Explanation of How America’s Mental Hospitals Were Gutted and How to Fix the Problem

By Stephanie Ramage

President Kennedy’s Community Mental Health Centers plan failed due to racial and labor tensions, a failure which has left this country with a legacy of heartbreak and shame.

The bill was the work of an Alabama Senator whose daughter suffered from mental illness. Sen. Hill crossed political lines to craft and champion Kennedy’s CMHC bill of 1963. But Northern senators upended the bill, claiming that funding for staff should be withheld until desegregation of mental hospitals in the South could be verified. This stance ignored many cultural nuances, among them that black families often did not want their loved ones in the care of white-majority hospitals for fear of neglect and abuse. This was not a sentiment that blacks at the time felt safe in voicing, so a crucial component of public discourse on the matter was missed.

To complicate matters, Northern lawmakers who were heavily supported by organized labor demanded that all personnel funding for the centers be withheld unless their Southern counterparts agreed to hire only union labor. Given the climate of the time, one can’t help but think that they had to know this would be the death knell of the bill. And it was.

While construction of the first 400 Community Mental Health Centers was funded, the staffing part of the legislation failed, so no payroll was provided.

The States, which were the primary source of care for the mentally ill—the vast majority of mental hospitals were state-owned, funded and run—took passage of the construction bill as an opportunity to evict thousands of patients and to begin phasing out their hospitals. This act on the part of the States had enormous consequences.

With no Congressional approval for paying staffers, the Federal government scrambled to find some way to take care of the hordes of sick people the States were dumping. What they came up with was a mish-mash of Medicaid, Medicare, and SSDI funding passed as part of the DHHS budget in 1965.

The States then transferred their patients to nursing homes where the Federal Medicaid, Medicare and SSDI checks were sent to the patients individually, but in many cases, the patients never got them. Many mentally ill people, some of them young, died in nursing homes of neglect and abuse over the next several decades as the nursing home operators took their federal checks.

Others–an exact number is hard to come by as records were thrown into chaos–went home to their families who were in some instances ill-equipped to care for them despite the desire to do so or, sadly, didn’t want them, ultimately ending up out on the street or in jail due to minor offenses or “compassionate arrests,” which means that law enforcement locked them up to give them shelter.

This sorry state of affairs didn’t happen over night. As legislators and administrators across the nation fought State budget cuts to hospitals and programs, it took decades to reduce our mental hospital system to the inadequate thing it is today.

Click on the following link to view the slideshow I prepared for my Public Policy masters program at Georgia Tech.

Ramage Slideshow Mental Health legislation proposal