``What's the practical alternative to "the for-profit nursing home industry, the adult 'care' industry, the home 'care' industry, state institutions for the deaf, the blind and the 'incurables'"? Since you appear to be arguing against both state & corporate institutions (as well as anything in-between), what is left? Families? Friends? Living alone?'' Yoshie
``The anti-therapeutic civil libertarian stance often seems to reduce to liberal individualism. As my next-to-last post should make clear, I am as much of a critic of psychiatry as any, but the notion that people with addictions, significant psychiatric illness, character disorders, etc., are potentially "informed consumers" in the same way as consumers of toasters is absurd.'' Christopher Rhoades Dÿkema
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I haven't been following this thread mainly because I don't know anything about psychiatric care or mental illness. What I do know about it how to to put together community based services. These are the alternative to the for-profit `care' industry, which of course isn't, government run institutions, or tossing people out on the street or into the hands of family, friends, or some volunteer organization.
What is needed is committed local/state/federal programtic planning, funding, and development and in depth field oversight. From below, you use the best existing community advocates who are themselves marginally or less significantly effected by their own psychiatric and mental disorders. In any community there is always a spectrum of people who range from marginally effected by their condition whatever it is, to those who are severely effected. You recruit those people who are already advocates and who are themselves involved in some form of services. They are the ones who need to configure the programs and provide the services. The more severely involved people become the clients served. This was a basic formula developed under the War on Poverty programs thirty years ago and it worked just fine---until the money was cut off (see my long rant on the Seventies).
It needs to be strongly emphasized that turning design, implementation, and service delivery over to the community most directly effected is not a model based on some concept of self-actualizing individualism. The model is better characterized as one of community based self-determination and service delivery.
The point to government oversight is to provide positive administrative support, not bureaucratic policing---and there is a significant difference between them. This was one of the techniques that was used to destroy thousands of US community based service organizations from the late Seventies through the Eighties and beyond. Most were finally polished off under Clinton or shuttled off to chase the underwhelming marginality of foundation funding where they could die a thousand deaths a year.
The `lucky' ones were privatized in some scheme or other and now form a significant part of the base of the so-called `service' economy. The healthcare industry is the key example---and of course it is nothing more than death on the installment plan, run as a giant for-profit industry in which the clients are mere government subsidy baring entities.
How to kill a well run and functioning community based services organization.
First you change over from governmental administrative oversight support to bureaucratic policing. This is a somewhat subtle process that begins with accountability management schemes imposed from above in the name of efficiency that are brought into play with tightening budgets. It then becomes a game of numbers and client loads to demonstrate a creditable use of money and resources. From accountability to credibility is a short step, and from there the slope steepens downward into the dark pits of justification. The administrative policing bar is raised on justifications for providing services higher and higher, as budgets tighten, tighter and tighter. Evidentially there is no sufficient justification to spend any money or do anything and so nobody gets paid and nothing gets done. The program is marked off as another tragic failure of big government.
>From Carol Cox:
``...To provide the 5% raise promised local staff, they are reducing that staff by one position, the position cut being that of adult outpatient services. They did get a grant which allowed them to purchase 2.5 hrs more a week of the time of a local psychiatrist for juvenile psychiatry. This particular psychiatrist is a very good one -- but in the time the state allots for his services those services will be quite limited, quantitatively and qualitatively. . .''
This is a concrete example of exactly what I was describing above---how to squeeze a program by limiting the resources and raising the justification bar and then forcing the program into a fools dilemma: given X resources, do we starve Y or shoot Z?
Chuck Grimes