Re-Open the Asylums: A New Take

Main Stairwell at Weston State Hospital, Weston, West Virginia. Photo by Richie Diesterheft from Chicago, IL, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons

The Jordan Neely case was a divisive one. Some think that Daniel Penny was a hero who stopped a dangerous possible offender; others think he coldly murdered a black man. Penny was acquitted by a jury in December 2024, though the court of public opinion is more divided. One thing, however, links those who support and reject Penny — their belief that Neely should not have been on that train.

Neely suffered from severe mental health issues that included schizophrenia. He had been institutionalised before, but this did not stick. When offered fifteen months in supportive housing and treatment, Neely left after three days. This was not followed up. Neely also had forty-two arrests, including one for punching a sixty-seven year-old lady. People argue that Neely should have been either in treatment or in prison.

What one often sees on social media is the cry of ‘re-open the asylums’ or ‘bring back institutions.’ This is in response to what seems to be a growing number of mentally ill, often homeless people, causing chaos and even crime on streets and public transport. Videos show men and women talking to themselves, shouting, menacing passengers and even sometimes assaulting them. We don’t have exact numbers, but the presence of social media makes it seem as though it was a common problem. Even if it’s uncommon, it’s too common.

One only has to look at Michelle Go, an innocent woman thrown to her death on the New York Subway in 2022 by a schizophrenic man. Only recently, a man miraculously survived a similar fate. Both pushers had a history of mental illness and criminal activity, with some believing that Go’s murder was an anti-Asian hate crime. Advice to stay away from the platform edge and avoid eye contact doesn’t always work, as seen in another recent stabbing case.

Is this an easy solution, or a solution at all? Let’s explore.

History of institutions

Throughout most of history, mental health institutions — or asylums as they were commonly known — were a subject of horror. As mental illness was a great taboo, and generally misunderstood, those suffering were at the mercy of a society that did not care. The wealthy and the lucky could be cared for at home, such as Sarah Shelton, the wife of Patrick Henry. Henry kept his wife at home, aware of the poor conditions of 18th century asylums. Those who were poor or had less understanding relatives were sent to asylums, sometimes from birth in the case of those with conditions such as Down’s syndrome.

It was relatively easy to place someone in an asylum, especially a woman. Elizabeth Packard was cruelly and wrongly placed in an asylum by her husband because she disagreed with him and his controlling nature. Packard was inside for three years, and whilst she won her freedom, she lost everything including her children due to the laws at the time. Another victim was Mary Todd Lincoln, who was institutionalised after what was a sham trial, and released after being helped by lawyer friends.

Asylums were notoriously poor in condition. Patients underwent convulsion therapy and lobotomies, were restrained for twenty- four hours a day. Rape, assault and deaths were common place. People could remain there for decades before dying of old age.

Things started to slowly change. Two prominent women involved in this were Dorothea Dix and Nellie Bly. Dix was a nurse and reformer whose advocacy for the mentally ill led to the creation of the first proper asylums in the United States. She even met Pope Pius IX and greatly impressed him. Several years later, ambitious journalist Bly pretended to be mentally ill and had herself placed in an asylum for ten days before being released. Her book ‘Ten Days in a Mad House’ scandalised society and helped reform efforts.

Even so, conditions remained poor throughout the next decades. President John F. Kennedy signed the Community Mental Health Act 1963. This pushed towards deinstitutionalisation, though the aim was to fund care in the community. Two years later, the now-late president’s brother toured the Willowbrook State School, an institution for intellectually disabled children, and was horrified by the conditions. Several more prominent figures investigated it over the years. In 1972, Geraldo Rivera’s investigation opened up the scandal to a new audience. Willowbrook was closed in 1975.

Deinstitutionalisation continued on well after the Kennedy administration. Ronald Reagan for example championed the issue both as Governor of California and President of the United States, such as when he repealed the Mental Health Systems Act of 1980. Other presidents such as Richard Nixon pushed for the law, and even healthcare reformers such as Bill Clinton preferred a community-based approach.

The Law

Federal, state and local laws have also traditionally favoured community care and opposed involuntary commitment. A landmark Supreme Court case in 1975 — O’Connor v Donaldson — ruled that it was unconstitutional for anyone not an immediate danger to themselves, or with a good support system, to be committed. In 1999, Kendra’s Law was introduced in New York state. Kendra Webdale was killed after being pushed in front of a train by a schizophrenic man off his meds. Kendra’s Law could mandate outpatient treatment for those meeting certain criteria, with an option of a seventy-two hour psych hold, but did not force medication or institutionalisation.

Another prominent figure in the anti-institutionalisation movement was Joyce Brown. New York Mayor Ed Koch introduced a programme of involuntary commitment in 1987. Brown was a forty year-old woman with a history of homelessness, schizophrenia and upsetting behaviour. She was the first person to be committed under the ruling, and immediately fought it. Brown won, and was eventually released. She alternated between the streets and group homes until her 2005 death.

The healthcare and civil rights groups also support the idea. Medicaid refuses funding for mentally ill individuals aged twenty-one to sixty-four in settings with more than seventeen beds. The ACLU also consistently fights against involuntary commitment and institutionalisation, having been a key ally of Kenneth Donaldson and Joyce Brown.

The Debate

The debate regarding institutionalisation and involuntary commitment rages on. The people you would think least likely to support it — liberals in areas like NYC and San Francisco — seem to be so frustrated with the system that they are inclined to agree with it.

Firstly, one must factor in liberty and safety. If a person is involuntarily committed, is it for genuine reasons — i.e, are they a risk to themselves and/or others, whether immediately or potentially? Do they suffer from an illness that cannot be safely managed in the community? Can they not be trusted or are unable to take medication outside of a controlled setting? Are those pushing for commitment doing so free of any ulterior movement such as financial gain or cruelty? Does the person being committed have certain rights?

Inside, are they free of coming to any harm from service providers? Are they treated in accordance with laws and modern medicine? Do they have someone to advocate for them, whether they are a friend, relation or someone mandated by law?

Secondly, what are their options outside of the facility? We must consider the homeless for example. Homelessness is a major problem in major US cities for a variety of reasons. If one is talking about the issue on the sole basis of rental and housing prices, it’s easy to see why. The average rent for a studio or one-bedroom apartment in NYC is $3,127 and $3,860 per month respectively. Those numbers are $2,251 and $2,906 in San Francisco, $1,692 and $2,159 in Los Angeles and $1,486 and $1,843 in Chicago. That’s not cheap. When it comes to shelters and group homes, many homeless people are reluctant to stay. Why? Well, many facilities require sober living, which means alcoholics and drug addicts cannot continue their habits. There are also curfews and rules. You cannot take your possessions, and there are risks of violence and sexual assault.

Can one afford to take medication outside of these institutions? Medicaid may be restrictive, and prices can vary depending on insurance. Even if they can afford it, will they take it? Do they have a support system? Even those who do may find that family members will not or cannot help them.

We also must look at the cost to the state. Taxes are already high in major cities, as is the cost of living, and adding to that is rather unpopular. If they do have the money, then it’s fair to say that we can’t trust the government to spend it properly. These institutions need proper staff, including medical professionals. There is a massive shortage of psychiatrists in the United States and medical students can’t be forced to pick it as a specialty.

Finally, we must factor in that not every crime on the subway is a mental health issue, and that mental illness is not necessarily an excuse for crime. Take for example the horrific murder of Debrina Kawan on the New York Subway, in which an illegal migrant set her on fire and watched her burn. There is no indication that the murderer was suffering from any mental illness that would have clouded his judgement.

The Conclusion

I’m not a subway user, or even an American. I can not know for sure how bad things are, though this does happen here in the UK — a schizophrenic man was recently given an indefinite hospital order after attacking three men on London transport. That being said, the average worker deserves to be able to travel without risk of harassment and crime. The streets and public transport system are not a dumping ground for the mentally ill. It is imperative that we balance compassion with realism and public safety. Not every mentally ill person is at risk of killing someone — indeed, they are more likely to be a victim of a crime than to commit it. That being said, it still happens. Not every homeless person would bite your hand off to have a warm meal and a roof over their head. We must talk about crime, addiction, illness and everything else.

Should America launch its asylum doors open again? That’s not for me to say. Whatever I think, it seems that support for it is slowly rising. There’s a lot to consider and I hope that whatever happens, it works.