In a time of competing narratives and virtually unprecedented levels of polarization, there is one sad truth that Americans can readily agree on: our mental-health system is broken.
Specifically, the U.S. has long faced a critical shortage of inpatient psychiatric-treatment beds, with devastating societal consequences. From its historic peak in 1955 to 2016, the number of state psychiatric-hospital beds in the United States plummeted almost 97 percent, in a trend known as “deinstitutionalization.” There are now fewer beds per capita in the United States than there were in 1850. An analysis of the broader system of both inpatient and other 24-hour residential-treatment beds similarly found a 77.4 percent decrease from 1970 to 2014.
While inpatient treatment beds represent only one aspect of a functioning mental-health system, they are a vital one. Without access to a bed, acutely ill individuals are left to wait for the proper treatment, forcing mental-health professionals to triage the most severely ill in hopes of short-circuiting the next awful, unnecessary massacre. At the same time, families are caught in their own nightmare, watching helplessly as their loved ones deteriorate in the absence of the right care. With nowhere else to turn, those in need end up in the only remaining systems that cannot say no: emergency rooms, homeless shelters and, too often, jails and prisons.
Without treatment beds, the criminal-justice system has become our de facto mental-health system. By 2014, ten times the number of people with serious mental illness were in prisons and jails as in state mental hospitals. Astoundingly, the largest mental-health facilities in the nation are now the Cook County and Los Angeles County jails.