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Culture War Roundup for the week of January 20, 2025

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They occasionally do this, but psychiatrists don't like it because they see it as schools pawning off their disciplinary problems on doctors rather than solving them themselves. I can't find it, but the local news did a story a few years back after one of the school shootings about how some local districts had adopted zero tolerance policies and were sending any kids who exhibited violent tendencies to Western Psych at the drop of a hat. The doctors they interviewed basically said that the ED is there for people who have acute mental health crises and not kids who got into fights. So what was happening was the kids were waiting for hours at the bottom of the triage list and when the doctor concluded they didn't meet the criteria for admission they were sent home. But the school got to say they referred him to psych immediately and didn't take any chances.

The upshot of what the one doctor was saying was that long-term behavior problems are the kind of thing that needs to be dealt with over the course of months or even years, and that psychiatric hospitals aren't equipped for that. He said that if the schools were concerned they needed to hire their own mental health staff that could work with students and parents to resolve the problems. I can tell you right now that this isn't going to happen because the incentives are aligned against it. If a school hires its own counselors and starts its own program for troubled youth then it's going to cost a lot of money and if one of those kids ends up doing something terrible the program is going to be put under a microscope and probably won't come out looking good. If they say "we sent him to Western Psych after we saw the red flags" then their insurance will pay for it and Western Psych can explain to the media why the treatment didn't work.

Realistically, though, the doctors were right: Not all problems are mental health problems. If a guy keeps getting into fistfights at bars that don't cause any serious injury we don't send him to the nuthouse. It's a criminal matter. And realistically we don't even do that much in a situation like that; while misdemeanor battery has around a five year max in most jurisdictions, first offense you can likely plead down to disorderly conduct. After that you'll get a combination of fines, probation, and suspended jail sentences until you either get into a fight while on probation or the judge looks at the rap sheet and simply loses patience. The most you might get in the way of treatment is court-ordered anger management classes (I know three people who have completed these and they all say it works). I've never heard of anyone going to Western over a barfight unless there are obvious extenuating circumstances.

What I'm looking for is more a custodial / residential school or reform school.