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THE US IS WITNESSING THE RETURN OF PSYCHIATRIC IMPRISONMENT  
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Jordyn Jensen
April 27, 2025
The Guardian
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_ From ‘wellness farms’ to expanded involuntary commitment
policies, the US is embracing psychiatric incarceration under the
guise of compassion _

View image in fullscreen ‘What we need is a complete paradigm shift
– away from coercion and toward collective care.’,

 

Across the country, a troubling trend is accelerating: the return of
institutionalization – rebranded, repackaged and framed as “modern
mental health care”. From Governor Kathy Hochul’s push to expand
involuntary commitment
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New York to Robert F Kennedy Jr’s proposal for “wellness farms”
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his Make America Healthy Again (Maha) initiative, policymakers are
reviving the logics of confinement under the guise of care.

These proposals may differ in form, but they share a common function:
expanding the state’s power to surveil, detain and “treat”
marginalized people deemed disruptive or deviant. Far from offering
real support, they reflect a deep investment in carceral control –
particularly over disabled, unhoused, racialized and LGBTQIA+
communities. Communities that have often seen how the framing of
institutionalization as “treatment” obscures both its violent
history and its ongoing legacy
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In doing so, these policies erase community-based solutions, undermine
autonomy, and reinforce the very systems of confinement they claim to
move beyond.

Take Hochul’s proposal
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which seeks to lower the threshold for involuntary psychiatric
hospitalization in New York. Under her plan, individuals could be
detained not because they pose an imminent danger, but because they
are deemed unable to meet their basic needs due to a perceived
“mental illness”. This vague and subjective standard opens the
door to sweeping state control over unhoused people, disabled
peopleand others struggling to survive amid systemic neglect. Hochul
also proposes expanding the authority to initiate forced treatment to
a broader range of professionals – including psychiatric nurse
practitioners – and would require practitioners to factor in a
person’s history, in effect pathologizing prior distress as grounds
for future detention.

This is not a fringe proposal. It builds on a growing wave of
reinstitutionalization efforts nationwide. In 2022, New York City’s
mayor, Eric Adams, directed police and EMTs to forcibly hospitalize
people deemed “mentally ill”
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even without signs of imminent danger. In California, Governor Gavin
Newsom’s Care courts compel people into court-ordered
“treatment”
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Now, these efforts are being turbocharged at the federal level. RFK
Jr’s Maha initiative proposes labor-based “wellness farms” as a
response to homelessness and addiction – an idea that eerily echoes
the institutional farms
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the 20th century, where disabled people and people of color were
confined, surveilled and exploited under the guise of rehabilitation.

Just recently, the US Department of Health and Human Services
(HHS) announced a sweeping restructuring
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will dismantle critical agencies and consolidate power under a new
“Administration for a Healthy America” (AHA). Aligned with RFK
Jr’s Maha initiative and Donald Trump’s “department of
government efficiency” directive, the plan merges the Substance
Abuse and Mental Health Services Administration (SAMHSA), the Health
Resources and Services Administration (HRSA) and other agencies into a
centralized structure ostensibly focused on combating chronic illness.
But through this restructuring – and the mass firing of HHS
employees
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the federal government is gutting the specialized infrastructure that
supports mental health, disability services and low-income
communities.

The restructuring is already under way: 20,000 jobs have been
eliminated
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regional offices slashed, and the Administration for Community Living
(ACL) dissolved its vital programs
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older adults and disabled people scattered across other agencies with
little clarity or accountability. This is not administrative
streamlining; it is a calculated dismantling of protections and
supports, cloaked in the rhetoric of efficiency and reform. SAMHSA –
a pillar of the country’s behavioral health system, responsible for
coordinating addiction services, crisis response and community mental
health care – is being gutted
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threatening programs such as the 988 crisis line and opioid treatment
access. These moves reflect not just austerity, but a broader
governmental strategy of manufactured confusion
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By dissolving the very institutions tasked with upholding the rights
and needs of disabled and low-income people, the federal government is
laying the groundwork for a more expansive – and less accountable
– system of carceral “care”.

This new era of psychiatric control is being marketed as a moral
imperative. Supporters insist there is a humanitarian duty to
intervene – to “help” people who are suffering. But coercion is
not care. Decades of research show that involuntary (forced)
psychiatric interventions often lead to trauma, mistrust
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poorer health outcomes
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Forced hospitalization has been linked to increased suicide risk
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long-term disengagement from mental health care. Most critically, it
diverts attention from the actual drivers of distress: poverty,
housing instability, criminalization, systemic racism and a broken
healthcare system.

The claim that we simply need more psychiatric beds is a distraction.
What we need is a complete paradigm shift – away from coercion and
toward collective care. Proven alternatives already
exist: housing-first initiatives
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and peer-led crisis response teams
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reduction programs [[link removed]],
and voluntary, community-based mental health services
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These models prioritize dignity, autonomy and support over
surveillance, control and confinement.

As Liat Ben-Moshe argues
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not simply replace asylums; rather, the two systems coexist and
evolve, working in tandem to surveil, contain and control marginalized
populations. Today, reinstitutionalization is returning under a more
therapeutic facade: “wellness farms”, court diversion programs,
expanded involuntary commitment. The language has changed, but the
logic remains the same.

This moment demands resistance. We must reject the idea that locking
people up is a form of care. These proposals must be named for what
they are: state-sanctioned strategies of containment, rooted in
ableism, racism and the fear of nonconformity.

Real public health does not rely on force. It does not require
confining people or pathologizing poverty. It means meeting people’s
needs – through housing, community care, healthcare and support
systems that are voluntary, accessible and liberatory.

As budget negotiations in New York
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– with expansions to involuntary commitment still on the table –
and as RFK Jr advances carceral care proposals at the federal level,
we face a critical choice: will we continue the long history of
institutional violence, or will we build something better –
something rooted in justice, autonomy and collective wellbeing?

The future of mental health care – and of human dignity itself –
depends on our answer.

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_Jordyn Jensen is the executive director of the Center for Racial and
Disability Justice [[link removed]] at Northwestern
Pritzker School of Law_

* mental health
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* Criminalization
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* incarceration
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* homelessness
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