 However, this shift in attitude, while helpful in moving patients out of the overcrowded state institutions and encouraging the development of centers for personalized treatment and rehabilitation, ultimately had mixed results.Today, most mentally ill people are either caught in a “revolving door” between their communities and a local institution, are homeless, or are in prison—the latter two living circumstances being precisely those that Deutsch cited in "The Shame of the States" as the only other options for those not already housed in a state institution, and those which he was trying to resolve.Satel's tone is reminiscent of Deutsch's as she calls releasing the mentally ill from state institutions “only a first step,” and calls for freedom from the “‘cold mercy’ that comes with criminalizing mental illness.”

According to the National Institute of Mental Health, today 1 in 5 adults experiences mental illness in a given year—and about 1 in 25 experience a mental illness that substantially interferes with or limits one or more major life activities.