Out of Institutions, Into the Streets: How Deinstitutionalization Fueled Homelessness
One Thursday afternoon, my roommate and I went to Sixteen Handles on 4th St. We were peacefully sitting at the front table eating our frozen yogurt when a man barged through the front door. This man was thin, older and unkempt. Most notably he was wearing a pillowcase as an outfit. Nothing else, just a pillowcase with two armholes. Before I knew it, there was a clattering sound coming from the cashier’s countertop. The man had taken the tip jar, and now he was on the move. As he fumbled with the door, he was shouting to an unspecified audience. Eventually, he remembered the complicated mechanics of door operation and bolted down the street. Just a typical day in NYC, right?
We started laughing but whether it was from fear, shock or the absurdity of the whole situation, I’m not entirely sure. All I can remember thinking is, “Wow, this is going to make a great story.” And it did, for the first few minutes, but as I continued to tell the story over and over, I realized that it was ultimately just depressing.
I had always heard that there were a lot of homeless people in New York City, but I was shocked by the sheer number, especially in Midtown. In a speech addressing the homelessness epidemic to the NYC City Council in January of 2020, Former Speaker of the NYCC Corey Johnson stated that there were around 80,000 homeless people in NYC. Then in 2024, the Homeless Outreach Population Estimate (HOPE) found in their yearly “point-in-time” survey that “A total estimate of 4,140 individuals experienced unsheltered homelessness on the night of January 23rd, 2024.” Homelessness is taking over the streets of NYC, and it has become an epidemic in need of a cure. People often blame homelessness on the rising housing prices and the cost of living, and while these financial concerns are contributing factors, a central underlying issue stems from the deinstitutionalization of mental asylums.
To understand how and why deinstitutionalization is the cause of the homeless epidemic in NYC, it is crucial to know the history of deinstitutionalization. Deinstitutionalization refers to the closing of mental asylums that began in the late 1940s and continued until the 1990s. Andrew Scull, a sociology professor at the University of California, San Diego, who specializes in the study of psychiatry, explained that social and political change began the long process of deinstitutionalization. People increasingly found it immoral to keep people with mental illness in asylums, and with the political changes from WWII, such as the unionization of hospital workers, there was dwindling support to keep them open. The general population began advocating for the closing of mental asylums because they thought it would be better for the patients to be a part of the community and have societal liberty, but this decision backfired and ended with the ever-growing mentally ill homeless population of today.
Even though deinstitutionalization began with good intentions, it failed drastically due to the lack of support and resources available for these individuals. Initially, the growing advocacy against mental asylums was brought to the attention of President John F. Kennedy, and in 1963, he signed the Community Mental Health Centers Act (CMHC). These community centers were supposed to provide care for the mentally ill, help with early identification of mental illness and supply preventive treatment. Unfortunately, these centers came to naught because of the insignificant focus on the severely mentally ill population and the lack of funding this plan received. Because of the failure of CMHC, the discharged patients had nowhere to go and had no support.
The final tipping point of deinstitutionalization, and the end of asylums, was the addition to the SSI program, Supplemental Security Income. Shortly after the institution of Medicaid and Medicare, during the 1970s, Congress enacted the SSI Act, which provided a basic income for individuals with disabilities and mental illnesses. This act was supposed to help younger patients with mental illnesses be discharged with the support of money. Some patients were able to go on to live successful lives integrated back into the community with the help of SSI. However, these individuals were few and far between. Most ended up reliant on their families given that the money was not enough to support them, and they were unable to succeed outside of an institution because they were unstable, often unable to keep a job. When the burden became too much for their families, they were left to fend for themselves, “living on the streets, and the sidewalk psychotic became an increasingly familiar feature of the American urban scene,” noted Dr. Scull in an article of his. The inordinate amount of mentally ill homeless people is due to the failed, albeit well-intentioned, attempts to liberate the mentally ill from mental institutions.
To summarize this saga, deinstitutionalization came about as a result of aspirations to rehabilitate and introduce mentally ill patients from mental hospitals and asylums into larger communities. Deinstitutionalization was intended to be supported by community members, but due to a lack of funding, planning and proper organization, the most needy of the mentally ill population fell to the wayside and became subject to homelessness. While the mentally ill do not make up the whole, or even half, of the homeless population, they take up spaces and resources that mentally healthy homeless individuals are also in need of, such as shelters and soup kitchens. These resources are not sufficient for those struggling with severe mental illness because they need additional and more structured help.
Now, America needs to make a new attempt to solve the problem caused by deinstitutionalization. It is possible to learn from past mistakes and muster up a solution that can improve the mentally ill and homeless population’s quality of life.
Deinstitutionalization caused an epidemic of mentally ill homeless people, and to address this problem, there needs to be more halfway houses that also involve strict, structured life coaching and assistance, which continues even after the individual moves out of the house. Deinstitutionalization was instituted under positive pretenses, but there was no proper plan put into place for these individuals after the asylums and hospitals were no longer an option. For a long time, the problems caused by deinstitutionalization have been swept under the rug by politicians and citizens alike. All the while, there are thousands of people who are suffering daily. Americans need to broaden their horizons and use empathy to realize that there are more problems in society than just the hot-button debates that are commonly publicized, and instead of only advocating for those issues, they should begin to prioritize finding solutions to the problems caused by deinstitutionalization.
Photo caption: Homeless man and his brother sleeping on the sidewalk in New York.
Photo credit: Adjoajo, Wikimedia Commons
