RMV writes:
A true story!Once upon a time in one of the largest cities in New Hampshire there existed a splendid community mental health center staffed by a formidable team of nurses, social workers,psychologists and a group of well-known,respected,conscientious psychiatrists known for their advocacy for and commitment to the chronically and severely mentally ill.(CSMI)Many,if not most of the 4000 clients were on New Hampshire’s version of outpatient commitment as they hung on the margin of rehabilitation versus re-hospitalization,The quality of the Center’s work and its level of success gained national recognition in the 90s.Monies from reductions in inpatient utilization had been carefully reallocated to New Hampshire’s community system to ensure the adequacy of that program.The last medical director, a noted proponent of care for the CSMI population was literally available 24/7 by phone or in person to the Center and area emergency rooms to reach out to one his own in difficulty.He expected and received the same degree of devotion from every member of his staff.
Fast forward 15 years.The false god of austerity has stifled concern for the mentally ill.The number of adult hospital beds has dwindled to half of even the post institutionalization ill number;monies for the centers has all but totally dried up.Jobs were frozen;the aforementioned medical director left last May.In recent weeks the Center has been recruiting without success.Why can’t they find anybody?Staffing has shrunk to four nurse practitioners and one psychiatrist;one psychiatrist to take responsibility for 4000 clients,certainly an invitation to do harm!No one wants such a job.Meanwhile the clients vegetate in their rooming houses(the lucky ones)or lie in doorways and inevitably get hauled off to jail where their aberrant behavior is likely to lead to further abuse and humiliation.In Boston,near where we live,is a small fountain dedicated to the memory of Dorothea Dix,standing today in perverse recognition of America’s moral decline.All that’s left of Dorothea’s revolution;a bird bath!!
The Octogenarians 
A correction in my most recent comment:
An important word (capitalized) was omitted in the following sentence: But it may also be causing deficiencies in ways that may NOT play out well against other equally, or more important interests.
We see so much that could be improved if only we had the resources! Specialists in health care cannot avoid observing the many forms of pain experienced by those in need. Empathy stirs deeply into our souls the pain of others. We believe that “Government” can direct resources to address these issues. To a degree it can. But should it, and if so, by what methods? I think that our goal should be minimal OVERALL pain.
Every person and every government has to confront the problem of allocating scarce resources that have alternative uses. Needs compete for resources. Resources (including talent) vary in degrees of scarcity. Will a central authority like a government, or will a relatively free market (where at all levels bidding for resources automatically takes place) perform this resource allocation most efficiently – most efficient relative to the myriad forms of needs balanced best to serve humanity’s trajectory into the future? Government tends to “play favorites” and if your favorite cause is selected, government is working for you – at least in that way. But it may also be causing deficiencies in ways that may play out well against other equally, or more important interests.
“Austerity” is considered by many to be a negative. It refers to a government that chooses against a forcible redirection of resources from competing uses in order to give special consideration to your cause. And or it can refer to government refusing to weaken the trust factor of its currency when it simply prints more dollars and directs them to aid your special causes.
Susanna states that trickle down has proven itself to be “voodoo.” Yes and no. “Voodoo” may mean that it does not serve her ideals or special interests – perhaps she shares the belief that a kind of ‘morality’ (religious like?) is served when government actions force an evolution to a much greater equality in the distribution of wealth. For the most part trickle down does work. If not so obviously in dollars, it works by helping all of us (the relatively poor included) to gain access to the excellent (often life-saving) products created by those who are reaping the rewards of wealth as they successfully sell what others need and desire.
That said, some things need an authoritarian hand. Defending the country from attack is high among them. A certain level of health care may require the discipline of Federal law to establish the better standards. Yet the current problems with Veteran’s healthcare should be a warning as to the dangerous limits of government efficiency.
” … perverse recognition of America’s moral decline.”
While in Alexandria, VA, two weekends ago and, in an attempt to avoid discussing the shallowness of the current political “debates,” the subject of the current drug epidemic became the focus … not the meth one, but the one that’s affecting middle-aged white males. In the course of the discussion, overprescription of opioids was identified as the source of such epidemic. This past weekend, Richard A. Friedman, professor of clinical psychiatry and the director of psychopharmacology clinic at the Weill Cornell Medical College, wrote a column in The NYTimes, supporting the introductory discussion:
I shared the above in another venue, adding that, while not personally of Governor Christie’s ideology or policies, his narrative addressing the heroine epidemic … which apparently is #1 concern with New Hampshire voters … was spot on. Christie did not mention it, but it appears that this drug epidemic is the direct result of economic uncertainty being particularly felt by the segment of the population Professor Friedman identified. In other words, uncertainty in the creation of JOBS with policy incentives that address transition to a changing economy with environmental and skill issues being ignored by willfully uninformed elements of the political class. As a result, the solutions offered are perceived as mere fantasies. Cutting taxes on wages not earned is a shell game. When people work … and at a living wage, taxes are paid (thereby adding to the funds for programs that benefit the disappearing Middle Class … EDUCATION, infrastructure, etc.), people spend money in consumer goods … the capitalistic wheels get greased and keep turning. Trickle down has already been proven as voodoo. To bring back the point of the heroin drug epidemic … it is the consequence not the cause of the sham so-called conservative ideology (conserving what?) Is perpetrating on financial insecurity. Of course, this underscores RMV’s incisive declaration of “The false god of austerity has stifled concern for the mentally ill” … with the “… recognition of America’s moral decline.” While mental illness is a manifestation, something’s rotting within us. We are unable to identify or relate to a sense of purpose … just frustration … to seek for that balance between the individual and the group. How can we neglect those who need us? Haven’t we learned the moral of the Pied Piper story yet? Can’t foster greed in the worship of the individual … by the same token, the group needs the creativity and ingenuity of the individual as well. In today’s column, Paul Krugman is also questioning, buttressing Professor Friedman’s treatise:
“… four nurse practitioners and one psychiatrist;one psychiatrist to take responsibility for 4000 clients …” INSANITY. Misapplied morality, in general? How to turn the moral decline around. Thank you RMV.
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