Editor’s note: This is the ninth and final installment in our series examining the roots of America’s housing crisis. To read the earlier pieces, visit the Roots of Today’s Housing Crisis.
Half a century ago, more than half a million people were warehoused in giant institutional psychiatric hospitals across the United States, where the care ranged from decent to indifferent to atrocious.
To combat the shoddy treatment of patients, reforms started to be implemented. We began to take the rights of those we put away seriously. The great emptying of the hospitals had begun. But the gains were short-lived, as we failed to understand that so many of these reforms would lead not to humane treatment, but to the streets and jails of America.
As an undergraduate in the 1970s, I volunteered at Marcy State Psychiatric Hospital in upstate New York — a sprawling complex of multi-storied brick buildings that housed thousands of patients. Most didn’t want to be there, but they had nowhere else to go — even if the courts would allow it. When I first met them, many of the patients shared very similar life stories: they had entered the hospital when young, and most had no hope of leaving, even in old age.
Upon entering, patients were usually assigned menial jobs — sweeping floors, delivering mail, and cleaning dishes. That work was often the main, sometimes the only, form of therapy they received — apart from a cocktail of powerful, mind-numbing drugs that they were forced to take.
By the time I arrived, the patients had no work. They didn’t understand why, only that a judge in Washington, D.C., had said they could no longer work. In a federal lawsuit filed by patient advocates and a public-sector union, the court ruled that patients in psychiatric hospitals must be paid minimum wage for their labor. That decision upended the institutions’ financial model, which depended on patient labor to make ends meet. Without it, many could no longer afford to stay open.
In 1973, what I witnessed at Marcy State was neither paid work nor unpaid work — it was no work at all. Instead, patients spent their days smoking hand-rolled cigarettes in large common rooms, the air filled with smoke and the din of blaring black-and-white television sets.
At the same time, states were severely limiting the ability to warehouse patients against their will. The Supreme Court soon held that routine involuntary commitment could be unconstitutional, marking the beginning of the end of these institutions.
Fiscal conservatives joined with their liberal counterparts in shutting down mental hospitals nationwide. Conservatives wanted to save money, while liberals wanted greater freedom for patients. The result was a monumental bipartisan failure.
Patient rights advocates had no plan other than to tear down the existing system while hoping that something better might come along. Destroying one system without a concrete plan, budget, or financing for a replacement is a dangerous exercise in hubris. For the mentally ill, that hubris led to a disaster that has been playing out on our streets and jails for nearly a half-century.
Starting in 1975, the patients were excited. They would tell me that they were finally leaving. “Jim, I’m going to a halfway house in Schenectady!” one would exclaim. Another would say, “They’re sending me to Albany to live in a halfway house.”
I’d ask, “How long will you be there?” The answer was always the same: “Six months.” Six months.” “Six months.” And then I’d ask, “Where will you go after that?” The answers were disturbing: “I don’t know.” “They haven’t told me yet.”
They didn’t know because there was no plan — only the hope that former patients would find a place to live, something to do, and continue to take their medications. Who would have thought that comprehensive outpatient and group-home treatment might not be a great money saver? Especially when those programs never fully materialized.
It was one of the cruelest hoaxes of self-deception in American history. After the halfway houses, there was often nothing but the streets for hundreds of thousands who had never lived on their own. Outpatient treatment facilities were woefully inadequate. For patients who struggled to maintain a regular medication regimen inside an institution or halfway house, doing so without walls was nearly impossible. It’s no wonder there is now an epidemic of addiction among the self-medicating ill, and for the great majority, there is still no work.
As for housing, NIMBYs oppose group housing at every turn. And if regular working people struggle to find decent, affordable housing, the ill can only dream of it from the comfort of a city sidewalk.
Our treatment of the mentally ill has swung from mass institutionalization to mass state-sponsored neglect. Marcy State Hospital — and dozens like it — are gone. Its patients are dead or scattered, and the nation’s mentally ill are now everywhere, without adequate medical care, food, or shelter. For nearly half a century, we have left them to survive on the streets, a testament to our failure and indifference.
James Burling is the vice president of legal affairs at Pacific Legal Foundation, a nonprofit legal organization that defends Americans’ individual liberty and constitutional rights. He is the author of “Nowhere to Live: The Hidden Story of America’s Housing Crisis.”