Mental Health Facility Closures 11-27-25

US states and counties began closing mental health facilities in the 1960s, a process known as deinstitutionalization, which accelerated through the 1970s and continued for decades. This shift was driven by a combination of factors, including new psychiatric medications, changes in commitment laws, a movement towards community-based care, and financial incentives like Medicaid.  

1960s: Deinstitutionalization began in earnest, driven by the development of new psychiatric medications and legislative changes, such as California's Lanterman-Petris-Short Act in 1967, which limited involuntary commitment. Federal funding was also shifted away from institutions towards community mental health centers (CMHCs).

1970s: The closure of large state hospitals accelerated. Events like a 1972 exposé on the Willowbrook State School and court cases that outlawed certain practices contributed to the movement to reform mental health care and move patients into the community.

1980s and beyond: The process continued with the closure of many more facilities. While the goal was to provide care in community settings like halfway houses and group homes, many patients were released into the community without adequate support, leading to an increase in homelessness and incarceration for people with severe mental illness. 

Factors contributing to the closures

Medication: The introduction of effective psychiatric medications, such as antipsychotics, in the mid-1950s allowed many more people to live outside of institutions.

Legislation and court rulings: Laws and court decisions in the late 1960s and 1970s made it more difficult to involuntarily commit people, and legal challenges further restricted the conditions under which individuals could be hospitalized.

Financial incentives: Federal legislation like the Mental Health Systems Act of 1980 and the IMD Exclusion in 1965 created financial incentives for states to shift care to community settings rather than state hospitals.

Reform movements: A growing movement pushed for mental health reform, emphasizing the negative conditions in large asylums and promoting community-based treatment models. 

US states and counties began the process of closing their mental health facilities (known as deinstitutionalization) in the 1950s. This movement accelerated into a full-scale, nationwide policy in the late 1960s and 1970s, with the steepest declines in patient populations occurring between 1965 and 1975. 

Key drivers and milestones include:

Discovery of psychiatric drugs: The introduction of antipsychotic medications in the mid-1950s made it possible to manage symptoms and reduce the need for confinement.

Cost concerns: States were motivated by the high cost of maintaining large, often poorly funded and overcrowded, state mental hospitals.

Federal Legislation: The Community Mental Health Act of 1963, signed by President John F. Kennedy, provided federal funding for community-based mental health centers as alternatives to institutionalization.

Medicaid Incentives: The establishment of Medicaid in 1965 had a major financial impact, as it made federal reimbursement for services in "institutions for mental diseases" (IMDs) with more than 16 beds ineligible, pushing states to move patients to smaller, community-based settings to receive federal funds.

Legal Challenges: Landmark court rulings in the 1970s, such as the 1975 Supreme Court case O'Connor v. Donaldson, restricted the rights of states to involuntarily confine individuals who were not a danger to themselves or others and who could survive in the community.

Patient Advocacy and Scandals: Socio-political movements advocating for patient civil rights and public exposés of abuse and neglect in facilities (like the 1972 Willowbrook State School television broadcast) fueled the momentum for reform. 

Between 1955 and 2005, the number of beds in state and county psychiatric hospitals declined by more than 90%. The process continued well into the 1980s and beyond, resulting in a dramatic reduction of the inpatient population and a shift toward a community-based care model, though often without adequate resources. 

https://www.google.com/search?q=when+did+us+states+and+counties+begin+to+close+their+mental+health+facilities

Comments

Closing these facilities was the mistake that expanded homelessness and addiction. Treatment for mental illness is abysmally behind in advances in research for more effective treatments.

Norb Leahy, Dunwoody GA Tea Party Leader