Funding tapered off through the first half of the 20th century. Staffs shrank, and in some facilities, a single doctor was responsible for hundreds of residents, who often lived in squalid, abusive, dangerous conditions.

For many, there was no path out, nowhere else to go. Hospitalization was a life sentence, or close to it.

“It is hard to describe the smell,” said Joseph Rogers, 66, executive director of the National Mental Health Consumers’ Self-Help Clearinghouse, who spent stretches of up to six months on locked wards, mostly in Florida, after a psychotic episode at age 19.

“I guess it is the smell of caged humans. Someone once told me that part of the smell comes from the medication everyone is on.”

He added: “You’re told when to go to bed, where to go, what to eat and when. They take all your freedom away, and in my eyes they’re not placed where you get any help.” He later founded the clearinghouse, which provides assistance and advocacy for people with psychiatric diagnoses.

By 1960, doctors had the first drug that could effectively blunt psychosis — chlorpromazine, brand name Thorazine — giving tens of thousands of residents a chance to live independently. In 1963, President John F. Kennedy initiated the Community Mental Health Act, intended to end institutional abuses and create a system of community-based care.

The idea was that those released from the institutions would move back into neighborhoods, with easy access to a doctor, therapists, at-home services if needed. The money saved by closing the hospitals would be used to support independent living.