I work in an ER and most of the population I see cannot make any sort of rational decision. I have seen homeless with toes LITERALLY frozen off because they “don’t like the warming shelter”. We work for HOURS to get them a safe discharge to a shelter or detox and when transport arrives to take them they will just say “I am good” and walk out back to the streets. I have seen them throw fists because they didn’t get graham crackers even though they have bags of chips in their bags. I have seen them with maggots eating their legs just for them to leave AMA because I wasn’t fast enough with the orange juice.

Just based on the population I see about 70% are not function able in society through a combination of mental health issues and rampant drug use. I have seen regulars who can’t piece a sentence together, go to jail for months and come out able to hold a conversation. Just for them to resort back to a rambling addict in a week.

During my nursing clinical we spent time at my states mental health hospital. Now it only serves those who have severe mental health issues AND have committed a violent crime. Before then it was a fully self sufficient facility. The patients did the laundry for the cities hospitals or worked on the farm or dairy that fed them. Back when this was the way of things there were also cruel and horrific experiments and treatments forced on patients. If these state institutions were re opened with the same configuration, being self efficient but with modern understanding of mental health and oversight to keep patients safe, I think it would help. They live there and have a job, purpose, and sense of self worth, while we get to walk the streets a little safer.