History Repeats As Public Mental Health Care Falls On Criminal Justice System

Sep 18, 2020

There has been an on-going conversation about mental health care in the U.S. After tragedies like the school shootings at Sandy Hook Elementary and Marjory Stoneman Douglass High School, some political actors are quick to blame mental health issues.

Despite these political talking points, public funding for mental health care has plummeted over the past few decades. And the history of mental health care in this country is fraught with mismanagement and abuse, often exacerbated by a lack of funding.

In the 18th century, many mental health issues were seen as an issue of morality and people exhibiting symptoms were often jailed. Moving into the 19th century, people were often warehoused in asylums where abuse was rampant. The revelation of the treatment in these facilities, through the work of journalists like Nellie Bly, sparked a public outcry in the late 19th and early 20th centuries. As psychiatric drugs were discovered in the mid-20th century, many political leaders promoted the idea of deinstitutionalization. 

"Once [psychiatric drugs] enter the picture, this is really transformative for these institutions because doctors are able to prescribe treatments that, for many people, dramatically improve their symptoms. ... Compared to the tools that had been available to them previously, they're more effective by a whole order of magnitude," says historian Zeb Larson, whose work has explored this history.

When these drugs were first introduced, some people believed they would allow the hospitals and asylums that care for people with mental illnesses to close. Both federal and state funding began to plummet, and after President Reagan's 1981 Omnibus Reconciliation Act, which repealed the Mental Health Systems Act, federal funding for mental health care plummetted. 

Now, as the price of health care in the U.S. has risen exponentially over the past few decades and many cities have had to close public mental health facilities, mental health care is once again falling on the criminal justice system. 

"In the 1780s, 1790s, people were frequently treated in jails. We’re back to that. The three largest mental health providers in the United States are Riker’s Island, Los Angeles County Jail, and the Cook County Jail. This is overwhelmingly where people receive treatment," Larson explains.

Editor's note: We removed the phrase "the mentally ill" and replaced it with "people with mental illnesses."