Across the United States, a concerning trend is emerging within mental health care policies: the resurgence of institutionalization, now rebranded as ‘modern mental health care.’
From Governor Kathy Hochul’s efforts in New York to expand involuntary commitments, to Robert F. Kennedy Jr.’s proposal for ‘wellness farms’ as part of his Make America Healthy Again (Maha) initiative, policymakers appear to be reviving the long-standing practices of confinement under the guise of care.
While these proposals take different forms, they share a troubling commonality: the expansion of state power to surveil, detain, and ‘treat’ marginalized populations deemed disruptive or deviant.
This trend reflects a deepening investment in carceral control over vulnerable communities, particularly those that are disabled, unhoused, racialized, and LGBTQIA+.
Throughout history, these communities have experienced how the label of institutionalization as ‘treatment’ obscures its violent past and current implications.
As a result, these policies ignore the potential of community-based solutions, undermine individual autonomy, and reinforce systems of confinement that they claim to move away from.
For instance, Hochul’s recent proposal intends to lower the criteria for involuntary psychiatric hospitalization in New York.
Under her plan, individuals may be detained not necessarily because they pose an immediate danger, but rather because they are perceived as unable to meet their basic needs due to a ‘mental illness.’
This vague and subjective standard paves the way for increased state control over unhoused individuals, disabled persons, and others who struggle to navigate systemic neglect.
In this context, Hochul’s proposal also expands the authority to initiate forced treatment to a wider range of professionals, including psychiatric nurse practitioners, potentially increasing the instances of forced commitment.
Additionally, this move requires practitioners to consider a person’s mental health history, effectively pathologizing past distress as justification for future detentions.
This is not a fringe policy; it is part of a growing wave of reinstitutionalization efforts across the country.
For example, in 2022, New York City Mayor Eric Adams directed police and emergency medical technicians to forcibly hospitalize individuals deemed ‘mentally ill,’ even in the absence of immediate danger.
Similarly, California Governor Gavin Newsom’s Care courts compel individuals into court-mandated ‘treatment.’
These initiatives are increasingly gaining traction at the federal level as well.
Kennedy’s Maha initiative advocates for labor-based ‘wellness farms’ to address homelessness and addiction, reminiscent of 20th-century institutional farms where marginalized populations were confined and exploited under the pretense of rehabilitation.
Recently, the U.S. Department of Health and Human Services (HHS) announced an extensive restructuring plan that will dismantle crucial agencies and centralize power under a new entity called the Administration for a Healthy America (AHA).
This aligns with RFK Jr.’s Maha initiative and former President Donald Trump’s directive for government efficiency.
The plan includes the merging of the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA), and other critical agencies into a centralized structure that claims to focus on chronic illness.
However, this move is perceived by many as the systematic dismantling of the specialized infrastructure that supports mental health, disability services, and resources for low-income communities.
The restructuring is already unfolding, leading to the elimination of around 20,000 jobs, the reduction of regional offices, and the dissolving of crucial programs aimed at supporting older adults and disabled individuals scattered across various agencies.
This strategy is not merely an administrative adjustment; it is seen as a deliberate dismantling of essential protections and support systems, cloaked in a narrative of efficiency and reform.
The cuts to SAMHSA threaten vital programs, including the 988 crisis line and opioid treatment access, raising concerns about the overall state of mental health care in the country.
These actions not only reflect financial austerity but are indicative of a broader governmental strategy designed to create confusion and reduce accountability.
By dismantling the very institutions responsible for advocating for the rights and needs of marginalized populations, the federal government appears to be facilitating a transition towards a more expansive and less accountable system of carceral ‘care.’
This new chapter of psychiatric control is being presented as a moral necessity by supporters, asserting a humanitarian obligation to intervene and aid those who are suffering.
However, coercive practices cannot be equated with care.
Research indicates that involuntary psychiatric interventions often lead to trauma, mistrust, and deteriorating health outcomes.
Forced hospitalization has been correlated with increased suicide risk and prolonged disengagement from mental health services.
Most critically, these policies often divert attention away from the root causes of distress—such as poverty, housing instability, criminalization, systemic racism, and a fractured healthcare system.
The argument for merely increasing psychiatric bed capacity is viewed as a misleading distraction from meaningful solutions.
What is needed instead is a paradigm shift towards collective care, emphasizing community well-being rather than coercion.
There are proven alternatives to institutionalization: housing-first initiatives, peer-led crisis response teams, harm reduction strategies, and voluntary community-based mental health services.
These models prioritize dignity, autonomy, and support over the surveillance and confinement consistently associated with traditional psychiatric institutions.
Liat Ben-Moshe suggests that prisons did not entirely replace asylums; rather, both systems have evolved in tandem to surveil, contain, and control marginalized individuals.
Presently, reinstitutionalization may be reemerging under a seemingly therapeutic guise, as indicated by proposals like ‘wellness farms’ and expanded involuntary commitments.
While the language has changed, the underlying logic remains rooted in surveillance, control, and confinement.
This juncture demands a proactive stance against the notion that confining individuals can be considered a form of care.
It is essential to identify these proposals for what they are: state-sanctioned containment strategies rooted in ableism, racism, and the fear of nonconformity.
True public health does not rely on coercion, nor does it necessitate the confinement of individuals or the pathologization of poverty.
It calls for addressing fundamental needs through housing, community care, healthcare, and support systems that are voluntary, accessible, and liberating.
As budget negotiations continue in New York and RFK Jr. promotes carceral care at the federal level, we face a pivotal decision: will we perpetuate the historical cycle of institutional violence, or will we strive to create a more just, autonomous, and collective future for mental health care?
The future of mental health care—and human dignity as a whole—depends on our response.
image source from：https://www.theguardian.com/commentisfree/2025/apr/27/psychiatric-incarceration-mental-illness
