By Divya Kakaiya, Ph.D., M.S./ San Diego Union-Tribune Op-Ed / April 24, 2023
As a psychologist who began practicing nearly 40 years ago, I’ve seen a significant shift in the care of the mentally ill since the mid-1980s — and it hasn’t been for the better.
After the deinstitutionalization movement began in California in the 1960s, many state mental health hospitals closed, forcing many folks who needed a lot of care onto the streets.
Without those facilities, many mentally ill people ended up in jails and prisons which are not set up to provide safe, compassionate care for brain illnesses. But in 1981, when President d Reagan deinstitutionalized the mentally ill and emptied the psychiatric hospitals into so-called “community” clinics, the problem got worse.
Most of those who were deinstitutionalized from the nation’s public psychiatric hospitals were severely mentally ill. Between 50 percent and 60 percent were diagnosed with schizophrenia. The fact that many of these people struggled with various forms of brain dysfunction was not recognized back then. With so many advances in brain science, experts now know that we need to be able to coordinate care in residential facilities, especially if we are housing people at $4,000 per day in a local medical hospital.
People with severe mental illness need to be supported every step of the way. They need to be housed with compassion and supplied with medications, state of the art brain health therapies, nutritious food that supports brain health and extracurricular activities that give them a chance to live meaningful lives. They need to receive quality care with programs like art and music therapy, equestrian therapy, job training and volunteer opportunities to become actively engaged members of society.
According to the Regional Task Force on Homelessness, in 2022 the number of homeless people in San Diego County was 8,427 individuals, a 10 percent increase from 2020. Of those surveyed, 85 percent said they had fallen into homelessness in our region.
Fran Butler-Cohen, the CEO of Family Health Centers of San Diego, said in 2019 that homeless patients made about 100,000 visits to California hospitals in 2017, up 28 percent from two years earlier. More than a third of those visits involved a diagnosis of mental illness, according to the Office of Statewide Health Planning and Development. By contrast, 6 percent of all hospital discharges in California during that time involved a mental health diagnosis.
Butler-Cohen said that in 2017, homeless people staying in San Diego hospitals cost $3,000 to $5,000 a day. Even at the low end, the cost to taxpayers is more than $1 million a year for one patient. Any quality, supported, residential program would not cost $5,000 per day. The system is paying for the care of the severely mentally ill homeless populations in multiple other ways.
One program that has the potential to be very successful if implemented correctly is the statewide CARE court system that Gov. Gavin Newsom and California lawmakers created last year and that county government is implementing locally so courts can impose services on people with severe mental illness. This program will provide the support and the extra guardrails needed for a person whose brain is not functioning at its optimum capacity.
We need to recognize that deinstitutionalization of the mentally ill is one of the primary causes of the rise of homelessness all over our country. Do mentally ill homeless people deserve care, dignity, security, compassion and brain growth? We know the answer is yes.
We also need to not be in denial that jails and prisons have become surrogate psychiatric hospitals for many people with severe mental illnesses, and we need to do something about that, too. Humanity asks that we look after the vulnerable with hearts of compassion.
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Remembering Reagan …
{ 23 comments… read them below or add one }
Thanks for publishing this excellent article. Reagan sold this plan by twisting the groundbreaking Lanterman Act. The purpose of the Act was to enable the developmentally disabled to live in the least restrictive environment that would at the same time keep them safe.
The audacity of this craven “money saver” is so inhumane as to be unbelievable. That people still revere this puppet of the far right astounds me.
I used to think Nixon was the worst President, then Bush. Then, along came t-rump. But, when you look at the overall devastation to this country, you have to put Reagan at the top. But, it wasn’t really him, he was the ad man, it was those behind him that he sold so willingly for.
Honestly Geoff, there have been so many really bad, homicidal madmen living in that DC building. Out of the 46 just how many weren’t is the question.
Nixon was bad. We know this, and more has come out in the ensuing year. When he was impeached we though the worst was over! But no, it was just starting down the rabbit hole.
When Ronnie the actor was put in he was so ‘television’ ready! Perfect for the MIC powerful who were desperately trying to get rid of the Vietnam Syndrome to start the war machine back up. War is so profitable, ya know?
But Nixon WAS bad, and even my dad who was an Iowa farm boy Republican through and through couldn’t vote for him in ’72. Only thing we ever agreed on I think…
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Here’s more Ronnie memories for those who have forgotten or weren’t old enough to understand that we have been living in Reaganland ever since. What an awful impact that reverberates into the future. If we have a future.
https://www.counterpunch.org/2023/04/17/ronald-reagans-fratricidal-basis-of-power/
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And of course we now have Trump who is just the latest figurehead, a product to be marketed. This is a 17 minute short:
I recommend EVERYONE to send this movie out to their email list!!! It perfectly encapsulates what is going on with the GOP:
Post-WW2 Anti-Fascist Educational Film | Don’t Be a Sucker | 1947
https://www.youtube.com/watch?v=8K6-cEAJZlE
None of this is new, just repackaged using a stars & stripes flag. History DOES TOO REPEAT.
The difference now is the billionaires that are funding all this have a LOT more money than previously and already own the corporate media. But still they are burning and banning books already…
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But then again:
“War Made Easy” Full Movie | How Presidents & Pundits Keep Spinning Us to Death
running time 1 hr 13minutes
narrated by Sean Penn, featuring Norman Solomon
https://vimeo.com/386267191
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sealintheSelkirks
Blame Reagan for stopping what was an abusive mental health system by treating humans like humans rather than caged animals? Riiiight.
Signed,
Born Bipolar (who would probably have been subject to abusive experimentation in the 70’s)
Ronnie, if you think Reagan the Sociopath closed the abusive California mental health system to ‘treat humans like humans,’ you really haven’t done your homework.
My BFF from elementary school started a serious mental breakdown when we were about 15, to the point where he even quit surfing. Then his mentally/emotionally abusive parents put him into this system as they couldn’t deal with it at about 18. He was repeatedly electro-shocked and drugged to the gills. I heard his stories until he withdrew from the world completely and would run away when he saw me coming.
And when it all got closed up Jeff ended up back out on the street and I would him in arguments with telephone poles in Strandway and other alleys in MB because there was NO funding for any other kind of help from that rat bastard Reagan; just throw them out on the street and maybe they’ll just die seemed to be the idea. Or jail which made the state money from federal matching funds.
Oh wait, Reagan said the ‘churches’ were supposed to take over the job! But those places dumped you if you didn’t accept their form of jesus.
My cousin Tony (who was 1 month older than me) was a diagnosed paranoid/schizophrenic, was very violent, and I had to protect his younger sister a number of times from beatings, and he had the same thing happen due to Reagan. He wandered the streets, jails, and prisons for decades before dying on the street in Eureka/Arcata NorCal about 20 years ago according to my younger brother who lives down there. I was actually surprised he lived that long…
So yes, I do blame Reagan because he did NOT give a crap about helping other humans much less funding anything worthy of being called humane. It was just the ideology of neoliberal right-wing Capitalism.
There was a Nixon tape released not too many years ago that was a ‘conversation’ between him and Reagan on race:
https://www.pbs.org/newshour/show/how-newly-discovered-audio-is-reviving-debate-over-reagans-legacy-on-race
Vile spew. And then read about the snitching he did on his fellow actors during the 1950s McCarthy commie witch hunts, the damage to unionizing he did (and he was a SAG member/official!), and don’t get me going on his ‘family values’ crap. Not after he divorced his wife and married the ‘best oral sex mouth of Hollywood’ who is most famous for Just Say No…
His campaign slogan: Let’s Make America Great Again. Sound familiar?
Hands down I hate the guy and we’re still living in a Reaganomics world. How’s that turning out 40 yrs later? Oh wait…
sealintheSelkirks
I vote to bring back hospitals to help the people you are talking about. I know what Reagan was trying to do but it didn’t work. He wanted the states to do their job but they haven’t so maybe this is one time I agree the feds need to get involved. Let’s get these hospitals up and running so these people can get off the streets and the help they need. I personally would rather have food and a bed than a street.
Just because he ended something that was an absolute atrocity, doesn’t mean he didn’t create something that was equally atrocious.
There are other options than closing down the system with no plan to implement services. This is not an either/or situation.
Ronny said the private sector would pick up the slack. Work great didn’t it?
Yep, that sector is always ready to help out.
Here is a weekend contemplation article for those who are ‘Reagan-challenged’ as to what that man has done to the US:
Dear Republicans, We Tried It Your Way and It Does Not Work
https://hartmannreport.com/p/dear-republicans-we-tried-your-way
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If that isn’t enough to gag you, then there is this list:
How did Ronald Reagan Screw up America? Let us Count the Ways!
https://www.dailykos.com/stories/2023/4/10/2163101/-How-did-Ronald-Reagan-Screw-up-America-Let-us-Count-the-Ways?pm_source=story_sidebar&pm_medium=web&pm_campaign=recommended
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I guess that’s enough history for this week, eh? But we are a notoriously short memory species…
sealintheSelkirks
Many of us considered Reagan to personify the “Counter-Revolution”; after every ‘revolution’ – like the overturn of values and lifestyles and the birth of new politics in the ’60s and ’70s – there was the push back from ultra conservative America. And Nancy led the “war on drugs,” and we saw how great that was.
Let’s be careful to not rewrite history here.
The LPS Act was a bipartisan effort that went through a democrat majority legislature before it hit Reagan’s desk. It was backed by civil liberty advocates.
kh, as a ‘bipartisan’ effort this country doesn’t have two parties as the reality has always been Class War with the party system locked in and operated by the wealthy elite who struggle between themselves for power and increased profits. And who mostly disregard the working class that they make those profits off of. Unless of course the serfs try to start a union or want to vote for a better political outcome instead of the two corporate-owned parties, or want an educational system that actually teaches their children critical thinking skills. You know, growth in their intelligence rather than less?
Instead GOP governors are stripping child labor laws. Corporate slaves don’t need no eddycation! Reagan Lives!
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Well, here’s more of what the Reagan campaign did that still is seriously affecting our country; the GOP hasn’t changed a bit except to get even more extreme than they were in 1980:
This is a continuation of the GOP strategy that first took shape in the election of 1980, when Heritage Foundation co-founder and Reagan strategist Paul Weyrich famously told a group of Republicans in a large Dallas church:
“Now many of our Christians have what I call the ‘goo goo’ syndrome. Good Government. They want everybody to vote. I don’t want everybody to vote. Elections are not won by a majority of people. They never have been from the beginning of our country, and they are not now. As a matter of fact, our leverage in the elections quite candidly goes up as the voting populace goes down.”
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Is Texas Going To Invalidate an Entire Election in Democratic-Leaning Houston?
The only way Republicans can hold onto power is with their phony proclamations of “voter fraud” as the excuse to restrict the franchise to white people through restrictions, purges, and intimidation.
https://hartmannreport.com/p/is-texas-going-to-invalidate-an-entire
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It certainly isn’t getting any better, is it?
sealintheSelkirks
I read that it was JFK that actually came up with this plan & that Reagan had the job of signing it. Don’t kill the messenger…look it up
Sadie: You didn’t read Geoff Page’s link below all the Lockwood reply, did you? Might want to read through all the comments before putting foot in mouth.
sealintheSelkirks
Read Geoff Page’s response just down from your comment.
Your history is so far off that it exposes your story as Democrat bs. Reagan didn’t de-institutionalize the mental ill in 1981. As President, he had no authority over the individual states, as to their mental institutions. He signed legislation in 1967 that concerned California. Not the entire U.S. and it mimicked legislation that PresidentKennedy championed, in 1962. Go back, and check yourself, and you will find that, in 1981, Reagan did in fact sign legislation, that basically repealed the Mental Health Systems Act of 1980 that was signed by Carter, but that in no way closed down mental health institutions across the U.S.. Oh, by the way, Congress passed that legislation, in 1981, to repeal the MHSA, and last time I checked, the Democrats had the majorities in both Houses. If you’re going to try to be relevant, at least get your ‘facts’, a little closer to being real
Your view of history is a little skewed.
“He signed legislation in 1967 that concerned California.” As the author stated, and as happened for many years and is still happening, the country followed California.
“it mimicked legislation that President Kennedy championed, in 1962.”
Hardly. From https://www.kqed.org/news/11209729/did-the-emptying-of-mental-hospitals-contribute-to-homelessness-here:
“1963 President John F. Kennedy signs the Community Mental Health Act. This pushes the responsibility of mentally ill patients from the state toward the federal government. JFK wanted to create a network of community mental health centers where mentally ill people could live in the community while receiving care.”
“1981 President Reagan repeals Carter’s legislation with the Omnibus Budget Reconciliation Act. This pushes the responsibility of mentally ill patients back to the states. The legislation creates block grants for the states, but federal spending on mental illness declines.”
So how does what Reagan signed mimic what Kennedy signed?
They did not directly repeal the Mental Health Act, it was included in a much larger bill, the Budget Reconciliation Act. Getting the mental health stuff in there was the result of Reagan and his puppet masters, they did not want to spend the money. Without the funding, the mental clinics across the U.S. closed.
Live in the Now and not the past . We can correct the future and learn from the past , but we cant go back and fix the past . Just mt 2 1/2 Cents on that .
When Reagan was Governor of California he appointed a monster named Ray Procunier as Director of California Corrections. While Procunier was Director, lobotomies, electroshock treatments and other experiments were performed on prisoners without their consent. I always have a hard time deciding who the worst U.S. President was, but Reagan was absolute garbage for sure.
In Reply, Ronald Reagan is often blamed for emptying the state’s hospitals onto the streets, but by the time he became California’s governor in 1967, the California mental health hospital population had already dropped to 22,000. It kept right on declining during his administration, driven by excitement over Thorazine and other new “tranquilizer” medications, with little thought to the social or personal consequences. Thorazine appeared to accomplish the same therapeutic results for mentally ill patients as those invasive procedures, but more effectively, with less risk. The relatively inexpensive pill appeared to be such a miracle that within a few years it was used not only to treat hospitalized patients, but as a means to release patients from institutions altogether, allowing them to be treated on their own. Deinstitutionalization had begun.
In 1963, President John F. Kennedy made deinstitutionalization federal policy, signing the Community Mental Health Act. The mental health law was part of Kennedy’s “New Frontier” program of social and economic reform coupled with technological innovations such as the space program.
The new law provided $150 million in federal funding over three years to build a network of “community” mental health centers that would take over treatment of mentally ill patients, allowing psychiatric hospitals to be largely emptied out, their patients released into society at large. Kennedy’s vision, and that of the Joint Commission on Mental Illness and Health whose 1961 report formed the basis for law, called for a network of treatment centers that would allow mentally ill people to integrate with their communities, living productive and fulfilling lives to the greatest extent possible.
The Last Bill JFK Signed — And The Mental Health Work Still Undone
https://www.wbur.org/news/2013/10/23/community-mental-health-kennedy