The deinstitutionalization crisis actually began in the 1950s—a full decade before President Kennedy proposed his Community Mental Health Act. When new psychiatric medications like Thorazine were introduced in the early 1950s, they offered hope that people with severe mental illness could live outside locked hospital wards. But instead of using breakthroughs to create better care, states saw an opportunity to slash budgets. They discharged thousands of people into communities where there were no support systems, no treatment options, and often nowhere to live—laying the groundwork for the homelessness crisis we see today.
Kennedy’s vision came after the damage was already being done. He was trying to fix a crisis that had already started before he even proposed the Community Mental Health Act in 1963. President Kennedy’s vision of treating people with mental illness with dignity in their own communities rather than isolating them in large, deplorable institutions.
The result was predictable and heartbreaking. The majority of discharged patients went to their own homes, nursing homes, or board-and-care homes, where they were “out of sight and out of mind.” But many of these placements were woefully inadequate—converted motels masquerading as care facilities, overwhelmed families with no training or support, or people who were simply cared for “not at all.” (1)
This means that Kennedy’s vision of community mental health centers wasn’t just idealistic policy-making—it was an urgent attempt to create the infrastructure that should have been in place before anyone was ever discharged. He was trying to build the safety net after people had already been pushed off the cliff.
The deinstitutionalization movement was “well intended but poorly executed”—and Kennedy understood this. His Community Mental Health Act was designed to replace the “cold mercy of custodial isolation” not with abandonment, but with genuine “community concern and capability.” (2)
However, after President Kennedy was assassinated, only half of the 1,500 community mental health centers were ever built, and they were never fully funded. This incomplete implementation contributes to the ongoing challenges in mental health care delivery even today. The escalating costs of the Vietnam War throughout the 1960s and early 1970s consumed massive federal resources that could have been used for domestic programs like the community mental health centers. Even as healthcare costs increased, the federal commitment to funding these centers didn’t keep pace with actual needs of the people being served. (3)
And when Ronald Reagan became president in 1981, he systematically dismantled what remained of federal mental health funding. He converted federal mental health funding into block grants to states, which effectively reduced overall funding and gave states the ability to redirect the money to other priorities. Reagan had already demonstrated his approach to mental health funding when he was Governor of California. He cut 2,600 jobs and 10 percent of the budget despite reports showing that hospitals were already below recommended staffing levels.
This funding crisis created a perfect storm: states were closing expensive institutional care without building adequate community alternatives, and the federal money that was supposed to create them was diverted to war spending and later eliminated entirely. This left many people with mental illness without adequate services in either institutional or community settings, contributing significantly to homelessness and the criminalization of mental illness that we still see today.
The money essentially went to military spending during the Vietnam war. After the war was over, it was eliminated and drastically reduced under Reagan’s budget cuts and ideological shift toward reducing federal social program.
It is my hope that by connecting President Kennedy’s vision to today’s backward slide, we can show people what’s happening now and remind them of what we know actually works and what Kennedy envisioned—building the foundation for change when the right conditions align again.
1. Kennedy’s other moonshot: The origins of intellectual and developmental disabilities research centers and Waisman Center; http://bit.ly/40M7a0e
2. Psychologist: JFK’s Sister Inspired Revolution for Millions with Disabilities; https://www.uml.edu/news/press-releases/2018/arcuspitch091318.aspx
3. Rosemary Kennedy; https://www.jfklibrary.org/learn/about-jfk/the-kennedy-family/rosemary-kennedy
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