Opinion: How deinstitutionalization contributed to the homelessness crisis

Whether in classic literature such as “One Flew Over the Cuckoo’s Nest” or in modern television series with “American Horror Story,” the impression the average American has of “asylums” is a decidedly negative one. The years they are best remembered for are filled with inhumane treatment of the mentally ill and barbaric practices such as lobotomy. As such, it seemed only natural that state-owned hospitals — a more modern term for many of the institutions once labeled as asylums — would be replaced with a more humane option. In the 1960s, President John F. Kennedy pushed for the use of outpatient health centers, where these individuals could be treated on an outpatient basis. Such an act would have been the first attempt in American history at establishing a unified national mental health plan. 

While it may have seemed like the goal was achieved with the Community Mental Health Construction Act in 1963, the plan ended up falling short of many of its promises. The proposed community mental health centers, as presented to Congress, would be outpatient facilities in each congressional district. These centers would provide care for individuals with severe mental illnesses while allowing them to continue with their everyday lives. It would allow individuals the ability to still receive an education, gain employment, and interact with society while still getting help.

In actuality, many of these promised facilities never opened. The price for such a grand national plan ended up being much more than originally believed. Additionally, many states saw these federally funded centers as the government officially taking responsibility for individuals with severe mental illnesses. As a result, state officials felt that they were justified in closing the earlier asylums in order to shore up their respective state budgets. This resulted in these people having neither a place to go nor a place to return to, rendering them homeless.

This led to an entirely new problem: the effective abandonment of many of those with severe mental illnesses. “There were no funds for neither continuity nor coordination of care,” said Northeastern professor Phil Brown, who did pioneering research on the deinstitutionalization phenomenon in the 1970s. “You had people who had no history of taking care of themselves. All of a sudden, they are out there trying to find a place to live, a job, housing or food, and physical or medical care.” 

“This would lead to an entirely new problem: the effective abandonment of many of those with severe mental illnesses.”

As time passes, the fates of these individuals seem to have become cemented in this state of transition. From the undelivered promises of the federal government, the responsibility of patient care shifted back not only to the original states but also to newly growing private facilities. Unfortunately, this is still not enough. By the time many of these individuals end up at an emergency room today, they already have a history of violence or drug use. Hospitals that do not have the resources to adequately help these people ultimately transfer them to private care. While these hospitals expect private centers to care for such individuals, there are lengthy legal processes to enter such facilities. This means that it’s more likely for these individuals to just end up where they started.

While these facilities can rely on such factors to not be forced to take in those with severe mental illnesses, there is one such location that is all too ready to pick up their negligence: America’s prisons. Research shows that almost a quarter of those who are currently imprisoned and a third of those who are homeless are suffering from severe mental illnesses. 

With all this in mind, is there really nothing that state-run psychiatric hospitals could provide to the mentally ill? Additionally, what about the original development plan for community health centers reflecting the ideals of a more unified nation? Originally, asylums were built on many of the same principles that were envisioned for these community health centers. Individuals at these locations could experience a sense of community, receive structured care, and even participate in vocational programs like farming to become more connected with their daily needs. The typical impression one has of an asylum comes from the post–World War II era — a time when a surge of those admitted resulted in physicians attempting quick procedures in order to make the populations more manageable.

More than half a century after this initial push away from the state psychiatric hospital, it seems like it has been long enough for us to take accountability for the programs that led to the abandonment of these individuals. Through this, we can find a way to incorporate the practices that were important for the care of individuals with mental illness, while leaving the mistakes of a less enlightened era behind.