From Compassion to Crisis: How America Abandoned the Mentally Ill

From Compassion to Crisis: How America Abandoned the Mentally Ill

The Xone Blog – Op-Ed #4

“The road to hell is paved with good intentions.”

— Traditional Proverb

In theory, America once dreamed of a mental health system rooted in dignity, compassion, and community. In practice, we traded psychiatric hospitals for prison cells, care for containment, and social responsibility for neglect.

The crisis didn’t begin overnight—but today, it’s impossible to ignore. Nearly one in five people incarcerated in the U.S. suffers from a serious mental illness. Emergency rooms double as makeshift psychiatric wards. Jails like Rikers and Cook County have more patients with schizophrenia and bipolar disorder than any state hospital. We’ve built a system that’s reactive, overwhelmed, and in many ways, designed to fail.

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The Beginning: Kennedy’s Vision, Undone by Inaction

In 1963, President John F. Kennedy signed the Community Mental Health Act into law, promising a shift away from massive, inhumane institutions toward localized outpatient centers. The idea was progressive: treat people in their communities, not behind locked doors.

But the follow-through never came. Of the 1,500 community mental health centers envisioned, fewer than half were built. The federal government passed responsibility to the states, but the funding vanished. As hospitals emptied, their former patients were left to fend for themselves—with little access to housing, treatment, or follow-up care.

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The Collapse of Inpatient Care

Deinstitutionalization wasn’t just a policy change—it was a cultural shift. Large state hospitals like Pilgrim State, Byberry, and Greystone Park were shut down, often with good reason. Abuse, overcrowding, and neglect were rampant.

One of the most shocking exposés came in 1972, when a young journalist named Geraldo Rivera exposed the horrors of Willowbrook State School in Staten Island. Airing on ABC News, the footage showed children with developmental disabilities living in filth, denied basic care and human dignity. Public outrage followed—but instead of reforming institutional care, policymakers began dismantling it entirely.

Another blow came from Medicaid itself. The Institutions for Mental Diseases (IMD) Exclusion, enacted in 1965, barred Medicaid funding for psychiatric facilities with more than 16 beds. This made long-term care for adults with serious mental illness financially impossible for many hospitals.

In 1955, the U.S. had over 340 psychiatric beds per 100,000 people. Today, we have fewer than 12. The infrastructure for care is gone—and nothing has adequately replaced it.

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Prisons: America’s New Asylums

As the safety nets vanished, jails and prisons stepped in—unintentionally and unprepared. Today, Los Angeles County Jail, Rikers Island, and Cook County Jailhold more people with mental illness than any psychiatric institution in the country.

The PBS FRONTLINE documentary The New Asylums reveals how correctional officers have become de facto mental health staff, managing individuals who need treatment—not punishment. Alisa Roth’s Insane and Dr. Ken Rosenberg’s Bedlam echo these realities: ERs are flooded with psychiatric emergencies, jails are overcrowded with untreated patients, and families are left with nowhere to turn.

Meanwhile, darker corners of this system still exist. The Judge Rotenberg Center, a controversial treatment facility for people with developmental disabilities, continues to use electric shock devices as behavior modification tools—a practice widely condemned by human rights advocates. The YouTube channel Shrouded Handreleased a haunting exposé, The Horrors of the Judge Rotenberg Center, revealing the disturbing persistence of institutional abuse in modern America.

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The Human Cost

The statistics are grim:

• 25–30% of the homeless population lives with a serious mental illness (HUD, 2023).

• Around 40% of incarcerated individuals have a diagnosed psychiatric disorder (Prison Policy Initiative, 2022).

• Individuals with serious mental illness are 16 times more likely to be killed by police during an encounter (Treatment Advocacy Center, 2020).

In juvenile detention, over 70% of youth meet the criteria for at least one mental health condition. These numbers don’t suggest a flaw in the system—they are the system. The mentally ill are not treated; they are punished, neglected, and recycled through emergency rooms, holding cells, and shelters.

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Crisis Recycling: The Hidden Cost of Inaction

In many cities, 5 to 15% of all 911 calls are related to psychiatric crises. A 2017 study in Los Angeles County found that just 5% of patients accounted for over 50% of all mental health-related emergency calls. In Denver, 800 individuals—called “frequent utilizers”—cost the city over $11 million annually in revolving-door services: ambulance rides, ER visits, jail bookings, and temporary shelter (Denver SIB Report).

Instead of care, we’ve built a cycle: crisis, response, release, repeat. Police officers spend up to 30% of their shifts responding to mental health-related calls, often for the same individuals with no long-term support plan.

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A System by Design—or a System Abandoned?

The system isn’t just broken—it was never completed. Psychiatric ER wait times now average 12–24+ hours. Community health centers are overwhelmed. Inpatient beds are scarce. And first responders are misused, exhausted, and unequipped.

This is not a health system. It’s a system of crisis recycling, driven by policy gaps and political neglect.

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The Path Forward

We can fix this—but only if we treat mental health as a public infrastructure priority:

• Repeal the IMD Exclusion and allow Medicaid to fund modern psychiatric hospitals.

• Fund both inpatient and outpatient care, bridging the long-term and emergency needs of patients.

• Expand housing-first initiatives, which provide stable living conditions as a foundation for recovery.

• Create diversion programs to steer individuals away from jail and toward treatment.

• Invest in mental health training for first responders and develop dedicated psychiatric crisis teams.

Most importantly, we must dismantle the belief that institutional care and abuse are synonymous. We don’t need to return to the horrors of Willowbrook—but we cannot pretend that letting people die on the streets is compassion.

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Conclusion: Mental Illness Is Not a Crime

We didn’t just close hospitals—we criminalized mental illness. We replaced long-term care with jail time and turned emergency rooms into revolving doors. We promised freedom but delivered abandonment.

The solutions exist. The need is undeniable. What’s missing is the political courage to rebuild a system that values human life, treats mental illness as illness, and recognizes that justice and dignity cannot survive without care.

It’s time to stop improvising—and start rebuilding.

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References & Suggested Viewing/Reading

1. Geraldo Rivera. Willowbrook: The Last Great Disgrace (ABC News, 1972)

2. PBS FRONTLINE. The New Asylums (2005)

3. Shrouded Hand. The Horrors of the Judge Rotenberg Center(YouTube, 2023)

4. Rosenberg, Ken. Bedlam: An Intimate Journey Into America’s Mental Health Crisis. Avery, 2019

5. Roth, Alisa. Insane: America’s Criminal Treatment of Mental Illness. Basic Books, 2018

6. Torrey, E. Fuller. American Psychosis. Oxford University Press, 2013

7. HUD. Annual Homeless Assessment Report, 2023

8. Prison Policy Initiative. Mental Health and Incarceration, 2022

9. Treatment Advocacy Center. Overlooked in the Undercounted, 2020

10. National Alliance on Mental Illness (NAMI). Policy Platform, 2023

11. Los Angeles Times. Repeat 911 Calls and the Mentally Ill, 2017

12. City of Denver. Supportive Housing Social Impact Bond Report, 2020