The Rise and Fall of the Asylum

Aerial view of St. Elizabeths Hospital’s west campus in 2015. (US Coast Guard/via Wikimedia)
Dr. E. Fuller Torrey discusses the unintended consequences of emptying out mental hospitals, and how we can do better today.

NRPLUS MEMBER ARTICLE T he president’s budget proposal includes the repeal of Medicaid’s IMD (Institutes for Medical Diseases) exclusion, a Johnson-era policy that withholds federal Medicaid monies from residential adult psychiatric facilities with 16 or more beds. In 1965, Congress incorporated the exclusion in the seminal Medicaid statute for two distinct purposes: first, to honor the spirit of the late John Kennedy’s 1963 Community Mental Health Act, which called for the large-scale depopulation of American asylums, and second, to ensure that states retained a role in funding those state mental hospitals, whose maintenance had been a state responsibility for more than a century. The


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