Ep. 33: Get Out, Right Now

About this episode

This episode explores the consequences of psychiatric deinstitutionalization in America and the failures of the mental health system.

In 1955, the United States had 558,000 people living in state psychiatric hospitals. By 2000, that number had dropped to under 55,000. Not because mental illness got better. Not because we found a cure. Because we closed the doors. What came next was supposed to be a revolution: community mental health centers, wraparound care, dignity over warehousing. What actually came next was the Los Angeles County Jail becoming the largest psychiatric facility in its county. Rikers Island. Cook County. Streets. In this episode, we follow the full arc of psychiatric deinstitutionalization in America, from the genuine horrors of the old state hospital system and the reform movement that dismantled it, to the Medicaid funding loophole that gave states a financial incentive to empty beds, to the civil commitment laws that narrowed the path to treatment, to the correctional system that absorbed what the mental health system stopped holding. We talk about the families navigating a support structure that was promised but never built, the evidence-based models we've had for fifty years and consistently refused to fund, and the question nobody in power wants to answer: if we know what works, why…

Topics covered

• psychiatric deinstitutionalization
• mental health system
• incarceration
• community mental health
• systemic neglect
• civil commitment laws

Keywords

• mental illness
• state psychiatric hospitals
• community care
• Medicaid funding
• treatment access
• systemic issues
• institutionalization
• homelessness

Mentioned in this episode

Organizations: Los Angeles County Jail, Rikers Island, Cook County

Books & works: American Psychosis: How the Federal Government

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