Partly it's dysfunctional but the options for treating severe mental illness (schizophrenia spectrum, bipolar, major depression) aren't that great.
When you seem some guy screaming on the street corner a monthly depot injection of an antipsychotic drug would probably calm them down but overall the drugs are unpleasant [1] and have serious side effects, particularly sedation, weight gain, and high blood sugar [2] A "functional" system would probably be one that can get people like that a diagnosis and get them treatment against their will.
Kanye West is a good example. He has a bipolar diagnosis but now thinks he is fashionably autistic so he quit taking his meds and now he is shooting music videos of black people in blackface giving the Hitler salute after a whiney autotuned complaint that they won't let him see his kids after he posted something on Twitter [3]. For him responsibility is not "don't cosplay as a Nazi" but "face up to your condition and take your meds" and he won't want to cosplay as a Nazi and they might let him see his kids.
I've known quite a few people who are schizophrenia spectrum without a diagnosis: one of them lived at our house for a year and a half until she threatened my wife with a knife and she took her own life a year later, another one called us up five times in one day last week with a scrambled story about how she got bit by a dog, I sat down and listened to her for about 20 minutes in which she got lucid just a few times and I was able to piece together the place where it happened, that she's talked to the security guard and the EMT but not the police, that she did see a doctor and get a Tetanus shot though she wasn't sure if it was a Rottweiler or a Pit-bull.
The good news is that new drugs are here and more are under development:
[2] last year my condition got worse and my doc put me on the minimum dose of seroquel before going to sleep which is 1/10 the dose they'd give to someone who is really psychotic. It was effective at getting me quality sleep and avoiding "paranoia against objects" in the morning but I gained 15 lbs and my A1C was borderline in my last bloodwork and my doc thinks I should get off it. Even the smallest dose is so sedating I can't believe anyone could take it during the day, my guess is that if I cut the pills in half the sleep promoting effect will still be strong enough.
When you seem some guy screaming on the street corner a monthly depot injection of an antipsychotic drug would probably calm them down but overall the drugs are unpleasant [1] and have serious side effects, particularly sedation, weight gain, and high blood sugar [2] A "functional" system would probably be one that can get people like that a diagnosis and get them treatment against their will.
Kanye West is a good example. He has a bipolar diagnosis but now thinks he is fashionably autistic so he quit taking his meds and now he is shooting music videos of black people in blackface giving the Hitler salute after a whiney autotuned complaint that they won't let him see his kids after he posted something on Twitter [3]. For him responsibility is not "don't cosplay as a Nazi" but "face up to your condition and take your meds" and he won't want to cosplay as a Nazi and they might let him see his kids.
I've known quite a few people who are schizophrenia spectrum without a diagnosis: one of them lived at our house for a year and a half until she threatened my wife with a knife and she took her own life a year later, another one called us up five times in one day last week with a scrambled story about how she got bit by a dog, I sat down and listened to her for about 20 minutes in which she got lucid just a few times and I was able to piece together the place where it happened, that she's talked to the security guard and the EMT but not the police, that she did see a doctor and get a Tetanus shot though she wasn't sure if it was a Rottweiler or a Pit-bull.
The good news is that new drugs are here and more are under development:
https://www.cobenfy.com/
[1] no diversion risk!
[2] last year my condition got worse and my doc put me on the minimum dose of seroquel before going to sleep which is 1/10 the dose they'd give to someone who is really psychotic. It was effective at getting me quality sleep and avoiding "paranoia against objects" in the morning but I gained 15 lbs and my A1C was borderline in my last bloodwork and my doc thinks I should get off it. Even the smallest dose is so sedating I can't believe anyone could take it during the day, my guess is that if I cut the pills in half the sleep promoting effect will still be strong enough.
[3] oddly not "X"