Deinstitutionalization and the Creation of Modern-Day Asylums

The U.S. has a history of mismanaging mental health. With the creation of the first institutions for the mentally ill back in the late 1770s, calls for reform followed shortly (Mother Jones). However, policies and initiatives have continually failed to address the systemic barriers that allow those with a mental health illness or those in crisis remain unprotected, especially during encounters with the police. One policy in particular not only fell short of resolving the country’s mental health and overall healthcare system but exacerbated the mental illness crisis (PBS). Intended to serve people with less restrictive and inhumane treatment, deinstitutionalization has contributed to the number of people with mental illness being homeless and incarcerated. 

Deinstitutionalization was the process of replacing and closing long-term psychiatric hospitals and asylums with community mental health services. For many, these institutions were carceral spaces. Before the transition, lobotomies, electric shock therapy, and forced sterilizations, among other inhumane treatments, were customary. Journalist Nellie Bly’s article Ten Days in a Mad-house and Ken Kesey’s One Flew Over the Cuckoo’s Nest provides a window into the brutality and cruel living conditions and treatment endured by those in mental institutions. 

TAKE ACTION

• Use community-based alternatives to 911 like Healing and Justice Center and Opportunity Alliance that provide services and mobile crisis teams for mental health issues. Use this online directory to find local services.

• Donate to Black Emotional and Mental Health Collective and Don’t Call the Police that provide resources and support for mental health. 

“It was based on the principle that severe mental illness should be treated in the least restrictive setting. As further defined by President Jimmy Carter’s Commission on Mental Health, this ideology rested on ‘the objective of maintaining the greatest degree of freedom, self-determination, autonomy, dignity, and integrity of body, mind, and spirit for the individual while he or she participates in treatment or receives services'” – From Out of the Shadows: Confronting America’s Mental Illness Crisis via PBS.

The framework started taking shape in the mid-1950s with the approval of the first antipsychotic drug, Thorazine, which was a hopeful “cure” for those with mental illness and presented an opportunity for patients to integrate back into the community (AMA Journal of Ethics, KQED). But what followed was a series of state and federal legislation from the 60s to the 80s, which encouraged moving patients out of state mental hospitals and back into their communities with the necessary resources for successful transition and living. However, adequate funding failed to come, and people with severe mental illness were sent back into communities that were unequipped to care for them. 

“Although deinstitutionalization was originally understood as a humane way to offer more suitable services to the mentally ill in community-based settings, some politicians seized upon it as a way to save money by shutting down institutions without providing any meaningful treatment alternatives” Senator Darrell Steinberg and Professor David Mills write a Stanford Law report. “This callousness has created a one-way road to prison for massive numbers of impaired individuals and the inhumane warehousing of thousands of mentally ill people.”

Despite mental health being a medical matter, cops are routinely deployed to handle those in crisis leading to dire outcomes — part of our country’s overreliance on law enforcement. Police encounters in place of medical treatment and intervention increase the likelihood of being caught in the carceral system and the chances of brutality and death.

Failure to invest in mental health has resulted in people with mental illness and in crisis receiving handcuffs, not care (The National Alliance on Mental Illness). 70% of youth in the juvenile legal system and 37% of people incarcerated in state and federal prisons have a diagnosed mental condition (The National Alliance on Mental Illness). 

Since the carceral system is not equipped to treat, people with mental illness remain in jail longer, are prone to recidivism, and experience symptoms worsening during their sentences (The Urban Institute). Also, they are two to three times more expensive to incarcerate (NAMI). “It costs less to put non-violent individuals with mental illness into treatment than to put them in jail. Diversion is both cost effective and humane.”

Since 2015, the police have fatally shot more than 1,600 people with a mental illness (Washington Post, NBC News). Unarmed Black men who exhibit mental illness are more likely to be fatally shot by police than white men who show similar behaviors (Science Direct). And people with untreated mental illness are 16 times more likely to be killed during an encounter with the police (Treatment Advocacy Center).

Ricardo Muñoz, Angelo Quinto, and Walter Wallace Jr. were murdered after police were called during mental health crises. 

To reduce the prevalence of people with a mental illness being incarcerated or having violent encounters with the police, we must invest in public mental health systems and shift to more community-based alternatives to 911. On July 16, the 988 hotline, the nationwide number for mental health crisis and suicide prevention services, will go live (CNET). Replacing the National Suicide Prevention Lifeline, the new hotline will connect callers to a trained mental health professional at a nearby crisis center. Although 988 will connect those in need with a mobile crisis team trained to handle and de-escalate mental health episodes, it’s expected that the hotline will be unable to handle the influx of calls due to being underfunded and underresourced.

The Dream Defenders’ Healing and Justice Center launched the Freedom House Mobile Crisis program in Miami. Instead of calling the police, a mobile crisis team — a medic, therapist, and an interventionalist — will be sent out to those who call their hotline at 1-(866) SAFE MIA within their five-mile radius. The goal is to provide an alternative to 911 and the police, ending the cycle of violence prevalent in communities that are often “flooded with police” (Healing and Justice Center).

Community-based mobile crisis teams provide immediate support and relief to underserved communities barred from healthcare services and allow us to move closer to the abolition of a force and system created solely to harm the most vulnerable.