After patients were released from mental hospitals, there wasn’t always a place for them to go. On this week’s episode, we explore if deinstitutionalization was a factor in the Bay Area’s homeless crisis. Bay Curious is a new podcast from KQED that’s all about answering your questions about the Bay Area.

Earlier this year, we asked for your questions on homelessness. More than 1,300 of you responded and we answered many of your questions in our first round of reporting.

There was one topic that kept coming up again and again as we sorted your questions. This week on the podcast, we answer listener Debbie Ow’s question:

“Is the situation as bad as it is because of the closure of mental health facilities in our state?”

Listen to the podcast for the answer.

Deinstitutionalization: A History

1833 Worcester State Hospital opens in Massachusetts as the first mental hospital fully supported by state funds.

Worcester State Asylum in Worcester, Massachusetts, dated 1905.
Worcester State Asylum in Worcester, Massachusetts, dated 1905. (Wikimedia Commons)

1860 Twenty-eight of the 33 existing U.S. states have state psychiatric hospitals.

1939-1945 During World War II conscientious objectors enter state psychiatric hospitals to replace doctors who were sent away for the war effort.

1946 Life Magazine publishes photos depicting the horrors inside the hospitals.

1954 Chlorpromazine, marketed as Thorazine, is approved by the Food and Drug Administration. It’s the first anti-psychotic drug widely used to treat the symptoms of mental illness. For many, it brought hope that some patients could live among the community.

"Bedlam 1946" spread from Life Magazine.
‘Bedlam 1946’ spread from Life Magazine. (The Jerry Cooke Archives)

1955 The number of patients inside public mental hospitals nationwide peaks at 560,000.

1959 The number of patients in California state mental hospitals peaks at 37,000.

President John. F. Kennedy
President John. F. Kennedy (Library of Congress)

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. JFK could have been inspired to act because his younger sister, Rosemary, was mentally disabled, received a lobotomy and spent her life hidden away. 

Less than a month after signing the new legislation, JFK is assassinated. He doesn’t see the plan through. The community mental health centers never receive stable funding, and even 15 years later less than half the promised centers are built.

The Community Mental Health Act of 1963.
The Community Mental Health Act of 1963.

1965 The U.S. Congress establishes Medicaid and Medicare. Mentally disabled people living in the community are eligible for benefits but those in psychiatric hospitals are excluded. By encouraging patients to be discharged, state legislators could shift the cost of care for mentally ill patients to the federal government.

1967 Ronald Reagan is elected governor of California. At this point, the number of patients in state hospitals had fallen to 22,000, and the Reagan administration uses the decline as a reason to make cuts to the Department of Mental Hygiene. They cut 2,600 jobs and 10 percent of the budget despite reports showing that hospitals were already below recommended staffing levels.

1967 Reagan signs the Lanterman-Petris-Short Act and ends the practice of institutionalizing patients against their will, or for indefinite amounts of time. This law is regarded by some as a “patient’s bill of rights”.  Sadly, the care outside state hospitals was inadequate. The year after the law goes into effect, a study shows the number of mentally ill people entering San Mateo’s criminal justice system doubles.

1969 Reagan reverses earlier budget cuts. He increases spending on the Department of Mental Hygiene by a record $28 million.

1973 The number of patients in California State mental hospitals falls to 7,000.

1980 President Jimmy Carter signs the Mental Health Systems Act to improve on Kennedy’s dream.

President Ronald Reagan
President Ronald Reagan (Library of Congress)

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.

2004 The U.S. Department of Justice estimates that 10 percent of state prisoners have symptoms that meet criteria for a psychotic disorder.

2015 In the San Francisco Homeless Count, 55 percent of people experiencing chronic homelessness report they have emotional or psychiatric conditions.

Did the Emptying of Mental Hospitals Contribute to Homelessness? 7 April,2017Jessica Placzek

  • Kurt thialfad

    Did the sanctuary policies contribute to homelessness?

  • Ellen

    Reagan closed most of the mental hospitals here in California, the downtown area was just over run with people with mental illness,
    and over the years it has spread into ever neighborhood. Now 45 years later hospitals drop mental patients in the downtown area in
    there hospital gowns. Reagan was a big disappointment for California residents, many of the mental patients are the homeless people you see everywhere.

    • Lola Themola

      Reagan in the White House also reduced public housing funds, exacerbating this problem. Most of our problems in the US today can be traced to the trends started by Reagan, i.e., Republicans.

  • Mark Eccles

    Thorazine was called a tranquilizer , that is it. Anti-psychotic is a modern name. There is no psychotic molecule, virus or bacteria. If you think the drug is medicine, you should try it for a time.

    • mscottcgp

      It has been supplanted with antipsychotics that are more effective

      • Mark Eccles

        More effective against what molecule, virus or bacteria specifically? And who makes these claims of improvement? The suppliers and distributors of the drug… until the patient runs out. The drugs are to keep the “patients” invisibly chained until they die. BTW a 25 year shorter average life expectancy, just a coincidence of course. Also the brain shrinks on the drugs, up to 1 % a year. Doctors should be making people smarter, not less intelligent. Are you following orders? Good.

        • mscottcgp

          Anti- psychitics work on brain neurotransmitters which are not viruses or bacteriae. Drug companies use double- blind controlled trials to make their claims. If you know anything about mental illness you would know that many people with schizophrenia and other disorders have been able to lead productive lives by using these meds.
          I ‘d like the link to the journal article(s) about brain shrinkage, please.
          I have no clue as to what you’re talking about “following orders” Pharmacy school is a 6 yr program BTW- You want to sound like an intelligent person? Try to get into pharmacy school

          • Mark Eccles

            Yes drugs that you call antipsychotics do affect HEALTHY neurotransmitters. Medicine has to prove the neurotransmitters are defective BEFORE they issue drugs, they don’t. There is no such thing as a double blind trial for “antipsychotics” because of the effects of the drug are markedly noticeable compared to a placebo. You claim the drugs work while others ( not profiting from selling drugs)claim that 2/3 of mentally ill people recover. I have several links of references, but I believe I can only enter one. As you ask for brain shrinkage…I have two on hand and

          • mscottcgp

            If you’ve read the”Nature” article, you will find that decreased brain volume is not necessarily a bad thing

            “. Meyer-Lindberg himself published a study last year showing that antipsychotics cause quickly reversible changes in brain volume that do not reflect permanent loss of neurons ”
            As far as efficacy of antipsychotics is concerned, I would rather err on the side of using them than not using them and the patient causes harm to themselves OR OTHERS.
            And I Don’t profit from the sale of pharmaceuticals- I hold no stock in big pharma;

          • Mark Eccles

            If you are following orders you do not get “medicated”.

  • gre nicholAs

    dear GOD, GOD Willing. Thanks. Amen.

  • KardASSianButt

    Whenever I see a homeless person, I think of Ronald Reagan

    • Lola Themola

      So do I.

      • virgil

        Yet as the report says—you should also think of JFK and in my opinion the ACLU as well.

  • Mood_Indigo

    It’s interesting how Ronald Reagan is blamed for the mentally ill in California on the loose. Lost are the facts that the bill was sponsored by two Democrats and one Republican and passed by a veto-proof majority. It didn’t matter what the Governor’s view was on the issue

    “In 1967, the Lanterman-Petris-Short Act (LPS Act) a so-called “bill of rights” for those with mental health problems passed the Democratic-controlled Assembly: 77-1. The Senate approved it by similar margins. Then-Gov. Reagan signed it into law.”

  • virgil

    This report does a service by going beyond the myth that Reagan and Reagan alone was the culprit in the homeless-mental illness connection. But it leaves out a factor I think should have been dealt with too—-the role of civil liberties groups that have often opposed forced confinement claiming it is the slippery slope to the Gulag!! Forced confinement or forced used of meds is nearly always opposed by civil liberties types as one step removed from Soviet style treatment of dissidents.


Jessica Placzek

Jessica Placzek grew up on the West Coast, went to college on the East Coast and figured out what she wanted on the Gulf Coast. She likes talking to people and learning, so she became a reporter. This is where she tweets: @jessicazyp

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