The United States faces an urgent mental health crisis that includes many individuals living on our streets and filling up emergency rooms.

Decades after the deinstitutionalization movement began, America continues to struggle with the consequences of dismantling a system that, while imperfect, provided structure and support for individuals with severe mental illness (SMI).

The once lofty ideals of community-based care have largely failed to materialize, leaving countless vulnerable individuals to fend for themselves. Psychiatrist and researcher E. Fuller Torrey’s book “American Psychosis” made a clear case for how deinstitutionalization has often meant abandonment. Similarly, Thomas Insel, the former director of the National Institute of Mental Health, has emphasized the need for a system that prioritizes both effective treatment and compassionate care.

Deinstitutionalization in the mid-20th century was driven by a mix of human rights advocacy, new psychotropic medications and financial concerns. The intent was noble: to replace the often inhumane conditions of large asylums with community-based care that would integrate individuals into society. However, as Torrey argues, the infrastructure necessary to support this vision was never fully developed. Funding for mental health services declined, leaving individuals with SMI to navigate fragmented and inadequate systems. Today, these individuals disproportionately populate prisons, homeless shelters and emergency rooms — environments ill-suited to their needs. Every day, the medical students and psychiatric residents I teach hear stories from patients about how difficult it is to access basic lifesaving medications, food and shelter.

It is estimated that 20-25% of the homeless population in the United States has a severe mental illness, amounting to over 120,000 individuals. Additionally, approximately 37% of incarcerated individuals in state and federal prisons suffer from mental health conditions. The financial toll is enormous: Untreated mental illness costs the U.S. economy up to $300 billion annually, including lost productivity, health care expenses and costs associated with incarceration and homelessness. Emergency room visits alone for psychiatric crises cost an average of $1,200 per visit, placing further strain on an already overburdened health care system.

A renewed commitment to institutional care does not mean a return to the asylums of old. Instead, it calls for a new model: facilities designed with humane and therapeutic principles and integrating modern medicine, including the amazing new pharmacological treatments that were not available 50 years ago, with an emphasis on dignity and recovery. Here’s why this initiative is necessary and beneficial:

Providing adequate care

Individuals with SMI often require long-term, specialized care that community-based services alone cannot provide. Properly designed institutions would offer consistent medical attention, therapy and socialization opportunities, helping residents achieve stability and a higher quality of life.

Reducing societal costs

The costs of untreated mental illness are staggering. Homelessness, incarceration and emergency medical care create a financial burden on communities and taxpayers. Investing in institutions — staffed with trained professionals and supported by robust oversight — would shift resources from reactive to preventative care, ultimately saving money and improving outcomes.

Improving public safety

A significant proportion of violent incidents involving police stem from mental health crises. Safe and well-staffed institutions could reduce such occurrences.

Addressing the workforce gap

Building and maintaining new care facilities would create a surge of job opportunities in construction, health care and ancillary services. These positions would not only strengthen local economies but also provide fulfilling careers for those passionate about mental health.

Leaving individuals with severe mental illness to navigate a society unprepared to meet their needs comes at a significant cost. The time has come for a paradigm shift that prioritizes integrated care for individuals with mental illness. Rebuilding the infrastructure to care for this population is not just a moral imperative; it is an opportunity to create a new path forward for all of us. By embracing a new patient-centered model of integrated care, the United States can turn the page on decades of neglect and lead the world in providing dignified, effective mental health treatment.

Dr. Alan M. Langlieb is the medical director of the inpatient psychiatric unit at MedStar Georgetown University Hospital. The opinions expressed are his own and don’t necessarily represent the views of MedStar Health or Georgetown University.