The Regan Era: Impact on Long-Term Mental Health Care

I often hear that the government promised to provide funding for community health centers, but it didn't happen. This is accurate, and there are many reasons behind it. For example, during the Reagan administration, Medicare's funding for long-term mental health care changed dramatically. Before Reagan's administration, Medicare covered long-term mental health care. However, during his tenure, Medicare refused to fund long-term care for patients, forcing many to either bear the costs themselves or be released after a short stay. Many could not afford the expensive long-term care, leading to a significant decrease in long-term care facilities.

Medicare's Shift and Its Consequences

During the Reagan administration, there was a shift in how Medicare funded long-term care. It was initially funded, but under Reagan's leadership, this changed. Many patients who required long-term care found themselves unable to access it due to the financial burden. With the closing of long-term care facilities, many were forced to leave and fend for themselves, often without the necessary care.

California and State Mental Hospitals

In California, there was a promise to transform the State mental hospital system into a network of community mental health centers. However, this promise never materialized. For example, in 1972, as Mendocino State Hospital was preparing to close, I was working as a crisis counselor at the Berkeley Free Clinic. We were told that at least one-third of the inmates would be given a bus ticket to Berkeley, where they could seek assistance.

Those who received the bus tickets often found it difficult to reintegrate into society. Many of them would start talking to street lights or other inanimate objects, leading to the intervention of law enforcement. It was clear that the transition to community care was not as smooth as planned, and many patients ended up needing long-term care more than ever.

The Proliferation of State Hospitals

There were several state hospitals like the Illinois State Hospital in Manteno that were closed under Reagan's policies. Not all of these institutions housed only the mentally ill. Many were also home to individuals who were mentally retarded or had other conditions. If their families could no longer care for them, they were placed in these institutions.

When the homeless are discussed, it's important to consider that many once had homes. The closure of state hospitals led to a significant number of individuals who were released without a safety net, contributing to the rise in homelessness. The shift from institutional care to community-based care was well intentioned but often ill-equipped to handle the true needs of those with long-term mental health issues.

Legal and Legislative Changes

There were also court cases, such as Rostker v. Goldberg, that challenged the constitutionality of keeping people locked up against their will when they were not a threat. In response to these rulings, Congress and Reagan reduced the institutionalized population. The government could not simply lock up people who had not committed any crimes, which was seen as a positive step towards personal freedom.

However, the decision to reduce the population of the institutionalized came at a cost. When someone like a mentally ill individual who had committed minor crimes was released back into society, there was no support for them. This led to a situation where some individuals who should not have been released were, and that became a concern. While the government recognized the need for more support, legally, it was challenging to draft legislation that would protect the safety of the public without infringing on the rights of those with mental health issues.

Today, the debate continues about how best to support long-term mental health care. While community health centers are essential, the structural and financial support needed to make this transition successful is often lacking. The legacy of the Reagan era in mental health care is a complex issue that affects countless individuals and families.

Keywords: Reagan, Mental Health Care, Medicare, Community Health Centers, Patient Rights