More health blogging

“Shrinkette,”: blogs about the “movement to empty psychiatric hospitals”: back in the 1970s. This was an effort on the part of activists who got a lot of attention and support from _One Flew Over the Cuckoo’s Nest_. It greatly restricted the powers of psychiatrists to commit people unless they could show “imminent danger.”

What struck me was this passage:

bq. Many states have turned over the responsibility for treating severely mentally ill individuals to health-maintenance organizations. Some of them, mostly nonprofits, are doing a creditable job. But for-profit HMOs, with few exceptions, have been disastrous for the severely mentally ill, who are expensive to treat. The newest antipsychotic medications, which are essential for some mentally ill patients, can cost $400 a month.

Now the libertarian in me says that families, charities, and charitable business should be in charge of the mentally ill. What’s striking me here is the failure of our market to cope effectively with mental illness. Part of the reason is that we don’t have a true free-market economy. Our government, through intense lobbying efforts, has tilted the playing field. However, the striking difference in attitude between the for-profit and non-profit HMOs calls Adam Smith’s invisible hand theory into question, at least when it comes to the mentally ill.

At the same time, the government isn’t doing a lot for these people either. Truly mentally ill patients need doctor help and may not know it. Involuntary committment laws are making this hard, and I’m not sure that we’ve found the right balance of freedom and care yet.

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