Why Deinstitutionalization Failed: The Unintended Consequences Revealed in ‘No One Cares About Crazy People’

From Asylums to the Streets: The Broken Promises of Reform

Deinstitutionalization was supposed to be a revolution in mental health care. The idea was simple: close the asylums, and provide care in the community. But as Ron Powers documents, the reality was far more complicated—and tragic. With the closure of state hospitals, hundreds of thousands of people with severe mental illness were released, often with little more than a bus ticket and a list of shelters. The promised network of community mental health centers never materialized at scale.



The consequences were immediate and severe. Homelessness rates soared, and jails became the new asylums. Powers shares stories of individuals cycling through emergency rooms, jails, and the streets, unable to access consistent care. Families were left to fill the gaps, often at great personal and financial cost. The book highlights the policy failures, the lack of funding, and the political indifference that allowed this crisis to unfold.

Powers also points to solutions: integrated care models, housing-first initiatives, and the need for sustained advocacy. He argues that reform must be holistic, addressing not just medical needs but also housing, employment, and social connection.



‘No One Cares About Crazy People’ is a sobering reminder that good intentions are not enough. Real change requires commitment, resources, and a willingness to learn from the past.