Did the Emptying of Mental Hospitals Contribute to Homelessness?

After patients were released from mental hospitals, there wasn’t always a place for them to go. On this week’s episode, we explore if deinstitutionalization was a factor in the Bay Area’s homeless crisis. Bay Curious is a new podcast from KQED that’s all about answering your questions about the Bay Area.

Earlier this year, we asked for your questions on homelessness. More than 1,300 of you responded and we answered many of your questions in our first round of reporting.

There was one topic that kept coming up again and again as we sorted your questions. This week on the podcast, we answer listener Debbie Ow’s question:

“Is the situation as bad as it is because of the closure of mental health facilities in our state?”

Click the red play button above for the full story, and look below for a timeline of deinstitutionalization.

Deinstitutionalization: A History

1833 Worcester State Hospital opens in Massachusetts as the first mental hospital fully supported by state funds.

1860 Twenty-eight of the 33 existing U.S. states have state psychiatric hospitals.

1939-1945 During World War II conscientious objectors enter state psychiatric hospitals to replace doctors who were sent away for the war effort.

1946 Life Magazine publishes photos depicting the horrors inside the hospitals.

1954 Chlorpromazine, marketed as Thorazine, is approved by the Food and Drug Administration. It’s the first anti-psychotic drug widely used to treat the symptoms of mental illness. For many, it brought hope that some patients could live among the community.

1955 The number of patients inside public mental hospitals nationwide peaks at 560,000.

1959 The number of patients in California state mental hospitals peaks at 37,000.

1963 President John F. Kennedy signs the Community Mental Health Act. This pushes the responsibility of mentally ill patients from the state toward the federal government. JFK wanted to create a network of community mental health centers where mentally ill people could live in the community while receiving care. JFK could have been inspired to act because his younger sister, Rosemary, was mentally disabled, received a lobotomy and spent her life hidden away. 

Less than a month after signing the new legislation, JFK is assassinated. The community mental health centers never receive stable funding, and even 15 years later less than half the promised centers are built.

1965 The U.S. Congress establishes Medicaid and Medicare. Mentally disabled people living in the community are eligible for benefits but those in psychiatric hospitals are excluded. By encouraging patients to be discharged, state legislators could shift the cost of care for mentally ill patients to the federal government.

1967 Ronald Reagan is elected governor of California. At this point, the number of patients in state hospitals had fallen to 22,000, and the Reagan administration uses the decline as a reason to make cuts to the Department of Mental Hygiene. They cut 2,600 jobs and 10 percent of the budget despite reports showing that hospitals were already below recommended staffing levels.

1967 Reagan signs the Lanterman-Petris-Short Act and ends the practice of institutionalizing patients against their will, or for indefinite amounts of time. This law is regarded by some as a “patient’s bill of rights”.  Sadly, the care outside state hospitals was inadequate. The year after the law goes into effect, a study shows the number of mentally ill people entering San Mateo’s criminal justice system doubles.

1969 Reagan reverses earlier budget cuts. He increases spending on the Department of Mental Hygiene by a record $28 million.

1973 The number of patients in California State mental hospitals falls to 7,000.

1980 President Jimmy Carter signs the Mental Health Systems Act to improve on Kennedy’s dream.

1981 President Reagan repeals Carter’s legislation with the Omnibus Budget Reconciliation Act. This pushes the responsibility of mentally ill patients back to the states. The legislation creates block grants for the states, but federal spending on mental illness declines.

2004 The U.S. Department of Justice estimates that 10 percent of state prisoners have symptoms that meet criteria for a psychotic disorder.

2015 In the San Francisco Homeless Count, 55 percent of people experiencing chronic homelessness report they have emotional or psychiatric conditions.