The community mental health services movement actually started in the 60s, and coincided with a deinstitutionalization movement that you can tie to general soci

The community mental health services movement actually started in the 60s, and coincided with a deinstitutionalization movement that you can tie to general social progressive policies during that time (civil rights etc). The idea (rightly so imho) was to destigmatize mental health, and to move to a model of reintegration, and not route people into institutionalization where they couldn't get out. This model declined during the 80s, and to a lesser extent 90s, for many many reasons. One is defunding, so you ended up in a situation where the institutions closed, but then as part of general government defunding (ala Reagan and post-Reagan trends), the community mental health services closed. Another issue that's probably less apparent is the neo-Kraepelinian movement in psychiatry that started in the 70s and accelerated during the 80s kind of was at odds with with the community services model. It allowed for treatments (think antipsychotics) that allowed people to leave institutions, but I think boxed in thinking about psychiatric care during subsequent decades. "Psychopathology as a medical illness" when it works in extreme cases is good at getting people out of residential institutions, but then is bound to a hospital-patient model that the US isn't very good at getting out of. So at the same time psychiatry was succeeding at getting people out of institutions through a biomedical model of psychiatry, it was kind of failing by neglecting the sociocultural side of psychiatry. So people get out of institutions because of effective medications, but then when they're out there, they're tied to hospitals for care and not community centers as they were originally envisioned. Basically, community-based care works, but requires a certain amount of infrastructure like anything, and it's been neglected to some extent because of biases in the healthcare system. It's also difficult once you recognize that psychiatric difficulties are bound up in very big socioeconomic structural issues that require a lot of political will to change, and if you don't, it incentivizes a head-in-the-sand kind of reaction. I wouldn't be surprised if there was a return to interest in these kinds of decentralized care models for various reasons in the coming decades, but it's hard to say. I think it's unfair to tie community mental health service trends to Reagan in particular, but I do think to the extent you attribute certain trends in public and government service funding to Reagan, it's accurate to say that Reagan-era trends were one contributor to problems. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266763/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266763/