Mental illness and homelessness – fiscal myopia strikes again

Yesterday, as I was going about my business in San Francisco, I passed a man lying in the gutter outside the Westfield Centre on Market Street (the swish multilevel shopping complex with some expensive label stores), who was poorly dressed, given the weather (cold) and was clearly having some sort of episodic fit. The street was packed with Sunday shoppers most of whom were well-heeled. I asked the person I was with whether we should ring 000 to get some sort of professional help for the man and he told me that it would be futile because they wouldn’t come out anyway. It was not an isolated incident. Throughout the city the extent of homelessness and the public nature of mental illness is stark. There are choruses of shouts, anguished cries, megaphoned self-dialogues emanating from almost every street corner, doorway, alleyway, train station and whatever. People who should be in care, suffering and crying out. For the richest country in the world to tolerate this degree of human rights violation is almost unimaginable. While the Australian health system is far from perfect, our mentally ill citizens are much better cared for in state facilities and are not left on the street, homeless, suffering from a variety of obvious physical and mental maladies – and basically abandoned by the system. There are some who escape the net and wander the streets of our cities, but, in general, we do not accept that the mentally ill should be left to their own devices. It tells me that any American claim to greatness is a pitiful, self deceit. This is a heartless society where citizens who are most in need of state support are the least able to access it.

Yesterday, I wrote about the myopic nature of fiscal austerity in terms of starving essential public infrastructure of necessary maintenance and improvement funds, which eventually comes back in the form of destructive floods, sewerage collapses, major bridge collapses, and other damaging manifestations.

Fiscal austerity targets public infrastructure because the cuts are less visible to mainstream society and the damage is usually revealed outside the current political cycle where the austerity is imposed.

Governments typically shift blame to past regimes when a serious breakdown in public infrastructure arises due to spending cutbacks in the past.

The lack of transparency of the risks involved in starving essential public infrastructure of necessary maintenance and development funding helps the government hide their culpability and preserve their political position.

In a similar vein, fiscal austerity is also targeted where spending on disenfranchised and powerless minorities is involved.

The mentally ill fall into this category. Most of us are ill equipped to handle a fellow citizen in deep mental crisis shaking and frothing in front of us. It is an incredibly confronting situation that makes most of us deeply uncomfortable.

It is hard to know what to do in a situation like that. Clearly, our responsibility as fellow citizens is to try to get professional help. That used to be a simple matter of ringing 000 or some other well-known number and waiting for the skilled help to arrive.

But when society has reached a point where its professional services are so overstretched through under funding in the name of some celebrated, but irrelevant AAA credit rating, that they won’t respond to emergency calls anyway, the situation becomes chronic and human rights violations occur.

The US is rather forward at exposing so-called human rights abuses elsewhere in the world, especially where there is ideological tension. But in its own borders, in its own large cities, the public health system engages in massive human rights violations every second of every day and the broader public appears powerless to deal with.

It makes the statements that followed the mass murders recently in San Bernardino along the lines that the Republican presidential hopefuls were deep in prayer for the victims appear grossly hypocritical.

These so-called Christians have massive human rights violations staring at them in the main streets, outside the major middle-class shopping malls, and all they can offer is prayers. When programs are put forward in the Congress for funding which would make an important difference they scream lies about the government running out of money.

In their own professional lives as Congress members they have the capacity to approve essential public outlays, which could relatively quickly solve these abuses and provide their fellow, suffering citizens with some dignity and some comfort.

Yet they spend their professional lives lying about the fiscal capacity of the currency-issuing US government and deliberately undermine its ability to act in the best interests of all US citizens.

It is rather mind blowing when the manifestations of the fiscal austerity are so much on public display – and we are not talking here about some degraded infrastructure, which is bad enough – we are talking about fellow humans who are allowed to suffer heinous hardships right before our eyes and the system barely lifts a finger to help because some bastard or another is so ignorant and/or venal that they think or say that the US government will run out of money.

Or at least, that is the smokescreen they set up to con the public into believing that cutbacks are the only way for the nation to remain prosperous, while at the same time they use the state fiscal capacities to bankroll their mates in various financial and other corporate ventures.

The US data is rather stark.

The data on homelessness in the US principally comes from two sources: The US Department of Housing and Urban Development (HUD) and the US Department of Education. The methodology used by each is different but some general trends are discernible.

The National Alliance to End Homelessness summarises the data as follows (Source):

1. “The number of people sleeping on the streets is declining”.

2. “The number of people sleeping in emergency shelters and transitional housing is increasing slightly in some measures and decreasing slightly in others.”

3. “The number of people living doubled up, considered homeless by some agencies but not by others, has grown substantially over the last several years.”

The latest report – The 2014 Annual Homeless Assessment Report (AHAR) to Congress – published by the US Department of Housing and Urban Development in October 30, 2015 provides comprehensive coverage of the extent of the problem in the US.

1. On average, “there were 578,424 persons experiencing homelessness on a single night in 2014 … an overall 10 percent reduction … since 2010, the year the Obama Administration launched Opening Doors, the nation’s first comprehensive strategy to prevent and end homelessness.”

2. “32 percent … were found in unsheltered locations”.

3. “Nearly one-quarter of all homeless people were children under the age of 18”.

4. “Homelessness declined by 2 percent (or 13,344 people) between 2013 and 2014 and by 11 percent (or 72,718) since 2007.”

5. Between 2007 and 2014, homelessness has increased by 28.7 per cent in New York State, 40.4 per cent in Massachusetts, 45.6 per cent in the District of Columbia, 14.4 per cent in Minnesota, and by 16.6 per cent in Missouri.

Reductions occurred in California (-18 per cent), Texas (-28.4 per cent), Florida (-13.6 per cent), New Jersey (-32.6 per cent), Oregon (-30.9 per cent).

There is a plethora of data available, which I will not summarise here. My main focus was on investigating the link between mental illness and homelessness.

A few years ago I completed a major research project in partnership with an Australian mental health facility investigating the effectiveness of early intervention programs with paid work opportunities for the prospects of use with psychotic disorders.

We found that for this cohort it was critical to intervene before the onset of the illness destroyed the individuals prospects to complete an adequate level of formal education. We also found that with properly designed jobs, which included flexibility to cope with the episodic nature of their illnesses and clinical support available within the workplace, severely ill young people could still make a significant and product is contribution via paid work.

Related research found that the likelihood of dropout and the descent into homelessness and chronic illness was reduced if early intervention and job provision was available.

Our research results were consistent with other studies in the US and elsewhere and provide very little scope for dispute. The issue is to convince austerity-obsessed governments that investing in a set of interlinked initiatives to target mental illness, joblessness, and homelessness is a superior use of real resources.

There is bi-directional causality. In other words, untreated mental illness lead to joblessness and often homelessness. But equally, the loss of a job set off a sequence of damaging events which took a person into a state of diminished mental health, which then, often, lead to family breakdown and homelessness.

It is thus critical to ensure that there are sufficient jobs available that are capable of being performed by the least skilled workers in the population. It is also critical to ensure that the onset of mental disability is treated adequately without delay.

In our final report we recommended a modified version of the Job Guarantee, tailored to the specific cohort with psychotic disabilities as one effective intervention available to public policy officials. The pilot job creation program run by the specific mental health institution in question was incredibly effective.

According to the March 2011 report from the US National Alliance on Mental Illness – State Mental Health Cuts: A National Crisis – “One in 17 people in America lives with a serious mental illnesses such as schizophrenia, major depression, or bipolar disorder … About one in 10 children live with a serious mental disorder”.

The report found that:

In recent years, the worst recession in the U.S. since the Great Depression has dramatically impacted an already inadequate public mental health system. From 2009 to 2011, massive cuts to non-Medicaid state mental health spending totaled more than $1.8 billion dollars. And, deeper cuts are projected in 2011 and 2012. States have cut vital services for tens of thousands of youth and adults living with the most serious mental illness. These services include community and hospital based psychiatric care, housing and access to medications.

This is a glaring example of the myopia (and heartlessness) of fiscal austerity.

We learn that “Communities pay a high price for cuts of this magnitude. Rather than saving states and communities money, these cuts to services simply shift financial responsibility to emergency rooms, community hospitals, law enforcement agencies, correctional facilities and homeless shelters.”

The HUD estimate that in 2015, around 20 per cent of the total homeless people in the US are Severely Mentally Ill. Other studies have this ratio up around 25 per cent.

In the population at large the SMI ratio is about 6 per cent. In other words, this cohort is disproportionately represented among the homeless.

As the US Today study writes:

They’re gripped by schizophrenia, bipolar disorder or severe depression — all manageable with the right medication and counseling but debilitating if left untreated. In the absence of such care, their plight costs the federal government millions of dollars a year in housing and services and prolongs their disorders.

Fiscal myopia.

The evidence is quite clear that outreach programs that are well funded and well targeted are very effective. The claim by many neo-liberals that this cohort do not wish to live in homes and are incapable of living in adequate domestic circumstances is not consistent with the evidence.

Is this one of those myths that pervade the economic policy debate to justify cutting spending in these very

And in case some defunct economist comes out and says that fiscal policy is ineffective, they should be reminded that since 2010, there has been a decline in homelessness in the US as a result of the federal government – Opening Doors – program, which is touted as “the nation’s first comprehensive Federal strategy to prevent and end homelessness”.

The Program recognises that:

1. “Homelessness is expensive; it is better to invest in solutions”.

2. “Homelessness is solvable”.

3. “Homelessness can be prevented”.

In my professional life I have sat in rooms with representatives from multilateral institutions, who were well-paid, have fancy mobile phones and in some cases, expensive jewelry (and that comment is not gender specific – I perhaps should have used the word bling), pull up to meetings in fancy cars – and then wax lyrical about how complex the problems of homelessness and unemployment are and then descend into a vacuous set of motherhood statements about the good intent of their organisations etc.

At one meeting, I just got so sick of listening to this nonsense that I informed one of these characters that the solution to unemployment was a simple as a government creating a job. The look on their face was quite something else. Fancy that! Solving unemployment by creating a job.

Similarly, the expansion of Medicaid in the US under the Affordable Care Act has clearly helped to reduce homelessness in general and for those with serious mental illness in particular. See, for example, the October 2014 Report on the Permanent Support Housing (PSH) initiative – Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices from the Field.

The evidence is clear. There are intervention strategies that are extremely effective in helping those with mental illness into secure and stable housing.

The so-called ‘Housing First’ or ‘Rapid re-housing’ strategies treats the mental illness after solving the housing problem. Clinical support accompanies the housing provision. These programs shift the mentally ill citizens off the streets immediately and provide long-term medical and psychiatric support.

Here is some evidence on Rapid re-housing initiatives in the US.

The problem is that these types of strategies are chronically underfunded.

The US Today investigation (August 27, 2014) – Mental disorders keep thousands of homeless on streets noted that in 2014:

President Obama requested a $301 million housing budget increase that would create 37,000 more permanent-supportive housing units and potentially wipe out chronic homelessness in America … That request stalled in Congress.

A more politically popular request for an increase in supportive housing for military veterans passed overwhelmingly and could eradicate veteran homelessness in the USA by next year

It is no surprise to learn (according to data from the AHAR Report cited above) that:

Between 2013 and 2014, homelessness among veterans declined by 11 percent … Homelessness among veterans declined by
33 percent (or 24,117) between 2009 and 2014.

Where there is cash outlaid, goals are achieved.

The evidence is very clear that outreach programs combined with housing first-type strategies, access to on-going treatment and drug provision, skill development and well-designed job opportunities – provide a very effective suite of interventions that not only achieves residential stability but also reduces the symptomatic nature of the mental disability and allows an individual’s material circumstances to improve out of sight.

In May 2015, the Republicans in the US Congress forced through legislation that deliberately cut public funding for affordable housing for low income American households (National Trust Fund).

The Republicans also have publicly opposed the Affordable Care Act, despite evidence that it is an effective support for homelessness.

I read a recent report that made me laugh. On November 21, 2015, the article – Republican Reeling As ObamaCare Opposition Is Crumbling In Red States – reported that “opposition to ObamaCare expansion is falling apart in the GOP stronghold.”

The reason? The report says that “the program has not caused the apocalypse that Republicans predicted” and that the program actually delivers significant benefits to targeted cohorts.


While some public policy problems are not readily solvable through increased outlays, the problem of homelessness, especially the over representation by mentally ill citizens in this cohort is readily remedied with extra funding and properly coordinated policy interventions.

Even in a narrow sense, leaving a significant proportion of our nation’s population to endure massive hardships on the streets is a total waste of productive resources.

It continually amazes me how so-called conservatives who believe in enterprise and all the other buzzwords they use standby and allow millions of people to remain unemployed for extended periods of time in destructive and unproductive states.

Whichever way one wants to construct the issue – the lack of funding for the mentally ill and the homeless in general – is another example of fiscal myopia.

Ultimately, the real costs of leaving this problem to sort itself out (the free market solution) are so large that the short-run ‘saving’ by public departments engaged in austerity become dwarfed by having to deal with a much larger problem in the future.

And then there is the question of humanity and human rights.

That is enough for today!

(c) Copyright 2016 William Mitchell. All Rights Reserved.

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    25 Responses to Mental illness and homelessness – fiscal myopia strikes again

    1. Steve says:

      It’s a goddamned disgrace and outrage clear and simple. Reaganism, DSGE and financialization and all of their attending follies have eroded the social contract that the government needs to have, and the ethical sensitivities of Americans. I swore I’d never become “a complaining old fogie”, but the truth is the truth in this case.

    2. Ikonoclast says:

      Being a little bit a sports tragic, I have followed the Jarryd Hayne story as he attempts to become an NFL player in San Fran. There are many levels to the NFL story of course. The most important to mention here is the high level of public subsidy for the NFL which is a private organisation with privately owned teams. The NFL governing body has to date, or at least very recently, been tax exempt. This is interesting when it is considered that the NFL Commissioner makes about $44 million per annum.

      The privately owned teams do pay tax if they make a profit. How much I am not sure. When it comes to stadiums, state governments and city or county local governments gift huge subsidies or virtually interest free loans to the private owners of NFL teams for stadium construction to ensure the team stays in or relocates to their prime city. Where modern stadiums can cost a billion dollars or more these public subsidies for private profit can equate to something like 300 million dollars per stadium over the life of a financing deal. I imagine an extra 300 million dollars even over several years would make a fair difference to homelessness and mental health issues in the Bay Area of San Francisco.

      In turn, we could talk about the false consciousness of the fans who root for “our team”. They pay for the team twice by public subsidy and cable TV or attendance. However, all the control and all the profits belong to the private owners. The system in total is bizarre.

    3. Exactly right, Bill! I’ve never been to San Francisco but my son, who’s not an overtly political person by nature, has been there on work trips and he was shocked by what he saw – the same as you are describing. He does say that it does seem worse there than in other US cities, for whatever reason.

      It’s only the political left that can change things for the better though. I know those on the left can be frustrating to those who understand the ideas of MMT but there’s too much overt criticism of the left and left politicians generally IMO. That’s just going to lead to a rift which is not going to do anyone any good. There’s no problem with a rift with those politicians on the right. They aren’t any use anyway!

      Whether it’s on the issue of homelessness, mental health, the JG or whatever we have to find a way, difficult as it might be, of working with politicians like Bernie Sanders, Jeremy Corbyn and others of like mind to end the kind of obscenities which you are describing.

    4. A.J.Miles says:

      Okay, I’ve only been looking at MMT in any great detail for a few months, so I would welcome correction if anything I say below betrays a poor understanding on my part.

      petermartin2001: “It’s only the political left that can change things for the better though. I know those on the left can be frustrating to those who understand the ideas of MMT but there’s too much overt criticism of the left and left politicians generally IMO. That’s just going to lead to a rift which is not going to do anyone any good. There’s no problem with a rift with those politicians on the right. They aren’t any use anyway!”

      I very much second the above. It’s certainly true that the operational realities described by MMT should be equally acceptable to individuals on the political Right and Left, because an understanding of MMT merely allows one to accurately assess the opportunities and constraints facing a fiscal sovereign in the pursuit of the latter’s public purpose (defined by ideological values).

      The incentive, however, to “get” MMT is much stronger under the current circumstances for Left rather than Right actors. People with economically Right-wing values probably find the fiscal austerity policies being pursued in most of the western world quite compatible with their conception of public purpose, and so they have every reason to avoid applying scrutiny to the Orthodox macroeconomic paradigm used to justify said policies. As Bill often points out, it’s much easier for them to simply pretend that there’s “no money around” when blocking public expenditure proposals than to admit that they actually regard any form of Social Spending as detrimental to their narrow and “Negative” (in Isaiah Berlin’s terminology) interpretation of individual Liberty. The Public are easily scared into voting for Austerity administrations when convinced that any alternative would lead to their (fiat currency issuing, flexible exchange-rate operating) country turning into “the next Greece”, but I don’t think parties of the Right could reliably win elections with the kind of platforms they’re currently espousing if the public understood that the only real reason for Austerity is ideological.

      Compare this to the Left, where the only real stumbling block to a wider acceptance (or at least discussion) of MMT appears to be a reluctance to accept that taxation isn’t necessary to “fund” spending in a technical sense. It’s not as if taxes play no role in MMT; one only has to read Abba Lerner to see how taxes serve (as one means among others) to regulate demand, and the (re-)distributive role of taxation can be made perfectly compatible with Functional Finance – please correct me if I’m wrong – if one understands that this refers to the redistribution of spending power, rather than income per se: if the economy ever gets close to full employment, via the combination of sufficient aggregate and targeted (e.g. anti-inflationary job guarantee) net public spending, then at such a point the only way for one societal group to gain spending “space” without inflation would be to remove a sufficient amount from another group (bearing in mind any differential in spending multipliers between the groups concerned). So redistribution can have its place in MMT, should one wish it. One could make the argument that the freedom MMT offers to evaluates taxation without referring to “Revenue-raising” criteria actually strengthens the Left’s hand: when the last British Labour government introduced the 50p top-tax bracket and the succeeding Coaltion governemnt removed it, discussion in the media focused entirely upon whether (very limited) research data suggested the measure had increased tax revenue, compared to the old rate. Nobody discussed whether it had contributed (or would have contributed, if continued) to lowering income inequality. Understanding that revenue raising isn’t necessary for a currency sovereign, and that levels of economically justifiable public spending (for a givn level of taxation) can vary widely, depending on the spending gaps left by the non-governemnt (foreign and private) sector’s saving intentions, brings other criteria for evaluating tax policy, like egalitarian spending outcomes, to the forefront.

      If anything, understanding MMT, and the associated implication that countries like the UK with persistent trade deficits and high levels of private debt (indicating a need to delever especially for households) would need to run larger fiscal deficits (nor “net injections”) just to get sustainable economic growth, should be a win-win for the left: they can have more of what they (and many voters) like – public services expenditure (not just capital expenditure either), infrastructure etc, and this can be done under current circumstances without needing electorally costly prerequisites like increasing the taxes imposed on marginal voters; what’s not to like!

    5. J Christensen says:

      The problem with austerity is that it’s slowly driving us all to mental illness from the bottom of the income scale up. Those on the street are in varying stages of dying. Those on lower incomes who are not yet homeless are gradually becoming overtaken with anxiety and depression because they know they will be there next; they can walk right over the homeless because they are already in survival mode.

      Yet there are some on higher incomes who are still somehow able to brush all of this aside, and continue to pursue their “bling” and other luxuries with a guilt free mind, and vote for more austerity to keep the cruel game going.

      We depend on functioning economies for survival in a world were the simple ability to work to pull our own sustenance from nature has been removed by society’s enforced order. There would seem to be some sort of moral duty on the part of a government that enforces such an order to take every measure possible to stop an unfolding apocalypse when the means to do so are well within it’s grasp, and yet, it’s the rare moment in history when that occurs.

    6. Barri Mundee says:

      This topic is particularly pertinent to me as I have an adult son with mental illness. If it weren’t for the fact that we are well off enough to support him I am quite sure he would be homeless or in jail or perhaps no longer with us by now.

      Whilst I agree that the mentally ill are better treated than in the US by and large, (We have seen the homeless up close and personal in San Francisco in 2015) there are still not enough resources available to assist the mentally ill.

      Hence I spread the word about MMT principles wherever I can!

    7. Barri Mundee says:

      Dear I Ikonoclast. I think one reason SF has more homeless is that it has a relatively benign climate so it is easier to be homeless than say in NY.

    8. Kevin Harding says:

      It is always good to start from basics .Good governance being the direction of real
      resources to where it is most needed.Generally this is to areas where the private
      sector cannot make profits.Decent affordable for everyone healthcare ,particularly the
      mentally ill.Infrastucture maintenance and improvement ,education,non co2 energy production.
      I would also add that distribution of resources to households via spending power needs
      to be directed by good governance .Progressive welfare and taxation to direct real
      resources away from the rich towards the poor.Capatalist labour markets without government
      direction have never solved the problem of the working poor.

      This is functional finance ,government spending and taxation as a tool for public purpose
      not as a household balancing the books.
      It is faith in the markets and aversion to the state sector which prevents right wing politicians
      from viewing monetary transactions through the MMT lens.

    9. Kevin Harding says:

      Very much agree with AJ Miles.

    10. Neil Wilson says:

      “The incentive, however, to “get” MMT is much stronger under the current circumstances for Left rather than Right actors”

      Not really. Huge swathes of the left are far more interested in taking sticks to the rich than they are in solving the problems of the poor and dispossessed. Helping the poor is more about their own status within their social group than it is about solving issues permanently. Effectively they act like heiresses wandering around doing ‘good works’ while being lauded by their peers. It’s the lauding that is more important than getting to the root cause and sorting out the issue once and for all.

      The existing UK labour leadership is still in thrall to ‘nobel prize winners’ that once again talk about banks as financial intermediary (Stiglitz today for example). It’s the same across Europe where the so called thought leaders can’t even get the basics of banking right.

      And they are supported by a set of people, largely of a certain age and social background, who are very fond of defending government bonds because they know they form the major backing for the, no doubt quite large, private pension pot they have.

      Certainly they don’t want that government welfare replacing with a much beefed up, and far more equal, state pension provision – regardless of how many poor people they have to sacrifice against the NAIRU to get there.

      No actual left-winger who cares about solving poverty, illness and homelessness could support the State Aid and banking restriction provisions of the EU treaty for example. An unfettered state can easily replace trading losses with substitution businesses and new local requirements. (The current argument here is that the price of steel would rise outside a free trade zone – when we’ve just closed a steelworks due to excessive international competition).

      So anybody who champions supranational organisations without federal financing powers, or trading agreements really isn’t on the side of those left behind.

      There’ll be a few more iterations of failures amongst the left before enough young blood gets in to change things. As ever change happens one funeral at a time.

    11. Phil says:

      You’re absolutely right that this could be solved more or less easily. But something deeper must be at work with regard to the history of this problem in the US.

      I grew up in Ireland during the austerity. We used to have very few homeless. Many beggars etc. were usually drug addicts that had access to council residency (horrible residency that was grossly inadequate, but still). When the austerity hit homeless seemed to increase. But even during the austerity I never saw anything like when I lived in Massachusetts.

      Boston is about the same size as Dublin. But the homeless problem was outrageous. Many were clearly mentally ill. A good number of them are veterans; some from Iraq, some from Vietnam. I couldn’t believe that when I saw all the flag-waving on TV.

      Even in London the problem seems different. There are a lot of homeless in London, no doubt. It is, after all, a huge city. But they seem to me treated differently. You often see aid workers talking to them on the street. There does seem to be some effort at outreach. Not enough, but still.

      There’s something weird about the homeless problem in America that is peculiarly American. I can’t quite put my finger on what it is. But whatever it is it shows serious deficiencies in the national character.

    12. Simonsky says:

      “There’s something weird about the homeless problem in America that is peculiarly American. I can’t quite put my finger on what it is. But whatever it is it shows serious deficiencies in the national character.”

      I’ve never been to America but it has always struck me that the bogus notion of ‘the self-made man(sic) reliant on no-one’ seems to be something that runs through the collective psyche sometimes summed up in the acronym YoYo (you’re on your own). It’s an illusion, of course because, we are all reliant on others and the self-made entrepreneur has relied on all sorts of support , infrastructure and family/emotional help to support them. It’s Sinatra’s ‘I did it My Way’ writ large. Post Thatcher, we’re still trying it here (UK) but it doesn’t work 100% because of welfare traditions going back 100 years.

    13. larry says:

      Barrie, It is just as bad in NY. It is simply less visible there. Most of them spend a great deal of time in and around the subway, except on those odd occasions when the city administration decides that it has to “clean out” the subway system of derelicts. Then of course they get complaints from residents and commuters about the homeless on the streets and they then cease pestering them.

      And the NY police are something else. Some friends and I were driving down 2nd Ave in Harlem about Midnight one New Years Eve and someone threw a guy out of the car in front of us and drove off. We stopped and tried to help the chap who was unconscious. A number of people came out of the residences and we told them that we were going to call the police. They begged us not to do so and to call the fire department instead. So, we did.

      A short time later we saw a police car driving toward us and, seemingly upon seeing the crowd in the street, the car turned off the avenue. After the fire department arrived to take care of the guy and take him to a hospital, we went looking for the police car that had deliberately turned off the street. We found it and complained to the two officers in the car about why they had deliberately failed to help a person in distress. They let us make our complaint and then told us to stop talking and leave or they would arrest us. I knew they weren’t kidding. We had no choice but to drive off, knowing that they would stay where they were. And this was a time when they shot fewer people than they do now.

      There is a kind of frontier mentality that is still alive in American culture, even though the “wild west” only lasted about 20 to 30 years in the 19th century. This underlies the excessive individualism that is part of the American way of life. Moreover, you are brainwashed throughout your school years from an early age with what is known as the American dream, part of which consists of the idea that anyone can become president, that everyone is equal as set out in the Declaration of Independence, memorizing Lincoln’s Gettysburg Address and being told it applies to your own life, that it is the greatest democracy in the world, and the like, all of which is a grotesque lie. The defects in American character that you saw are underwritten by serious defects in American culture (its beliefs and value system).

    14. larry says:

      Re ringing 000, the emergency number has either changed or you needed to ring 911. But your companion was mostly right. Although the fire department *might* have come.

    15. larry says:

      One reason Americans are so money focused is based in reality, for if you fall out of the system, you don’t just fall into the basement, you fall into a black hole from which you are likely never to emerge. And many are frightened of this very possibility, and you become frightened of it from a very early age. You have seen some of the consequences of what happens when someone is unable to work within the system, for whatever reason. It is truly awful, yet it is extremely difficult to get anyone to believe that the US is this bad.

    16. Willy says:

      As I have mentioned before, daily doses can inculcate a fear in a person which festors to a hate of these desperate people. They become the very hounds of hell, constant reminders that it is a very real place on earth for people who are weak and poor. Walking to the various jobsites from BART in the early morning city I see many of these individuals, and have walked past more than a few being removed dead from the sidewalk. Its funny, in all that time I’ve never seen the dead being removed between 9-5 on my break and lunchtime travels. A shame it seems I might be the only SF reader of this blog, but that makes sense in this Silicon Calvanistic city of the chosen and the damned.

    17. larry says:

      Willy, you are not alone in the reading of SF. “Silicon Calvinistic city of the chosen and the damned” – nice image. It wasn’t always this way. But that seems long ago.

    18. Hepion says:

      I sometimes wonder why do we accept unemployment. Here in Europe we don’t leave people without medical care for example. So why do we accept that there are some people that have no access to jobs?

      Then I remember that all economic thinking emanates from america, which is deeply imbued in ethnic antagonism.

    19. Steve says:

      The human mind, like matter, is infinitely fragmentable and compartmentable. This is why people can have diverse and even contradictory political, economic and monetary opinions. This is kind of a two edged sword in that differences of opinion can lead onto genuinely new thinking (but only if the philosophical underpinnings of that new thinking are consistent and thoroughgoing which marks the difference between a crank and the innovator or even a visionary) or lead to cognitive dissonance on the scale of an entire society as we’ve all been noting in discussing Bill’s post. The latter mindset and mental habit also tends to degenerate into continual contentiousness as in Democrat/Republican, Tory/Labour etc. and which also ends up with one or the other side declaring TINA and trying to enforce their reality on everyone. The “trick” in avoiding this scenario is integration/the integrative process itself which consists of combining only the particles of truths, workabilities and applicabilities in both opposing ideas, theories etc. and not trying to enforce any of the untruths, unworkabilities or inapplicabilities of either side which only ends up throwing the entire process back into inevitable contentiousness/mere duality as in the political party situations as per above. Finding an actual solution to problems consists of this integrative process of opposing ideas, theories etc. and which leads to a third and more unifying condition. People can see this as correct and the actual process, but what is most difficult is overcoming/deciding on the importance of the ethical superiority of such integration over opinion or involvement with personal agenda of power and/or control. And this is why a thoroughgoing linguistic/psychological/philosophical unity is so important…because it clarifies and focuses one’s understanding while simultaneously raising the ethical nature of the debate.

    20. Podargus says:

      Inadequate resources being devoted to mental health is not a new problem and the USA is not unique in this regard.I write from an Australian perspective (and experience as a first responder).
      The essay is perfectly correct as are the comments. However,what seems to have escaped notice is the role that excessive population plays in a civil society.It is a destructive role. Overcrowding inevitably results in the weak being left behind and treated callously. That occurs,although to a lesser extent,even when there are more or less adequate government financed services provided.

      The USA and the UK are overpopulated by any measure and there is no prospect of that situation improving while immigration is allowed to continue. The plutocracy are quite happy with that state of affairs.

    21. Kevin Harding says:

      I live in Brighton UK and homelessness is a real problem here.It has been
      for a long time but always increases during periods of Tory government.
      Where I think people are right to draw a distinction between left and right is
      that the fiscal myopia of which Bill has commented on in the last two blogs
      are in fact touching on a deeper myopia.
      The myopia of the efficiency of market forces.Private sector firms cannot make
      profits on flood defenses,sewer repairs or mental health services for the homeless
      without government commission.As I have no doubt bored people with many
      times before it is the government’s direction of real resources which is the
      underlining reality of fiscal stimulus .
      Those with faith in market forces embrace austerity.Personally I do not advocate full
      socialism being a mixed economy kind of guy but to faith based economics the
      state is the enemy.

    22. “Huge swathes of the left are far more interested in taking sticks to the rich than they are in solving the problems of the poor and dispossessed”

      I don’t suppose we’d put it quite like that but we see the argument. The opposing idea would be that we can leave the rich in place, in control of the mainstream media, in control of the means of production, in control of ‘democracy’ even, while we get on, unhindered, with solving the problems of poverty using the principles of MMT?

      I suppose it comes down to the question of whether the frauds outlined in Warren Mosler’s excellent “Seven Deadly Innocent Frauds” are really quite as innocent as he’s allowing. Might he have been slightly too charitable to use this term? Some of us do think that.

      There is a class war going on and there’s no doubt who’s winning it. The rich, the 1%, the ruling class (call them what you like) are the ones using the sticks, both literal and metaphorical, to club the rest of society into submission. Do we fight back? Yes, of course. Is pointing out that the rich aren’t paying their fair share of taxes an important part of that struggle? Yes of course it should be.

      We don’t want to have a real class war with real sticks (aka guns and bombs) but if we don’t soon start to make some progress then it won’t be too long before some hothead leftists take up a “Red Army Faction” style struggle which I personally would consider to be counterproductive.

    23. Bob says:

      “Is pointing out that the rich aren’t paying their fair share of taxes an important part of that struggle? Yes of course it should be.”

      Peter, there is ton of other stuff to look at also.

      It does but it is even more important to fix the distribution so they do not amass huge piles of wealth in the first place. JG, unions, “trust busting” etc to prevent the rich from throwing a hissy fit. So I say fix the distribution first and then you can make decisions stick.

      It seems better to have the rich fighting over numbers in a spreadsheet than anything real. Good can be dangerous when it advances mediocrity by limiting the actions of the truly capable. Money acts as a motivator and there is no reason financial hoarding should limit access to goods from the poor.

      The state also has to pay the politicians and they have to pay them more than commerce can . It’s very simple. Those who pay the piper call the tune. We also need more transparent government. Reduction in surveillance and ‘military-industrial complex.’

      Politics should be golden handcuffs. You are paid by the people and you are pensioned by the people and you are not permitted to do anything else once you become a politician or afterwards. Any suggestion that you have been influenced by a corporate should involve a very long jail sentence.

    24. John G says:

      Fitting with Bill’s theme of fiscal madness and infrastructure decline, I’ve just been reading about Flint, Michigan and its water supply.
      It borders on criminal negligence.

    25. Thorvald says:

      Well written Bill. With family member with mental illness, I am glad we live in Norway where they get decent care and even an adequate disability pension. The same care is also provided for refugees who have mental illness, many of them arriving now. The US situation is outrageous, so glad you take the time to write about it. Must come to a point when the social fabric just starts to crack?

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