Or - how they threw the mentally ill in the streets but we KEEP paying the taxes for mental institutions.
This article ain't going to be funny, save perhaps black humor. Life is a tragedy to he who feels and a comedy to he who thinks. We need a bit of both here.
As a child of the 1980s (Born/tiny in the 70s, kid and grew up through the 80s) an Xer - I've been on a nostalgia trip and am writing a fiction set in an alternative 1980s. To me Reagan was a bad guy since my family was mostly left/liberal especially my "Hippie" parents. This is nothing like the hyper left aka the so-called "Woke" of today. I might make a different article on that.
There's so much being said on the bad of Reagan and history has given him a better image than he deserves. Like Nixon it wasn't so much that he was so evil but he set the stage for the bad and pure crazy things going on today. Yes, he had a good side but he also helped strip away at the New Deal that helped America be so prosperous and by the end of his term (which Bush Sr filled) we had HORSE MEAT at the Supermarkets. This was something not seen save specialty shops or animal feed lots since the Great Depression. YUCK, btw.
The focus of this article is his effect on public mental health. I'm writing this like an informal editorial article I used to do for real publications, yes newsprint, in the 90s and into the 00s. And I have an AI search to check for all the "Sooource!?" trolls that just don't like what I say even if they'd laugh at me as a fool for taking the time to do a college essay to check on what should be obvious and was openly part of history.
In essence - Reagan took from the tax money the Federal Government had allotted to pay for state mental institutions and gave it to largely rich elite people. We STILL pay that $ but it goes straight to tax breaks for the rich elite. However while our institutions had problems it was a way of sheltering and containing those with severe issues who couldn't fend for themselves versus the streets and prison. The latter, bouncing between the street and prison became the norm and costs easily TEN times confinement and treatment would.
It wasn't the ONLY thing cut - NASA's "Space Race" we STILL pay for - we could have several O'Niel Space Stations orbiting the Earth since the early 1990s by now. It's all gone to ultra rich for tax breaks.
Also NONE of this $ trickled down - the already rich elite getting this Corporate Welfare still shipped jobs to China and other outsourcing places, hired more illegals and funded automation to replace or reduce the wages of American workers. When it wasn't used for this it went to Cayman Island tax shelters. Wages have stagnated while the wealthy got richer, not fearing the Government breaking up their monopolies and paying less and less in taxes to only get wealthier.
The real problem is that we have a small percentage of the population that has serious mental problems, usually schizophrenia, which emerges in adolescence and often leads to a diminished life needing care. When no facilities to force confinement for treatment are available these people become a ruinous burden on their families and bounce from the streets to jail and back. Again this costs much more than having them confined and treated. Same with just putting the more functional ones who do cooperate with professionals and take medication welfare and low skill job options. Welfare is far cheaper than jail but that has been cut also. The programs, NOT the TAXES we pay for them...
So how the HELL did a near adult - but still in grade school/Jr High - with serious mental problems, no impulse control, no ability to learn or concentrate just be warehoused in a public school to waste his time and disrupt the teachers and other students?
Because there are no mental institutions to just put him in.
Likewise the man on the right a few minutes after that image was taken brutally slashed to death with a pocket knife a young pretty Ukranian Refugee woman who sat down in front of him. He also had had a life of bouncing from the streets to jail and his family was not able to take care of him nor force medication.
I'm no "Knee-Jerk Liberal" - the kid deserves FULL jail time for doing that to his teacher (assistant teacher) who btw got fired, rather harassed into quitting for pressing charges. The stabber deserves the CHAIR. Race has been brought up but that's distraction. Even if they were white should be no excuse. Also a LACK of racism in the system gave an extra layer to prevent the mentally ill student from being isolated and the mentally ill man from both being locked up for his crimes AND his victim from not assuming he was just another person instead of avoiding sitting near him or any of his "Fellows" who seem to have ignored his victim bleeding to death.
For my argument for returning mental hospitals - with NO NEW TAXES - by using funds we have to still PAY but cut corporate welfare I'm not being "Liberal" rather practical.
WELFARE is CHEAPER than JAIL - simple as that.
Mental Institutions are more expensive than Welfare but cheaper than jail.
Society PAYS again and again for not confining the mentally ill who are not served by jail.
So it's not about some hippy dippy form of "Compassion" - its an argument for raw sanity and saving MONEY - that we pay and pay and pay for NOTHING other than giving rich elite a tax break and every DIME of that costing us a DOLLAR in police, judges, trials and JAIL alone not to mention the human cost of their crimes.
I suppose there are some people here who'd worry - after all on the internet you say "Hello, World!" and people call you mentally ill and tell you to "End yourself"... And what about the wonderful Fursuit Lifestylers... Or, people who think they are a historical figure reborn, people with extreme religious and political views?
Well even if we bring back nuthouses we'd still have a standard of "A danger to oneself or others". I think we'd have most people who were ultra delusional still not touched and allowed to let their lives fall apart with no interference including being homeless. Then if this desperate situation turned them to petty crime - or addiction such as all the fetanyl addicts who spend half the day lurched over the other half the day begging or robbing for dimes to get more - that would be 'a danger to oneself or others' legally.
So - again this is something to get "Political" over.
NOT by wasting time "Arguing" online.
Get out the word processor and some stamps.
WRITE - snail mail - letters to your Senate and Congress reps. Polite, concise, to the point.
Putting crazies who are clearly a danger to themselves and others in government funded confinement treatment vs letting them bounce from the streets to jail saves a dollar for a dime spent. And again we are the ones paying for both the dollar and dime now...so some elite gets PORK gets CORPORATE WELFARE...
I'm not being left/right here - this is $ that gives the LEAST deserving or needing people an unfair advantage and takes $ we need to have spent on unfavorable but least worst choices which is what the Government is for. At least stop the PORK.
So make it clear they'd better either use your $ properly or stop taxing you it or you'll vote them out even if their opponent is Satan or something. No more tolerance.
Sign and Date.
Mail it to them.
Because I am so SICK of how much PORK we've fed our rich elite for decades...
Up to you and all of us, people...
----MaxxFeral
9/22/2025
---source and sources...
BTW - I DO get lots of "Source... SOOOuuuRRRCE!?" trolls - and it hurts because I used to have ambitions being a journalist. But we live in a "Post-Truth World" and the media is just entertainment. Literally. The big companies owning them changed the titles late 90s to escape the few remaining laws on journalism/news - but can still call themselves news. So when a "Souurrce!?" troll comes around screaming for documentation of the obvious they just want you to do a college essay's work to prove the obvious then deny it or even openly laugh at you for wasting the time and being such a FOOL to respond... And you were a coward/fool to refuse or just block them. I do just block them they can call me what they will.
Just in case anyone cares about this "Source" because perhaps they were Y gen or Z or Alpha...? I LOATHE these neologisms, just my opinion... But if you didn't experience REAGAN well you were lucky but you need to understand that the increasing poverty we have today, class division, monopoly sprang from HIM.... That's a different issue -
On THIS issue - his gutting of (among many things) the mental asylum $ and re-directing it, here:
---Via AI - but read through it - saved me hours for stuff I knew because I lived in this era and people read the news then, even KIDS did it, and the news wasn't trash. Now it's so low the Enquirer is seen like People used to be seen as. THIS is something AI is great for - I'm writing an article - I still CHECK it and I get NO MONEY for it so why spend hours I don't have to and don't have time to do to prove the OBVIOUS...?
By all means I accept communication, real correction and debate but will just block/delete obvious harasser trolls.
### Background on Deinstitutionalization and the Reagan Era
Deinstitutionalization—the process of closing large state-run mental hospitals and shifting care to community-based services—began in the United States in the 1950s and 1960s, well before Ronald Reagan's presidency (1981–1989). It was driven by a combination of factors: the introduction of antipsychotic medications like chlorpromazine (Thorazine) in the 1950s, which allowed many patients to live outside institutions; civil rights concerns about abusive conditions in "snake pits" like state asylums; and federal policies under Democratic presidents, such as John F. Kennedy's Community Mental Health Act of 1963, which provided funding for community mental health centers (CMHCs) as alternatives to hospitalization. By 1975, the national population in state and county mental hospitals had already declined by 62% from its 1955 peak of 559,000 patients.
However, Reagan played a significant role in accelerating and exacerbating the challenges of deinstitutionalization, both as Governor of California (1967–1975) and as President. His actions were rooted in fiscal conservatism, emphasizing reduced government spending, tax cuts, and devolution of responsibilities to states (often with less funding). This led to further closures of institutions and inadequate support for community care, contributing to rises in homelessness, incarceration, and untreated mental illness among affected populations. Critics argue these policies prioritized budget savings over humane care, with estimates suggesting that by the 1980s, up to one-third of the homeless population had serious mental illnesses, and prisons became de facto "mental health facilities."
### Reagan's Tax and Budget Adjustments Related to Mental Health
Reagan's approach to mental health funding was consistent with his broader "Reaganomics" philosophy: supply-side economics, deregulation, and sharp reductions in domestic spending to offset massive tax cuts. As governor, he signed the Lanterman-Petris-Short (LPS) Act in 1967, which limited involuntary commitments and ended indefinite institutionalization, aligning with deinstitutionalization goals but also enabling cost-cutting by closing facilities. During his governorship, California's state hospital population dropped from about 22,000 in 1967 to 6,431 by 1975, with three hospitals shuttered, wards mothballed, and over 2,000 Department of Mental Hygiene staff laid off. Reagan justified these as eliminating "hotel operations" in expensive state-run hospitals, aiming to shrink government by about 10% overall.
As president, Reagan's key actions included:
- **Economic Recovery Tax Act of 1981 (ERTA)**: Signed early in his term, this slashed the top marginal income tax rate from 70% to 50% (later to 28% via the Tax Reform Act of 1986), reduced corporate taxes by $150 billion over five years, and lowered the lowest bracket from 14% to 11%. It also trimmed estate taxes. These cuts reduced federal revenues by about 9% initially, contributing to tripling the national debt from $900 billion to $2.7 trillion by the end of his presidency. To partially offset this, Reagan agreed to tax increases in 1982–1987 (e.g., the Tax Equity and Fiscal Responsibility Act of 1982 undid about a third of the 1981 cuts), but overall, the policy favored high-income earners and corporations.
- **Omnibus Budget Reconciliation Act (OBRA) of 1981**: This was the pivotal budget measure affecting mental health. It repealed most of President Jimmy Carter's Mental Health Systems Act (MHSA) of 1980, which had allocated $150 million over three years for CMHCs to support deinstitutionalized patients. OBRA consolidated federal funding for social services—including mental health, alcohol and drug abuse programs—into block grants to states, reducing federal oversight and cutting total funding by about one-third. States received lump sums with flexibility but often lacked the resources or political will to maintain services, leading to underfunded or unbuilt community facilities. This shift reflected Reagan's emphasis on "states' rights" and smaller federal government, but it effectively starved community-based care intended to replace institutions.
These adjustments did not directly "close" federal institutions (which were state-run), but they accelerated closures by withholding promised support. For instance, California's state mental health budget in 1960 was about $124 million (equivalent to $1.3 billion in 2024 dollars), but post-Reagan cuts, funding for community alternatives lagged, with patients often ending up in jails or on streets at higher long-term costs (e.g., $3,000–$5,000 per day for homeless patients in hospitals vs. cheaper supported housing).
### Where the Tax Money (Savings) Went
The "tax money" in question refers to the budgetary savings from mental health cuts and the broader fiscal space created by tax reductions. Reagan's policies did not redirect funds explicitly from mental health to other areas; instead, the savings were absorbed into general budget reductions, with tax cuts returning money primarily to wealthy individuals and businesses under the theory of "trickle-down" economics (via the Laffer Curve, positing that lower taxes would spur growth and revenue). However, the tax cuts did not fully "pay for themselves"—revenues fell initially, leading to higher deficits and increased borrowing.
Here's a breakdown of how the savings and tax reductions played out:
| Category | Details | Impact/Where Funds Went |
|----------|---------|-------------------------|
| **Budget Savings from Mental Health Cuts** | OBRA 1981 cut federal mental health funding by ~33% via block grants; repealed MHSA's targeted CMHC allocations. States often diverted block grants to other priorities (e.g., not severe mental illness but milder needs), leading to service gaps. In California under Gov. Reagan, hospital closure savings (~15% DMH personnel cuts) were not fully reinvested in communities; a 1975 audit found released patients lacked services, costing triple in local hospitals. | Savings went to state general funds or were lost to underfunding. Nationally, this contributed to a 93% drop in institutional populations (1955–2010s), but without alternatives, costs shifted to prisons/jails (e.g., 1 in 15 Cook County Jail inmates mentally ill by 1990) and emergency care. No direct redirection; part of broader domestic spending cuts (e.g., welfare, education) totaling ~$35 billion in 1981. |
| **Tax Cut Beneficiaries (Federal Revenue Forgone)** | Top 10% of earners saw increased income tax share post-1980s, but lowest 50% paid less. Corporate tax breaks saved businesses $150B over 5 years. Overall, federal receipts grew 65% (1981–1989) but outlays grew 69%, ballooning debt. | Primarily to high-income households and corporations (e.g., top rate cut from 70% to 28%). Proponents claimed it stimulated investment/growth; critics say it widened inequality without proportional benefits to social programs. Some offset via 1983 Social Security/Medicare payroll tax hikes. |
| **Increased Federal Spending Areas** | Despite domestic cuts, military spending rose from $134B (1980) to $253B (1989), adding ~$1.5T to debt. | Tax cut-enabled deficits funded defense buildup (e.g., Cold War initiatives) and interest on debt, not social services. Mental health savings indirectly supported this by freeing up budget space. |
In essence, the "savings" from mental health did not create a surplus for redirection; they were part of austerity measures to accommodate tax cuts, which disproportionately benefited the affluent while increasing reliance on debt. This led to long-term societal costs: homelessness doubled in the 1980s, with mental illness a key factor, and incarceration of the mentally ill surged (e.g., from 1980s onward, prisons housed more mentally ill than hospitals).
### Long-Term Consequences and Substantiation
These policies are widely criticized for failing to deliver on deinstitutionalization's promise of humane, community-based care. Reagan's governorship saw at least one suicide linked to closure threats, and his presidency's cuts left many without support, contributing to the 1980s homelessness crisis (e.g., San Francisco posters called streets "America’s newest mental institution"). Bipartisan elements existed—Democrats like Kennedy initiated the shift—but Reagan's fiscal conservatism amplified the failures, as block grants proved easy to cut locally due to NIMBYism and competing priorities.
For a balanced view, sources like Politifact note that while liberals pushed civil rights reforms, fiscal conservatives like Reagan drove cost-saving aspects. Studies (e.g., NIMH 1988) show only ~1/3 of homeless were mentally ill, but untreated cases rose post-cuts. Modern echoes include California's Proposition 63 (2004), which taxed high earners to fund mental health, addressing gaps Reagan's policies widened.
----Sources:
Mental Health Systems Act of 1980 - Wikipedia
In 1981 President Ronald Reagan, who had made major efforts during his governorship to reduce funding and enlistment for California mental institutions, pushed a political effort through the Democratic-controlled House of Representatives and a Republican-controlled Senate to repeal most of MHSA.
en.wikipedia.org
Here’s how Reagan’s decision to close mental institutions led to the homelessness crisis
Kakaiya, Ph.D, is a licensed clinical psychologist and neuroscientist, lives in 4S Ranch.As a psychologist who began practicing nearly 40 years ago, I’ve seen a significant shift in the care …
sandiegouniontribune.com
The Mental Health Systems Act of 1980 | Bell | DttP: Documents to the People
By the summer of 1981, the Omnibus Budget Reconciliation Act of 1981 was signed into law by President Ronald Reagan. Continuing the controversial trend in denying or disregarding the need for mental health care from his days as governor of California, where there was at least one suicide after the threat of closing a facility, President Reagan made cuts from the budget with mental health being amongst the first to go.24
journals.ala.org
How Reagan’s Decision to Close Mental Institutions Led to the Homelessness Crisis
Hands down I hate the guy and we’re still living in a Reaganomics world. How’s that turning out 40 yrs later?
obrag.org
The Republican who emptied the asylums - Capitol Weekly | Capitol Weekly | Capitol Weekly: The Newspaper of California State Government and Politics.
Frank Lanterman won an assembly seat in 1950 with one goal: securing a steady water supply for his family’s land holdings and subdivisions in the Verdugo hills community of La Cañada outside Los Angeles, a task he completed in his first year in office. In the years to come, his influence would expand far beyond his hometown and he would become one of the most consequential legislators of his time by leading the effort to transform how California cares for people with severe mental illness.
capitolweekly.net
Ronald Reagan's shameful legacy: Violence, the homeless, mental illness - Salon.com
As a consequence of such hearings and a 1986 study of nursing homes by the Institute of Medicine, Congress passed legislation in 1987 requiring all Medicaid-funded nursing homes to screen new admissions to keep out patients who did not qualify for admission because they did not require skilled nursing care.
salon.com
r/AskHistorians on Reddit: I often hear that "the Reagan administration shut down mental institutions and released the mentally ill into the streets." Is this an accurate assessment of the situation, and if not, what is the real story?
Posted by u/[Deleted Account] - 3,679 votes and 140 comments
reddit.com
Hard truths about deinstitutionalization, then and now - CalMatters
Too many people who were institutionalized for mental disorders suffered abuse, neglect and mistreatment. Gov. Reagan signed the Lanterman-Petris-Short Act in 1967, all but ending the practice of institutionalizing patients against their will. When deinstitutionalization began 50 years ago, California mistakenly relied on community treatment facilities, which were never built.
calmatters.org
A World That No Longer Exists? Deinstitutionalization, Danger, and California’s Senate Bill 43 | American Journal of Psychiatry Residents' Journal
Auerback A: The Short-Doyle Act: California community mental health services program: background and status after one year. Calif Med 1959;90:335–338 ... Calif. Welfare and Institutions Code § 5001 ... Prasad M: Starving the Beast: Ronald Reagan and the Tax Cut Revolution. New York, Russell Sage Foundation, 2018 ... DeRisi W, Vega WA: The impact of deinstitutionalization on California’s state hospital population.
psychiatryonline.org
Focusing on mental health instead of gun laws to reduce crime, former Vice President Mike Pence told a National Rifle Association gathering that "in the 1960s, liberals emptied our psych wards." That’s oversimplified. Ronald Reagan and other fiscal conservatives played a big role
Ultimately, Cohen said, "the failures" of deinstitutionalization "don’t fall on any party." Pence said, "In the 1960s, liberals emptied our psych wards." Some of the impetus for shifting people with serious mental illness out of institutions came from legislation signed by Democratic presidents and supported by civil rights advocates. However, fiscal conservatives also played a crucial role, including Reagan, who signed landmark bills, first in California and then for the nation.
politifact.com
Deinstitutionalization Came From Kennedy and Governor Reagan, Not President Reagan
Combined with a focus on outpatient and in-home treatments and civil rights for the mentally ill, inpatient treatment for mental illness shrank considerably. By the time the 1980s rolled around deinstitutionalization was almost already complete, although it would continue slowly into the current day. Yet Reagan may still be largely responsible for starting the process over a decade earlier. In 1967, Reagan as then-governor of California would sign into law the Lanterman–Petris–Short (LPS) Act which would prevent the state from forcibly institutionalizing the mentally ill against their will for various conditions, likely the first in a series of liberalization policy changes for mental illness.
investigativeeconomics.org
Mike Pence said ‘liberals’ emptied mental health hospitals in 1960s. They didn’t act alone. | Department of Psychiatry and Behavioral Neuroscience | The University of Chicago
Outpatient care is less expensive and often produces better results, but still requires funding. And prisons, where a large number of mentally ill people end up today, is both expensive and terrible for recovery. Since at least the 1930s, Cohen said, policymakers have sought to cut costs through "de-institutionalization" — removing people from inpatient settings.
psychiatry.uchicago.edu
Did the Emptying of Mental Hospitals Contribute to Homelessness? | KQED
After patients were released from mental hospitals, there wasn’t always a place for them to go. On this week’s episode, we explore if deinstitutionalization was a factor in the Bay Area’s homeless crisis.
kqed.org
HOW RELEASE OF MENTAL PATIENTS BEGAN - The New York Times
In restrospect it does seem clear that questions were not asked that might have been asked. In the thousands of pages of testimony before Congressional committees in the late 1950's and early 1960's, little doubt was expressed about the wisdom of deinstitutionalization.
nytimes.com
Public Policy and Mental Illnesses: Jimmy Carter's Presidential Commission on Mental Health - PMC
The very title suggested a fundamental shift in emphasis. Nearly two decades earlier, the Joint Commission on Mental Illness and Health (1955–1961) focused largely on the problems faced by individuals with serious and persistent mental disorders, many of whom were institutionalized (Grob 1991).
pmc.ncbi.nlm.nih.gov
Reaganomics - Wikipedia
He also stated that "a large proportion" of them are "mentally impaired", which he believed to be a result of lawsuits by the ACLU (and similar organizations) against mental institutions. During the Reagan administration, fiscal year federal receipts grew from $599 billion to $991 billion (an increase of 65%) while fiscal year federal outlays grew from $678 billion to $1144 billion (an increase of 69%). According to a 1996 report of the Joint Economic Committee of the United States Congress, during Reagan's two terms, and through 1993, the top 10% of taxpayers paid an increased share of income taxes (not including payroll taxes) to the Federal government, while the lowest 50% of taxpayers paid a reduced share of income tax revenue.
en.wikipedia.org
What we learned from Reagan's tax cuts | Brookings
The tax bill speeding through Congress is being sold – by its advocates – as so good for the economy, that it will boost growth and offset any losses from the cuts. Those of you who were around in the 1980s might be feeling a sense of deja vu, especially when you recall what Ronald Reagan had to say back in 1981.
brookings.edu
Reagan tax cuts - Wikipedia
During this time the Social Security Act created a Social Security tax, though because the Social Security tax is capped at ~$130,000 per individual this did not add to the overall top marginal rate. Under President John F. Kennedy the top marginal rate was decreased in the Revenue Act of 1964 to 70%. In 1980 Ronald Reagan was elected and promised to cut the top marginal tax rate.
en.wikipedia.org
California: Reagan and the Mental Health Controversy on JSTOR
jstor.org
Ronald Reagan and the Commitment of the Mentally Ill
The Alcohol, Drug Abuse, and Mental Health Block Grant: Origins, Design, and Impact. In Rochefort, D. A. (ed.), Handbook on Mental Health Policy in the United States. New York: Greenwood Press. Rossi, P. H. (1989). Down and Out in America: The Origins of Homelessness. Chicago: U. Chicago Press. Rousseas, S. (1982). The Political Economy of Reaganomics: A Critique.
sociology.org
Creating a Science of Homelessness During the Reagan Era - PMC
A decade after the nation's Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals.
ncbi.nlm.nih.gov
Thanks! One issue I hear is the human rights issue but I think its distraction. If a person is a danger to themselves or others it's well established that they can be confined involuntarily, right? And many recent public shocking stories such as a random stabbing on a bus or a large violent student who nearly beat a teacher to death over her taking his video game are people who should have been put in an institution well before they did things that serious. Most had done dozens of robberies, made thefts, some violent action over a decade first, then they killed someone. How would this work with re-instating institutions?
Addressing the Human Rights Issue and Involuntary ConfinementYou're correct that the human rights argument in the context of deinstitutionalization can sometimes be overstated or used as a distraction from practical issues. The legal framework for involuntary confinement of individuals deemed a danger to themselves or others is well-established in the U.S., but its application is complex and varies by state. Below, I’ll address the legal basis for involuntary commitment, the challenges with reinstating mental institutions, and how such a system might work to address cases like those you describe (e.g., individuals with a history of escalating crimes culminating in severe violence).Legal Basis for Involuntary ConfinementInvoluntary commitment is permitted under U.S. law when an individual poses a clear and present danger to themselves or others due to mental illness. This stems from landmark cases and state laws:
• O’Connor v. Donaldson (1975): The U.S. Supreme Court ruled that individuals cannot be confined in mental institutions against their will unless they are dangerous to themselves or others and require treatment for a mental disorder. Non-dangerous individuals capable of surviving safely outside cannot be held indefinitely.
• State Laws (e.g., Lanterman-Petris-Short Act in California, 1967): Most states have laws allowing temporary holds (e.g., 72-hour "5150" holds in California) for evaluation if someone is suicidal, homicidal, or gravely disabled due to mental illness. Longer-term commitments require court hearings, medical evaluations, and evidence of ongoing danger or inability to function.
• Civil Liberties Protections: Post-1960s reforms, driven by civil rights concerns, tightened criteria to prevent abuses (e.g., indefinite warehousing of non-dangerous patients). This was a response to historical abuses in asylums, where people were often committed for minor or non-clinical reasons (e.g., nonconformity, poverty).
In practice, these laws mean that individuals like those in your examples—committing random violent acts or escalating crimes—can be involuntarily confined if their behavior is linked to a diagnosed mental illness and meets the "danger" threshold. However, several barriers prevent this from happening proactively:
1. High Legal Threshold: Courts require clear evidence of imminent danger, not just past crimes or potential risk. A history of robberies or assaults may not suffice unless directly tied to mental illness and current dangerousness.
2. Short-Term Holds: Many states limit initial holds to 72 hours or a few weeks, with long-term commitment requiring judicial oversight. This often results in "revolving door" releases if community care is unavailable.
3. Underfunded Systems: Deinstitutionalization left gaps in both inpatient and outpatient care. Many areas lack sufficient psychiatric beds or crisis intervention teams, making it hard to hold or treat individuals even when legally justified.
4. Diagnosis Challenges: Not all violent offenders have a clear mental health diagnosis qualifying for commitment. For example, personality disorders (e.g., antisocial personality disorder) are often excluded from commitment criteria, as they’re not always deemed "treatable" mental illnesses.
Challenges with Reinstating Mental InstitutionsReinstating large-scale mental institutions to address cases like those you describe—individuals with a history of escalating crimes (e.g., thefts, assaults) who later commit severe acts like stabbings or near-fatal attacks—would face significant hurdles:
1. Scale and Cost:
• Historical Context: In 1955, the U.S. had 559,000 state hospital beds for a population of 150 million (3.7 beds per 1,000). By 2010, this dropped to 43,000 beds for 310 million (0.14 beds per 1,000). To restore 1955 levels, adjusted for population growth to 330 million in 2025, would require ~1.2 million beds, costing billions annually (e.g., one 250-bed facility costs ~$50–100M to build and ~$25M/year to operate).
• Current Shortages: The U.S. has a shortage of ~120,000 psychiatric beds (per 2016 estimates), with some states having fewer than 10 beds per 100,000 people. Rebuilding would require massive investment, likely funded by tax increases or reallocating budgets (e.g., from prisons, which now house many mentally ill individuals).
2. Community Care Failures:
• Deinstitutionalization intended to replace asylums with community mental health centers (CMHCs), but funding never materialized fully. For example, the 1963 Community Mental Health Act promised 2,000 CMHCs by 1980; only ~750 were built by 1981, and Reagan’s 1981 OBRA cuts reduced federal support further. Reinstating institutions without robust outpatient systems risks repeating past failures, where patients are released without support, leading to homelessness or crime.
3. Legal and Ethical Barriers:
• Civil liberties protections make mass institutionalization politically and legally contentious. Critics would argue it risks returning to abusive "warehousing" of the pre-1970s era, where patients faced neglect or forced treatments (e.g., lobotomies, overmedication).
• Preventive commitment (locking someone up before a major crime based on minor offenses) would face constitutional challenges under due process clauses, as it could infringe on personal freedom without clear evidence of imminent danger.
4. Public Opposition:
• NIMBYism (Not In My Backyard): Communities often resist new mental health facilities due to stigma or property value concerns, complicating site selection.
• Stigma: Mental illness stigma could fuel resistance to funding institutions, as taxpayers may prioritize other issues (e.g., education, infrastructure).
5. Workforce Shortages:
• The U.S. faces a shortage of mental health professionals (e.g., ~28,000 psychiatrists in 2020 vs. a need for ~40,000). Staffing new institutions would require training and recruiting thousands of psychiatrists, nurses, and therapists, a process taking years.
How Reinstating Institutions Could WorkTo address cases like those you describe—individuals with a pattern of escalating crimes (e.g., dozens of robberies, thefts, or violent acts) who later commit severe offenses (e.g., stabbings, near-fatal assaults)—a modern institutional framework would need to balance treatment, public safety, and civil rights. Here’s a potential model, grounded in current knowledge and addressing your concerns:
1. Tiered System of Care:
• Acute Crisis Beds: Expand short-term psychiatric beds (e.g., 72-hour holds) in general hospitals or specialized crisis units for immediate stabilization of individuals showing dangerous behavior (e.g., a student assaulting a teacher over a video game). These would serve as entry points for evaluation.
• Intermediate Facilities: Create medium-term (weeks to months) facilities for those needing structured treatment but not lifelong confinement. These could target individuals with documented patterns of escalating behavior tied to mental illness (e.g., schizophrenia, bipolar disorder).
• Long-Term Secure Hospitals: For individuals with severe, treatment-resistant conditions and a history of violence (e.g., repeat offenders who’ve committed stabbings), reinstate secure state hospitals with mandatory treatment protocols. These would be reserved for the small minority meeting strict "dangerousness" criteria, avoiding mass institutionalization.
2. Early Intervention and Screening:
• Criminal Justice Integration: Use data from arrests (e.g., dozens of prior robberies) to flag individuals for mental health screenings. Courts could mandate evaluations after repeated minor offenses, especially if mental illness is suspected. For example, a 2020 study found ~20% of jail inmates have serious mental illnesses, often untreated.
• School and Community Programs: Train teachers, police, and social workers to identify early signs of severe mental illness (e.g., the student in your example). Programs like California’s Proposition 63 (Mental Health Services Act, 2004) fund prevention and early intervention, reducing escalation to violence.
• Mobile Crisis Teams: Deploy teams to respond to public incidents (e.g., erratic behavior on a bus) with authority to initiate holds if needed, diverting individuals from jails to treatment.
3. Legal Reforms:
• Lower Threshold for Commitment: Revise state laws to allow earlier intervention based on patterns of behavior (e.g., repeated thefts or assaults linked to mental illness) rather than waiting for a major crime. This would require balancing with due process protections, such as mandatory judicial review within days.
• Assisted Outpatient Treatment (AOT): Expand programs like New York’s Kendra’s Law (1999), which mandates outpatient treatment for individuals with a history of non-compliance and violence. AOT has reduced hospitalizations and arrests by ~50% in some studies.
• Parole/Probation Conditions: For offenders with mental illness, integrate treatment into parole or probation terms, with institutionalization as a fallback for non-compliance.
4. Funding Mechanisms:
• Reallocate Criminal Justice Budgets: U.S. states spend ~$50 billion annually on corrections, much of it on mentally ill inmates (e.g., ~$80,000/year per inmate in California). Diverting a fraction to mental health facilities could fund thousands of beds. For example, closing one prison could finance a 500-bed hospital.
• Tax Initiatives: Model after California’s Proposition 63, which taxes incomes over $1M to raise ~$2B/year for mental health. A federal or state tax increase could target high earners or corporations, reversing Reagan-era cuts.
• Medicaid Expansion: Increase federal Medicaid funding for mental health, which was restricted under Reagan’s 1981 OBRA. This could support community and institutional care without relying solely on states.
5. Focus on High-Risk Cases:
• Risk Assessment Tools: Use validated tools (e.g., HCR-20 for violence risk) to identify individuals like those in your examples—repeat offenders with mental illness likely to escalate. These could guide commitments before a major crime (e.g., a stabbing).
• Case Studies: For someone like a “violent student” or “bus stabber,” a reinstated system would need:
• Pre-Crime Intervention: If the student had prior outbursts or the bus assailant had robbery convictions, screenings could trigger AOT or short-term holds.
• Post-Crime Commitment: After a severe act, secure hospitalization with treatment (e.g., antipsychotics, therapy) could prevent release until stabilized, unlike current systems where many are released quickly due to bed shortages.
6. Safeguards Against Abuse:
• Oversight: Independent boards to monitor facilities, ensuring humane conditions and preventing pre-1970s abuses (e.g., overcrowding, neglect).
• Time Limits: Regular reviews (e.g., every 6 months) to reassess patients’ need for confinement, avoiding indefinite stays.
• Community Integration: Pair institutional care with robust outpatient programs to transition patients back to society, reducing recidivism.
Addressing Your Examples Specifically
• Random Stabbing on a Bus: If the perpetrator had a documented history of mental illness and prior offenses (e.g., dozens of robberies), a reinstated system could:
• Flag them during earlier arrests for evaluation.
• Use AOT to mandate treatment after minor crimes, potentially preventing escalation.
• Commit them to a secure facility post-stabbing for treatment, not just incarceration, with release contingent on stabilization.
• Violent Student Beating a Teacher: If the student had prior violent incidents tied to mental illness:
• Schools could refer them to crisis teams for evaluation after early outbursts.
• A medium-term facility could provide structured treatment, addressing underlying issues (e.g., psychosis, impulse control disorders).
• Post-incident, a secure hospital could ensure treatment before release, unlike current systems where juvenile detention often lacks mental health focus.
Evidence and Feasibility
• Data: Studies show ~15–20% of U.S. inmates have serious mental illnesses, and 50% of homeless individuals have mental health issues. A 2014 Treatment Advocacy Center report estimated that increasing psychiatric beds to 50 per 100,000 people (vs. ~14 in 2010) could reduce these numbers significantly.
• Precedents: Programs like AOT in New York and California’s Proposition 63 show that targeted interventions work when funded. For example, AOT reduced violent incidents by 47% in New York (2005 study).
• Costs vs. Benefits: Building 100,000 new beds at $100,000/bed = $10B initial cost, with $5B/year operating costs. Compare to $15B/year spent on incarcerating mentally ill inmates. Long-term savings could come from reduced crime and homelessness.
Counterpoints and Challenges
• Civil Liberties: Critics would argue that expanding commitments risks overreach, especially for minor offenders. Safeguards like judicial oversight and clear criteria are essential.
• Stigma: Reinstitutionalization could reinforce stereotypes about mental illness, requiring public education to frame it as treatment, not punishment.
• Implementation: States would need to coordinate, as federal mandates without funding (post-Reagan) often fail. Political will for tax increases or budget shifts is uncertain.
In summary, reinstating institutions could work by focusing on high-risk individuals with clear mental health-driven patterns (like your examples), using a tiered system of crisis, intermediate, and secure care. Legal reforms, early intervention, and funding (e.g., via taxes or prison budget reallocation) are critical. The human rights issue is valid but manageable with strict oversight to prevent abuses, ensuring confinement targets only those who are truly dangerous due to untreated mental illness. This would address the gap between current laws allowing commitment and the lack of infrastructure to enforce them effectively.
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