Call for Rebuilding Asylums Sparks Debate on Involuntary Treatment and Mental Health Care

A recent social media post by conservative activist Christopher F. Rufo has ignited discussion regarding the necessity of rebuilding mental asylums and implementing long-term, involuntary treatment for individuals described as "hardcore street psychotics." Rufo's tweet, shared on September 11, 2025, asserts that such individuals, often with histories of homelessness, drug abuse, and violence, "can wreak havoc on a city," necessitating their commitment.

"We need to rebuild the asylums and commit hardcore street psychotics—who almost always have a long history of homelessness, drug abuse, and violence—to long-term, involuntary treatment. A small number of such 'frequent flyers' can wreak havoc on a city," stated Christopher F. Rufo.

Rufo, a contributing editor at City Journal, has previously argued that the deinstitutionalization movement, initiated by policies like the Community Mental Health Act of 1963, has led to an "invisible asylum" where individuals with severe mental illness cycle through streets, jails, and emergency rooms. He contends that the current system lacks the capacity to adequately treat and manage severe mental illness, particularly when compounded by addiction and homelessness.

The call for expanded involuntary commitment, however, faces significant ethical and practical challenges. While proponents argue it provides essential care for those unable to seek it themselves and enhances public safety, critics emphasize concerns about patient autonomy, human rights, and the potential for abuse. Involuntary treatment is typically applied when an individual has a severe mental illness, poses a significant risk of harm to themselves or others, and no less restrictive options are available.

The effectiveness of involuntary treatment in achieving long-term improvements remains a subject of debate, with some studies indicating limited evidence. The coercive nature of such interventions can lead to psychological distress, loss of autonomy, stigmatization, and a weakened therapeutic alliance between patients and healthcare providers. Data from Chicago, for instance, shows a rise in police-initiated forced hospitalizations, with concerns raised about racial disparities and the trauma these encounters can inflict.

Healthcare providers face a complex ethical dilemma in balancing beneficence (acting in the patient's best interest) with respecting patient autonomy. Many advocate for a continuum of care that includes less restrictive interventions, such as intensive outpatient programs and robust community-based services, which are often underfunded. The United Nations Convention on the Rights of Persons with Disabilities also challenges the use of substitute decision-making frameworks, asserting that all individuals possess decision-making capacity.