Washington, DC, January 9, 2024 --  

American cities are falling into lawlessness. Reviving mental hospitals may help reverse the trend.

The disheveled men and women of Eastern Market park are a volatile bunch. On weekday mornings they start out quiet, patiently waiting for appointments at the drug addition and mental health clinic across the street. The park starts the day swept clean by the Capitol Hill Business Improvement District. By mid-day, fentanyl dealers set up shop underneath trees on the plaza. By late afternoon, men are passed out on paths covered with litter. Loud, obscenity-filled arguments break out between groups of people loitering in the plaza. At night, the plaza mostly empties, as some return to their homes, and others sleep in doorways or underneath the Southeast Freeway.

Residents of the affluent Capitol Hill neighborhood surrounding the plaza try to avoid the drama as they walk to the Metro station entrance on the corner. A $14 million renovation of the park, completed in 2021¹, intersected with both the Covid pandemic and opioid epidemic, turning the area into an outdoor drug den. Police and city leaders chose to look the other way. Charles Allen, the city councilman for the neighborhood, answers resident safety concerns by telling them to have sympathy for "victims experiencing addiction."²

Such misguided sympathy amounts to deadly enablement. Allowed to purchase and publicly ingest sometimes lethal fentanyl does with impunity, addicts are then revived from overdoes by the anti-opioid Nalaxone obtained over-the-counter at pharmacies, from vending machines at fire stations, or from paramedics. Those revived are left on the streets to do it all over again. In 2022, 461 people died of overdoses in Washington, DC. Deaths for 2023, only published thorough July, are at similar levels.³

Washington DC is not alone. San Francisco, Portland, Los Angeles, San Diego and New York also struggle with lawless spaces taken over by addicts and the mentally ill. Lesser problems dating back decades were inflamed by three major events: first by the spread of synthetic opioids to urban areas, then by the Covid pandemic that relaxed law enforcement, and finally by protests against police brutality in the wake of the George Floyd murder. That latter movement was a blow to police morale, and DC and other forces have since been severely understaffed. The police now ignore criminal acts they consider low priority like public drug use and disturbing the peace.

Not all jurisdictions are giving in to lawlessness. In New York City, Mayor Adams directed police to remove the mentally ill from the streets -- a population that has significant overlap with illicit drug users. His has been forcing them into psychiatric hospital beds, despite limited capacity.⁴ In California, Governor Gavin Newsom pushed thorough new laws allowing forced treatment for addicts and the mentally ill, but nearly all California counties have delayed implementation until 2026.⁵

It's not just Democrats seeking reforms. In the U.S. Congress, GOP Rep. Michael Burgess introduced a bill to allow Medicaid to pay for in-patient mental health services, a change that would provide funding for the re-institutionalization plans pushed by Adams and Newsom. This passed the House on December, and has bi-partisan support in the Senate.⁶

Resistance stems from the left's concern that involuntary commitments violate civil liberties. Abuses were widespread in mid-20th century mental hospitals, and public opinion turned against them after the 1962 novel One Flew Over the Cuckoo's Nest (later made into a Broadway play and motion picture). In 1965, Congress banned Medicaid banned payments for in-patient psychiatric treatment, triggering the decline of the institutions.

Today, most mental hospitals are gone. Between 1970 and 2014 the number of patients hospitalized for psychiatric care dropped from 470,.000 to 170,000⁷ despite American population growth of over 60 percent. Per-capital mental health hospitalizations fell by 75 percent over this period.

Clearly, the decline in psychiatric hospitalization has gone too far. Changes in the law and public funding are not enough. Since few mental hospitals still exist, new treatment centers with adequate capacity must be built without repeating the mistakes of the past.

Concerns over civil liberties for those forced and confined to treatment must be addressed. Unfortunately, the Adams and Newsom plans do not do enough to address them.

Adequately protecting rights means limiting commitments to people convicted of breaking the law. Since laws on the books typically prohibit the regular activities of addicts and the mentally on the streets (the same laws that police choose not to enforce) simply enforcing existing laws may be sufficient.

The community-based mental heath system envisioned in the 1960s has failed. America has traded half a million people confined to abusive mental hospitals for an even larger number living on the streets, tens of thousands dying each year from drug overdoses, and the abandonment many parts of our cities to lawlessness. This must not continue. For politicians who resist reform, it's high time for voters to show them the door.

Related Web Columns:

Not Over Yet, November 7, 2023

Brazenly Criminal, May 2, 2023

Urban Migration, September 11, 2018

Notes:

1. DC Department of General Services, Eastern Market Metro Park Project, as posted January 9, 2023

2. Barracks Row Safety Walk, as witnessed by author, October 25, 2023

3. DC Office of the Chief Medical Examiner, Opioid-related Fatal Overdoses: January 1, 2017 to July 31, 2023, October 23, 2023

4. New York Times, New York City to Involuntarily Remove Mentally Ill People From Streets, November 29, 2022

5. Calmatters, ‘You Have a Crisis Out There’: Gavin Newsom Scolds Counties Over Delays in Mental Health Law, December 16, 2023

6. Politico, Mental hospitals Warehoused the Sick. Congress Wants to Let Them Try Again., January 1, 2024

7. National Association of State Mental Health Program Directors, Trend in Psychiatric Inpatient Capacity, August 2017