Today, asylums no longer exist. Now, state hospitals are actually psychiatric hospitals run by state governments, and they are not simply repositories for unwanted people. These hospitals offer and are focused on short-term care. People are hospitalized only if they are an imminent threat to themselves or others – not simply because they have a mental disorder. (Spielman, Jenkins & Lovett) Lengthy psychiatric hospitalizations occur only under specific circumstances and with careful safeguards, as discussed in Chapter 9.

In the wake of deinstitutionalization, many people with mental disorders were able to live happier and more fulfilling lives, with increased dignity and independence, than would have been possible during the heyday of state hospitals. These are people who were able to secure sufficient housing, treatment, and community supports; for these people and their loved ones, deinstitutionalization was an enormous victory.

1.5.1 Challenges of Post-Deinstitutionalization

However, the story of deinstitutionalization is not an entirely happy one. Lack of adequate community opportunity, care, and support for people with mental disorders has led to new challenges. There are not enough community-based mental health centers, and they are often inadequate and underfunded. Mental health staff may not be trained, or have the resources, to handle the needs of people with severe mental illnesses. Additionally, there is often no provision made for the other services people require to be able to access mental health care: housing, food, and job training. Hardest hit are people who already have additional barriers to success – including people of color. Populations who, even in the best of circumstances, were likely to face discrimination in accessing community services, housing, and education, had greater challenges post-deinstitutionalization in making their homes in the community (Deas-Nesmith & McLeod-Bryant, 1992). Homelessness and criminal engagement – the topic of this text – are significant risks for underserved groups. (Spielman, Jenkins & Lovett).

Some observers, noting the current housing crisis, along with overflowing jails and prisons, are quick to blame deinstitutionalization for many of these problems. Indeed, a large portion of the homeless population has one or more mental disorders. An estimated 25-30% of houseless individuals have a serious mental illness such as schizophrenia, and a startling 50% have traumatic brain injuries – far beyond the numbers found in the general population (Padgett, 2020). Likewise, jails and prisons began to fill to overflowing around the same time state hospitals were emptying, and these institutions are now the largest providers of mental health services in America.

Other observers will point out that deinstitutionalization did not cause homelessness, nor deprive people of mental health treatment in their communities. Rather, shortages of care and housing exist; funding is elusive. Also, stigma, the persistent and unfounded negative reputation surrounding people with mental disorders, contributes to the marginalization of this population. It is harder for people who experience mental illness or disability to find housing, get jobs, and otherwise succeed. Denial of these opportunities based on a person’s disability status may be illegal, but it is common and persistent (Ponte, 2020).

The deinstitutionalization movement also did not require the growth of jails and prisons. In fact, the “war on drugs” of the 70s and 80s, and the “get tough on crime” movements of the 80s and 90s are more direct causes of mass incarceration in America. The supposed shift of people directly from state hospitals into jails and prisons is sometimes referred to as transinstitutionalization, a hypothesis suggesting that the same group of people simply moved from one institution (hospitals) to another (prisons). However, while people with mental disorders are disproportionately found in jails and prisons, this is for many complicated reasons that go beyond the simple assumption that a person with mental illness simply had to be moved from one institution to another. (Prins 2011)

For example, studies have indicated that people with mental disorders get “stuck” in jail and prison significantly longer than other people – they are denied pretrial release, and they receive longer sentences. Additionally, once in prison, they are often not provided with adequate or effective treatment, leading them to fail to qualify for parole, which keeps them in prison. Or, if released untreated, they fail to succeed upon release; they are at high risk of reoffending and cycling back into the criminal justice system (Ponte, 2020).

There is also strong evidence that simply putting more people into psychiatric hospitals is a very expensive reaction that would not actually significantly decrease the number of people with mental disorders in the criminal justice system. Rather, solutions like providing housing and other community supports are far more effective in preventing criminal system involvement. (Prins, 2011). All of these issues – and more – are discussed in detail later in this textbook.