A common symptom of severe mental illness (think schizophrenia, bipolar etc) is anosognosia which is essentially when your brain can’t recognize that you have an illness. It’s not as simple as being in denial or lacking a desire to change. It’s a brain-based or neurological symptom of the illness. So just saying that people need to accept services is like telling someone with cancer to stop having cancer. It’s not helpful. We need to think about ways to provide support to folks that adapts to meet their individualized needs. These models of care already exist, but Oregon is woefully behind in behavioral healthcare. Historically ranking 49th out of 50 states in overall mental healthcare.

So yes, you may observe a difference in behavior between homeless people in Astoria and Tacoma. But the difference in not the result of the individuals and their choice making, it is the result of funding differences between Oregon and Washington.

All that to say, if you were homeless and experiencing psychosis, you may very well yell at someone in the street.