De-Institutionalization in Mental Health: In ancient Greece and Rome, “asylum” was not merely a building, but a symbol of safety and respect for those persecuted by society. Debtors, those accused of crimes, persecuted slaves, and helpless citizens from other states—all found refuge there. Today, as we discuss modern society and human rights, a critical question arises: Aren’t those struggling with severe mental illness (SMI) in America among the most deserving of that safety and refuge?
Unfortunately, the reality is that these individuals, discharged from mental hospitals, are now forced to live in nursing homes, jails, prisons, or on the streets as homeless individuals. This situation is not only inhumane but also exposes a collective failure of society.
The Prevalence of Severe Mental Illness and the Lack of Resources
According to the National Institute of Mental Health, approximately 6.3 percent of the U.S. population suffers from severe mental illness. This includes long-term mental illnesses, often involving psychosis, that profoundly affect an individual’s ability to function. Based on 2010 data, this means that approximately 14.8 million American citizens are living with SMI.
Experts believe that for such a large population, there should be at least 50 mental health beds per 100,000 people to provide acute and long-term treatment. However, in many states, this number has dropped to only 5 beds per 100,000. As a result, those who most desperately need residential treatment are unable to access it.
Transinstitutionalization: From One Institution to Another
The policy of closing mental hospitals and integrating individuals into the community has given rise to a new problem—transinstitutionalization. This means that patients did not transition from hospitals to a better life, but were instead pushed into jails, prisons, nursing homes, or homelessness. It is estimated that approximately 16 percent of the total population incarcerated in US jails and prisons suffers from serious mental illness. In 2010, when nearly 2.36 million people were incarcerated, approximately 378,000 inmates were in desperate need of mental health care, not punishment.
How Did We Get Here?
The Beginning of Deinstitutionalization
The process of closing state mental hospitals began during the Civil Rights Movement. Three main reasons were cited: the belief that mental hospitals were inhumane, the promise of new medications, and the expectation of reduced government spending. However, time proved that all three of these hopes were unfulfilled.
Many people still live in deplorable conditions, medications have not been equally effective for all patients, and already weak community services were suddenly overwhelmed.
The Historical Role of State Hospitals
There was a time when state mental hospitals were not just places of treatment, but functioned as a community. They offered a comprehensive system of medical care, therapy, vocational training, and social engagement—an all-in-one approach. Before the 1950s, many hospitals had farms and workshops where patients could work with dignity.
But as private companies entered the system with profit motives, patient work and activity were replaced by passivity.
Legal Limitations and the Concept of “Least Restrictive Setting”
Several court decisions in the field of mental health have limited the process of hospitalization. The concept of the “Least Restrictive Setting” ensured that no one would be unnecessarily confined.
However, the unintended consequence of this well-intentioned policy is that many seriously ill patients are left without treatment. Instead of being hospitalized, they are left on the streets, where they are neither safe themselves nor a safe part of society.
Bed Shortages and Government Policies
In the 1960s, laws were enacted to establish community mental health centers to provide support for patients discharged from hospitals. But the reality on the ground was that these services never developed adequately.
Medicaid and other programs gave states a financial incentive to close their hospitals. As a result, people with serious mental illness were sent to large, under-resourced, and often private, for-profit institutions, where the quality of care was questionable.
Social and Economic Factors
Most people with serious mental illness are poor or marginalized. Expensive housing, harsh laws on drug-related offenses, and inadequate community services—all combine to push them toward jail.
Emergency rooms are overwhelmed with these patients, but there are no lasting solutions. Ultimately, they are released back onto the streets, where the cycle begins anew.
What is Needed Now?
State mental hospitals must be re-established as the “last resort.” They must become the entry point for those who would otherwise end up in jail or homeless.
In recent years, the U.S. has witnessed several horrific incidents involving people with serious mental illness committing violent acts. Following these events, it is not enough to simply debate the availability of weapons. The real question is why we have allowed our mental health services to become so weak.
Reimagining a True Sanctuary Experts believe that even today, at least 50 beds are needed per 100,000 people. In 1955, this number was 340, but by 2010, it had dropped to just 14.
A modern “asylum” should not mean a prison-like building. Today’s hospitals are being built like hotels—safe, clean, and humane. Similarly, centers can be created for people struggling with serious mental illness where they can find safety, dignity, treatment, and meaning in life.
Conclusion: A Return to Humanity
Ancient civilizations considered asylum a symbol of compassion and protection. Today, when we have science, resources, and experience—everything—it is our moral responsibility to provide that same refuge to the most vulnerable among us.
A true, humane, and dignified asylum for people struggling with serious mental illness is not only their right but also a test of our society’s humanity.
