From Moral to Immoral Treatment: The Failure to Fund the Treatment of the Seriously Mentally Ill in Texas and the Nation, 1860 to 2018



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This study presents a case study of the treatment of serious mental illness in one state, Texas, and its largest city and county, Houston, and Harris County. It also examines critical factors leading to the federal government's involvement in the treatment of severe mental illness from the 1960s through the early 1980s. This new role for the federal government inaugurated a massive deinstitutionalization movement fueled by new federal funding streams and federal court decisions that dramatically altered the treatment of severe mental illness in the United States. Across the country, states released patients from psychiatric hospitals often to highly inappropriate facilities or the streets. The new federally funded community mental health centers focused on treating new, less ill patients from the community rather than treating those exiting the state hospitals. The number of state hospital beds dropped from a high of 550,000 in 1955 to less than 40,000 today. The result has been the criminalization of mental illness resulting in the imprisonment of over 350,000 severely mentally ill citizens, and the recognition that the largest mental health facility in every state is the largest county or city's jail. While other studies have chronicled this history on the national level, this fast-growing state and local community show the fate of the mentally ill who need more services than medication and counseling. For those lacking appropriate treatment, their illness often causes them to commit crimes leading to their arrest and jail. From its history of moral treatment in asylums that removed the mentally ill from jails, Texas and the nation have moved to the immoral treatment of jailing and imprisoning the mentally ill for the illnesses they cannot control. The failure of Texas and the nation to fund appropriate systems for the treatment of mental illness in the wealthiest nation and one of its wealthiest states points to the dramatic need for change in our health care system.



Deinstitutionalization, Criminalization of mental illness, Moral treatment, Failure, Funding, Treatments, Texas, Houston, Harris County