Insane Asylums are Back in Fashion?

    The police detention of the homeless, plus the pros and cons of involuntary care, was brought up during the last class. It got me interested in the statistics behind correlations to mental illness, homelessness, and violence. Violence was used as the justification behind Elyn Saks's involuntary admission, and the result I'm interested in is money. Money keeps the world turning and directly relates to homeless care and other expenses, so it should be kept in mind for all discussions. 

    Walk through any major city, and you'll see people living on the streets, many of whom are struggling with mental health issues. It's heartbreaking, but it's also a serious public safety concern. New York City subways are an everyday reminder. There is clear space given to the homeless because we constantly see videos of people being attacked, pushed onto tracks, and disturbances. Yet there is more to their story. Studies show that about 25% of homeless people are dealing with severe mental illnesses like schizophrenia or bipolar disorder, compared to just 6% of the general population (National Institute of Mental Health [NIMH]). Many of these illnesses do place them at a higher risk of violent tendencies. A 2019 study found that homeless individuals with psychotic disorders are 15 times more likely to commit violent acts than those without these conditions (Fazel et al. 567). This also places them in danger as mental instability makes them far more likely to die in altercations with the police.

    Homelessness and mental illness are a vicious cycle that constantly self-feed each other. Drug addictions are also a leading cause as addiction is one of the fastest illnesses to become unmanageable and is considered to be a mental illness. People with untreated mental health issues often can't hold down jobs or maintain relationships, which pushes them into homelessness. And getting the help they need is even more challenging once they're on the streets. Cities end up spending $30,000–$50,000 per person annually on emergency services, shelters, and even jail time when outpatient mental health care at a shelter with a higher chance of becoming self-homed would cost way less (Culhane et al. 12).

    Involuntary treatment could be a way to break this cycle. It's controversial as it would mean detaining someone just on the suspicion that they should be tested for a mental illness or other afflictions. The idea of forcing someone into care is a weighty ethical question, but it can be measured logically to the pros and cons, as there can never be a proper answer to drawing a line between human freedom and the care someone needs.

    However, we can't just target homelessness based on a mental illness but not include those who have the same afflictions but aren't homeless. There are plenty of people with severe mental illnesses, advanced schizophrenia, or extreme bipolar disorder who don't realize they're sick. The medical term for this is anosognosia, and it's a real barrier to treatment for many (Treatment Advocacy Center). People might refuse help even when they're a danger to themselves or others. A 2020 study found that untreated schizophrenia increases the risk of violent behavior by 4–6 times compared to the general population (Large et al. 843).

    Considering the two main groups affected by enforcing involuntary care, we must consider the history of involuntary treatment, and it does have a dark history. Involuntary treatment was used to target marginalized groups, especially Black people and women, as a means to detain them for many nefarious purposes based on flimsy or biased diagnoses if not directly falsified (Metzl 34). If we bring involuntary treatment back into the conversation, we need to make sure it can't be corrupted like many government-based policies overtimes. That means that all those mental illnesses that place an individual at risk of vision would be blanket treated the same regardless of the person's situation. This directly goes against Saks' recommendation based on her experience. In her memoir, The Center Cannot Hold, she talks about the trauma of being forcibly hospitalized but also acknowledges that involuntary treatment can save lives in extreme cases. She argues that it should only be used when someone is a clear danger to themselves or others (Horgan). The blanket approach to avoid corruption would directly violate this as anyone, regardless of their situation, would be seen as a threat simply based on a diagnosis, and if they weren't detained as a homeless person suspected of being mentally ill.

    Involuntary care is an idea that has been floated previously in America as a means to deal with the homeless and other groups affected by violence. Yet, it is a profoundly ethical question with no correct answer. It doesn't get simpler at the logical level as there are balanced pros and cons, all of which affect the turbulent ethics. Yet this isn't even in consideration of the legality behind the idea, as America is a country that continues to focus more and more on a person's freedoms, which this proposal directly opposes. 

Works Cited

Culhane, Dennis, et al. “The Cost of Homelessness: A Perspective from the United States.” *European Journal of Homelessness*, vol. 7, no. 1, 2013, pp. 1–16.  

Fazel, Seena, et al. “The Prevalence of Mental Disorders among Homeless People in High-Income Countries: An Updated Systematic Review and Meta-Regression Analysis.” *The American Journal of Psychiatry*, vol. 176, no. 7, 2019, pp. 561–571.  

Horgan, John. “The Freudian Lawyer: The Meaning of Madness.” *John Horgan (The Science Writer)*, 25 Feb. 2025, https://johnhorgan.org/books/mind-body-problems/chapter-five.  

Large, Matthew, et al. “The Relationship between Schizophrenia and Violent Crime.” *JAMA Psychiatry*, vol. 77, no. 8, 2020, pp. 840–848.  

Metzl, Jonathan. *The Protest Psychosis: How Schizophrenia Became a Black Disease*. Beacon Press, 2010.  

National Institute of Mental Health. “Mental Illness.” *NIMH*, 2022, www.nimh.nih.gov/health/statistics/mental-illness.  

Treatment Advocacy Center. “Anosognosia.” *Treatment Advocacy Center*, 2021, www.treatmentadvocacycenter.org.