The Cost

Assistant Village Idiot from fifteen years ago.  AVP is now retired but was a social worker at a New Hampshire psychiatric facility.  A very thoughtful guy.  This is a piece about the fantasies we all indulge in when regarding those who can't cope in society.  He tells the stories of how two former psych patients manage in small town New England.  Sounds ideal but, as AVP reminds us, that is not reality.  It's a subject I know a bit about.

It is the ideal solution everyone is thinking about in the back of their minds when they are setting policy. This is the way life should be. This is how communities should act. It is the thought behind Tolkien's anarcho-monarchism, the idea behind the libertarians's love of small, naturalised, spontaneous solutions, the force behind all the liberal programs to teach job skills, develop natural networks of support, and have self-determination.

Wouldn't it be nice if.

It's 90% fantasy.

How would you replicate this solution in Boston? Hell, how would you replicate it in Concord? There are many, many more people out there, all of them with added difficulties - some of their own making, but many not. Making a life for all of them is an expensive proposition. In fact, it is furiously more expensive than any of you imagine. To do this right, to provide the services that people need to have a life, is well beyond our ability to fund. Well beyond. We might hope for technological solutions to bail us out over time: medications with fewer side effects, or gene manipulation to pull some of the developmental and psychiatric problems out of the equation. Better methods of incentive and persuasion to keep people in the treatment they need. New communication technologies that allow people to work without having their oddness and lack of social or employment skills show.

But for now, we have these people, and they are real people, and they are just difficult and expensive.

Conservatives and liberals have their separate ways of screwing this up. Small-government types entertain the fantasy that a lot of this would work itself out if people were more self-reliant - if individuals and families stepped up and made these natural solutions happen. They have a point, of course. I am very reluctant to apply for disability benefits for young people, knowing that this dooms them to a rather meager, helpless life in many cases. A lot of people could indeed smarten up and fly right if they had to. The risk of that is, some people can't, even with significant family support, or can't quite, and pushing them out into the world is merely kicking them when they are down. And let me assure you, you don't know which one's are which.

Liberals feel your pain, and in their kind-heartedness think we could do what is necessary if we would just try harder. They also have no idea how extensive the problems are. But you can see how they sense it at a distance, because a lot of them move into parts of the human-services bureaucracy where they are no longer providing services. They set up information clearinghouses, in order to connect people to services that already exist. They go into advocacy, trying to get this miserly, uncaring society to see how much we need to increase our support and grow new programs. They believe that if we all just pull together, dammit, we could make this pretty good. And so human service bureaucracies, and non-profits supported by government money, become about 50% people not doing anything that actually provides services. They go to meetings a lot.