Donald Trump just did something that would have been considered political suicide ten years ago. He signed an executive order to bring back mental asylums.
Not “behavioral health facilities.” Not “community wellness centers.” Mental institutions. Insane asylums. He used those exact words.
“Hate to build those suckers, but you’ve got to get the people off the streets.”
That’s the President of the United States talking about a policy that Democrats dismantled decades ago. And he’s not apologizing for it.
The Creedmoor Memory
Trump got personal during the press briefing, sharing a story from growing up in Queens. There was a place called Creedmoor—a state psychiatric hospital. Young Donald asked his mom why there were bars on the windows.
“People that are very sick are in that building,” she told him.
That building still exists, but it’s a shadow of what it was. New York emptied most of its mental institutions starting in the 1960s. The promise was that community-based care would replace the old asylums. Patients would get treatment in less restrictive settings. Families would be supported. Everyone would be better off.
That’s not what happened.
What Actually Happened
The institutions closed. The community care never materialized. And the patients? They ended up exactly where Trump says they are now—on the streets.
Walk through any major American city and you’ll see the results. San Francisco. Los Angeles. Portland. Seattle. New York. Tent encampments full of people who are clearly suffering from severe mental illness, talking to themselves, threatening passersby, living in conditions that would have horrified previous generations.
We didn’t end institutionalization. We just moved the institution to the sidewalk. Except now there’s no treatment, no medication management, no safety—for the patients or anyone else.
“The Democrats in New York, they took them down, and the people live on the streets now,” Trump said. “That’s why you have a lot of the people in California and other places, they live in the streets.”
He’s not wrong. The deinstitutionalization movement was driven by progressive activists who viewed mental hospitals as oppressive. Some were. The solution was supposed to be better care, not no care.
The Cost Question
Trump acknowledged the elephant in the room during an interview last year: “It’s massively expensive.”
Building and operating psychiatric facilities isn’t cheap. Staff. Security. Medical care. Decades of deferred investment means starting almost from scratch.
But what’s the cost of not doing it? Cities spending billions on homeless services that don’t work. Emergency rooms clogged with psychiatric patients who have nowhere else to go. Businesses fleeing downtown areas. Families afraid to use public transit. Citizens stepping over human suffering on their way to work.
At some point, the cost of inaction exceeds the cost of action. Most Americans reached that point years ago. Politicians are finally catching up.
The Political Shift
This would have been unthinkable rhetoric from a Republican president even a decade ago. The libertarian wing would have screamed about government overreach. The fiscal conservatives would have balked at the price tag. The moderates would have worried about looking cruel.
Trump doesn’t care about any of that. He sees a problem—severely mentally ill people living and dying on the streets—and he’s proposing the solution that actually worked before it was dismantled.
Democrats are in a bind. They can’t defend the status quo because everyone can see the status quo is a disaster. But admitting that deinstitutionalization failed means admitting that progressive policy failed. That the compassionate approach produced the least compassionate outcome imaginable.
What Comes Next
An executive order is just the beginning. Actually rebuilding the infrastructure will require funding, legislation, legal frameworks, and fights with civil liberties groups who still believe that letting psychotic people freeze to death on sidewalks is preferable to supervised care.
But Trump just moved the Overton window. He said the thing that everyone knows but nobody in politics was willing to say: we need mental institutions again. The experiment in closing them failed. Time to try something different.
“Hate to build those suckers.” Classic Trump. No polish, no euphemism, no pretending this is anything other than what it is—a necessary response to a self-inflicted disaster.
The people on the streets deserve better than what we’ve given them. So do the communities living with the consequences. Trump just signed the paper that says it’s time to actually do something about it.