Get Out, Right Now

In 1955, the United States had 558,000 people living in state psychiatric hospitals. By 2000, that number had dropped to under 55,000. Not because mental illness got better. Not because we found a cure. Because we closed the doors.

What came next was supposed to be a revolution: community mental health centers, wraparound care, dignity over warehousing. What actually came next was the Los Angeles County Jail becoming the largest psychiatric facility in its county. Rikers Island. Cook County. Streets.

In this episode, we follow the full arc of psychiatric deinstitutionalization in America, from the genuine horrors of the old state hospital system and the reform movement that dismantled it, to the Medicaid funding loophole that gave states a financial incentive to empty beds, to the civil commitment laws that narrowed the path to treatment, to the correctional system that absorbed what the mental health system stopped holding. We talk about the families navigating a support structure that was promised but never built, the evidence-based models we've had for fifty years and consistently refused to fund, and the question nobody in power wants to answer: if we know what works, why don't we do it?

Content note: This episode covers institutionalization, incarceration, homelessness, solitary confinement, and systemic neglect of people with serious mental illness.

SOURCES:

PrimaryHistories of Deinstitutionalization

Fuller Torrey, E.(2014). American Psychosis: How the Federal Government Destroyed the MentalIllness Treatment System. Oxford University Press.

Grob, G.N.(1994). The Mad Among Us: A History of the Care of America's Mentally Ill. FreePress.

Deutsch, A.(1948). The Shame of the States. Harcourt Brace.

Sociology andTheory

Goffman, E.(1961). Asylums: Essays on the Social Situation of Mental Patients and OtherInmates. Anchor Books.

Szasz, T. (1961).The Myth of Mental Illness. Harper & Row.

Criminalizationand Incarceration

James, D.J. &Glaze, L.E. (2006). Mental Health Problems of Prison and Jail Inmates. Bureauof Justice Statistics.

TreatmentAdvocacy Center. (2016). The Treatment of Persons with Mental Illness inPrisons and Jails: A State Survey.

Gilligan, J.(1996). Violence: Our Deadly Epidemic and Its Causes. Putnam.

Homelessness

Tsemberis, S.(2010). Housing First: The Pathways Model to End Homelessness for People withMental Illness and Addiction. Hazelden.

Padgett, D.K.,Gulcur, L., & Tsemberis, S. (2006). Housing First Services for People WhoAre Homeless with Co-Occurring Serious Mental Illness and Substance Abuse.Research on Social Work Practice.

TreatmentModels

Stein, L.I. &Test, M.A. (1980). Alternative to Mental Hospital Treatment. Archives ofGeneral Psychiatry.

Swartz, M.S. etal. (2001). Can Involuntary Outpatient Commitment Reduce Hospital Recidivism?American Journal of Psychiatry.