In colonial times, people who couldn’t take care of themselves, including homeless children, the mentally ill, old folks suffering from dementia, and those we used to call mentally retarded, were lumped together as “the indigent.” There were no public facilities for them, so local communities would “board them out.” That meant turning them over to farmers and shopkeepers who put them to work without pay and who were usually given a small public stipend for their care. The result was that many were horribly abused — fed slop, housed in chicken coops, and that sort of thing. There are even documented cases of some of these helpless people starving or freezing to death.
Horrified, physicians and do-gooders beginning in colonial times created various small institutions for them: orphanages for children and hospitals for those with mental problems, mostly major cities. By the 1840s, as the country’s population swelled, so did the number of such institutions, most of them funded by the states.. However, they proved to every bit as horrible as the boarding out system.
Starting in the 1840s, reformers such as Dorothea Dix toured those for the mentally ill and exposed overcrowding, filth, and physical abuse. Many “patients” were even chained to walls. Given the state of medical knowledge at the time, there was no effective treatment, so these places were just huge warehouses, and few who were admitted ever left. When they died, many were buried in unmarked mass graves.
Dix and a number of others led a nationwide movement to create decent, publicly funded asylums to provide humane care. (Note the word asylum, a word whose connotation, at least back then, indicated a safe and peaceful place.) The matter largely faded from the public consciousnesses until the 1950s and 1960s, when journalists (including me in Rhode Island) investigated the asylums and found all the same old neglect and mistreatment. In Rhode Island in the early 1970s, I toured buildings where thousands of people, most drugged into a zombie state, slept on concrete floors and spent their days sitting in or wandering hallways, often sloshing barefoot through puddles of urine.
In many institutions, including Rhode Island, the worst wards were in buildings named for Dorothea Dix.
By then, the availability of new psychotropic drugs offered the hope that some of these people, or at least NEW patients who hadn’t been damaged by years of abuse, could be “deinstitutionalized.” Some, it was thought, could be managed at home by their families. And those who could not, it was believed, could be cared for in small “group homes” that would be located in neighborhoods and operated by professional staff.
If done right, it could well have worked. But in practice, it has proved largely to be a return to something akin to the colonial boarding out system. It has failed miserably. Why? The group home system was never properly funded, nowhere near enough of them were created, some were operated by people who cared only for state money, and lots of folks objected to group homes in their communities.
So now, many who would once have been institutionalized sleep on the streets.
Today, some are advocating a return to the asylum system that was long ago proven to be a failure. It failed because of under-funding and lack of public oversight, but I see no reason to believe that there is a public will to do it right this time. And some of those who advocate bringing it back are concerned more about unsightly people on the streets than about taking proper care for them.
Meanwhile, it should be pointed out, at this point, that many of the homeless are NOT mentally ill or mentally deficient. Many are just people who can’t afford a place to live because they lost their jobs, are mired in addiction, or lack the skills to work in a modern economy. And I don’t hear anybody proposing a workable and humane way to handle them, either.
Meanwhile, the problem of homeless children was addressed earlier and somewhat more effectively with the creation of the foster child system. That has worked better than anything we have done for the mentally ill, but it still has significant and well-documented problems.