Deinstitutionalization: A Bipartisan Failure

Pictured is the Oregon State Hospital, one of the oldest continuously operated hospitals on the West Coast.
Creative Commons/Wikimedia Commons

By its own stated goals, deinstitutionalization of the mentally ill, or the massive reduction of in-patient psychiatric treatment, has been a failure. The Kennedy-era dream of the asylum as a means of last resort, supplemented by so-called “community mental health centers” — a well-meaning rhetorical flourish that never approached the elixir it was conceived to be — was only half realized. State hospitals for the mentally ill have seen their populations well more than halved as ivy furrows up the sides of colossal structures that used to house society’s most troubled souls. The supplemental network of community centers was never actualized in any meaningful way; while progressives ascribe this failure to a misallocation of funds, its root cause is tied to the nature of severe psychiatric illness — the notion that a schizophrenic with intense violent ideations can be adequately treated “in the community” is a gross misunderstanding of the very nature of psychosis itself.
While the advent of psychotropic medications and abuses within hospital walls made a degree of deinstitutionalization natural, and necessary, given the profound overcrowding of some congregate facilities — the push to radically undercut the number of psychiatric hospital beds was driven in large measure by the “anti-psychiatry” movement. These ideologues, who deemed mental illness a socially constructed phenomenon driven by disparate power dynamics between patient and proctor, shared the relativist flavor of their modern progressive peers and the anti-authority sentiments of the mid-twentieth century cultural rebellion of which they were aggrieved soldiers. Conservatives joined in, largely because of the cost savings involved in reducing the number of psychiatric beds, all culminating in President Ronald Reagan’s 1981 Omnibus Budget Reconciliation Act that block granted mental health funding to states and made hospitalization for psychiatric patients more difficult. The mentally disturbed languished under a bipartisan consensus that hospitalization was either oppressive or inefficient.
When incidents of abuse arose, which were rampant in institutions where patient populations well outstripped staff, the Burkean imperative would have been to prudentially address conditions within those facilities, not to burn them to the ground in a moral haste. And if some patients could operate in a more integrated setting, a similar sensibility would presume that their care would not come at the expense of the more severely impaired, for whom leaving the structured life of a psychiatric hospital would prove disastrous. But the typically cautious demeanor of social conservatives toward profound change was all but absent as drastic and immediate revolution overtook our national mental health system, leaving the most vulnerable among us with limited options and outlets for healing.
On a state level, E. Fuller Torrey said it best in his 2014 National Review piece on California’s mental health troubles: “It is probably easier in California today to gain admission to Stanford University than to gain admission to a public hospital psychiatric bed.” In 1955, there were 339 state psychiatric hospital beds for every 100,000 people; in 2000, that number fell to a mere 22 according to a study cited by the nonprofit health advocacy organization Unite for Sight. Conservatives talk about our incoherent mental health infrastructure in the wake of a mass shooting, but both parties have refused to view the state hospital network as a resource in fighting violent psychosis for any but those who can magically secure one of the dwindling number of inpatient beds. The prison system, homelessness and addiction have filled the voids left in the wake of deinstitutionalization, and costs incurred in anti-poverty programs and the penal system combined with rampant human capital costs are enough to make most libertarians shudder. To scratch the surface of the mental health crisis in this country, conservatives who valiantly stand for freedom ought to extend it to those who desire inpatient institutional care, even if it comes at the behest of “civil rights” actors who deem such places an arm of apartheid. It shouldn’t, as Torrey says, be easier to be admitted to an elite university than a state hospital. Society’s most vulnerable deserve better.