Across the country, a troubling trend is accelerating: the return of institutionalization – rebranded, repackaged and framed as “modern mental health care”. From Governor Kathy Hochul’s push to expand involuntary commitment in New York to Robert F Kennedy Jr’s proposal for “wellness farms” under his Make America Healthy Again (Maha) initiative, policymakers are reviving the logics of confinement under the guise of care.
These proposals may differ in form, but they share a common function: expanding the state’s power to surveil, detain and “treat” marginalized people deemed disruptive or deviant. Far from offering real support, they reflect a deep investment in carceral control – particularly over disabled, unhoused, racialized and LGBTQIA+ communities. Communities that have often seen how the framing of institutionalization as “treatment” obscures both its violent history and its ongoing legacy. In doing so, these policies erase community-based solutions, undermine autonomy, and reinforce the very systems of confinement they claim to move beyond.
Take Hochul’s proposal, which seeks to lower the threshold for involuntary psychiatric hospitalization in New York. Under her plan, individuals could be detained not because they pose an imminent danger, but because they are deemed unable to meet their basic needs due to a perceived “mental illness”. This vague and subjective standard opens the door to sweeping state control over unhoused people, disabled peopleand others struggling to survive amid systemic neglect. Hochul also proposes expanding the authority to initiate forced treatment to a broader range of professionals – including psychiatric nurse practitioners – and would require practitioners to factor in a person’s history, in effect pathologizing prior distress as grounds for future detention.
This is not a fringe proposal. It builds on a growing wave of reinstitutionalization efforts nationwide. In 2022, New York City’s mayor, Eric Adams, directed police and EMTs to forcibly hospitalize people deemed “mentally ill”, even without signs of imminent danger. In California, Governor Gavin Newsom’s Care courts compel people into court-ordered “treatment”.
Yeah right now we’re mostly either letting them freeze to death on the street or just putting them in jail or prison and letting the COs beat them to death or use restraints unsafely. I do doubt, however, that the people they hire to staff these places and the facilities they give them to work in will be all that much safer.
The problem with the deinstitutionalization movement under Reagan was that the primary motive was saving money. While community care is significantly less expensive in the long term, if its your primary purpose for its own sake they wind up getting neglected due to lack of funding on the community end.
There’s also the fact that a lot of these people need long term occupational and vocational rehab to return to the community because we’ve destroyed their ability to live outside of ‘The System’ and a lot of people attribute that to some inherent moral failing as opposed to a niche and self-reinforcing form of PTSD.
What we really need to pour money into is intermediate / stepdown psych care like crisis stabilization and rehab, and long term residential care with a focus on community reintegration like group homes where they might have a central gathering area where they do targeted therapeutic activities, but they’re also encouraged to go out to community events.
Which also brings in the point that there are thre major social points that I think would solve like 80% of the American mental health crisis:
something to fix food insecurity but I haven’t decided what yet.
heavy, HEAVY taxes on any real estate that the owner does not personally occupy for 30-50% or more of the year.
reinstate the idea of the commons where there’s lots of public spaces including both natural spaces like parks but also structured meeting and activity spaces (more public libraries could be a great option). And with at least a few publicly funded event organizers who plan regular festivals and volunteer events.
Actually you could combine that last with the food thing and have large public cafeterias where there’s a couple cheap food options daily.