Beyond the obvious calls to hire more police and clear homeless encampments, a handful of presidential candidates have resurrected a long-ago idea — bring back the mental institutions that were largely shuttered in the 1980s.
“Over the same period that we sought closure of mental health institutions, we have seen a spike in violent crime in this country,” Vivek Ramaswamy, the biotech entrepreneur and 2024 GOP hopeful, said in August. “That doesn’t mean drugging up a bunch of people with Zoloft and Seroquel. It means restoring purpose, faith-based approaches and otherwise. But those are politically incorrect discussions right now. Cops doing their jobs and mental health institutions, I say bring both of those things back.”
Ramaswamy is in good company, as the same idea has been floated by GOP front-runner Donald Trump as well. The former president included reviving mental hospitals in his vast policy docket, calling for strict bans on urban camping in favor of treatment or arrest.
Advocates say the proposal not only promotes clean, safe cities but could help mentally ill people who are not being done any favors sleeping outdoors or sitting in prison.
Gov. Ron DeSantis (R-FL) hasn’t gone quite as far, but says deinstitutionalization may have been a mistake, lamenting that “We used to have more of an institutional process where people would be institutionalized, who couldn’t function in society.”
Trump, DeSantis, and Ramaswamy are the top three candidates in the GOP race, commanding 78% of polling between them and thus indicating broad support for mental hospitals on the Right.
Of course, saying something on the campaign trail and actually implementing it are two vastly different ventures.
Mental institutions have always been controversial, dealing as they do with those who struggle to function in society. But they have been under attack in the U.S. at least since a 1946 Life magazine expo offered a disturbing look inside the hospital walls.
Momentum picked up in the 1950s and ’60s as new drugs were released to treat mental illness and figures such as French philosopher Michel Foucault and novelist Ken Kesey, author of One Flew Over the Cuckoo’s Nest, whipped up public sentiment against institutionalization.
The number of U.S. patients in public mental hospitals peaked in 1955 at 560,000. President John F. Kennedy signed the Community Mental Health Act in 1963, which was designed to move away from massive state-funded hospitals toward community mental health centers, though stable funding was never secured.
Some argue that Ronald Reagan played a role as well. As California governor, the future president signed a bill that ended involuntary commitment. In the White House, critics contend, Reagan pushed the issue more broadly at the federal level. This is disputed, however.
“It is a left-wing myth that Reagan closed mental institutions,” Reagan biographer Craig Shirley told the Washington Examiner. “During the Reagan administration, the ACLU went to court and said mental patients were being held against their will and they needed to be released. They argued their constitutional rights were being violated.”
In Shirley’s telling, that move led to a “manufactured homeless crisis” that began in the 1980s and continues today.
In any case, bringing the hospitals back would require a tremendous effort in Washington, likely involving Congress and the president working together, as well as the allocation of significant funds.
There’s also the crucial issue of involuntary commitment, perhaps the stickiest point of any debate about mental hospitals. How does one square the concept with traditional conservative notions of limited government?
Few details are available at this point on how the candidates would implement their ideas. Ramaswamy Communications Director Tricia McLaughlin said he plans to roll out a comprehensive plan on mental health in America in the coming months. The Trump and DeSantis campaigns did not respond to questions from the Washington Examiner.
But Trump has called for bringing back institutions before.
As president, he made some noise about it following the 2018 school shooting in Parkland, Florida.
“We are going to be focusing very strongly on mental health because here’s a case of mental health,” he said. “Part of the problem is that we used to have mental institutions.”
Trump found support in high places, such as University of Pennsylvania professor Dominic Sisti, who has advocated bringing back the asylum. However, this history also raises questions about Trump’s follow-through since he still had nearly three years left in office from that early 2018 pledge and did not bring back institutionalization.
Trump also put off some mental health advocates by calling the shooter a “sicko” and by associating the mentally ill at large with such a violent act.
“There’s no evidence to suggest that former hospital patients are committing crimes,” said Joseph Rogers, executive director of the National Mental Health Consumers’ Self-Help Clearinghouse. “If anything, they are victims of crime.”
Rogers argues that mental hospitals were closed for a reason and that bringing them back would “set us back 100 years.”
That’s not the experience of Betsy Smith, a spokeswoman for the National Police Association.
Smith spent 29 years as an officer and still works as a police trainer. She remembers having the option to send people to government-run mental health institutions in the late 1970s and early ’80s.
“If someone was mentally ill, we could take them to these mental health institutions and they could be involuntarily committed,” she said. “Doctors and mental health professionals would work with them to deal with their issues. Sometimes they would get out, and sometimes they wouldn’t.”
Rogers has a less rosy memory of that arrangement. He spent time in an institution himself around the same time period.
“I was diagnosed with bipolar disorder and ended up hospitalized on and off for a couple of years,” he said. “These were big institutions with very little staffing — it’s like a prison almost. I had a psychiatric disorder and felt like I had been sent to a prison as punishment. The paint was chipping, the beds were from the 1930s. It was like being in a third-world country.”
Smith acknowledges things were not ideal 40 years ago but says much has been learned in the intervening decades that could inform a renewed effort. She also says many people now end up in literal prisons due to mental illness, with staff that is ill-equipped to help them.
She also argues that some people with mental illness really are violent, pointing to the murder of Los Angeles County Sheriff’s Deputy Ryan Clinkunbroomer as an example. Clinkunbroomer was shot and killed on Sept. 16 by a man whose mother described him as a paranoid schizophrenic. The man has pleaded not guilty by reason of insanity.
“Their family members don’t have any alternative to deal with them,” Smith said. “So when they get violent, they call 911. We show up, and we often have to use force, or even deadly force. Just because you’re mentally ill doesn’t mean you get to commit crimes.”
Crime aside, there is solid evidence linking mental health to homelessness. For example, the San Francisco Homeless Count found in 2015 that 55% of the homeless reported having emotional or psychiatric conditions.
But if the solution is hospitals, the fix won’t be cheap. Estimates hold that it would cost $150,000 per patient per year to house people in modern state mental facilities. It will take more than campaign promises to secure that kind of money.