The Deinstitutionalization of the Mentally Ill

Since the 1950s, the large majority of mental health hospitals across the country have been closed, resulting in a dramatic decrease of psychiatric beds providing treatment to the seriously mentally ill. As a result, prisons, jails, and the streets have seen a significant increase in mentally ill residents.

More than 170,000 people with mental illness experience homelessness nationally. According to the Treatment Advocacy Center, in 44 states, a jail or prison holds more mentally ill individuals than the largest remaining state psychiatric hospital.

The effects of deinstitutionalization are summarized in the book Nowhere To Go, The Tragic Odyssey of the Homeless Mentally Illby E.Fuller Torrey, M.D.

  1. Twice as many seriously mentally ill (SMI) on the streets and shelters as in public mental hospitals.
  2. Increases in SMI individuals in jails and prisons.
  3. SMI individuals regularly released from hospitals with little or no provisions for follow-up or aftercare.
  4. Increases in violent acts perpetrated by the untreated mentally ill.
  5. Inadequate housing for the mentally ill.
  6. The majority of mentally ill people discharged from hospitals have been officially lost.

By Paul Webster

Paul is an advocate, legislative and policy expert, and the Director of Hope Street Coalition. Hope Street focuses on the intersection of homelessness, mental illness, and chronic addiction. He has worked at the local, state, and federal levels most recently as a Senior Policy Advisor at the U.S. Department of Housing and Urban Development.

5 replies on “The Deinstitutionalization of the Mentally Ill”

In April 2021 before large budget meetings, below was sent to our county supervisors and a local newspaper. I never had a response but would like to work with those who think a good beginning for the state of California would be to get some mental hospitals and treatment centers open asap. The money is there, why aren’t the hospitals?

From a local NAMI parent:

California State Mental Hospitals are boarded up and we have been told there are no plans to reopen them or build new ones. Which I find outrageous. And if anyone would like to work with me to get this changed, please contact me.

In my opinion: Modern day psychiatric hospitals and treatment facilities could and should provide everything we need in one medical facility: Professional medical expertise and treatment, security, accountability, locked facilities when needed, long term care when needed, emergency and short-term care when needed. They should be open to the general public not just criminals. HIPAA laws should be reformed so that family members are no longer excluded, and so that the ill person’s treatment and recovery does not hinge on his civil rights choices, when he is incapable of making such choices. MediCal and insurance would be accepted.

Above is my fervent first choice. Our daughter was hospitalized right away and given this treatment in Wisconsin at the outset of her illness, where she never went to jail. It had great success compared to Santa Barbara, where she spent three months in jail waiting for a treatment bed.

YES, we need to continue the funding and do everything we can to ensure the continuation and success of the AOT program, here and throughout California.

AOT is there for us now, when the treatment centers and hospitals are not. AOT and ACT should be there after the treatment facility as well, as they are so needed. When AOT is funded and staffed, it is successful.

Thank you for your comment. California is committed to continuing the failed policy of community-based mental health for the seriously mentally ill as an alternative to creating residential treatment facilities. Those advocating for appropriate housing and treatment for the unhoused mentally ill and addicted need to join with those that are fed up with the abject failure of policies and funding attempting to address homelessness and push for a separate continuum of housing that heals and intensive treatment for those suffering on the streets. That is why Hope Street Coalition exists.

What do you suggest? Going back to warehouses for the mentally ill that are largely unchecked and full of abuses? I agree what we have now is not right. People are in the wrong places for treatment, if they can get it. But what is the answer?

Thank you for your comment. The notion that we either continue the open air asylums of the streets or return to warehouses of uncared for and abused people with mental illnesses is a false choice. A continuum of appropriate housing and care exists invalidating the binary choice of streets vs warehouses. Residential care facilities, board and care homes, “lighthouse” programs, and other types of clinically intensive residential care facilities to provide long-term stability and wellness are the goal. The money is there and the models of housing and care are there. What is needed is increased awareness of these types of facilities and the political will to support them. At the same time that Hope Street is advocating for the scaling of housing that heals, we discourage the use of housing and non-clinical services as substitutes for clinical interventions, which is the current approach to addressing homelessness.

I saw this comment today somewhere on your website. I very much agree with it. This is what I would rather be pushing for. I can’t help but feel from being involved for five years, that modern day state run hospitals with standards and accountability, would do a better job than each community trying to fulfill this monumental task on their own. Here is the comment: “The only real thing that will help people dealing with addiction (drug/alcohol) and mental illness are HOSPITALS built in EVERY COUNTY that can specifically deal with these problems. In my opinion, everything else are just “band-aids”. Yes, programs that provide housing, training, job placement, and counseling are good, BUT these people need real, ACUTE medical care FIRST! We should be able to point to and identify numerous Mental Health and Addiction HOSPITALS ALL OVER So Cal and CA! There should be at LEAST one in every County, if not several. The time has come! Our current Hospital model is NOT working to treat these populations! Getting them a motel room for a few nights, or handing out some sandwiches, or giving them a new set of clothes will NOT solve their long term MEDICAL PROBLEMS! We need to sound the call to BUILD HOSPITALS that deal with MH and addiction!” If Dr. Pinsky agrees with me we can put him in charge of our new CA Mental Health Hospital program. Does he agree with me?

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