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"don't stigmatise people with a mental illness" is the call to action.

Stigma prevents people getting help, even for mild MH problems that respond well to talking therapy. Stigma increases social isolation and reduces opportunities for work. We know that both of these make mental illness worse.




Respectfully, I don't see how this is actionable for me as an individual. Ok, I'm not stigmatizing people with mental illness, now what?

I still have hundreds, if not more people, with mental illness roaming downtown, living on the streets, regularly leaving feces on sidewalks, screaming at passerbys and expressing what appears violent behavior and nothing is being done about it.


I can't fix your police or healthcare systems, and I do appreciate that it sucks if you have people behaving unpredictably around you. We do need to remember that if they have a mental illness then they're probably not living on the streets out of choice, and that if they had affordable meds and healthcare you would be seeing a lot less people on the street.

What I can do is to ask you to not assume that violent behaviour is a result of a mental health problem; or to not assume that a person with a mental illness is going to be violent. (Apparently I can do that more politely than I have so far.)


I disagree. It's a negative step - don't do X, for some value of X. OK. Fine. What's next? I asked in search of positive steps.


Tackling stigma is a positive step. I don't know why you don't get that. It is more than just "don't do x".

You're just arguing about words.

"Don't discriminate against people with a mental illness when recruiting for a job" becomes "give people with a mental illness the same treatment at job interviews".

But if you want a bigger list:

Reform the broken healthcare model in the US

Push for evidence based treatment. This will usually be a short course of CBT; sometimes it'll be a talking therapy and meds. Sometimes it'll be meds and talking therapies and weekly / monthly visits from a nurse or an occupational therapist. Rarely it'll be a stay in hospital. Even more rarely it'll be a forced stay in hospital against the patient's wishes. Even more rarely it'll be a forensic hospitalisation - a forced stay in hospital ordered by the courts instead of a prison stay.

Push for employment programmes to get people with a mental illness back into employment. See for example the Sainsbury Centre for Mental Health documents http://www.centreformentalhealth.org.uk/pdfs/dwp_commissioni...

Push for social inclusion programmes; volunteer for those programmes;

San Francisco has a death by suicide rate of 9.8 per 100,000. There is probably some work to do around funding suicide prevention work (which happens earlier than a suicide attempt) and funding suicide intervention (which happens around the time of an attempt). http://www.sfhip.org/modules.php?op=modload&name=NS-Indicato...


Find me a qualified candidate who can function in my workplace, and there won't be any discrimination issues. That doesn't mean I'm going to tolerate the sort of acting out described above. I can and do regularly work with the mentally ill, but I'm not about to go recruiting amongst the homeless in hopes of finding a skilled software engineer.

"Reform the broken model" is a positive, actionable step in the same way that "Change the culture!" is a positive, actionable step. Which is to say it's a statement of a goal rather than anything immediately useful. But more "arguing about words", right?

You shouldn't cite the suicide rate without context. Following your link, SF is doing better than average in California.


I gave context to the suicide rate by linking the page I did which clearly shows the San Francisco has met the target of less than 10 people per 100,000 dying by suicide, with a little green dial.

But suicide is still a significant cause of death, especially for middle aged men, even in San Francisco.


I don't know why you don't get "violent behavior in public is not acceptable". We'll never be satisfied with "its ok to hurt people if you're part of a stigmatized subgroup". Its not ok. Its not going to be ok, and its not stigmatizing to recognize violent offender in public - its reality. They need to be stopped, period.


I haven't said that violence is acceptable. I'm not sure how you could come to that conclusion, so could you point out where I said it?

What I have said is that when you see violence in public you should not assume the perpetrator has a mental illness because they probably don't; and when you see someone with a mental illness you should not think that they are violent, because they probably aren't.

I can understand the downvotes for tone - it's too late to edit so I'm stuck with those.

I can't understand the downvotes for this post https://news.ycombinator.com/item?id=8548999

Edit: downvoters - please let me know why you're downvoting my later posts.


I got it from a repeated ignoring of the basic issue, and an attempt to redirect the conversation away from the topic. That's pretty close to denial.

And I'd have to disagree - anyone who is acting out in public has certainly got some mental problem, pretty much by definition. Whether its a persistent illness is between them and their doctor. But from the coffee shop's point of view, they gotta be dealt with, period.




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