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    The United States is witnessing the return of psychiatric imprisonment | Jordyn Jensen

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    Across the country, a troubling trend is accelerating: the return of institutionalization – rebranded, repackaged and framed as “modern mental health care”. From Governor Kathy Hochul’s push to expand involuntary commitment in New York to Robert F Kennedy Jr’s proposal for “wellness farms” under his Make America Healthy Again (Maha) initiative, policymakers are reviving the logics of confinement under the guise of care.These proposals may differ in form, but they share a common function: expanding the state’s power to surveil, detain and “treat” marginalized people deemed disruptive or deviant. Far from offering real support, they reflect a deep investment in carceral control – particularly over disabled, unhoused, racialized and LGBTQIA+ communities. Communities that have often seen how the framing of institutionalization as “treatment” obscures both its violent history and its ongoing legacy. In doing so, these policies erase community-based solutions, undermine autonomy, and reinforce the very systems of confinement they claim to move beyond.Take Hochul’s proposal, which seeks to lower the threshold for involuntary psychiatric hospitalization in New York. Under her plan, individuals could be detained not because they pose an imminent danger, but because they are deemed unable to meet their basic needs due to a perceived “mental illness”. This vague and subjective standard opens the door to sweeping state control over unhoused people, disabled peopleand others struggling to survive amid systemic neglect. Hochul also proposes expanding the authority to initiate forced treatment to a broader range of professionals – including psychiatric nurse practitioners – and would require practitioners to factor in a person’s history, in effect pathologizing prior distress as grounds for future detention.This is not a fringe proposal. It builds on a growing wave of reinstitutionalization efforts nationwide. In 2022, New York City’s mayor, Eric Adams, directed police and EMTs to forcibly hospitalize people deemed “mentally ill”, even without signs of imminent danger. In California, Governor Gavin Newsom’s Care courts compel people into court-ordered “treatment”.Now, these efforts are being turbocharged at the federal level. RFK Jr’s Maha initiative proposes labor-based “wellness farms” as a response to homelessness and addiction – an idea that eerily echoes the institutional farms of the 20th century, where disabled people and people of color were confined, surveilled and exploited under the guise of rehabilitation.Just recently, the US Department of Health and Human Services (HHS) announced a sweeping restructuring that will dismantle critical agencies and consolidate power under a new “Administration for a Healthy America” (AHA). Aligned with RFK Jr’s Maha initiative and Donald Trump’s “department of government efficiency” directive, the plan merges the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA) and other agencies into a centralized structure ostensibly focused on combating chronic illness. But through this restructuring – and the mass firing of HHS employees – the federal government is gutting the specialized infrastructure that supports mental health, disability services and low-income communities.The restructuring is already under way: 20,000 jobs have been eliminated, regional offices slashed, and the Administration for Community Living (ACL) dissolved its vital programs for older adults and disabled people scattered across other agencies with little clarity or accountability. This is not administrative streamlining; it is a calculated dismantling of protections and supports, cloaked in the rhetoric of efficiency and reform. SAMHSA – a pillar of the country’s behavioral health system, responsible for coordinating addiction services, crisis response and community mental health care – is being gutted, threatening programs such as the 988 crisis line and opioid treatment access. These moves reflect not just austerity, but a broader governmental strategy of manufactured confusion. By dissolving the very institutions tasked with upholding the rights and needs of disabled and low-income people, the federal government is laying the groundwork for a more expansive – and less accountable – system of carceral “care”.This new era of psychiatric control is being marketed as a moral imperative. Supporters insist there is a humanitarian duty to intervene – to “help” people who are suffering. But coercion is not care. Decades of research show that involuntary (forced) psychiatric interventions often lead to trauma, mistrust, and poorer health outcomes. Forced hospitalization has been linked to increased suicide risk and long-term disengagement from mental health care. Most critically, it diverts attention from the actual drivers of distress: poverty, housing instability, criminalization, systemic racism and a broken healthcare system.The claim that we simply need more psychiatric beds is a distraction. What we need is a complete paradigm shift – away from coercion and toward collective care. Proven alternatives already exist: housing-first initiatives, non-police and peer-led crisis response teams, harm reduction programs, and voluntary, community-based mental health services. These models prioritize dignity, autonomy and support over surveillance, control and confinement.As Liat Ben-Moshe argues, prisons did not simply replace asylums; rather, the two systems coexist and evolve, working in tandem to surveil, contain and control marginalized populations. Today, reinstitutionalization is returning under a more therapeutic facade: “wellness farms”, court diversion programs, expanded involuntary commitment. The language has changed, but the logic remains the same.This moment demands resistance. We must reject the idea that locking people up is a form of care. These proposals must be named for what they are: state-sanctioned strategies of containment, rooted in ableism, racism and the fear of nonconformity.Real public health does not rely on force. It does not require confining people or pathologizing poverty. It means meeting people’s needs – through housing, community care, healthcare and support systems that are voluntary, accessible and liberatory.As budget negotiations in New York continue to drag on – with expansions to involuntary commitment still on the table – and as RFK Jr advances carceral care proposals at the federal level, we face a critical choice: will we continue the long history of institutional violence, or will we build something better – something rooted in justice, autonomy and collective wellbeing?The future of mental health care – and of human dignity itself – depends on our answer.

    Jordyn Jensen is the executive director of the Center for Racial and Disability Justice at Northwestern Pritzker School of Law More

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      They Caught the Flu, and Never Came Home

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      The virus leads to an estimated 36,000 deaths in the United States each season — many of them so sudden that families are left reeling.Lauren Caggiano had felt sick for days by the time she tested positive for the flu in an emergency room on a February afternoon. Hours later, she was in the intensive care unit. By 4 in the morning, she was on a ventilator.Ms. Caggiano, a paralegal who lived in Oceanside, Calif., doted on her two dogs and had recently become a grandmother, died two days later. She was 49.“You don’t really think, if you’re in decent health, that’s going to be what gets you,” her son, Brandon Salgado, said.Many people recover from a bout of flu within a few days or a week. But every year, the virus still kills more than 36,000 people across the United States and sends hundreds of thousands to the hospital. The Centers for Disease Control and Prevention has said that this flu season has been especially severe.Some of those who died were at greater risk for getting seriously ill because of underlying conditions or their age. Others, like Ms. Caggiano, were otherwise healthy before their infections. Some had not received the flu shot, which reduces but does not eliminate the risk of death. Some were hospitalized for weeks; others felt ill for only days before they died.All of their deaths came as a shock to the people who knew them.A Swift DeclinePart of what stunned Mr. Salgado was just how quickly his mother died.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Massachusetts governor calls Trump’s attacks on Harvard ‘bad for science’

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      Massachusetts governor Maura Healey said on Sunday that Donald Trump’s attacks on Harvard University and other schools are having detrimental ripple effects, with the shutdown of research labs and cuts to hospitals linked to colleges.During an interview on CBS’s Face the Nation, the Democratic governor said that the effects on Harvard are damaging “American competitiveness”, since a number of researchers are leaving the US for opportunities in other countries. After decades of investment in science and innovation, she said: “intellectual assets are being given away.”In the past week, the US president cut off billions of dollars to Harvard in federal funds, after the university refused to concede to a number of the administration’s demands. Trump also called for its tax-exempt status to be revoked, a potentially illegal move, against the world-famous college in Cambridge, Massachusetts.Of the moves against colleges, Healey said: “It’s bad for patients, it’s bad for science, and it’s really bad for American competitiveness. There’s no way a state can make up for the cuts from federal funding.”She added: “I was in a hospital recently, Boston Children’s, where some of the sickest kids in the country receive care. Cuts to Boston Children’s and other hospitals are a direct result of Donald Trump’s actions, as these are part of a teaching hospital system.“These cuts to universities have significant ripple effects, resulting in layoffs of scientists and doctors, and clinical trials for cancer treatments have been shut down.“As governor, I want Massachusetts and America to soar. What Donald Trump is doing is essentially inviting other countries, like China, to take our scientists and researchers. This is terrible, especially considering what he has done to the economy. I am working hard every day to lower costs in my state, cut taxes, and build more housing, while Donald Trump is making life more expensive and harder for all of us.”Since Trump took office, his administration has deployed an “antisemitism taskforce” to demand various policy changes at different universities around the country.Columbia University, one of the first institutions targeted by the taskforce, quickly caved to the Trump administration’s demands to restore $400m in federal funding. Some of the measures that Columbia conceded to included banning face masks on campus, empowering security officers to arrest people, and placing control of the Middle Eastern department under a new senior vice-provost.Former Columbia University president Lee Bollinger said on Sunday that the Trump administration’s attacks on academic institutions represent a significant attack on first amendment rights.skip past newsletter promotionafter newsletter promotion“This is a kind of weaponization of the government’s power,” Bolinger said on CNN, adding that it “seems like a campaign of intimidation”.“This is a kind of weaponization of the government’s power,” he said.Earlier this month, the federal government sent Harvard two separate letters with specific demands. After the university publicly rejected those demands, the administration quickly froze nearly $2.3bn in federal funding.The conflict between the administration and the elite university took a strange turn on Friday, with the New York Times reporting that an 11 April letter from the administration with additional demands – which escalated the showdown – was “unauthorized”. The university disputed that the letter was “unauthorized,” claiming the federal government has “doubled down” on its offensive. More

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      Sudan Clinic Workers Killed in Zamzam Camp

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      Relief International said nine employees were killed when gunmen stormed the Zamzam camp in El Fasher, in the western Darfur region.Sudanese paramilitaries killed the entire staff of the last medical clinic in a famine-stricken camp in the western region of Darfur, Sudan, as part of a broader assault that killed at least 100 people, aid groups and the United Nations said on Saturday.The assault on the Zamzam camp, which holds 500,000 people in the besieged city of El Fasher, was notable even by the standards of a civil war that has seen countless atrocities as well as accusations of genocide.Paramilitaries with the Rapid Support Forces, or R.S.F., broke through the camp perimeter on Friday evening after hours of shelling. They then destroyed hundreds of homes and the camp’s main market before turning their attack on the camp’s last remaining medical clinic, according to Relief International, the aid group that runs the facility.Nine hospital employees were killed, including the head doctor, the aid group said in a statement on Saturday. “We have learned the unthinkable,” the statement said. “This is a profound tragedy for our organization.”Kashif Shafique, the group’s Sudan director, said in a phone interview that the aid workers — five medics and four drivers, his entire staff at the clinic — had been shot dead.Paramilitaries had warned the medics to leave the day before the attack, Mr. Shafique said. But they had to treat civilians wounded by shelling and, in any event, the main routes out of the camp were closed.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      ‘The Pitt’ Captures the Real Overcrowding Crisis in Emergency Rooms

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      From the “chairs” to the hallway medicine, the show’s depiction of an emergency medicine system that is beyond capacity rings true for medical experts.The emergency department waiting room was jammed, as it always is, with patients sitting for hours, closely packed on hard metal chairs. Only those with conditions so dire they needed immediate care — like a heart attack — got seen immediately.One man had had enough. He pounded on the glass window in front of the receptionist before storming out. As he left, he assaulted a nurse taking a smoking break. “Hard at work?” he called, as he strode off.No, the event was not real, but it was art resembling life on “The Pitt,” the Max series that will stream its season finale on Thursday. The show takes place in a fictional Pittsburgh hospital’s emergency room. But the underlying theme — appalling overcrowding — is universal in this country. And it is not easy to fix.“EDs are gridlocked and overwhelmed,” the American College of Emergency Medicine reported in 2023, referring to emergency departments.“The system is at the breaking point,” said Dr. Benjamin S. Abella, chair of the department of emergency medicine at Mount Sinai’s Icahn School of Medicine in New York.“The Pitt” follows emergency room doctors, nurses, medical students, janitors and staff hour by hour over a single day as they deal with all manner of medical issues, ranging from a child who drowned helping her little sister get out of a swimming pool to a patient with a spider in her ear. There were heart attacks and strokes, overdoses, a patient with severe burns, an influencer poisoned by heavy metals in a skin cream.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      ‘The goal is to disassemble public health’: experts warn against US turn to vaccine skepticism

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      As vaccine hesitancy increases in the US, isolated, tight-knit and religious communities have frequently been at the center of high-profile outbreaks.Such is the case in west Texas, where a rural community is the center of an expanding measles outbreak that has already claimed the lives of two Americans – the first deaths from the disease in nearly a decade.However, as the conspiracy theories of Maga conservatism marry the bugbears of the US health secretary and vaccine skeptic Robert F Kennedy Jr, the one-time fringe view of vaccines has become increasingly mainstream – with activists in right-leaning population centers taking lessons learned from the Covid-19 pandemic into the realm of childhood inoculations.One need look no further than Sarasota, Florida, for a full-throated political denunciation.“Generally, people are weak, lazy,” said Vic Mellor, an activist based near Sarasota, and a close ally of former Trump national security adviser Michael Flynn.Mellor owns the We the People Health and Wellness Center in nearby Venice. Mellor, in a shirt that shouts “VIOLENCE MIGHT BE THE ANSWER”, is a self-professed attendee of the January 6 insurrection at the US Capitol.“And that lazy part just makes them ignorant … Covid has proven that obviously this is true. I mean, all the facts are starting to come out on Covid now – that it was a hoax. That is just an extension of where this hoax began decades earlier with the vaccines, OK? This is all a money grab, this is all a power grab.”The pandemic was real, and it started Mellor down the road of questioning vaccines. Where he once opposed only the Covid-19 shots, he now opposes vaccines entirely – arguing they harm children despite experts on vaccines considering them one of mankind’s greatest medical achievements.“This is not an isolated, rural, religious community, which I think is what a lot of people associate with an anti-vaccine mentality,” said Kathryn Olivarius, the author of Necropolis: Disease, Power, and Capitalism in the Cotton Kingdom, and a historian of disease at Stanford University. “This is in the heart of everything.”Sarasota has become a proving ground for the Maga right. Among nail salons, mom-and-pop Cuban restaurants and roadside motels lining US 41, known locally as the Tamiami Trail, a visitor can find the gates of New College. This was once a public university prized for its progressive liberal arts education. Now it is part of the new conservative experiment in remaking higher education led by activists aligned with Donald Trump and the Republican Florida governor, Ron DeSantis.Along the same road is the Sarasota memorial hospital, an aberration in American healthcare – it is publicly owned with open board elections. The normally sleepy election became contentious when insurgent “health freedom” candidates, supported in part by Mellor, entered the race. Three won seats on the nine-member board in 2022.Even the name of this stretch of sun-bleached asphalt is up for debate. This year, a state Republican lawmaker – who has also introduced bills to limit vaccine requirements – briefly proposed changing its name to the “Gulf of America Trail” – a nod to Trump’s renaming of the Gulf of Mexico.Arguably the most salient artifact of this activism in Sarasota is the least visible: vaccination rates against measles.Measles vaccination rates for kindergarteners have plummeted over the last two decades – from 97% in 2004 to 84% in 2023, according to state health records. Sarasota is roughly on par with the vaccination rates in rural Gaines county, Texas – the center of the ongoing measles outbreak that sickened 279 people in in that state alone. Notably, both Gaines county and Sarasota have large home-schooling communities, meaning vaccination rates could in fact be lower.It is well known in research circles that right-leaning states across the US south and west have worse health metrics – from obesity to violence to diseases such as diabetes. That reality was supercharged during the pandemic; as vaccine mandates became a fixation on the right, Republican-leaning voters became more skeptical of vaccines. In turn, places with politically conservative leaders experienced more Covid-19 deaths and greater stress on hospitals.Measles is one of the most contagious diseases known to medicine. At least 95% of the population needs to be vaccinated to prevent outbreaks of the disease. But despite a supremely effective vaccine that eliminated the disease from the US in 2000, vaccine hesitancy has increasingly taken hold.skip past newsletter promotionafter newsletter promotionConservative activism alone can’t be blamed for declining measles vaccination rates. The measles vaccine in particular has been subject to a sustained firehose of misinformation stemming from a fraudulent paper linking the vaccine to autism in 1999. For years, this misinformation was largely nonpartisan. And Florida’s anti-vaccine movement was active even before the pandemic – with a vocal contingent of parents arguing against strengthening school vaccine standards in 2019.What appears new in Sarasota is how local conservative activists have brought opposition to vaccines into the heart of their philosophy. By Mellor’s telling, he and a loosely affiliated group of Maga activists began to adopt anti-vaccine beliefs as the pandemic wore on – helping organize major health protests in the area in recent years, such as mask mandate opt-outs and the “health freedom” campaign for hospital board seats.Mellor said his nearby property, the Hollow, was a gathering place during the pandemic (it is also a part-time gun range). He cites ivermectin, an anti-parasitic drug that became a fascination of the right, as the reason “we didn’t lose people at all” during the height of the pandemic. Available clinical evidence shows it is not effective against Covid-19.Kennedy has fit neatly into this realignment. He enjoys trust ratings among Republicans nearly as high as Trump, according to polling from the health-focused Kaiser Family Foundation. Kennedy has already spread dubious information about measles vaccines in public statements (notably: from a Steak ’n Shake in Florida) – a response one vaccine expert said “couldn’t be worse”.“While children are in the hospital suffering severe measles pneumonia, struggling to breathe, [Kennedy] stands up in front of the American public and says measles vaccines kill people every year and that it causes blindness and deafness,” said Dr Paul Offit, the director of the Vaccine Education Center and an attending physician in the division of infectious diseases at the Children’s Hospital of Philadelphia. Severe side effects from the vaccine are possible, but they are much rarer than disability and death from measles.“This is what happens when you have a virulent anti-vaccine activist, a science denialist, as the head of the most important public health agency in the United States,” said Offit. “He should either be quiet or stand down.”The same poll found trust in public health agencies has fallen precipitously amid Republican attacks. More than a quarter of Republican parents report delaying childhood vaccines, the poll found, a rate that has more than doubled since 2022. There is no analogous trend among Democratic parents. Despite how claims espoused by vaccine skeptics can be easily refuted, their power has not been undercut.“The anti-vaccine business is big business,” said Offit, pointing to the myriad unproven “treatments” offered by promoters of vaccine misinformation, some of which are offered at Mellor’s We the People health center. “We have been taken over by a foreign country, and the goal of that foreign country is to disassemble public health.”The misery of measles did not take long to appear in Texas – measles-induced pneumonia has already led pediatricians to intubate children, including at least one baby, according to the Associated Press. About one to three people out of 1,000 who are infected by measles die from the infection, and one in 1,000 suffer severe brain swelling called encephalitis, which can lead to blindness, deafness and developmental delays.“We actually don’t have the perspective people in the past had on these diseases,” Olivarius. “I have spent many, many, many years reading letters and missives from parents who are petrified of what’s going to happen to their children” if there are outbreaks of yellow fever, polio or measles, Olivarius said about diseases now largely confined to history – thanks to vaccines.“The lesson from history is these are not mild ailments,” she said. “These are diseases that have killed hundreds of millions of people – and quite horribly too.” More

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      Trump Returns to a Favorite Issue: Health Care Price Transparency

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      In a new executive order, President Trump will reaffirm his commitment to one of his favorite health care policies of his first term: His push to make the prices paid for medical services more public and transparent.Mr. Trump will sign the order on Tuesday afternoon, according to a White House official. After years of halfhearted compliance from hospitals and insurance companies with the previous policies, Mr. Trump is signaling a more aggressive approach to enforcing the rules and making pricing data accessible to patients, the official said.Health care prices have historically been shrouded in secrecy, negotiated in private between doctors, hospitals, drug companies and the insurance companies that pay their bills. The parties in those negotiations have fought hard to keep those numbers out of public view, saying that confidentiality is key to their bargaining process. Economics literature — which relied heavily on a study of Danish concrete prices in the 1990s — has suggested that making them public could actually backfire, by increasing health care prices.But with two major rules issued jointly by the departments of Health and Human Services, Treasury and Labor during his first term, Mr. Trump tried to force the industry to become more transparent. One rule required hospitals to publish the prices they charged to various insurers for a set of common services. Another required insurance companies to publish a more comprehensive listing of the prices they had negotiated with various health care providers.Industry compliance has been grudging, slow and marked by extensive litigation. After the rules became final in 2021, many hospitals simply declined to publish the required lists. Others tried to make their price information hard to find. The Wall Street Journal reported that several had inserted code into their web pages listing prices that made the pages impossible to find using an internet search engine.Nevertheless, the requirement did provide new information to researchers, employers and some patients about the nature of health care prices — and their wide and often inexplicable variation. The policy has so far not delivered on one of Mr. Trump’s key promises from his last term, that price transparency would significantly drive down health care costs. Health care prices have continued to rise.The new executive order will task H.H.S., Treasury and Labor with considering new ways to expand the reach of current initiatives, but it does not call for much in the way of specific new policy. Any meaningful new transparency initiative would require regulatory action or legislation, or both. But the signing of the new order does suggest that Mr. Trump has not forgotten about this priority, which he often referred to in his first term as “bigger than health care itself.” More

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      An Invisible Medical Shortage: Oxygen

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      Oxygen is vital to many medical procedures. But a safe, affordable supply is severely lacking around the world, according to a new report.At the height of the Covid-19 pandemic, millions of people in poor nations died literally gasping for breath, even in hospitals. What they lacked was medical oxygen, which is in short supply in much of the world.On Monday, a panel of experts published a comprehensive report on the shortage. Each year, the report noted, more than 370 million people worldwide need oxygen as part of their medical care, but fewer than 1 in 3 receive it, jeopardizing the health and lives of those who do not. Access to safe and affordable medical oxygen is especially limited in low- and middle-income nations.“The need is very urgent,” said Dr. Hamish Graham, a pediatrician and a lead author of the report. “We know that there’s more epidemics coming, and there’ll be another pandemic, probably like Covid, within the next 15 to 20 years.”The report, published in The Lancet Global Health, comes just weeks after the Trump administration froze foreign aid programs, including some that could improve access to oxygen.Boosting the availability of medical oxygen would require an investment of about $6.8 billion, the report noted. “Within the current climate, that’s obviously going to become a bit more of a challenge,” said Carina King, an infectious disease epidemiologist at the Karolinska Institute and a lead author of the report.Still, she said, governments and funding organizations should prioritize medical oxygen because of its importance across health care. People of all ages may need oxygen for pneumonia and other respiratory conditions, for severe infections including malaria and sepsis, for surgeries and for chronic lung conditions.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      How Trump’s Medical Research Cuts Would Hit Colleges and Hospitals in Every State

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      A proposal by the Trump administration to reduce the size of grants for institutions conducting medical research would have far-reaching effects, and not just for elite universities and the coastal states where many are located. Also at risk could be grants from the National Institutes of Health to numerous hospitals that conduct clinical research on […] More