Exposés such as Ken Kesey's ‘One Flew Over the Cuckoo's Nest’ (1962) and journalistic investigations highlighted systemic horrors, fueling a movement for reform. Advances in psychotropic medications, like chlorpromazine in the 1950s, promised outpatient treatment, reducing the need for long-term institutionalization.
Deinstitutionalization—the process of releasing patients from state hospitals and shifting care to community-based services—gained momentum in the 1960s. President John F. Kennedy signed the Community Mental Health Act in 1963, aiming to establish 1,500 community mental health centers to replace large institutions.
This bipartisan effort was driven by civil rights concerns, fiscal pressures, and optimism about new treatments. However, funding fell short; only about half the planned centers were built, leaving many former patients without adequate support.
Ronald Reagan played a pivotal role in accelerating this process, both as governor of California and later as president. In 1967, as California's governor, Reagan signed the Lanterman-Petris-Short Act, a bipartisan bill that restricted involuntary commitments and aimed to protect civil liberties by making it harder to institutionalize individuals without due process.
This led to the closure of several state hospitals in California, reducing the inpatient population from about 37,000 in the late 1950s to under 7,000 by the 1970s.
Proponents argued it ended abuses, but critics noted the lack of community alternatives, resulting in many patients ending up homeless or in jails.
Nationally, as president in 1981, Reagan signed the Omnibus Budget Reconciliation Act, which repealed much of President Jimmy Carter's Mental Health Systems Act of 1980.
This shifted mental health funding to block grants for states, cutting federal oversight and resources by about 30%.
Reagan's administration emphasized fiscal conservatism, viewing large institutions as inefficient. By the end of his presidency, the national state hospital population had plummeted to around 100,000.
While deinstitutionalization predated Reagan—beginning under Eisenhower and accelerating under Kennedy and Johnson—his policies are often blamed for exacerbating the crisis.
Supporters argue he envisioned community care, but inadequate funding turned it into "transinstitutionalization," where prisons and streets became de facto asylums.
The consequences were profound. Homelessness surged in the 1980s, with estimates suggesting up to one-third of the homeless population suffered from severe mental illness.
Jails filled with mentally ill individuals; today, the largest mental health providers in the U.S. are county jails like Rikers Island and Los Angeles County Jail.
Critics, including some mental health advocates, argue that while abuses in asylums were real, deinstitutionalization without robust alternatives created a public health disaster.
Reagan himself later reflected on the policy's shortcomings but defended it as aligning with civil liberties.
Trump's Comments on Reopening Mental Institutions
In recent years, former President Donald Trump has repeatedly advocated for reopening mental institutions as a solution to homelessness, crime, and public disorder. As of 2025, Trump has escalated this rhetoric, tying it to his administration's crime crackdown initiatives.
In a July 2025 executive order titled "Ending Crime and Disorder on America's Streets," Trump directed federal agencies to facilitate states' use of civil commitment laws, allowing involuntary institutionalization for those with severe mental illness or addiction who pose risks to themselves or others.
This order effectively seeks to override aspects of 1960s-era policies, including the Olmstead v. L.C. Supreme Court decision (1999), which mandated community-based treatment over institutions.
Trump's comments have been direct and unapologetic. In an interview with the Daily Caller, he stated, "Yeah, I would" consider reopening "insane asylums," criticizing states like New York and California for closing facilities like Creedmoor and Bellevue, which he claims led to patients being "dumped" on streets.
He argued, "You can’t have these people walking around," emphasizing public safety.
During campaign speeches Trump has linked this to broader issues, proposing "tent cities" for the unhoused and expanded facilities like Alcatraz for violent offenders.
Critics, including the ACLU, condemned the order as a threat to civil liberties, warning it could unjustly lock away disabled and unhoused people without addressing housing affordability.
Trump countered that modern institutions would be humane, focusing on treatment rather than punishment.
This stance aligns with Trump's broader platform, including his 2024 campaign website, where he pledged to reopen state mental hospitals.
Supporters see it as pragmatic, addressing visible urban decay; detractors fear a return to abusive eras.
As of September 2025, implementation remains ongoing, with states like California and New York debating compliance.
The Rise of Psychotic Episodes and Marijuana's Role: Examples and Evidence
Amid discussions of reopening institutions, a growing body of evidence links increased marijuana use—particularly high-potency cannabis—to rising psychotic episodes, potentially justifying renewed institutional care for affected individuals. Since legalization in many states, cannabis potency has surged, with THC levels rising from 4% in the 1990s to over 15% today, amplifying risks.
Longitudinal studies show regular cannabis use predicts higher schizophrenia risk. A meta-analysis found users are twice as likely to develop psychotic disorders.
High-potency strains exacerbate this; one study linked them to cannabis-induced psychosis, where up to 50% of cases progress to schizophrenia or bipolar disorder.
Teens are particularly vulnerable: A Canadian study of over 20,000 adolescents found cannabis users 11 times more likely to develop psychotic disorders, with risks tied to young age, frequency, and potency.
Examples abound. In a Finnish cohort of 18,000 with cannabis-induced psychosis, nearly 50% later received schizophrenia diagnoses.
Abrupt cessation after long-term use can trigger acute episodes, including hallucinations and delusions, mimicking schizophrenia.
Neurobiologically, cannabis disrupts dopamine systems; a 2025 study found increased dopamine in the substantia nigra/ventral tegmental area among users with psychosis, a hallmark of the disorder.
Another revealed biological links via elevated dopamine, heightening vulnerability.
Clinically, cases have risen post-legalization. A U.K. psychiatrist noted "a visible rise" in intensive support needs for cannabis-induced psychosis in 2025.
In the U.S., emergency visits for cannabis-related psychosis increased 54% from 2016 to 2019.
Interactions with factors like childhood trauma amplify risks.
While not all users develop psychosis—genetic predispositions play a role—the trend supports arguments for institutional options for severe cases.
Deinstitutionalization under Reagan aimed to liberate the mentally ill but often stranded them without support, contributing to social issues. Trump's push to reopen facilities addresses these failures, particularly amid rising psychosis from marijuana, where examples show temporary episodes becoming chronic. Yet, debates persist: Advocates warn of rights erosions, while proponents see humane necessity. As psychosis cases climb with cannabis use, the balance between liberty and safety remains contentious.
Happy Halloween from the HLJ staff!
Editorial comments expressed in this column are the sole opinion of the writer.
