From the 1850s to the 1980s, large state-run psychiatric facilities housed most of America's citizens with mental illness. This practice began to change in the 1960s, when legislation dismantled the state-run asylum system, replacing it with a community-based care policy that ultimately failed as well.
Support for closing asylums and transitioning to community-based care facilities, or outpatient treatment centers, began to grow in the 1950s. By then, the public was aware of the issues with asylums: they were frequently overcrowded, and many patients experienced deplorable conditions. At the same time, several new psychiatric drugs became available. Doctors were able to sell politicians on the idea that these drugs would make it possible for previously institutionalized patients to live in the community. The research that led to deinstitutionalization began in the 1950s, but it wasn't until the 1960s that the federal and state governments passed laws which closed asylums en masse.
The consequences of deinstitutionalization were not immediate. Many politicians were eager to save money by placing the responsibility of care onto communities and the federal government instead of the states.
The asylums were far from perfect - there were many cases of systemic mistreatment. One of the most horrifying examples was the Willowbrook State School in New York. Some institutions also practiced eugenics and sterilized patients. However, the facilities kept many people with mental illness off the streets, out of jail, and in relatively safe housing with access to treatment.
Many People Became Homeless
The homeless population in the United States has risen significantly over the years. This rise is partly due to policies that release people with mental illness from treatment facilities without adequate options for future housing. Mental illness often coincides with substance dependency, such as to drugs, alcohol, or both.
In 2015 the San Francisco Homeless Count Report revealed 35% of the city's homeless population have psychiatric or emotional conditions, another 27% have PTSD, and 10% have experienced traumatic brain injuries. There is a strong link between homelessness and mental illness, though there are numerous social, political, and economic reasons for destitution.
Some Individuals With Destructive Or Criminal Tendencies Landed In Prison
When large mental asylums were still in use, the population of prisoners with mental illness was only about 1% in 1880. Once institutions began closing in the 1960s, the number started rising significantly.
By the 1980s, around 10% of the imprisoned population suffered from mental illness. New York Daily News once dubbed the Los Angeles County Jail "the largest de facto psychiatric inpatient facility in the US," with New York City's Rikers Island coming in second.
Some People Returned To The Institutions Where They Previously Lived
A handful of patients from the Willowbrook State School in Staten Island, NY, returned to the closed facility. The school once housed more than 6,000 children and adults, all with some level of mental or physical disability. Convicted kidnapper Andre Rand was one of many who reportedly camped in the woods near the empty structure or lived in the tunnel system built beneath the complex after its closure in the late 1980s. Rand was a former employee at the Willowbrook School.
The State Government Saved Money, Arguably At The Expense Of Public Safety
Large, densely populated, and well-staffed mental health facilities are expensive to run, which is why state governments aimed to shift patient care costs onto the federal government. Throughout the 1960s and '70s, legislators passed various laws that chipped away at funding for mental health care.
Though the majority of people with mental illness are nonviolent, some incidents led to legislation requiring they get treatment. In 1999 a man named Andrew Goldstein pushed Kendra Webdale in front of a New York City subway train, killing her. He had failed to take his medication for diagnosed schizophrenia.
After the incident, Kendra's Law went into effect, which, according to New York Daily News, "gave courts the power to compel the mentally ill to accept treatment as a condition of living in society." The law lets judges order the mental health system to treat those with severe mental illness - this potentially gives people access to mental health treatments before they develop dangerous behaviors.