including low-income housing loss, social security and social service cutbacks, and
drastically reduced employment prospects.38
The narrative linking deinstitutionalization and homelessness was prolific, and it
greatly informed public policy and debate about contemporary urban homelessness.39 A
1983 Koch administration internal report, “Legal Considerations Relating to Efforts to
Rehospitalize Homeless Mentally Ill Persons,” is telling: The use of the term
“rehospitalization” assumes that hospitalization—better known as institutionalization—
was a part of many homeless people’s histories, and that it was a necessary part of their
future.40 Examining this narrative, and the narratives that linked mental illness and
homelessness, more broadly, provides important insight into the homeless crisis and New
38 Some in the Koch administration realized the complexity of the issue, as well. Nathan Leventhal’s
reflection almost a decade after the end of his tenure in the Koch administration is telling: When asked
about the rise of homelessness that occurred while he was Deputy Mayor, Leventhal first responded, “I’m
not sure where it all came from.” Prompted by his interviewer to make the connection between
deinstitutionalization and homelessness (“Part of it [homelessness] came from the proprietary hospitals,
right?”), Leventhal then spoke of how the state hospitals closed, and “they [former patients] all wound up
in New York.” Leventhal, Edward I. Koch Administration Oral History Collection, 93-96.
39 In a 1983 report presented at the National Governor’s Association Task Force on the Homeless, New
York Governor Mario M. Cuomo listed deinstitutionalization as one of the four “causes of homelessness
today,” along with unemployment, scarcity of affordable housing, and social service cutbacks and the
culling of disability rolls. Governor Mario M. Cuomo, 1933/1983 - Never Again: A Report to the National
Governor’s Association Task Force on the Homeless (July 1983). This is a more multifaceted, less single-
issue characterization of the role of deinstitutionalization in the rising homelessness of the 1980s than that
presented by other authors. Countless newspaper articles and scholarly reports focused on mental illness as
a particular feature of New York City’s street homeless population, in particular: for just a few examples,
see “Asylum in the Streets,” WNBC special report, December 29, 1983”; Deirdre Carmody, “New York Is
Facing ‘Crisis’ On Vagrants,” New York Times, June 28, 1981; Deirdre Carmody, “The Tangled Life and
Mind of Judy, Whose Home Is the Street,” New York Times, December 17, 1984. Later scholarly works
would perpetuate this narrative: see Isaac and Armat, Madness in the Streets (1990); Ann Braden Johnson,
Out of Bedlam: The Truth About Deinstitutionalization (New York: Basic Books, 1990); David A.
Rochefort, From Poorhouses to Homelessness: Policy Analysis and Mental Health Care (Westport, CT:
Auburn House, 1993).
40 The report recognizes that the very notion “that state hospitals will admit and indefinitely retain
dependent mentally ill persons [is] grounded in the history of the state mental health system.” The author,
thus, recognizes the specter of deinstitutionalization on current homeless policy and “community
expectations,” and attempts to demonstrate that current legal precedent would make “rehospitalization” for
most people both costly and legally tenuous. Paul Litwak, “Legal Considerations Relating to Efforts to
Rehospitalize Homeless Mentally Ill Persons,” December 15, 1983. Mayor Edward I. Koch, Departmental
Correspondence, New York City Municipal Archives, 2.