Last updated on 2023-04-11
Ezra Klein’s recent podcast about mental health in America and how we got to this moment of dysfunction spurred my memory.
Until listening to this podcast, I always thought that the closing of the mental hospitals/ institutions in the 1970’s and 1980’s was caused by the NYCLU/ACLU cases about Willowbrook and other facilities abysmal conditions, as well as the Florida case, O’Connor v. Donaldson (1975), in which a unanimous Supreme Court ruled that states cannot confine a non-dangerous individual who can survive on his own, or with help from family and friends.
It made sense to me that the sequence of events was:
- Geraldo Rivera was making his name shaming the New York Government for the horrific conditions in Willowbrook on Staten Island;
- The contemporaneous NYCLU/ACLU cases (Wyatt v. Stickney in 1972, and Wyatt v. Aderholt in 1974), regarding Willowbrook and other facilities, which resulted in state institutions being forced to reduce abuse, reduce patient populations, increase staffing ratios, and generally improve conditions – all of which critically led to a need to increase funding;
- O’Connor v. Donaldson (1975), in which a unanimous Supreme Court ruled that states cannot confine a non-dangerous individual who can survive on his own, or with help from family and friends.
- Then the wider cultural reaction, as demonstrated by movies related to the subject. Here is a partial list: Asylum 1972, Don’t Look in the Basement 1973, Horror Hospital 1973, Seven Beauties 1975, One Flew Over The Cuckoo’s Nest 1975, Sybil 1976, Carrie 1976, I Never Promised You a Rose Garden 1977, Halloween 1978, The Fifth Floor 1978, The Bell Jar 1979, et cetera. . .
- The Civil Rights of Institutionalized Persons Act (CRIPA) of 1980, which codified protections for institutionalized persons.
Really, there is SO MUCH MORE to the story than that. . .
In response to the cases in the 1970’s and the growing public awareness and outcry, Jimmy Carter signed and congress passed the Mental Health Systems Act of 1980, which provided block grants to States for funding community mental health facilities. In the signing statements from Senator Kennedy, Representative Waxman and the president and Mrs. Carter, they state this act was intended to provide funding for the facilities to continue operating in compliance with the court cases staffing and care requirements.
But in 1981, Ronald Reagan defunded the Mental Health Systems Act, established the year prior, in the Omnibus Budget Reconciliation Act of 1981. In a dirty political move, the omnibus bill removed all federal funds in the Act but kept the patient bill of rights. Thus, Reagan could say that he was protecting the patients’ rights but took away all federal funds for States and local governments to provide for the patients’ care.
It is shocking how our current moment, in which cities are straining under the crisis of homelessness – involving addiction, mental illness, and poverty, can be traced back to the famous “Reagan tax cuts” which massively cut taxes on those earning the most and cut all government spending except for the military (which increased dramatically).
We might have avoided this fate if we had not cut the mental health services and the social safety net so much. And it is sick to see conservatives blame the “government” for failing on these issues, when it is their side that defunded the programs that were meant to address these issues. AND WE ALL FALL FOR IT!?!!??