Julie McDonald Commentary: Did Deinstitutionalization of Mental Hospitals Lead to Homelessness?


My great-uncle Paul Sullivan, an outspoken, self-educated World War I veteran, ranted for years about his spineless, weak-willed father who allowed his mother to be railroaded into a mental institution so that relatives could raise her baby girl as their own.

Family lore often has its roots in truth, which we discovered when my sister Sue, the family genealogist, sought my great-grandmother’s medical records from the Central State Hospital of Indiana. I didn’t know you could obtain those records, but my great-grandmother died more than 80 years ago.

Those records show that Great Uncle Paul, a vice president for the Monon Railroad, spoke the truth.

His mother had given birth to a baby girl at the age of 41 and likely suffered from postpartum depression, easily treated today with therapy, antidepressants and perhaps hormone replacement. Instead, my great-grandfather’s sister and her husband, who had a son but no daughter, had her declared insane and committed to the state hospital in 1906. They raised my Great-Aunt Fran as their daughter.

My poor great-grandmother spent the better part of 27 years locked in a state institution, released only at the age of 63 when my grandparents brought her home to live with them. She died two years later.

Tragic stories like my great-grandmother’s and reports of cruel and inhumane treatment of mentally ill hospital patients (think of lobotomies, Nurse Ratched in One Flew Over the Cuckoo’s Nest, and boys at the Massachusetts School for the Feeble-Minded who were fed Quaker oatmeal laced with radioactive tracers) prompted the deinstitutionalization of people with severe mental illness in the 1950s and later those with developmental disabilities in the 1970s. Government officials also wanted to save money, and they figured medication could serve as adequate treatment of mental illness.

But like many well-meaning but not well-thought-out progressive ideas, the movement failed to consider what would happen to chronically mentally ill patients who today make up about a third of the people who are homeless — only one leg of a complicated problem. Many others are addicted to drugs or alcohol. Some were abused as children. Others earning low incomes simply can’t afford to pay for housing. They fall through the cracks and wind up on the street.

“Although homelessness among the chronically mentally ill is closely linked with deinstitutionalization, it is not the result of deinstitutionalization per se but of the way deinstitutionalization has been carried out,” states a 1984 abstract by H.R. Lamb in the National Library of Medicine. “The lack of planning for structured living arrangements and for adequate treatment and rehabilitative services in the community has led to many unforeseen consequences such as homelessness, the tendency for many chronic patients to become drifters, and the shunting of many of the mentally ill into the criminal justice system.”

Dr. Daniel Yohanna, vice chair and an associate professor in the Department of Psychiatry and Behavioral Neuroscience at the University of Chicago Pritzker School of Medicine, addressed the issue in a 2013 piece, “Deinstitutionalization of People with Mental Illness: Causes and Consequences,” published in the AMA Journal of Ethics.

“Three forces drove the movement of people with severe mental illness from hospitals into the community: the belief that mental hospitals were cruel and inhumane; the hope that new antipsychotic medications offered a cure; and the desire to save money,” he said.

We’re seeing the consequences today in the homelessness and criminalization of people with mental illness. Many cannot hold steady jobs. Some are violent and need to be locked up. 

In early October, 28-year-old John Cody Hart, a Southwest Washington transient released from the Clark County Jail in July while waiting for a bed to open at Western State Hospital, traveled to New Meadows, Idaho, checked into the Hartland Inn, and then fatally shot the couple who owned it — Rory Mehen, 47, and his wife, Sara Mehen, 45. He had earlier been charged in Clark County with first- and second-degree assault after an August 2021 attack.

Clark County Senior Deputy Prosecutor Luka Vitasovic argued against his release, saying, “The community does not need somebody suffering from untreated mental illness out committing unprovoked serious violent offenses.”

A judge released him and now two people are dead.

Yohanna concluded that state hospitals must play a larger role in providing long-term care to people with severe mental illness.

“As a nation, we are working through a series of tragedies involving weapons in the hands of people with severe mental illness,” he wrote, adding that our society must address the lack of mental health services, “especially for those in need of treatment but unwilling or unable to seek it.” He said we can design safe refuges from a difficult world to improve the lives of people with severe mental illness.

Nobody wants a homeless encampment in their neighborhood. Lewis County commissioners recently voted to ban homeless camps on county-owned land, which apparently would displace fewer than two dozen people. 

The county must provide 72 hours of notice to people in the encampments before clearing them. And, thanks to a 2018 U.S. Court of Appeals ruling, government officials must be sure homeless people have access to adequate shelters if such bans are enacted.

The Salvation Army’s night-by-night shelter in Centralia — the only shelter in Lewis County — has been criticized as unfit for dwelling. 

So where are people to go? 

Lewis County plans to build a night-by-night shelter on Kresky Avenue and open it in 2023. How it will be funded is unclear. And what will be required to obtain shelter? Lewis County Commissioner Sean Swope advocated for “accountability,” requiring proof of a job before people can obtain services. But can a mentally ill person keep a steady job? Perhaps some but not all.

Portland city officials recently banned unsanctioned street camping and mass campsites. While doing so, they also voted to help homeless people find jobs place those who need help into centers for treatment of addictions and mental health problems. And they plan to construct six new housing campuses throughout the city, each with a capacity of 250 people.

I don’t know the best solution to the homelessness issue. I do believe it’s heartbreaking for people who are mentally ill — people who have done nothing to cause their suffering — to live without adequate food or a roof over their heads. Part of the answer may lie in building hospitals staffed by caring professionals to provide for people incapable of working. Another factor may entail providing food and clothing to those who most need it.

I admire volunteers from Gather Church, Love INC (Love in the Name of Christ), and the Lewis County Gospel Mission who live out the gospel message in Matthew 25:35-36: “For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.”


Julie McDonald, a personal historian from Toledo, may be reached at memoirs@chaptersoflife.com.