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Dale A's avatar

“The Reagan-era deinstitutionalisation of the homeless has been a nationwide disaster for years”

The states were already well on their way to deinstitutionalization at the state level long before Reagan was president, it was the fulfillment of patients rights advocacy and a general trend away from forcible incarceration for mental illness. Blaming Reagan is a cherished liberal myth supported by people who never bothered to learn anything about the history of mental treatment and refuse to put it in the context of an evolving sociopolitical response to SCALE.

The cultural context is especially significant: liberals at the time bemoaned involuntary treatment for mental illness and took Kesey's “One Who Flew Over the Cuckoo's Nest” for a documentary.

Deinstitutionalization actually started in 1955, when mental hospital patient populations began a long decline as mental health treatment "evolved". Patient populations didn't just drop per capita, but in absolute numbers. ORBA barely had any impact on psychiatric patient populations, which is a fact liberals always forget to bring up.

There was a good reason to deinstitutionalize beyond cost reduction: the hospital environment is poorly conducive to mental health and is really only suitable for the worst cases--and is not especially good at treating those. If someone can be functional on meds, it's far preferable to have them living on their own than cooped up in a locked-doors-and-fluorescent-lighting facility. In part because of the introduction of anti-psychotic medication and out-patient therapy, patient populations plummeted in the 1970s and were a small fraction of their peak in the 50s. While some form of involuntary treatment is obviously necessary (and continues), it's a joke to hear these people call for it when everything they did politically undermined public support for it.

It's also extremely expensive--liberals who bemoan the cost of mental illness have never bothered to take out a calculator and figure out the costs of maintaining people in a reasonably controlled environment with full medical staff for years. Not only have medical costs in general rapidly risen (which impacts the cost of mental health treatment of any kind), but institutional costs are also much larger than when men with butterfly nets would capture stray loonies and drive them over to the local nuthouse (which doubled as a workhouse--liberals always forget to mention).

The truth is that had mass institutionalization continued to this day, liberals would be mad as hell about all the people incarcerated in places "just like prisons" for being a little different (the NYMag article complete with cherry-picked examples practically writes itself). Instead today they complain that mentally ill people wind up in prisons. They're complete hypocrites on the subject and have a convenient case of amnesia--not only about mental illness but about their own fashionably stupid tendencies.

What I think really drives the "blame it on Reagan" mentality is that urban liberals come across deranged homeless people created by the soulless urban setting they cherish, and they feel very frowny face about it, so the easiest thing to do is to blame some Republican for not building giant facilities that involuntarily house these people with magically effective staff that fly down from heaven to spoon yum yums and warm feelings into them. Until of course a Republican builds such a place, then it will be called a modern day racist gulag run by "literal Nazis".

In any case what is obvious to anyone who has ever been involved in mental health treatment is that it scales very poorly and becomes extremely complex and unworkable as it scales. There really is no right answer for what it should look like in the overscaled, atomized hellhole we currently live in. Nothing you can do in this dysfunctional environment is capable of solving the large problems it has created, or will not produce equally large problems on its own. QED.

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Ralph's avatar

Well said, “Live not by Lies”

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