The U.S. stands at a dangerous crossroads in mental health policy.
On one hand, research shows that voluntary, community-rooted care helps people with psychiatric disabilities lead healthier, fuller lives. On the other, political leaders are pushing to resurrect a deeply flawed past: institutionalization, expanded involuntary commitment and coercive treatment.
Congress must choose a path forward. It must reject coercion and invest in rights-centered, community-based care. A critical piece of this is preserving the federal Protection and Advocacy for Individuals with Mental Illness program — one of the few safeguards for people receiving mental health services today.
The Protection and Advocacy for Individuals with Mental Illness Act of 1986 extended the federal Protection and Advocacy systems to include individuals with psychiatric disabilities. The act grants these systems authority to monitor facilities, investigate abuses and protect rights through legal advocacy, representation and litigation. Protection and Advocacy also has “access authority” to enter psychiatric facilities, residential settings and service providers. Today, there are 57 such systems across all states and territories, coordinated by the National Disability Rights Network.
Recently leaked Department of Health and Human Services restructuring plans reveal proposals to slash funding and eliminate the Protection and Advocacy systems altogether, just as political rhetoric calls for mass institutionalization.
President Trump, Health and Human Services Secretary Robert F. Kennedy Jr. and others are pushing for expanded involuntary commitment and large-scale psychiatric confinement, frequently conflating “mental illness” with criminality. These narratives draw on longstanding aesthetic and political associations between mental health and dangerousness — what scholars describe as the rationalization of law and policy to manage disability through control, not care.
Without the federal Protection and Advocacy program, there is no federally mandated, independent oversight of abuse, institutional conditions or legal violations in psychiatric settings. Cutting its funding would leave those in the most dangerous environments unprotected.
Recent examples underscore why this oversight is essential. Disability Rights Michigan investigated multiple psychiatric hospitals where patients were abused and doctors falsified documentation to justify involuntary commitments.
Indiana Disability Rights secured the release of an individual lobotomized at age 15 and confined for more than 40 years — just one of many interventions to end unnecessary and harmful institutionalization.
The Disability Law Center of Utah documented inhumane conditions and lack of psychiatric care that contributed to a patient’s death. A subsequent complaint revealed rampant abuse within psychiatric facilities — including one institution so notorious for sexual violence that staff referred to it as “The Rape Hospital,” leading to its license being revoked.
Disability Rights Tennessee is pursuing litigation against the state’s juvenile justice system for pervasive abuse and solitary confinement of youth with mental health disabilities.
Supporting voluntary, rights-based care is not a denial of the seriousness of mental health conditions. It is precisely because people with psychiatric disabilities may experience profound distress and vulnerability that we must reject simplistic, punitive responses. Institutionalization has never “cured” schizophrenia, nor have forced injectable medications. Research consistently shows that pressure and coercion often backfire, undermining the very motivation and self-direction that are essential for sustained behavioral change.
Instead of expanding forced treatment, we should be scaling up what works: voluntary, wraparound services that address the root causes of mental distress and support community integration.
Examples, many of which have also been targeted for cuts or elimination by the White House, include Certified Community Behavioral Health Clinics; Coordinated Specialty Care programs for early psychosis; peer-led services such as the Collaborative Support Programs of New Jersey that build trust, promote self-determination and support holistic recovery outcomes, and non-police, non-coercive crisis response teams like Denver STAR and Promise Resource Network’s crisis services, which have diverted thousands of calls from law enforcement and reduced arrests, ER visits, and unnecessary hospitalizations.
Involuntary hospitalization can have lasting negative effects: eroding trust in providers, increasing trauma and elevating the risk of suicide and long-term disengagement. Forced treatment is often experienced as punitive, disempowering and isolating — especially for youth and those already marginalized by race, gender and disability.
Yet even as evidence of the harms of coercion and the benefits of voluntary supports grows, the federal infrastructure backing these alternatives is under attack. Slashing funding will leave more people vulnerable to costly emergency care, institutionalization and abuse.
This isn’t theoretical. In January, Disability Rights of West Virginia filed a lawsuit over egregious abuse by state facility workers. The Protection and Advocacy system found that one psychiatric hospital had spent over $45 million on contract staff alone in a single fiscal year — more than the entire national monitoring budget for fiscal 2025.
And Protection and Advocacy for Individuals with Mental Illness is just one piece. Additional cuts to Protection and Advocacy funding, including the Protection and Advocacy for Individuals with Developmental Disabilities, threaten the broader financial stability of these programs, undermining their ability to remain solvent, retain staff or continue critical services, as already seen in places like Arkansas and New Jersey.
Cutting mental health funding while promoting coercion is not care at all — it is a terrifying return to the policies of the 19th and early 20th centuries, when individuals could be committed to remote state institutions for decades with little to no due process or legal recourse. It threatens decades of hard-won progress secured by the disability rights movement, including Olmstead v. L.C., the landmark 1999 Supreme Court decision affirming the right of people with disabilities to live in the least restrictive setting appropriate.
These policies are not accidental. As outlined in a recent blog by the Center for Racial and Disability Justice, the Health and Human Services reorganization reflects a long-standing strategy that treats care as expendable, centralizes power in biomedical institutions, and frames human need as a burden. Resurrecting coercive systems while defunding rights-based advocacy fits squarely within this logic: one that prioritizes control over compassion, and austerity over support.
We cannot allow history to repeat itself. That means Congress must fully fund the Protection and Advocacy program at or above $40 million; preserve and expand the Substance Abuse and Mental Health Services Administration’s community-based programs; and reject all efforts to lower civil commitment standards or expand coercive institutionalization.
Protecting rights is not a luxury. It is the foundation of any democratic society. We must fight to defend our rights — before it’s too late.
Jordyn Jensen, M.Ed., is the executive director of the Center for Racial and Disability Justice at Northwestern Pritzker School of Law. Nev Jones, Ph.D., is an associate professor in the School of Social Work at the University of Pittsburgh.