuse was giving me AI. Also, I think it was a disservice to the piece and read more propaganda than education.
I would first like to start by extending by condolences to you and your family. I have had many family members struggle with addiction and I know the toll it takes on the people who suffer from it and the people around them. Having said that, I think the trauma of your sister's death has led you to some incorrect and extremely dark conclusions. You seem like a you want what's best for people and I respect that. However, I think what you have written is not aligned with what you seem to value because you are advocating for cruel, inhuman treatment of America's most vulnerable population and you are advocating for it off of a completely incorrect premise. What you are championing in this article is going to hurt hundreds of thousands of people. What follows is going to be a very long comment but I feel like I need to set the record straight about this article's content and mission and doing so requires a look at the facts.
Your conclusion about homelessness is not supported by the data. According to the Substance Abuse and Mental Health Services Administration 48.4 million people in America suffer from a substance use disorder with 21.2 million people suffering from both addiction and mental illness. Of these people, only 10.2 million received treatment. Clearly there is a huge treatment gap in this country as you say.
The problem here, is that you immediately say that everyone suffering from homelessness is either mentally ill, addicted to drugs, or both. There were 771,480 people experiencing homelessness in 2024 in this country according to the United States Interagency Council on Homelessness. I don't have current numbers because the agency was completely eliminated after Donald Trump was sworn in in 2025. Nevertheless, I think you can see the problem right away with your assertion. Even if you assume that every single one of those 771,480 people experiencing homelessness were either mentally ill, addicted to drugs, or both, it still only accounts for about 1.5% of total population of addicts in this country. If it was the case that homelessness is simply an inevitable result of untreated drug addiction, wouldn't the number of homeless people in the country be significantly higher?
You also make an assertion that economic circumstances have nothing to do with homelessness. This is flatly untrue looking at the data. Referring back to the USICH 2024 study, if you look at the homeless population over the course of the past 17 years, you notice that the number has been steadily rising since 2018 but plateaus between 2020 and 2022. Now they weren't able to adequately get a number of homeless people in 2021 due to the pandemic but between 2020 and 2022, the number rose by 2,000. Then, in 2023, the number of homeless people rose by 70,642 and it rose by 118,376 people in 2024. That is a huge spike in homelessness. Now, you're probably wondering how the number stayed so flat during and immediately after the pandemic but spiked in the last two years. That is because between 2020 and 2022, the government rolled out a host of protections from people who lost their jobs during the pandemic, most notably eviction freezes. Once those policies were rolled back, homelessness spiked as the economic situation continued to worsen after the pandemic. This is something that is very easily observed by the data so clearly your assertion that homeless people don't need housing and that this is a mental health issue and not an economic one is flat out wrong. If that were the case, the eviction freezes would have done nothing to stop homelessness but the data show that they clearly did.
So already, the entire premise of this article is based on an incorrect conclusion. The vast majority of addicts are not homeless and a large part of our current homelessness crisis is a result of worsening economic circumstances combined with a roll back of protections against homelessness after the pandemic. However, if this article only misrepresented the homelessness issue in this country that would be one thing. However, what you are advocating for as the solution is a deeply disturbing position to hold.
Your policy prescription for the homelessness crisis is involuntary commitment. Let me start by saying that you're already getting some facts wrong. You talk about San Francisco and Los Angeles without mentioning that the state allows for 5250 involuntary psychiatric holds which essentially extends an in patient stay up to two weeks after the 72 hour hold. That means that a person in California can be involuntarily committed for 17 days in an in-patient facility. That is already far longer than your typical in-patient stay, most people are usually held for about 7 to 10 days. So already, you're talking as if these states aren't doing enough when they already have the mechanisms in place that you advocate for.
On a deeper level though, your article seems to assert that rounding up homeless people and forcing them to get psychiatric and addiction treatment is the only thing that we need to do to stop this crisis. Already, I outlined that not every homeless person is a mentally ill addict so do you believe that every panhandler should be arrested and put into an already overburdened mental health emergency system? Inpatient facilities are constantly overcrowded and can't keep people for too long because there isn't enough space for everyone suffering from a mental health crisis. If someone needs a higher level of care, involuntary in patient stays are not equipped to provide it because they are not equipped to keep the entire nearly million homeless people in addition to all the housed people with mental illness.
(Continued in the comment below because I hit the character limit).
Furthermore, as someone who has had multiple inpatient psychiatric stays and knows many others who have as well, these places are not good places to be. Even if you are there voluntarily, they feel like prison. You are stripped of so many privileges and you're not even allowed to go outside at most of them. Furthermore, the staff who runs them are generally not good, they are overworked and underpaid. I never had a helpful or healing therapy session at my in-patient stays, I even left one with a misdiagnosis that led me to receive inadequate mental health care for over four years. And mind you, I went to each one voluntarily. I know some people who were involuntarily committed and every single one has described it as a traumatic and difficult experience. Our current healthcare system is broken and not equipped to help people with mental illness, even those who want to get help. Do you really think it will improve if we just throw more people into the system who are there unwillingly? You seem to argue that we need to rid the system of any abuses but the the system itself is not working and making it more carceral and punitive will not change that.
Inpatient clinics are designed to transition people into other programs, whether those be residential treatment, partial hospitalization, or intensive outpatient. All of these programs are very expensive and if you are homeless and don't have any income, prohibitively so. You might suggest that we should make these programs more affordable but that doesn't address a very huge problem.
The problem is that these people have nowhere to live.
That's why people go for housing first, because if someone has housing, they can get treatment. You don't force someone into a broken system, give them treatment that they do not consent to, and then throw them back on the streets expecting them to be okay. To make your proposal work would require a comprehensive reform of the entire healthcare system which would require a lot of money and years of investment to see any kind of positive outcomes. This would require both a substantial increase in taxes and a massive reallocation of government spending. Now mind you, I approve of that. The problem is, the people who share your world view about involuntary commitment do not have that same idea.
On July 24, 2025 President Donald Trump signed an executive order titled "Ending Crime and Disorder On America's Streets." In this executive order the President says "The overwhelming majority of these individuals are addicted to drugs, have a mental health condition, or both..." that the Attorney General will, "seek, in appropriate cases, the reversal of Federal or State judicial precedents and the termination of consent decrees that impede the United States’ policy of encouraging civil commitment of individuals with mental illness who pose risks to themselves or the public or are living on the streets and cannot care for themselves in appropriate facilities for appropriate periods of time..." and that the Secretary of Health and Human Services will "ensure that discretionary grants issued by the Substance Abuse and Mental Health Services Administration for substance use disorder prevention, treatment, and recovery fund evidence-based programs and do not fund programs that fail to achieve adequate outcomes, including so-called “harm reduction” or “safe consumption” efforts that only facilitate illegal drug use and its attendant harm..."
So what you are advocating for, the whole premise of this essay, is something that is already supported by the current administration and has been for over a year. You are not bringing a fresh new perspective on homelessness that liberals don't want to hear, you are uncritically regurgitating the Republican Party line, almost to the letter. And the Republicans are famously not about providing government assistance to anyone, they haven't been since at least The New Deal. So what were are left with is a party that wants to destroy what little remains of the American social safety net while also introducing more punitive measures towards the most economically disadvantaged people in our country (who so happen to be disproportionately Black, Latino, and Native American). This is cruel and unjust but don't just take my word for it. In 2022, the United Nations Committee on the Rights of Persons with Disabilities says "Institutionalization is a discriminatory practice against persons with disabilities...it constitutes detention and deprivation of liberty based on impairment...a form of violence against persons with disabilities....Institutionalization contradicts the right of persons with disabilities to live independently and be included in the community..." Addiction is a disability, you said it yourself in your article. Do you honestly believe that state sponsored violence against disabled people is the solution? Do you think it would have saved your sister?
Again, I would like to reiterate that I am deeply sorry for your loss. I understand you and your family are in a lot of pain and that you did everything you could to save your sister. I understand that my criticism is very harsh and pointed but I don't believe you are a bad person. I think you have let the trauma of your sister's death cloud your judgement as to the reality of the current moment that we are in and I want you to know that you are going down a very dark road that will not lead to salvation, only more suffering for people like Liffy. I hope before you go further with this advocacy to do a little more research because I feel like articles like this are very irresponsible and can cause people to end up supporting cruel, inhumane policies and call it kindness.
Longreads-ModTeam | an hour ago
Removed for breaking subreddit rule #4: we want recommendations, not self-promotions.
Available-Guava5515 | 16 hours ago
OK so...
I sympathize with the terrible situation you were in with your sister.
But I want to point out one thing: you yourself have said that your family put her through treatment, through rehab, a whopping 12 times.
What do you expect the state to do that your family has not already tried?
Is it that you think, somehow, the state will be able to procure some kind of "better" rehab that will finally be effective, that would have saved your sister?
Or is it that you all want to pass the buck, financially and emotionally, and place the responsibility somewhere else?
You tried. Many times. Are you advocating for treatment options, which your sister already had access to by your own admission? Or is there some bigger aim you're really arguing for? By all means, I think we should fund treatment programs and mental health facilities; what Reagan did to this country by removing those options is an atrocity.
But I genuinely do not know why you're using your sister's case to vilify the city of Seattle for not having the resources to do what you've already tried and has already failed. You did everything you could, and it was not enough. I agree that treatment is necessary, but your argument does not make sense. Treatment did not save your sister.
"She was left to die and we called it freedom". But she wasn't. She literally wasn't. You rescued her and put her through treatment, again, 12 times. Why are you blaming the city and state? Where did your sister's responsibility and autonomy begin and end?
ETA: the fact that you, a private wealth manager, are propping up Sara Nelson here, of all people, does not help your case. Neither does the fact that you initially posted in SeattleWA, which all Seattle-area residents know as a deeply right-wing subreddit that routinely advocates for draconian and punitive conservative policies. Frankly, this sounds like propaganda, written to justify sweeps and imprisonment as a response to homelessness.
I'll also note that your sister died in Idaho. Again, why are you using Seattle and the state of Washington as an example of failure here when the fact is that a rural town in Idaho is where she died? Are you weaponizing your sister's death because you don't like to see homeless people on the streets? Is that what this comes down to? Disguising a right-wing agenda and dressing it up as empathy? Anti-Wilson propaganda, perhaps? This is more on the city council members who have failed to make any meaningful changes (like Sara Nelson) than it is on her.
Readers, beware.
carolina822 | 15 hours ago
My brother is in similar circumstances (minus the rehab stints, because he flat refuses to go.) He is college educated, used to have a wife and kids and a nice middle class home and job, and now he is an unrepentant, toothless meth-head. My parents have offered all of the supportive things you're supposed to do and he will. not. take. it. Short of putting these people who refuse help in jail I'm not sure what other solution there is.
We absolutely need a comprehensive safety net to give the opportunity for healing to anyone who needs it. I'm not sure that using as an example someone who had every advantage at their disposal and still refused help is going to convince the regular taxpayer to open their hearts or wallets.
Beneficial_Dog_6531 | 13 hours ago
And telling a story about a person who was offered substance abuse programs and mental health counseling multiple times without it sticking, and claiming that this is the true face of homelessness in Seattle, is more likely to shut hearts and wallets.
As a recovering alcoholic, let me just say that I have endless sympathy for people caught in the cycle of addiction, including people who did not escape it, like OP's sister. But believing that the housing crisis and poverty are just smoke screens for people with advanced degrees who "chose" addiction is a fundamentally conservative position.
Easy-Concentrate2636 | 9 hours ago
I agree with this. Majority of homeless people in NYC, where I live, are not on the street. Most of them are in shelters or in informal temporary living arrangements (living with family or friends). Many of them work jobs that don’t pay enough to pay for rent and food.
ladyluck754 | 12 hours ago
Private Wealth Managers are the type of folks who vote to ensure social safety nets and regulations are non existent for everyone else, but then cry that they’d like social safety nets & regulations for them only. Cause they only care about themselves!
[OP] hatchmr | 15 hours ago
Thank you for reading. I’m new to Reddit and not partisan. Perhaps read again, I lived through this for many years, and one of my main points is that we don’t have correct laws in place when someone has lost their mind and will to severe addiction. We need to protect them, treat them, not let them die on the streets. We don’t do this to Alzheimer’s patents or young children. California, Oregon and BC have already passed laws to address this. Yes 12 rehabs, but while totally out of her mind and a danger to herself there was nothing that could hold her. No laws, systems in place. That needs to change.
Wide-Pop6050 | 14 hours ago
Gold crawl pause support chunky close license elastic
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motherofspoos | 10 hours ago
oh, I think it's coming. Republicans have been talking about it, and once it happens, we'll hear screams and laments from the opposition about "autonomy". This is a catch-22 if ever I saw one.
Available-Guava5515 | 15 hours ago
So you ARE advocating, more or less, for imprisonment to keep people in treatment. Again I ask, where did your sister's responsibility and autonomy begin and end?
PurePerfection_ | 14 hours ago
I would also add that it's unclear to what end we would be detaining these individuals. Yes, they could be kept alive in a restrictive environment where they are denied access to drugs. However, to make involuntary treatment morally defensible, there needs to be a reasonable possibility of successful long-term rehabilitation and reintegration into the community. OP writes that meaningful relationships and family are crucial to recovery. Many individuals in OP's sister's position are not going to have her innate capacity to form these connections and will not have supportive loved ones who are ready and willing to engage in the process.
Governments and rehab facilities can't assign someone a family, or give them the ability to build one from nothing. Realistically, the most they could do is confine unwilling people for a longer duration than the law currently allows while administering the same addiction treatments that are available to those who seek help willingly and have the means to access it. They could facilitate the transition back into society by providing stable housing and job placement. But then what? It isn't ethical for the government to just have custody of recovering addicts in perpetuity to ensure they don't relapse. If the root cause is a permanent biological change that overrides free will as OP suggests, I'm not convinced that forcing long-term treatment would do anything more than delay the inevitable.
kamace11 | 14 hours ago
Personally I believe that in some cases yes, institutionalization for treatment and care is better than letting these people die in the street of an OD, or of sepsis, or of starving to death in an isolated farmhouse because of their schizophrenic solutions.
Even you say in one of your comments that Reagan's dissolution of the state hospital system was a mistake, because anyone with eyes and ears and the ability to read has heard these stories time and again.
Why you come so hard and nastily at this guy who was directly and personally harmed by the system you yourself admit is inadequate is bewildering.
[OP] hatchmr | 14 hours ago
This is the point. From the article:
“Ate her will is not a figure of speech. It is, increasingly, a description of tissue. The National Institute on Drug Abuse and its longtime director, the neuroscientist Nora Volkow, have spent two decades establishing what is now the mainstream medical understanding: addiction is a chronic disease of the brain.
Sustained use floods and then exhausts the reward system, hijacking the circuitry that evolved to make food and family and safety feel good and rerouting all of it toward the drug, while the same disease erodes the prefrontal machinery that is supposed to weigh consequences and apply the brakes. The craving is widened into a superhighway; the off-ramp of judgment is paved over. By the time the disease is advanced, the organ that does the choosing has been physically remodeled to choose the one thing that is killing it. This is why willpower is the wrong word, and why my sister’s doctorate could not save her. You cannot reason your way out of a rewired brain any more than you can will a tumor to shrink.”
LadybugGirltheFirst | 12 hours ago
Alzheimer’s patients can’t take themselves out of treatment multiple times. Young children can’t take themselves out of treatment multiple times. Your sister was provided with the resources and chose to not take advantage of them.
wuchanjieji | 8 hours ago
If Alzheimer’s patients and children were allowed to choose whether or not to continue medical treatment, you can bet they would not. We have determined as a society that they are not capable of making decisions for themselves due to their mental capacity. OP is arguing that the way we frame addiction as a choice, as you have here, is not supported by medical experts and researchers who study addiction.
ario62 | 4 hours ago
As a caregiver to my dad with Alzheimer’s - what the fuck protection are “we” offering Alzheimer’s patients? I would love to know and get in on some of this protection. Get a grip.
I’m sorry your sister died, but you say “we need to protect them, treat them”. Uh, what do you think 12 stints in rehab is if not treatment? If she decided not to participate and really work towards sobriety, there’s nothing any law or “protection” could do to save her. Look, I also lost my sister to addiction in 2021. Myself and my parents contributed financially to 3 rehab stints before she died. Ultimately, addicts need to want to get better. If you think locking addicts up and controlling them via conservatorship is the answer, then you know way less about addiction than you claim.
ApprehensiveSea4747 | 3 hours ago
I also cared for an elder with Alzheimer’s, and I had exactly the same question.
How many doctors did I ask for a capacity letter? In the face of ridiculous (and dangerous) situations? How many times did I seek inpatient psychiatric care for behavior disturbance and was denied because she wouldn’t agree? Her memory care threatened to evict her without treatment (she was violently striking people), and I had the facility nursing notes documenting the episodes. Yet MDs considered this “not a danger to herself or others.”
Alzheimer’s patients have a lot of “autonomy “ to refuse care. It’s a massive headache for caregivers. Depending on their DPoA, managing their financial affairs can be a nightmare as well.
Wishing you peace. It’s a tough road.
ario62 | 3 hours ago
Ugh your comment gave me the chills. I’m so sorry you went through all of that. Of course your family member didn’t agree to go to inpatient psych care! She wasn’t in any position to make those kinds of decisions, and look how that turns out. You must have been so stressed when memory care was threatening to evict. Because then WTF are you supposed to do??? THERE. IS. NO. SAFETY. NET. I finally found a memory care facility and persuaded my mom to let me move him there. It took a year to convince her. Guess what? The facility evaluated him and he “wasn’t a good fit” aka too much to handle. I don’t have it in me to go through the process again and potentially get denied again.
I’m my dad’s POA, and my mom is still in decent shape, so financial affairs have only been a slight headache so far compared to everything else. But now my mom is trying to push more of their financial stuff onto my plate and I’m just maxed out. Our ONLY saving grace is that he’s a service disabled veteran, so the VA pays for an aide to come to the house 10 hours a week. Otherwise, everywhere I turn to for help, I get rejected in some way shape or form. And don’t think we didn’t have to fight with the VA for the 10 hours a week!
Besides the Alzheimer’s and Parkinson’s, he’s healthy. I am scared this is going to be my life for a very long time. I’m really scared. I hope you have peace and are doing well. I’m really sorry that you dealt with all of that. Sorry for the long rant.
Hugs
Shitp0st_Supreme | 17 hours ago
I have saved this to read. I’m so sorry for your loss.
[OP] hatchmr | 14 hours ago
Thank you 🙏
Sea_Promise_8015 | 12 hours ago
Great read, so sorry for your loss. I work with people who are at the intersection of mental health issues, substance issues and homelessness and this is something I struggle with as well. Of course we want people to have autonomy but what is autonomy when they are not in their right mind. Our legal system (I am in Minnesota) of course wants to honor someone's choice but what is choice when the addiction is calling the shots? Our systems don't have a great history when given full power over people but this huge swing the other way has been incredibly damaging. A doctor who has worked with the Boston Healthcare for the Homeless program described knowing a person who lived rough for a decade and he always honored her choices of not wanting treatment. A few years passed and he sees her again at a dinner looking amazing and he compliments her progress and she asked why he let her suffer in the streets all those years. I think about that a lot.
aluckybrokenleg | 10 hours ago
> A few years passed and he sees her again at a dinner looking amazing and he compliments her progress and she asked why he let her suffer in the streets all those years. I think about that a lot.
Any public health intervention needs to be evaluated by the sum of its effects.
E.g. Someone goes to the doctor and says they have an unusually bad cold, with an unusually bad cough and they do an exam and nothing is unusual, they get sent home with tylenol. If they come back a week later with no improvement, they get an x-ray or maybe just straight antibiotics for pneumonia treatment.
That person can say "Why didn't you give me an x-ray and antibiotics when I first showed up"? And the answer is "Because that would be incredibly costly for little benefit, and promote antibiotic resistant infections if we did it for every such case".
Same for this story. Let's go with the unprovable hypothetical that if this woman had earlier been forced in to treatment she would have recovered.
For her to receive that, hundreds of people would have had to receive useless involuntary treatment, and many of them would have been traumatized by it. It's not worth it and there's no research that firmly suggests that it is.
If someone invents a crystal ball so we can know who will benefit from involuntary treatment and who won't, then we can consider shifting our attitude away from patient rights, but it doesn't exist.
Marie1420 | 9 hours ago
Can you compare the predominant US system relative to some of the European countries in terms of policies, involuntary hospitalization/treatment, and the results thereof? I’m curious if any of those countries have more conservatorship and involuntary hospitalization/treatment. And whether they have less loss of life due to addiction. I assume many of those countries have better funded housing for the homeless, so I doubt citing a lowered number of homeless population as a barometer of success. Just curious if you can opine on what happens on other developed countries. Many thanks.
knitwit3 | 7 hours ago
I do agree that mental healthcare and addiction treatment are sorely lacking in America. Where I disagree is that I think your family's wealth has kept you from understanding poverty's role in homelessness.
Most Americans are squeezed between low wages and high rent. The cost of everything is going up dramatically, but jobs pay the same. Federal minimum wage is still less than $8 an hour. Many homeless people work jobs, but they still can't afford housing.
Corporate greed is limitless right now. Congress has been bribed by campaign donations, so they're currently as useful as a steer's nuts. America's safety nets have been ripped to shreds, and anyone can fall through the gaping holes into homelessness. All it takes is a few missed paychecks.
Jobs hire and fire at will. It's so easy for someone to be fired because they missed a few days of work due to illness, car problems, or needing childcare. It's a cruel irony that health insurance is tied to your job but you can be fired for being sick.
Nervous_Insect5976 | 12 hours ago
I understand that people are uncomfortable with mandatory treatment and hospitalizing people against their will. It's a fair position, given the history and the fact that taking away people's autonomy is something to be weighed very heavily.
But the alternative is to let them wander the street? Talking to themselves? Shitting in the street, sleeping under bridges, and eventually dying?
Bring back rehab, bring back the mental hospitals. Make them really nice. They can hang out in the garden, play video games, go swimming when they aren't going to therapy and all the other treatment activities. And slowly phase them back into society. Not a 30 day trip, or a 3 month trip. Keep them until they are ready to go back out. Hook them up with a therapist and psychiatrist on the outside, a support group, a social worker to check in weekly. Give them housing in a small apartment complex or triplex for other people just like them so they can have a sense of community and not feel judged. Hook them up with classes so they can get their associate's degree or a certificate. Have them go out into the community and socialize and go to bowling or karaoke night so they can build their own support network. Help them find a job or apply for disability. And they just stay at that house until they're ready to move out on their own or find roommates and when they do that, still give them support so they don't get overwhelmed. And over time, they can stand on their own two feet.
And if they fuck up, just take them back and start over.
The reality is that some people are going to have to be taken care of for the rest of their life. For whatever reason, they are just wounded and we either let them die on the side of the road or we step in and help them.
We also need to fight NIMBYism, decriminalize drug use, and offer needle exchanges and safe injection sites.
I have a cousin who is schizophrenic and he's been homeless for years. We try to help him, but we can't because he doesn't want the help. And he's not a threat to himself or others so there's nothing to be done. A bright and kind person lost to mental illness and all the good he could for society is lost as well.
sudosussudio | 6 hours ago
People should look up wet houses. A lot of models right now come with the assumption than addiction can be treated but for some like my uncle they just can’t beat it and having them housed is better than letting them die in the street. It is also less of a civil liberty hazard though nimbys typically hate them.
Nervous_Insect5976 | 6 hours ago
That's a good idea. Kind of like a low barrier shelter right?
aluckybrokenleg | 8 hours ago
> Bring back rehab, bring back the mental hospitals. Make them really nice. They can hang out in the garden, play video games, go swimming when they aren't going to therapy and all the other treatment activities. And slowly phase them back into society.
A few things:
There is no political appetite for the taxes needed for "very nice" involuntary rehab facilities, which as you describe them, will be housing A LOT of people. Taxpayers mostly want these folks to disappear, just like in to the asylums, which also never really worked.
There's no good evidence that what you're suggesting will work, which means it's based on wishes and desires.
You can dress up a prison any way you want, but you're describing prison and a half-way house system.
ZeusBruce | 17 hours ago
Amazing read that hit home for me. There's clearly no easy solution for the addiction crisis, and all too often it really feels like there's no solution at all. It fucking sucks. Wish I had something better to contribute.
Thank you for sharing.
CursedNobleman | 14 hours ago
This comes up as being AI generated.
Wide-Pop6050 | 13 hours ago
Ghost vegetable piquant fuel cover straight public placid
This post was anonymized with Redact
CursedNobleman | 13 hours ago
I threw it in the first ai checker on google. The fact that the poster is just throwing it all over reddit, the em-dashes and phrasing, all suggest it's just dross.
Mother-Pen | 10 hours ago
The flowery language when discussing the neurological impacts of long term drug abuse was giving me AI. Also, I think it was a disservice to the piece and read more propaganda than education.
SuperPinkShark | 5 hours ago
I would first like to start by extending by condolences to you and your family. I have had many family members struggle with addiction and I know the toll it takes on the people who suffer from it and the people around them. Having said that, I think the trauma of your sister's death has led you to some incorrect and extremely dark conclusions. You seem like a you want what's best for people and I respect that. However, I think what you have written is not aligned with what you seem to value because you are advocating for cruel, inhuman treatment of America's most vulnerable population and you are advocating for it off of a completely incorrect premise. What you are championing in this article is going to hurt hundreds of thousands of people. What follows is going to be a very long comment but I feel like I need to set the record straight about this article's content and mission and doing so requires a look at the facts.
Your conclusion about homelessness is not supported by the data. According to the Substance Abuse and Mental Health Services Administration 48.4 million people in America suffer from a substance use disorder with 21.2 million people suffering from both addiction and mental illness. Of these people, only 10.2 million received treatment. Clearly there is a huge treatment gap in this country as you say.
The problem here, is that you immediately say that everyone suffering from homelessness is either mentally ill, addicted to drugs, or both. There were 771,480 people experiencing homelessness in 2024 in this country according to the United States Interagency Council on Homelessness. I don't have current numbers because the agency was completely eliminated after Donald Trump was sworn in in 2025. Nevertheless, I think you can see the problem right away with your assertion. Even if you assume that every single one of those 771,480 people experiencing homelessness were either mentally ill, addicted to drugs, or both, it still only accounts for about 1.5% of total population of addicts in this country. If it was the case that homelessness is simply an inevitable result of untreated drug addiction, wouldn't the number of homeless people in the country be significantly higher?
You also make an assertion that economic circumstances have nothing to do with homelessness. This is flatly untrue looking at the data. Referring back to the USICH 2024 study, if you look at the homeless population over the course of the past 17 years, you notice that the number has been steadily rising since 2018 but plateaus between 2020 and 2022. Now they weren't able to adequately get a number of homeless people in 2021 due to the pandemic but between 2020 and 2022, the number rose by 2,000. Then, in 2023, the number of homeless people rose by 70,642 and it rose by 118,376 people in 2024. That is a huge spike in homelessness. Now, you're probably wondering how the number stayed so flat during and immediately after the pandemic but spiked in the last two years. That is because between 2020 and 2022, the government rolled out a host of protections from people who lost their jobs during the pandemic, most notably eviction freezes. Once those policies were rolled back, homelessness spiked as the economic situation continued to worsen after the pandemic. This is something that is very easily observed by the data so clearly your assertion that homeless people don't need housing and that this is a mental health issue and not an economic one is flat out wrong. If that were the case, the eviction freezes would have done nothing to stop homelessness but the data show that they clearly did.
So already, the entire premise of this article is based on an incorrect conclusion. The vast majority of addicts are not homeless and a large part of our current homelessness crisis is a result of worsening economic circumstances combined with a roll back of protections against homelessness after the pandemic. However, if this article only misrepresented the homelessness issue in this country that would be one thing. However, what you are advocating for as the solution is a deeply disturbing position to hold.
Your policy prescription for the homelessness crisis is involuntary commitment. Let me start by saying that you're already getting some facts wrong. You talk about San Francisco and Los Angeles without mentioning that the state allows for 5250 involuntary psychiatric holds which essentially extends an in patient stay up to two weeks after the 72 hour hold. That means that a person in California can be involuntarily committed for 17 days in an in-patient facility. That is already far longer than your typical in-patient stay, most people are usually held for about 7 to 10 days. So already, you're talking as if these states aren't doing enough when they already have the mechanisms in place that you advocate for.
On a deeper level though, your article seems to assert that rounding up homeless people and forcing them to get psychiatric and addiction treatment is the only thing that we need to do to stop this crisis. Already, I outlined that not every homeless person is a mentally ill addict so do you believe that every panhandler should be arrested and put into an already overburdened mental health emergency system? Inpatient facilities are constantly overcrowded and can't keep people for too long because there isn't enough space for everyone suffering from a mental health crisis. If someone needs a higher level of care, involuntary in patient stays are not equipped to provide it because they are not equipped to keep the entire nearly million homeless people in addition to all the housed people with mental illness.
(Continued in the comment below because I hit the character limit).
SuperPinkShark | 5 hours ago
Furthermore, as someone who has had multiple inpatient psychiatric stays and knows many others who have as well, these places are not good places to be. Even if you are there voluntarily, they feel like prison. You are stripped of so many privileges and you're not even allowed to go outside at most of them. Furthermore, the staff who runs them are generally not good, they are overworked and underpaid. I never had a helpful or healing therapy session at my in-patient stays, I even left one with a misdiagnosis that led me to receive inadequate mental health care for over four years. And mind you, I went to each one voluntarily. I know some people who were involuntarily committed and every single one has described it as a traumatic and difficult experience. Our current healthcare system is broken and not equipped to help people with mental illness, even those who want to get help. Do you really think it will improve if we just throw more people into the system who are there unwillingly? You seem to argue that we need to rid the system of any abuses but the the system itself is not working and making it more carceral and punitive will not change that.
Inpatient clinics are designed to transition people into other programs, whether those be residential treatment, partial hospitalization, or intensive outpatient. All of these programs are very expensive and if you are homeless and don't have any income, prohibitively so. You might suggest that we should make these programs more affordable but that doesn't address a very huge problem.
The problem is that these people have nowhere to live.
That's why people go for housing first, because if someone has housing, they can get treatment. You don't force someone into a broken system, give them treatment that they do not consent to, and then throw them back on the streets expecting them to be okay. To make your proposal work would require a comprehensive reform of the entire healthcare system which would require a lot of money and years of investment to see any kind of positive outcomes. This would require both a substantial increase in taxes and a massive reallocation of government spending. Now mind you, I approve of that. The problem is, the people who share your world view about involuntary commitment do not have that same idea.
On July 24, 2025 President Donald Trump signed an executive order titled "Ending Crime and Disorder On America's Streets." In this executive order the President says "The overwhelming majority of these individuals are addicted to drugs, have a mental health condition, or both..." that the Attorney General will, "seek, in appropriate cases, the reversal of Federal or State judicial precedents and the termination of consent decrees that impede the United States’ policy of encouraging civil commitment of individuals with mental illness who pose risks to themselves or the public or are living on the streets and cannot care for themselves in appropriate facilities for appropriate periods of time..." and that the Secretary of Health and Human Services will "ensure that discretionary grants issued by the Substance Abuse and Mental Health Services Administration for substance use disorder prevention, treatment, and recovery fund evidence-based programs and do not fund programs that fail to achieve adequate outcomes, including so-called “harm reduction” or “safe consumption” efforts that only facilitate illegal drug use and its attendant harm..."
So what you are advocating for, the whole premise of this essay, is something that is already supported by the current administration and has been for over a year. You are not bringing a fresh new perspective on homelessness that liberals don't want to hear, you are uncritically regurgitating the Republican Party line, almost to the letter. And the Republicans are famously not about providing government assistance to anyone, they haven't been since at least The New Deal. So what were are left with is a party that wants to destroy what little remains of the American social safety net while also introducing more punitive measures towards the most economically disadvantaged people in our country (who so happen to be disproportionately Black, Latino, and Native American). This is cruel and unjust but don't just take my word for it. In 2022, the United Nations Committee on the Rights of Persons with Disabilities says "Institutionalization is a discriminatory practice against persons with disabilities...it constitutes detention and deprivation of liberty based on impairment...a form of violence against persons with disabilities....Institutionalization contradicts the right of persons with disabilities to live independently and be included in the community..." Addiction is a disability, you said it yourself in your article. Do you honestly believe that state sponsored violence against disabled people is the solution? Do you think it would have saved your sister?
Again, I would like to reiterate that I am deeply sorry for your loss. I understand you and your family are in a lot of pain and that you did everything you could to save your sister. I understand that my criticism is very harsh and pointed but I don't believe you are a bad person. I think you have let the trauma of your sister's death cloud your judgement as to the reality of the current moment that we are in and I want you to know that you are going down a very dark road that will not lead to salvation, only more suffering for people like Liffy. I hope before you go further with this advocacy to do a little more research because I feel like articles like this are very irresponsible and can cause people to end up supporting cruel, inhumane policies and call it kindness.