Providing Social Welfare Can Save Billions of Dollars, Researchers Say

Peter Simons
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In an article published in the journal Annals of Family Medicine, researchers Karen DeSalvo and Andrea Harris suggest that treatment is more effective and healthcare costs are reduced when contextual care is implemented that addresses social and economic needs.

Photo Credit: Public Domain

The authors argue for the necessity of “payment models that encourage the health care system to address social needs.” They suggest that in the long run, healthcare costs are lessened when these contextual factors are addressed.

After all, they suggest, people often cannot afford their medication or do not have access to transportation for follow-up appointments. In such cases, people are not able to continue receiving treatment, and they are more likely to use urgent care or emergency services—more expensive services in the long run.

Beyond that, the authors cite the research that social needs such as hunger or poor nutrition have a large impact on health. They discuss new policies being implemented to attempt to encourage medical care to include these resources.

“For example, the Centers for Medicare and Medicaid Services recently announced the Accountable Health Communities demonstration model that encourages health care providers to build linkages with community organizations, such as Meals on Wheels, that can address their patients’ social needs such as hunger or poor nutrition.”

In another study cited by the authors, people who were identified as lacking basic resources such as food, housing, and transportation, were provided with a program to supply some of those resources. The researchers were attempting to determine if such resources could affect cardiometabolic health (so mental health concerns were not assessed). The researchers found that those who entered the program “saw statistically significant improvements in blood pressure and cholesterol levels.”

The evidence suggests that access to food, housing, and transportation resources can affect any number of health concerns, and mental health is likely no different. Despite the prevailing belief that social welfare is expensive, the authors argue that such programs could actually save up to $72 billion annually in health care costs.

According to the researchers,

“Leaders must work to create healthy communities by addressing factors further upstream such as the environment, housing, transportation, and access to healthy food and safe spaces.”

They provide the following recommendations to accomplish this goal:

  • “First, clinical teams should identify and support the social needs of our patients with the rigor they would apply to avoiding other medical errors.
  • Second, health systems should show leadership by holding their executives accountable not only for outcomes for their patient population but also for the health outcomes of their communities.
  • Third, communities can only advance health if they have access to timely, specific data. Data availability will require continued focus on creating a culture of data sharing for public health advancement.
  • Fourth, federal and state policy makers should work with states to maximize funding flexibility to accommodate local innovations aimed at investing in upstream social determinants of health.
  • Fifth, education of the clinical and public health workforce should encourage an understanding of the social determinants of health and provide training in working across sectors.
  • Sixth, it will require an increase in investment in the social determinants of health.”

 

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DeSalvo, K., & Harris, A. (2017). Bending the trends. Ann Fam Med, 15(4), 304-306. doi: 10.1370/afm.2101 (LINK)

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Peter Simons
MIA-UMB News Team: Peter Simons comes from a background in the humanities where he studied English, philosophy, and art. Now working on his PhD in Counseling Psychology, his recent research has focused on conflicts of interest in the psychopharmaceutical research literature, the use of antipsychotic medications in the treatment of depression, and the general philosophical and sociopolitical implications of psychiatric taxonomy in diagnosis and treatment.

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65 COMMENTS

  1. From a big picture common sense point of view, this post is pretty much a statement of the blatently obvious.

    I will say, however, the medical community today is much worse than this implies. They should start by not attempting to impoverish others with their staggering health care costs and out of control iatrogenic illness creation system.

    Although, I do agree providing legitimately beneficial services which actually improve social welfare is a good idea. Not certain why the medical industry should be in charge of such, since decreasing medical profits is a financial conflict of interest for today’s for-profit only medical community.

    So, in as much as I have zero doubt improving social welfare would decrease societal medical costs. These services should be headed up and provided by those without a financial conflict of interest.

  2. Impoverishment in the midst of prosperity, deficits alongside surplus, and waste like it was going out of style, this is what we’ve got.

    Rather than supporting people in their unemployment, I would think it would be more economical (i.e. make more sense) to see that they were gainfully employed. Of course, that is not the suggestion that is being made, and in the name of health. Also, wouldn’t it be less wasteful again not to label and drug people so that their health is endangered and employment is problematic in first place.

    When people have a decent income, a purpose in life, of course, housing, food, and transportation are not going to be so problematic either. Having the government provide housing, food, and transportation to people, who have been removed from the employment market, is not really such a cost effective, nor health conscious, measure all things considered.

    I’d say perhaps these researchers need to rethink this matter a little more. Putting marginalized and under utilized people to work, it seems, would be a much more economically feasible, and health conserving tactic. Medicalizing large discarded segments of society, in the fashion in which it is done, can only increase overall health care costs in the long run.

        • As a self-proclaimed anarchist, you should know that capitalism has replaced the master/slave relationship of slavery and the lord/serf relationship of feudalism with the employer/employee relationship. Indeed, the early workers who were forced into factories referred to their labor as “wage slavery.” I bring this up in the hopes that you might consider no longer moralizing about employment.

        • Another problem with this supposed employment vs. welfare dichotomy is that it exists only in theory. In the real world, you have massive employers like Walmart whose business model is to pay workers so little that they need food stamps, Medicaid, and subsidized housing. So it’s not like having a job in any way guarantees that a person’s basic needs will be met.

          https://www.forbes.com/sites/clareoconnor/2014/04/15/report-walmart-workers-cost-taxpayers-6-2-billion-in-public-assistance/#3de678e7720b

        • Frank,

          When I was suffering from extrapyramidal side effects to “medications” for nearly 4 years I actually was genuinely disabled.

          When I was suffering from desperate anxiety as a result of withdrawing from “medications” – I was not genuinely disabled.

          • Could you wait on customers with severe anxiety (or akathisia)? The jobs available out there are service jobs, dealing with *customers* for minimum wage. I know I still can’t deal with people on days/weeks when I’ve had zero sleep and my blood sugar drops out and when I freak out about every little thing–you all act as if iatrogenesis is just a little blip and we should just pull ourselves up by our bootstraps and get back onto the wheel even tho our gears are stripped.

            How about we save a bunch of money by not subsidizing the medications that are damaging our brains, eh? Or put the MIC on a diet…that’ll save some dough. But no, people like Frank, and all you others behave like this psych drug thing is minor inconvenience.

            Get real, and quit scapegoating those that suffer–believe me, living on disability is barely that. Why dontcha get pissed at some bankers or something? The mean spiritedness I’m seeing here is shocking; and yes, it’s SCAPEGOATING.

            Deja vu all over again~

            O and ps
            Should we kick all those useless eaters on Social Security retirement off the ‘entitlements’ and make them bag groceries or work as greeters at Walmart? No man is an island. I’m guessing that not having any social supports is what brought a majority of us to the ‘mental health’ system in the first place.

            pss to Frank’s reply below (no reply button)
            I’m not claiming ‘mental illness’–but I am claiming IATROGENIC damage from involving myself in the ‘mental health’ system when I was distressed and had nowhere else to turn.

            IATROGENIC DAMAGE.

          • Didn’t say I wasn’t pissed at the upper crust. They are the reason that things are such as they are. Under employment figures are so high because it serves corporations and their interests to keep real jobs down, not because there is a deficit in work to be done. Politicians have been bought by corporate interests.

            There are people here claiming that “mental illness” doesn’t exist, and that psychiatrists are not real doctors. Okay. Doing so, claiming a “mental disability”, and living off it, doesn’t help that argument one iota. Use it, and you’ve just provided the psychiatry you resent so much with a rationale for existing.

          • Frank’s ideology doesn’t seem to have room for the reality of iatrogenic damage.

            And hey, anyone remember this classic Emma Goldman quote?: “Everyone’s survival should depend on their success in the capitalist labor market!”

            Yeah, I don’t recall that one either.

          • Iatrogenic damage certainly is a reality, but iatrogenic damage is hardly the be all end all of existence. I wouldn’t imagine everybody injured by a psychiatrist has been injured hopelessly so. I don’t encourage iatrogenic damage either, I encourage treatment plan non-compliance. One can, after all, resist the forces that would inflict injury on one.

            I’m afraid I’m more familiar with Emma Goldman saying, “If I can’t dance, I don’t want to be part of your revolution.”

            I suppose one could waste a lot of time doing nothing but wasting time, but still, sustainability is always going to be an issue.

          • One should have access to work as well as ‘food, shelter, and clothing’. As Bertolt Brecht has been translated as having put it, “Grub first then ethics”. Necessities take precedent over theory. I don’t see it as very reasonable, nor economically feasible, to remove large numbers of people, as has and is being done, from the work force. It is very wasteful, and wasteful doesn’t serve us very well, does it? Of course, this ‘artificial invalid’ business is a money maker for some rapacious corporate imperialists and “mental illness” industry careerists, too, but, all in all, everybody loses from it as a rule.

      • Well, “having a PURPOSE and a means of support” is miles ahead of not having such when it comes to “mental/emotional state”. The question is, who makes the money, and on what? Bring back competition (and anti-trust laws), and maybe somebody besides the ultra rich would be getting somewhere. Need I remind you that all sorts of people are talking about “the American dream” being dead now. They wouldn’t be talking in such a way if the system worked for them, too. It is my view that there are many people out of work because it serves the big corporations to have a large unemployed labor force. (Just as it serves them, and not their employees, to mechanize.) Do things differently, and the big corporations, having been granted person-hood status, will not be the only “people” to benefit.

        • I agree 100%. There is proof that our Western society makes people ill. Some group did a study over three generations on health outcomes for immigrants to the USA. At the start, their health outcomes were all over the place, but after the third generation, they had American problems like heart disease, cancer, anxiety and depression in numbers similar to those who had been here many generations. Part of psychiatry’s job is to keep the focus off of “the system” so the rich can get richer and the powerful more powerful. But I fear I am preaching to the choir now!

          — Steve

          • “…Part of psychiatry’s job is to keep the focus off of “the system” so the rich can get richer and the powerful more powerful…”

            You’re not preaching to the choir. But you could be!

    • Nicely said, Frank, I completely agree as well. I see every day in a city hospital the depressed, demoralized, unemployed population on government welfare who got on disability for reasons I do not understand “depression”, “anxiety”,and “bipolar” who are now getting more unhealthy from lack of mental and physical activity. Our disability policies are not helping to empower in any way. Psychiatry gets them sicker with their drugs that cause all sorts of medical complications. Human service agencies need dependent people to survive so not all that motivated to empower people to leave them. It is also really difficult to get off SSI and SSDI if you are now out of the workforce for years, not developing new work skills and social skills that come with being with others and challenging oneself. There needs to be better financial incentives to get off disability. The medical costs are astronomical for taking care of a population that is used to being taken care of by the government (taxes from those of us who work and pay taxes), has fractured families and social networks, and has unhealthy lifestyles. Employment is therapeutic and good for one’s self-esteem. The disability policies need to change to help people become productive members of society.

        • All I know is when I had to bust my butt to find and keep a job so that I could provide for myself I sure didn’t have time to sit and think about all the different ways that I could kill myself and end all of this stupidity. Having a job kept me going and when I had no job and no way to provide for myself it led to my attempts to kill myself. Of course, this is just my experience and I can’t assume that this is the truth for anyone else.

      • DSM 4 TR has a list of 9 stressors that needs to be mitigated and that is exactly what we are discussing.Why not tax those people who are not following a proper life style and eventually end up gulping the entire health budget.If the govt. wants and has the will it can raise the money for the psychiatrically disabled.It’s their right and not alms.Look at the difference in health resources allocated to the life style diseased patients and the psychiatry cases.Look at their quality of life.They should get increased number of paid absenteeism.Cut the insurance of people of people who are exploiting the health industry.Also identify those fake case sheets tailor made for such people for reimbursements.If psychiatry people are dying,let the patients from the life style disease also meet the same fate.Those who go for more than 2 deliveries,deny them any insurance or sops.Tax the third child heavily because he/she will turn out to be another parasite on the health budget.Tax heavily anything that is bad for a persons health and divert that fund towards psychiatry because in psychiatry there is no food or life style that causes psychiatric illness.

  3. With the technology advances and decreasing population theres more than enough resources to go around – even if some people want to have more than everyone else.

    Its not like the 1970s, now we have machines that can do practically everything.

    Today tax returns can be run off machines, medical diagnosis IS done by machines, cars can drive themselves trains can drive themselves. There’s no need to hoard technology.

  4. Thank you for thoughtfully presenting this article.

    Perhaps I misunderstand your personal comments, but I thought that they actually represented views similar to those of Dr. Thomas Szasz, for whom I have the deepest respect. His illumination of the myth of mental illness is fundamental to what I believe. I do, however, have two issues with Dr. Szasz. He was, after all, a very right wing conservative, a libertarian, and I believe that while he had important points to make, that he was mistaken about the fundamental nature of two things in regards to “mental illness.” Both of these issues involve the idea of personal responsibility.

    Let me say first of all that psychosis and schizophrenia, when you first experience them, are usually quite devastating experiences. You might find yourself truly believing that the President is trying to kill everyone, or that your neighbor is murdering people and burying them in the basement, and you might believe this totally and sincerely. You might, then, try to kill either the President or your neighbor whom you think is murdering people, and you might do this not because you are a malingering asshole, which is how Dr. Szasz essentially describes such people, but because you sincerely believe that you are helping people. This is not to justify or support such behavior. But there is, in fact, a case to be made for the insanity defense and the idea that you are not culpable for your actions in a criminal way. It’s not that you weren’t acting responsibly. It’s that you simply didn’t have the connection with the world that would enable you to act as other would act, but you were, in fact, trying to be responsible. And I don’t say that because I haven’t known people who were in mental hospitals, having used the insanity defense to escape personal responsibility for actions that they were fully aware were wrong. But there are some people who are so out of it (I would have been one of them) that they are truly unable to understand what their culpability might have been. This is a basic issue that goes to the heart of antipsychiatry’s personal responsibility issue, and I think that Dr. Szasz, as a right wing libertarian, got it wrong.

    As a personal note, I have not only seen people abuse the system to escape culpability, I have also seen people who were genuinely way out there who were dangerous. I have been threatened and personally assaulted by such individuals, and yet these very same individuals, when restored to their usual selves, have sometimes come to me, admitted that what they did was wrong, and apologized. So there is hope, but there are also times when people simply cannot be held responsible for what they have done, but without taking all sense of responsibility away from them for the rest of their lives.

    Deeper than that is the concept of disability. There is, quite simply, no way that some people who suffer from psychosis or schizophrenia could work. None at all. I know that I, personally, would have been so distracted by the phenomena that I saw happening around me that I would have followed them, become wrapped up in them, and been unable either to recall what my work assignment was or to even understand its importance in the light of what I was experiencing. Are there actually people who use their diagnosis to create excuses for themselves and malinger? Yes, certainly there are. But the reason that this is accepted as an excuse for claiming disability is actually valid, because some of us are disabled in that fashion. So Dr. Szasz, while doing an admirable job of pointing out one very small problem has actually stigmatized those who are having a genuine problem, which I know is real, because I had it. Now, denying people the role of social responsibility is in fact used as a justification for taking their power of making their own decisions away from them, and I deplore that situation and the people who do it. However, there are actually circumstances in which a person cannot be a responsible member of society as we normally construe it, and using Dr. Szasz’s rationale about it all is not sensible. Dr. Szasz saw social interaction as games. I do not. There is a real game element to it all, but it is certainly not the sum of what interaction or psychology is about.

    I find it unfortunate that antipsychiatry, in its efforts to create liberation for the “mentally ill,” is willing to close its eyes to the reality that these people (myself among them) actually face, simply in order to embrace an ideological position that is intended to liberate us.

    In other words, it’s not cut and dried. There ARE two sides to these questions, and simply brushing them away is neither intellectually honest nor psychologically sensitive. These are the two problems that I have with antipsychiatry’s excessively ideological position in these two areas.

    Respectfully, of course,
    Eric Coates

    • I’m not making an argument for the violating some people’s human rights. You, the way I read this, are making such an argument. Treat people like ‘adult children’, and where is the end of it? Nowhere apparently, in your case. We’ve got this line draw, and legally sanctioned, between the responsible human being and the irresponsible ‘adult child’. With freedom comes responsibility, without responsibility, there is no freedom.

      I’ve spent much more time in the hospital when I wasn’t in a floridly “psychotic” state than when I might have been in such a state, and only with my first hospitalization do I feel I was in such a state. I think my expedience there pretty typical. With that hospitalization, too, I was doing everything I could, considering my state of mind, to try to escape. My experience is that most of the people within these institutions don’t, as if anybody did, need to be there.

      I can’t make an argument opposing human rights for human beings, but go ahead, provision sanctuary for your ‘subhumans’ if you think that an absolute necessity. I value my freedom too greatly to call myself a person for whom the bill of rights should not apply…fully. I’m not somebody who wants to lock the front door to those human rights violations that I’m letting into the house through the back door.

      • I’m sorry, Mr. Blankenship, but I don’t believe that I have suggested here that anyone is less human than anyone else. However, I do believe, and I know from experience, that when you are in a psychotic state that you may simply be living in a different version of reality than others are, and that the expectations about responsibility that apply to the world that others are in but you are not in might not be responsibly applied to you. I am not in any way suggesting that there is a special category for some people, or that they are some sort of privileged “child” who is allowed to rampage as they want to. If you get right down to it, I believe that society should protect itself from dangerous, irresponsible people. But I also believe that there are times when society should make allowances for what someone is going through. That’s all I meant to say.

          • So society doesn’t exist, huh? That’s what Ronald Reagan, Margaret Thatcher, and Ayn Rand thought. Why am I not surprised that you agree with them?

          • I was only using the quotation marks because I prefer some people’s society to others, and because I’m referring to the previous statement (i.e. quoting from a previous comment) in which society is supposed to protect us from the loony birds, and the loony birds from themselves. Of course, who’s going to protect loony bird society from society at large is another question altogether. Also, of how the matter of that threat to society at large being a threat to loony bird society must make society at large an additional society of loony birds, just uncaught loony birds (i.e. dangerous to self and others).

            My issue is human rights, regarding which society has hung a sign around every “mental patients” neck saying N/A (not applicable). The question is, not only when and where should you make a law, such as you’ve got with mental health law, curtailing civil liberties, and the personal responsibility that goes along with those freedoms, but if you should do so.

    • Hey Eric,
      I had meant to make a comment earlier, but got distracted. Just wanted to voice my agreement for much of what you have said in your original comment. It’s unfortunate that Frank is twisting your meaning. I had to learn to give my wife a lot of ‘grace’ as Christians call it. It’s not about treating her like a child BUT realizing that if she’s going to heal, I had to do MORE than my fair share and sometimes, especially in the beginning of her healing journey, I couldn’t hold her responsible for her actions. I understand that it’s harder for a society to make these allowances, but I do wish we’d try. I grew up far-right, but helping my wife heal has definitely moved me toward the center and hopefully made me more empathetic toward others.

      Sam

      • Thank you, sir. I realize that many people have very strong feelings about all of this, but I do also feel that there are, believe it or not, legitimate questions on both sides of every debate among us here on MIA. Is there one everywhere in the outside world? No, because people are only too willing to manipulate discussions to serve their own purposes. But here on MIA, I believe that most people are sincere, even though we have some Big Pharma lurkers out there, and so I really do see both sides of it.

        I hope and pray that you and your wife are well. It takes patience and kindness and forbearance. Good luck.

    • Physically handicapped are only doing that quantum of work that they can.And those who are healthy in the conventional sense have the support of politicians,trade unions,organizations,ideologies,strikes and violences which helps them survive.As far as homicidal patients are concerned,the jails all around the world are full of criminals who are not psychiatric cases.Psychiatry patients has no takers,no support system,no scientific model,no good drugs,worse still even the family will forsake them.If they have an excuse for not doing something,use the strategy of the right person for the right job,i.e ergonomics.But then their behavior should become a source of concern for anyone,because that is what they will.Society will have to change for them because they are the majority.You got to give a special status to the patient because your drugs and theories are not helping him unlike the drugs for life style diseases.
      Just imagine for a while,if the support system of the life style diseased patients are withdrawn,what would happen?They will go mad.It would be utter chaos.They are strong because of their union is strength proverb and not because these clowns have an iota of grey mater more than psychiatry patients.
      A healthy individual is one who has physical,mental,social and economic health.It’s not the mere absence of a disease.The new generation of doctors are dumb fools cramming books but while handling cases they are zeros added up together.They don’t have a psychiatry curriculum.They can skip psychiatry and still become specialists and superspecilists.In India,once they even scrapped psychiatry from our MBBS curriculum saying that its a useless subject.This is how our health ministry is serving the psychiatry population which will only enhance the public perception that psychiatry is not a clinical discipline.These people are malingerers and should be harassed till they stop “malingering”.And that is the reason why atrocities committed against them are never investigated thoroughly.They are burnt alive,killed and hanged apart from the suicides.
      I have been taking drugs for 15 years now,and I do not see much of a change when you take into account that it is 15 years.Apart from that a constellation of iatrogenic illness have emerged and you got to consume more drugs to stabilise them.Even when you are working better than others,they have a low threshold to kick you out of your job.
      Despite all these years of treatment,I have only slipped down the social ladder and my family members perished as a result.Even if you are a workaholic,this illness and the drugs will put you to sleep or tire you off.But people will say,he is lazy.They have been brain washed to believe that the illness is not the culprit but the personality trait is responsible and therefore attack the patient and not the illness.If you cannot kill the illness then kill the patient is society’s attitude.

  5. After all, they suggest, people often cannot afford their medication or do not have access to transportation for follow-up appointments. In such cases, people are not able to continue receiving treatment, and they are more likely to use urgent care or emergency services—more expensive services in the long run.

    suggested revision:

    After all, they suggest, people often cannot afford the drugs doctors prescribe or do not have access to transportation for follow-up appointments. In such cases, people stop receiving drugs and therapy, and they are likely to experience aversive withdrawal symptoms and use urgent care or emergency services—bigger wastes of money in the long-run.

      • I agree with you about militarism. War mongering is not something I would foster.

        Putting people to work is one thing you can spend money on that would probably be better than spending to keep them out of work. I see the second option as counterproductive, and something that creates a disincentive to working in the first place. I don’t know how valuable your leisure is to anybody else, but I don’t find many people eager to pay for mine.

        • You don’t seem to understand what I am saying. I wouldn’t want to discourage anyone from working (i.e., engaging in productive labor). What I’m saying is that leaving the survival of people with severe psychological problems and/or iatrogenic drug damage to the tender mercies of the capitalist labor market – which is already failing the majority of workers who are *not* impaired – is barbaric.

          What I am also saying is that employment is inherently exploitative and therefore should not be fetishized and held up as some kind of great solution to everyone’s problems.
          Again, I am not talking about work as engagement in productive labor; I am talking about selling oneself on the capitalist labor market, which most working-class people are forced to do in order to survive, as this how capitalism works. I am talking about the Calvinist bullshit notion that work is inherently good even if it’s meaningless and degrading drudgery that enriches the employer and grinds the employee into dust. This is a working-class argument I am making and that is why you and some of the other readers are probably having difficulty understanding it.

        • You can save billions of dollars…on food, clothing, and shelter…by paying people not to work. Really? I just think the logic behind this kind of construct is pretty twisted. What do you get out of it? People who don’t work because they can get by without doing so. Iatrogenic damage is only so pervasive, but pay people to claim to have it, and you will start to find iatrogenic damage everywhere. If it’s not iatrogenic, it’s “mental”. Either way, medicalization is on the march, and gaining, despite all efforts to forestall and contain it.

          • I think that welfare-shaming, poor-shaming, and disability-shaming are pretty twisted. How come you never worry about what the rich are doing with “muh tax dollars”? You seem to think that poor and disadvantaged people are all manipulative and lazy. Again, you sound like a Reaganite.

            More to your point, though — Yes, you can conserve resources in the long run by investing in the welfare of the population. This is what is done to varying degrees in the Scandinavian countries that have a higher quality of life than we do here. (I have criticisms of social democracy, too, but I agree with the principle that we help ourselves by helping others.)

          • I’m not out to spare the rich. Government is corrupt these days because of all the money corporations dish out to get politicians in their pocket. This political corruption, in its turn, does very little to curtail the corruption in the psychiatric system, with its relationship to the pharmaceutical industry, that grows out of it, and goes along with it.

            Is investing in the welfare of the population keeping some people permanently subsidized by the government who are fully capable of pulling their own weight? You’ve got two problems here I believe, one is systemic, paying people not to work doesn’t encourage working. The second is the iatrogenic damage you mentioned. The longer a person is subsidized by the system, the more the likelihood that their physical health will suffer. Getting people out of the system is seldom on anybody’s agenda the way it should be.

    • Disability payments for us so-called “psychiatric patients” were never meant to be forever. I think this all developed during the time period when many people did eventually leave the system but needed a little help to get back on their feet. This was when so-called “mental illness” was episodic and not a chronic thing.

      Unfortunately, with the wonderful toxic drugs as the only standard of treatment things moved from episodic to chronic and that’s when trouble started with disability. I think that there are a lot of people who would like to work, at least part-time, but they’re afraid to do so because of all the rules surrounding getting disability and working at the same time. Some money at least is better than no money at all. You can do it, but you have to be extremely careful and it would be better to have a job where you are paid in cash to keep a paper trail from developing. And people don’t live on disability extravagantly either. $700 a month doesn’t go very far to pay for rent and utilities and food and the wonderful drugs that you are often forced by law to stay on. It’s always interested me that the poorest people are expected to buy some of the most expensive drugs for their mandated “treatment”. Talk about a Catch-22 situation.

      • I think the idea is that “disabilities” are pretty permanent. You lose an arm, a new one is not likely to grow back. Psychiatric “disabilities” however represent man-made artificial “disabilities”, and that’s another thing altogether. Artificial arms are one thing, artificial arms for artificial amputations are something entirely different.

        I’m not saying people aren’t injured by prescription drug use. They certainly are. I am saying that you can exaggerate the extent of that injury, just the same as you can claim injury for, say, “mental injury and anguish” of a very subjective, and, therefore, correctable nature, but doing so only increases the distance one would be at from any such potential correction, and thus makes its occurrence even more dubious.

        As an aside, I know of work programs in the mental health system that had to fold because of conflicts with the SSI disability system. Its a systemic problem, for sure, but this kind of industrial collapse doesn’t support the idea that “disability payments” were intended to be temporary.

        • *What* jobs?

          Living wage jobs?

          Minimum wage jobs?

          What freaking jawbs?

          Our standard of living has been eroded by the corporations who have bought our ‘government’ and shipped all decent jawbs overseas~

          You’re right, there’s plenty of work to be done, unfortunately, it isn’t compensated for in a way that sustains a mere individual in our present economic system. How many gigs does it take to pay the rent, *and* the gas money to get there, let alone afford a vehicle?

          I went without a car for 7 years cuz I COULDN’T afford one, let alone repairs, tires, insurance etc. and yet a vehicle is just about a requirement for employment. Public transit has been gutted–those of you preaching about JAWBs obviously are living in a fantasy world and I’ll BET you’re getting some sort of benefit your own selves.

          No Social Security for you, huh, Frank? Just how did you accumulate all your worldly goods anyways?; are you getting paid to sit behind a keyboard and pick on those unfortunates on the bottom of the food chain and rail about anti-psychiatry? As I mentioned to another regular on these pages; I’d rather have a root canal than sit in a room with you and work on the ‘movement’. Maybe one of the reasons there *is* no movement.

          Your rants against the disabled and the poor are scapegoating pure
          and simple.

          • A Celebration of Ignorance

            Carl Sagan: “I have a foreboding of an America in my children’s or grandchildren’s time–when the United States is a service and information economy; when nearly all the key manufacturing industries have slipped away to other countries; when awesome technological powers are in the hands of a very few, and no representing the pubic interest can even grasp the issues; when the people have lost the ability to set their own agendas or knowledgeably question those in authority; when, clutching our crystals and nervously consulting our horoscopes, our critical faculties in decline, unable to distinguish between what feels good and what’s true, we slide, almost without noticing back into superstition and darkness. The dumbing down of America is most evident in the slow decay of substantive content in the enormously influential media, the 30-second sound bites (now down to 10 seconds or less), lowest common denominator programming, credulous presentations on pseudoscience and superstition, but especially a kind of celebration of ignorance.” From The Demon-Haunted World: Science as a Candle in the Dark (1995)

            and the cherry on top:
            https://www.counterpunch.org/2017/08/11/the-rise-of-neoliberal-culture-and-the-making-of-an-indecent-state-and-society/

            an excerpt:
            “How is the distortion of the notion of freedom by neoliberal beliefs related to political humiliation? The state, in serving the market, functions as a disciplinary regime, especially in relation to people who are working-class and poor. Sociologist Wacquant (2009) indicates that the state punishes the poor for their failure to be entrepreneurial-consumer subjects. The poor receive bare amounts of resources from the state, as a way of punishing them for not serving the state/market. From this perspective, humiliation involves communicating to people who are poor that they are economic failures (on the dole), and failed political subjects—hence disposable. Other sociologists dispute this idea of punishment and instead argue that the state disciplines the poor by devising ways to force poor people to live by market rules (Soss, Fording, & Schram, 2011). By receiving austere levels of resources, it is believed poor people will be motivated to work hard and improve their lot. Whether one sees this as discipline or punishment, each involves dependency on the state that is more concerned about the vitality of the market than it is about its poorer residents. The state, in other words, distorts political freedom by equating it with economic freedom and in the process disciplines or punishes poor persons who are constructed as failures. We might call “these people” economic-political losers who have demonstrated misuse of the “freedoms” the state provides. “They” are shamed in myriad ways in the media, which may function to incentivize some segments of the population to work harder. Shame, in this instance, becomes a tool of the market to produce and maintain entrepreneurial-consumer subjects who exercise their “freedoms” by obeying the imperatives of the market society. In short, the state is directly involved in humiliating poorer persons instead of working to facilitate parity of political participation and a just distribution of resources.”

            Ya Basta!

          • Forgive me for any misunderstanding. My rant is against the rich. Without their fleecing (re:Proudhon) there wouldn’t be any poor.

            The job situation is another thing again because I think it is mostly manufactured, that is, people don’t have jobs because other people don’t want them to have jobs.

            The “incapacity” thing that psychiatry is so much a part of, that legal argument, I have seen destroy people, but it is not something that I myself have anything to do with, and, in fact, I would do away with it if I could.

            Tolerance for difference, that’s what I support, however, I also think there are a lot of capable people who are inclined to plead “incapable” if it pays the bills. This is something they could manage themselves in the right circumstances, and so the actual issue is this wrong set of circumstances that we are stuck with. You, Human being, went into a few of them.

            What I’m not saying is that anybody need rot if they don’t want to do so, however, if one wants to be a rotter, certainly, in today’s world, one has every opportunity to be one. I think there is a very good reason Marx focused on a worker state rather than a bum state. If someone feels altruistic, they can always volunteer. I have done so. I don’t think any dictatorship of bums, however, is likely to go over very well. We’ve still got Aesop’s fable of the grasshopper and the ant to contend with.

          • How many people are really too debilitated to throw hay bales into the back of a pickup truck? I’ve done that before, too. Are you saying that all of these so-called disabled people are too disabled to do that? Seriously!?

        • Psychiatric disabilities are assessed from time to time and accordingly they rate your percentage disability.But the board of doctors have immense power in denying you a disability and it cannot be easily verified because its not as tangible as a physical disability.There can be inter observer and intra observer bias,just like a BP or blood sugar reading is never uniform,although they may be still normal or abnormal depending upon the circumstance when it is being checked.White coat hypertension hypertension is one such example of pseudo-hypertension that is not there to be treated,but needs to be followed up.
          A physically handicapped also can throw hay bales and do heavy work.Why certify him as disabled?Aren’t they taking part in para-olympics?So they can certainly do all the physical work that a normal individual does.Ask them to attend gymnasiums and they will become weight lifters.They will eventually not only throw hay bales on the truck,but probably even throw the truck onto the hay bales!!Cyclist Armstrong.He got real strong arms.I think I am referring to the handicapped….

  6. Hello again,
    have you seen this?
    http://psychrights.org/Research/Digest/Effective/MIrwinNonDrugSchizophreniaTreatment.pdf

    Also, being gainfully employed would be good, off course, but it would necessitate, that we stigmatized could do something better than others (the market-capitalism is stagnating) and that our “afflictions” would want us to “work for the man” after we have been treated like sub-humans, anyway 🙂
    I would recommend giving spare agricultural land to the homeless and unemployed and institutionalized and providing a framework to form eco-communities like in Wales:
    http://lammas.org.uk/en/welcome-to-lammas/

    Keep up the good work…