Just like with mental health care (a noted contributing cause), the undeniable truth is that state and local governments are to blame for deteriorating quality

Just like with mental health care (a noted contributing cause), the undeniable truth is that state and local governments are to blame for deteriorating quality of life, not the federal government. The states are piggybacking off Medicaid and SSI to house the insane in the community (pseudo-institutions pretending not to be) as a fraudulent and deadly workaround to the IMD exclusion, often backed by the imperial judiciary. SSI pays the rent, Medicaid pays the "community services", and Olmstead gives political cover. Everyone loses, not just those with SMI, but the addicted, the non-addicted poor, and everyone else using or depending on community and shared services. Government-funded propaganda like NPR and PBS and their local affiliates have been instrumental in the obfuscation and half truths, so good riddance to them. Replacing them with blogs like this will be slow but ultimately better for everyone.