Getting rid of large mental institutions in America over the past few decades shook up a lot more than just how psychiatric care works. Some people say, “closing the asylums just put the ‘crazy people’ on the streets and now we all get to deal with them.” I’ve seen how this plays out in real time, especially in places like Spokane, Washington. That’s where a sparkling new $33 million downtown library has ended up tangled in the fallout.

The Switch Up Away from Large Mental Institutions

The rise and fall of the psychiatric hospital system marks a wild chapter in U.S. history. Mental hospitals—sometimes called insane asylums—were all over the country by the early 20th century. They housed huge numbers of people with all sorts of mental health and substance use struggles. But stories about abuse, lack of dignity, and overcrowding inside these places grew over time. Geraldo Rivera’s 1972 report sealed their fates.

By the 1950s, new medications and changing attitudes fueled a movement called deinstitutionalization. Politicians and advocates figured the best way forward was to bring people out of locked hospitals and back into neighborhoods with access to communitybased treatment.

On paper, that plan sounds way more humane. People with mental illness would get care, support, and maybe even a real shot at life outside hospital walls. But the reality turned out far messier, leaving a gap that’s still felt today.

Public Libraries and the New Urban Reality

Here’s where things get personal for me. I remember when the Spokane Central Library reopened in 2022 after major renovations. The place was stunning; full of light, shiny new studios, meeting rooms, and spaces for kids. It was supposed to be a community hub, bringing creative energy and learning to downtown. It almost felt like walking into a dream version of what city leaders promised: a real crown jewel for Spokane.

But now, the library is packed all day with people who have nowhere else to go, many clearly struggling with untreated mental illness, addiction, or the stresses of being homeless. It’s basically turned into a lowbarrier day shelter with books. The hopes of using the library as a safe spot for activities like Girl Scout meetings with fifth graders flew out the window when we found syringes and chaos in the rooms we’d reserved. Even library staff and security felt overwhelmed. This new reality is part of a bigger story playing out in public spaces across the country.

Why Deinstitutionalization Failed to Give a Boost

Community based care makes sense when it actually exists and is funded. The problem is, the old asylums were closed down way faster than new support systems could be set up. There are community mental health clinics and shelters, but these are usually underresourced and in high demand. So, when someone can’t get hospital level care, affordable housing, therapy, or substance use help, they’re left with only a handful of places: the streets, the jail, or (if they’re lucky) a hospital ER for a brief stay.

Fast forward to cities in 2024; emergency rooms, jail bookings, shelters, and public libraries have turned into catchall spots for people with nowhere else to go. When mental health is left untreated, crises break out in public, not behind locked doors. Case in point: the Spokane Central Library had 669 calls to 911 in just 18 months after renovation. That’s not the sign of a thriving library; it really signals a system pushed far past its limit.

Real Impacts on Neighborhoods and Families

This is not just an “urban” or “downtown” problem. Parents I know have stopped bringing their kids to the library because it feels too unsafe. That’s not an easy choice. But if you’re seeing your child walk past people in visible distress—maybe high, in crisis, or having public outbursts—when do you decide enough is enough?

As fewer families and community programs use these shared spaces, there’s less pressure on city leaders to step up and make things right. The result: libraries, meant to be hubs for everyone, end up as last resort day shelters, court annexes, and crisis centers. They’re now doing jobs they weren’t built or funded to handle.

Understanding Life After the Asylums: What Has Changed?

• Homelessness rates: Cities with high living costs and limited mental health beds—like Spokane, Seattle, LA, and others—see larger homeless populations that include many with serious psychiatric needs.
• Jail as mental institution: Local jails have replaced asylums as America’s leading mental health providers, according to groups like the Treatment Advocacy Center. Jail isn’t treatment, and people cycle in and out, often getting worse every time.
• Lack of continuity: Instead of coordinated care, people bounce between police encounters, ERs, shortterm shelters, and the streets. There’s no one keeping track unless you’re lucky enough (or sick enough) to get rare intensive services.

Calls for Help: Libraries on the Front Line

Public libraries never asked to take on this work. In Spokane, library staff hand out food, call for help when someone overdoses or has a psychotic break, and try to keep the peace all day. It’s not only security issues—it’s everything from trauma to overdose to plain exhaustion. For many librarians, this isn’t the job they signed up for.

Hidden Costs: Resources Diverted From the Mission

It’s worth thinking about what else $33 million might have funded in Spokane—like supportive housing, mental health outreach, or crisis services that last. The stunning library now budgets for nonstop security, clean up, social workers, and frequent police calls. Even with all that, there is still no clear answer to the cycle. Sometimes the most public effects—fights at the entrance, overdoses, and stressfilled calls—don’t even make the news.

What Can Actually Help?

Stepping up for people with severe mental illness takes a serious commitment, and there’s no onesizefitsall solution. Here’s what has made a real difference in places I’ve checked out:

• Housing first programs: Putting people into stable apartments—without strict requirements up front—can make daily mental health care possible.
• Mobile crisis teams: Outreach workers and clinicians who actually go out to people on the street help prevent police involvement and ER visits.
• Permanent supportive housing: Longterm, staffed apartments for folks with the highest needs. These programs are expensive but get the best results.
• Community treatment teams: Wrap around teams that follow people wherever they go and stick with them for the long haul.
• Peer support workers: People who’ve been there and know how to relate, whether it’s in a shelter, under a bridge, or at a library’s help desk.

Frequently Asked Questions

How did deinstitutionalization start in the U.S.?
Large mental hospitals began shutting down in the 1950s and 60s because of new treatments and worries about abuse and human rights. Government leaders vowed to replace them with community services, but those systems never reached the needed scale.

Why do people with mental illness end up in libraries or on the streets?
Many folks can’t qualify for inpatient care or find housing, so they use the few public spaces that are open and safer. Libraries, in particular, are welcoming and warm but aren’t equipped for daily medical or psychiatric needs.

What could cities do better?
Investing in a mix of lowbarrier housing, mobile crisis response, and coordinated case management has worked in cities that commit money and resources. No single plan alone solves it, but dividing up the load makes life better for everyone involved and lowers overall harm.

Where Things Stand, and Where We Go From Here

Watching something like the Spokane Central Library struggle to fill so many roles is a wakeup call. Shutting down psychiatric hospitals without solid new options left many people stranded, and places like libraries are left to pick up the slack. If we want public spaces to work for everyone, fixing mental health care and housing absolutely has to be part of the answer. Otherwise, these problems don’t vanish—they just pop up anywhere people are allowed to gather, even when that’s not what anyone intended.

Sources: Nextdoor.com

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