Sherman Criner is the co-founder and co-editor in chief of The Lemur and a third-year undergraduate student majoring in History and Public Policy. He is interested in political history, theology, and classical ethics.
As you read this article, more than half a million Americans are experiencing homelessness, a crisis that continues to grow each year. The issue has reached such a magnitude that even the U.S. Supreme Court was forced to weigh in, as seen in City of Grants Pass v. Johnson, a case that questioned whether cities could constitutionally remove homeless encampments from public areas. A key component of this crisis is the widespread failure of the American mental health system. The closure of asylums, once seen as a necessary step to protect civil liberties and reduce mistreatment, has instead led to devastating consequences. The National Institute of Mental Health estimates that nearly 6% of the U.S. population suffers from serious mental illness (SMI), such as schizophrenia or bipolar disorder. Among the homeless population, the rate is far higher, with studies suggesting that approximately 21% of homeless individuals suffer from severe mental illnesses that impair their ability to function independently.
Without long-term institutional care, many individuals with severe mental illness have found themselves not in treatment but in jail or on the streets. The justice system has almost become a substitute for psychiatric care, with 43% of state and 23% of federal prisoners having a history of mental illness. As a result, those suffering from severe psychiatric conditions are shuffled between emergency rooms, jails, and the streets—never receiving the consistent, effective care they need to break this cycle.
Each of these examples paints a rather dire picture of a society that chooses not to provide for its most vulnerable, either out of an unwillingness or inability. Yet, there might be a way to remedy this societal ill without infringing upon the fundamental dignity of homeless individuals. It is past time that America’s leaders revisit one rather obvious solution that “worked” in the past: institutionalization. But before going into the case for reopening these facilities, one must first understand why they closed.
The first mental institution in the U.S., the Public Hospital for Persons of Insane and Disordered Minds, was established in Williamsburg, Virginia, in 1773. Early institutions like this one operated under crude and often inhumane conditions, with patients subjected to confinement, restraint, and experimental treatments. However, by the 19th century, reformers like Dorothea Dix pushed for more humane care, leading to the establishment of state-run asylums that pioneered structured, long-term treatment for mental disorders.
During the 19th and early 20th centuries, the standards of care in mental institutions varied widely. Some asylums became self-sustaining communities, offering work therapy, structured social environments, and rudimentary medical treatments. However, many facilities struggled with overcrowding, underfunding, and outdated medical practices. To compound these issues, the advent of the eugenics movement in the late 19th and early 20th centuries led to especially troublesome practices such as the forced sterilization of those deemed “unfit” to reproduce, further complicating the ethical landscape of institutional care.
By the mid-20th century, quasi-scientific treatments such as electroconvulsive therapy (ECT), insulin shock therapy, and lobotomies became increasingly common. While some of these treatments had limited success in controlling symptoms, they were often administered without patient consent and led to severe, irreversible damage. The infamous case of President John F. Kennedy’s younger sister, Rosemary Kennedy, who was left permanently incapacitated following a lobotomy, fueled public skepticism and contributed to the growing call for institutional reform. Even today, nearly nine decades after her tragic lobotomy, politicians and activists alike still point to Rosemary’s story as an example of why mental institutions must remain shuttered.
The horrors of these treatments and the degrading conditions in many asylums came to define the public perception of institutionalization. Investigative reports, such as those by journalist Nellie Bly in the late 19th century and exposés on facilities like Willowbrook and Pennhurst in the 20th century, revealed widespread neglect and abuse, reinforcing the view that institutional care was synonymous with cruelty rather than treatment. These stories have created a Chernobyl-like effect in which the public’s opinion of a given practice has become so skewed by a bad story that the practice as a whole is abandoned.
So, as America entered the 1950s and 1960s, the deinstitutionalization movement gained momentum. Reports of overcrowding, neglect, and abuse in mental hospitals flooded the airwaves, leading to calls for reform and closure. More importantly, the introduction of antipsychotic medications like Thorazine in the 1950s led policymakers to believe that individuals with SMI could live independently with proper medication and community support. This public pressure ultimately manifested in governmental action, as demonstrated by the 1963 Community Mental Health Act, which moved financial responsibility from state institutions to community-based programs, and the landmark Supreme Court case, O’Connor v. Donaldson (1975), which ruled that individuals could not be institutionalized against their will unless they posed a clear danger.
While deinstitutionalization was rooted in noble ideals, its execution was deeply flawed. Community care systems never received the funding necessary to support the influx of discharged patients, leading to widespread transinstitutionalization—where individuals with severe mental illness simply shifted from hospitals to jails, homeless shelters, and emergency rooms. Today, state-run psychiatric hospitals still exist, but they are only a fraction of what they once were. In 1955, the U.S. had approximately 558,000 psychiatric beds; as of 2016, that number had plummeted to just 37,679. This drastic reduction means that many individuals who would benefit from institutional care are left with nowhere to turn.
The U.S. should, at the very least, rethink its approach to severe mental illness. This does not mean an immediate return to the inhumane asylums of the past. Rather, politicians and policy analysts must begin to consider the expansion of both state-run and private psychiatric hospitals as a genuine option to address America’s homelessness crisis. A well-regulated, modernized institutional care system could provide the long-term treatment necessary for individuals with severe mental illness while maintaining rigorous oversight to prevent the abuses of the past.
Now, some critics may argue that reinstitutionalization violates individual rights. Though true in some respects, this contention seemingly ignores the very basis of American governance: the social contract. As John Locke asserts, individuals enter into civil society to protect their life, liberty, and property, recognizing that “the enjoyment of the property he has in this state is very unsafe, very unsecure” in the absence of governance (Second Treatise of Government, Ch. IX). In this framework, individuals willingly accept certain limitations on their absolute freedom in exchange for the state’s protection. Moreover, Locke acknowledges that those who lack the capacity for reason—such as individuals suffering from severe mental illness—may not be fully autonomous actors in the social contract.
Locke also stresses that while public spaces are held in common, they must be preserved for the benefit of all, arguing that no one has the right to infringe upon the liberty of others, either by monopolizing shared resources or violating their natural rights (Second Treatise, Ch. V). Further, he argues that a person who “by reason of his weakness… is not capable of managing his property” may require intervention for their own well-being (Second Treatise, Ch. VI). Thus, reinstitutionalization, when implemented ethically and with safeguards, aligns with the Lockean principle that the government’s role is to ensure both individual and collective security, even if that necessitates some restrictions on personal liberty for those who cannot exercise it safely.
The deinstitutionalization movement dismantled a broken system, but in doing so, it left nothing to take its place. As a result, the U.S. is now grappling with a mental health crisis that affects not only those suffering from severe illnesses but also society writ large. Crime rates, homelessness, and overwhelmed emergency services are all symptoms of this systemic failure. It is time to reimagine institutional care—not as a return to the asylums of the past, but as a forward-thinking approach to mental health that prioritizes patient dignity and effective treatment. A humane, well-regulated system of both state and private psychiatric institutions could help restore stability to those who need it most, benefiting both individuals and society as a whole.
By Sherman Criner
