Community Mental Health Centers Act

St. Elizabeths Hospital in Washington, a federally funded mental hospital, reached its peak population of 7,529 patients in 1955, one of the largest in the country. In the 1950s mental health advocates and changes within psychiatry led the American Psychiatric Association and the National Institute of Mental Health to call for alternatives to such institutions, among them outpatient clinics and community mental health centers. Chlorpromazine, sold as Largactil, made it seem far more plausible that patients once thought to need lifelong hospitalization could be treated as outpatients.

Congress took up the idea in S. 1576, the Mental Retardation Facilities and Community Mental Health Centers Construction Act, and the House Committee on Interstate and Foreign Commerce reported the bill in 1963. President John F. Kennedy signed it that year, and the photographer Abbie Rowe recorded the ceremony. The law provided federal money for community mental health centers, including crisis care. Kennedy expected each state to build its own facilities according to geography, local needs for inpatient and outpatient care and the staff it could deploy, with almost no federal oversight.

The act arrived alongside other pressures on the asylums: the cost of lifelong hospitalization, a civil rights movement that pressed for more humane psychiatric care, and the creation of Medicare and Medicaid. Together they led to the closure of many psychiatric hospitals and began the era of deinstitutionalization. State hospitals across the country shut down, and the number of inpatients fell from over half a million in 1950 to about 30,000 by the early 1990s. A 2024 policy analysis in Frontiers in Public Health notes that most communities never received the federal funds the act promised for crisis care.