In 1967 the governor of California signed into law a bill effectively ending involuntary commitment of people suffering from mental disorders. At the time 22,000 Californians resided in state mental hospitals. Ten years earlier the number had been 37,500. These institutions were seen as dehumanizing. Involuntary commitment would now be restricted to those who were deemed as potentially dangerous to themselves or those around them. The commitment had to be sponsored by a family member and/or ordered by the court. A mentally-ill patient who refused treatment typically did not receive any at all. That governor won election to the presidency with a landslide victory in 1980.
One of President Ronald Reagan’s early accomplishments 
was dismantling the Mental Health Systems Act of 1980, an achievement of his predecessor, Jimmy Carter. That act disappeared into Omnibus Budget Reconciliation Act. Federal money – less money, of course – for mental health programs now went to the states in block grants. The Reagan administration went next to making Social Security Disability qualifications much more restrictive. 340,000 people lost their SSI benefits.
And so it goes. Four people died on Portland’s streets during the recent frigid weather. Conservative determination to not spend money on those deemed undeserving and liberal determination to not impinge on the freedom of even the craziest has resulted in:
As the old commercials said, “Pay me now, or pay me later.”
A University of Pennsylvania study in 2001 examined 5,000 homeless people with mental illnesses in New York City. The taxpayer cost averaged $40,500 a year ($55,000 in 2016 dollars) for their use of emergency rooms, psychiatric hospitals, shelters, and prisons.
As a retired Clinical Psychologist who spent over forty years in the public mental health system working with the chronic mentally ill population both in and out of hospital settings I can say with confidence that there is a subset of mentally ill that require long term, and in some instances lifelong, institutional care at a level that governments have abandoned since the Reagan era. Reagan accomplished for the mentally ill what Bush accomplished for the Middle East.