It’s 8 AM, and the streets of Olympia are at low tide. In the name of compassion, we have built a system that may be even crueler than what came before.
In the absence of the old asylums, Olympia’s mentally ill are now crowded into a city-sanctioned tent encampment, then shuffled through the institutions of the modern social-scientific state: the jail cell, the short-term psychiatric bed, the case-management appointment, the feeding line, and the needle dispensary. In 1962, Washington State had 7,641 state hospital beds for a total population of 2.9 million today, it has 1,123 state hospital beds for a population of 7.6 million-a 94 percent per-capita reduction. A half-century ago, many, if not most, of these wayward souls would have been institutionalized. In Olympia, approximately 250 individuals have become entangled within this broken system of care, cycling through the streets, the local jails, and the emergency ward at Providence St. Olympia, Washington-a city of 52,000 tucked between a joint military base and a state forest-is one such place.
By contrast, the contours of the problem are much more intelligible, even manageable, in smaller cities and towns. It’s difficult, if not impossible, to imagine how public officials could “solve” the problem of mental illness in these places, which are home to tens of thousands of individuals suffering from the “perilous trifecta” of mental illness, addiction, and homelessness. In major metropolitan areas such as Los Angeles, San Francisco, and Seattle, the scale of mass psychosis is overwhelming, and the inadequacy of the public response is self-evident. I’ve spent the better part of two years looking at this invisible asylum in West Coast cities. In slaying the old monster of the state asylums, we created a new monster in its shadow: one that maintains the appearance of freedom but condemns a large population of the mentally ill to a life of misery. The question now is not, “What happened to the asylums?” but “What replaced them?” Following the mass closure of state hospitals and the establishment of a legal regime that dramatically restricted involuntary commitments, we have created an “invisible asylum” composed of three primary institutions: the street, the jail, and the emergency room. If anything, with the proliferation on the streets of psychosis-inducing drugs such as methamphetamine, the United States has more cases of serious mental illness than ever before-and less capacity to treat and manage them. Though there were sometimes brutal abuses in the state mental hospitals of the early twentieth century, the closure of the asylums did not put an end to mental illness. In a long arc-from President Kennedy’s Community Mental Health Act of 1963 to the present-federal and state governments dismantled mental asylums and released the psychiatrically disturbed into the world. The story of American deinstitutionalization has become familiar.
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