Beyond Prisons, Mental Health Clinics

Vanishing Services

At the same time as these institutions shut across the state, the city of Chicago, under the watch of Mayor Rahm Emanuel, shut down six of twelve public mental health clinics in 2012.⁷ Cuts to Chicago’s public housing that began during the mid-1990s ramped up.⁸ In 2013, Chicago’s unelected school board voted to close fifty public schools, affecting approximately forty thousand students primarily in Black and Brown communities on the west side. Since 2001, more than 150 public schools in low-income Black and Brown communities across Chicago closed or restructured—harming neighborhoods and displacing the “problem” of “low academic achievement” back onto communities and young people.

The shuttering of public institutions that regulate the lives of the most marginalized communities is an uneven, but strong, nationwide trend. A 2012 report by The Sentencing Project states: “In 2012, at least six states have closed 20 prison institutions or are contemplating doing so, potentially reducing prison capacity by over 14,100 beds and resulting in an estimated $337 million in savings.”⁹ Between 2010-2011, 1,069 public schools closed, primarily in urban communities of color across the nation.¹⁰ Public housing vaporized, losing a quarter million housing units over the last decade, according to political scientist Edward G. Goetz, author of New Deal Ruins: Race, Economic Justice, and Public Housing Policy.¹¹

Ending Confinement—or Just Cutting Funds?

Through one lens, today’s closures suggest to some observers that the prison nation is retreating—loosening its grip on those it has historically targeted for surveillance, confinement, and punishment. Natasha Frost, Associate Dean at Northeastern University’s School of Criminology and Criminal Justice, even went so far as to state in the New York Times in 2013, “This is the beginning of the end of mass incarceration.”¹²

Yet if imprisonment is understood to include other sites of enclosure like psychiatric hospitals and large state institutions for people with disabilities,¹³ then the decline in incarceration began in the 1960s. In 1955, the state mental health population was 559,000, nearly as large (if measured on a per capita basis) as the prison population today. By 2000, it had fallen to below 100,000.¹⁴ In addition, by 2011, eleven states had closed all state-operated institutions for people with intellectual/developmental disabilities.¹⁵

The earlier exodus of people identified with mental and physical disabilities from state institutions was the result of two things: policy that aimed to cut funding to these public facilities, and massive organizing. Deinstitutionalization of those labeled as mentally ill or intellectually disabled during that era was fueled by grassroots mobilization by those most affected by the problems within institutions, as well as shift in professional opinion, major exposés of abuse, and activism (including in the legal arena) by family members of those with disabilities. For instance, in 1979 self-advocates (people with intellectual disabilities who engage in advocacy) in Nebraska held a press conference stating that all institutions should be closed and that people with disabilities have the right to live freely in communities of their own choosing.¹⁶ Although rationalized by the argument that people with disabilities need not be segregated from their peers in order to have access to the supports they need, these earlier waves of de-institutionalization coincided with emergent shifts in governance—notably the privatization of public entities—and provided a prototype for future closures of all kinds of state institutions.

Today, states grapple with decarceration and deinstitutionalization, not necessarily because of an ethical recognition of the continuing harm of confinement and segregation, or because of an understanding of the intertwined histories of capitalism, white supremacy, ableism, and punishment in the United States, but because of a desire to curb public spending on social services. These include the very services that people need as alternatives to more oppressive edifices and as preventive measures to winding up in such places. While public neighborhood urban schools, public housing, and mental health clinics are shuttered, private companies and “not for profit” services partially fill the void.

Reagan’s Harsh Legacy

Earlier forms of “downsizing”—deinstitutionalization movements in particular—offer an important window into our current political moment. They also offer a warning about the importance of thinking more critically about human capture and confinement and the use of public dollars. Populations in psychiatric hospitals began to plummet in the 1950s; deinstitutionalization in mental health was in full swing by the 1970s, when Reagan became the Governor of California and decided to close down all the state hospitals.¹⁷ Hardly a champion of the oppressed, Reagan referred to institutions housing people with mental disabilities in California as “the biggest hotel chain in the state.” Not only did this characterization neatly obscure the squalid conditions inside public facilities, but “fiscal responsibility” masked the (imagined and real) possibilities for profit through privatization. While there were possible positive outcomes—for instance, the benefits of living in the community with supports and not in large state run institutions—few to none of the local necessary community services were supported, either financially or ideologically.

Earlier waves of deinstitutionalization invoked efficiency and the imperative of shrinking big government—both pillars of neoliberalism—and yet many of these developmental centers and psychiatric hospitals were converted into public prisons shortly afterwards. For example, by 2011, Illinois had closed eight mental health hospitals and institutions for people with intellectual disabilities, two of which became correctional facilities and one a women’s prison.¹⁸ Far from shrinking big government, these public facilities were repurposed for other forms of human captivity.

As political actors like Reagan began to champion closing the “hotels” of the state and argued for the end to “big government”—and indeed public resources for housing, healthcare, and social services shrank—support for policing and prisons grew. The era of the “carceral big government” exploded as the welfare state morphed into a more punitive set of institutions.

It is important to note that big government did not decline as Reagan’s “hotels” shut their doors. The shrinkage of the safety net from the Reagan era to the nineties, coupled with an expansion of corrections, created a trade-off between social services and incarceration. In Punishing the Poor, sociologist Loïc Wacquant documents that in 1980 public housing received federal funding of 27.4 billion dollars, while the federal budget for corrections was 6.9 billion (not including spending on police or courts). By 1990, funds for public housing had been reduced to 10.6 billion dollars, while the corrections budget rose to 26.1 billion (and then almost doubled again by 1995).¹⁹ In essence, by the nineties, resources for jails and prisons exceeded support for public housing programs in the U.S., at a moment when housing assistance was especially needed because of the reduced economic support for poor families.

A Chance to Reinvest

Today, closures of mental health clinics and schools in Chicago are not necessarily leading to the rise of penal “big government,” as rebalancing also includes cuts in prison spending. As with earlier deinstitutionalization movements, this is an opportunity for jubilation but also a time for analysis and radical activism. While the rhetoric of the earlier era was (and for many still is) that “big government” must be dismantled, in reality the government did not shrink—nor did people necessarily become freer. Today, even as prisons are included in these forms of “downsizing,” without public investment in public services—neighborhood schools, housing, and health services—racialized and ableist forms of capture and confinement continue.

In this current moment of state supported institutional closures, learning from earlier organizers’ engagements with the state’s deinstitutionalization initiatives is crucial. As early as the 1970s, disability advocates recognized that the devil was in the details. The closure of an institution did not mean the budget of that institution was then transferred to community services.

Closures didn’t automatically translate into people’s liberation or the end of confinement. Monies that had been utilized for the care of people with disabilities either disappeared from the budget altogether or remained for the upkeep of institutions, even those with a very small number of residents. Former Commissioner of the Massachusetts Department of Youth Services Jerome Miller, who closed down all juvenile detention centers in Massachusetts in the 1970s, observed that when institutions began to close in New York State and Pennsylvania, while thousands of patients were left with little housing or treatment options in the community, the budget for the depopulated hospitals actually increased (at the beginning stages of deinstitutionalization). Miller notes that although most ‘mental patients’ left the institutions in past decades, the staff, resources, and budgets remained tied to the institution and not available for community use.²⁰

Alternatives emerge when facilities shut their doors. Closures, as prison justice organizer Angela Davis suggests, provide an opportunity for not only a “radical imagining” of the kind of social landscape desperately needed—but also the moment to build it. As people move between different forms and scales of cages, and as patterns of surveillance and punishment morph, new forms of capture do emerge and yet resistance is also possible. The state often refuses to offer services in place of the ones that were shuttered, leaving the responsibility to the individual (or her family and the market). This is a moment to collectively demand, fund, and build public infrastructure that will move everyone closer towards a world that does not rely on segregation and confinement, or access to private capital, as its mode of dealing with structural inequities.