President Donald Trump speaks to reporters from the South Lawn of the White House in Washington, D.C., August 21, 2019. (Tasos Katopodis/Reuters)

There are reports circulating that President Trump’s advisors are looking at ways to effectuate his call to “open up institutions” for the most seriously mentally ill in response to recent mass shootings. The standard army of “mental health experts” are out in force, expressing the same breathless canon of “concerns” to credulous journalists all-too-eager to “debunk” the president.


Glenn Liebman, the chief executive of Mental Health America’s New York chapter, asks (and proceeds to answer, because there’s only one acceptable answer to the question he asks): “Do we need more funding for mental health? Of course. But the funding for mental health shouldn’t be going back to the past and saying that we should be building more institutions. We need less [sic] institutions and more community money.”

What “past?” This is tired– no one is advocating for a full-throated return to the days of “snake pits” and insulin shock. If one imagines things like a pendulum, and the days of mass institutionalization which Mr. Liebman and I both find imprudent are considered on the one hand, consider how far things have swung in the other direction:

The institutionalized population Liebman’s home state has fallen over 97%, from roughly 93,300 in 1955 to 2,300 in 2017. And the decline is similar across the country– states are consolidating their once-extensive networks of hospitals down to levels unseen since the 1850s, and the rates 0f incarceration and homelessness among the most severely ill have skyrocketed in their stead. The typical resident left in the sort of facility that Liebman insists–and this is remarkable– requires less investment, is one so profoundly debilitated by psychosis, a mood disorder, or other condition that no “community” placement would be safe, either in the short or long run. The Glenn Liebmans of the world– the “community mental health” advocates, the “experts” anonymously cited in every breathless anti-stigma piece, the ones who claim, in contravention of all evidence to the contrary, that mental illness is unrelated to violence, the ones who advocated for the mass exodus from the state hospitals in the name of liberation– have gotten almost everything they’ve asked for. The “asylums” are shells of themselves. You can’t get committed there, in many cases, until it’s too late. As DJ Jaffe says, it’s harder to get into Bellevue than Harvard.


I worry that the president will make this issue toxic, because whatever his virtues, Donald Trump is not a man of tact or nuance. This is a matter of great importance to people who are voiceless in a debate that, too often, involves questions of life or death– is there a bed for my schizophrenic son in the state hospital? But with a class of “mental health experts” wont to pretend that failure is success and loath to address the substance of the crisis, maybe the brash real estate mogul is the last best hope that someone will, to use that most tired phrase, “do something.”