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It's amazing to me that "fund community-based treatment and supportive housing" don't count as 'serious' solutions, but spending the same money on hospital beds somehow does?
I do suspect that a big part of the reason is that many of us misunderstand the economics of institutional vs. community-based services. #CripTheVote
For a very long time, we have promoted the idea that community-based care is cheaper. This is often true on a per capita basis when you are bringing people out of a facility, but isn't true when you're talking about creating an entitlement to service-provision. #CripTheVote
Because people are justifiably reluctant to enter an institution, more people use community-based services when they are offered. #CripTheVote
Because of that, meeting the needs of everyone in need of help via community-based methods may be more costly. #CripTheVote
This is further exacerbated when you account for the cost of housing, which is built into the structure of institutional settings but not into most community-based services. #CripTheVote
This is, obviously, not an argument for institutionalization. But it does offer some insight into why policymakers often push for it.
They see it as a way to save money by offering a benefit people will only take when in crisis, as opposed to a benefit that people will take up when they need it (and thus prevent them from going into crisis).
This isn't an argument for institutionalization - it is an argument for recognizing that community-based services will likely cost more money than institutions at scale, even if they cost less per capita. #CripTheVote
This is, of course, also an important reason why community-based approaches don't get taken seriously:
If the real problem is that you don't want to see crazy people on your morning commute, then supportive housing doesn't do a damn thing for you. But let's not pretend it's about the welfare of the people you want out of sight. 🙃
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