An average of 40,000 people with mental illnesses die prematurely per year in England, between 2018 and 2020, approximately 120,273 people with mental illnesses died prematurely. Of these, an estimated 80,182 deaths—about two-thirds—were considered potentially preventable, equating to roughly 26,727 preventable deaths annually. GOV.UK+1www.rcpsych.ac.uk+1www.rcpsych.ac.uk

Extrapolating these figures over a decade suggests that approximately 267,000 adults with SMI in England may die prematurely from preventable causes every ten years. These deaths are often linked to treatable physical health conditions. Contributing factors include limited access to healthcare, stigma, socioeconomic disadvantages, and systemic neglect.

Globally, mental disorders are associated with approximately 8 million deaths annually, accounting for about 14.3% of all deaths worldwide. Individuals with mental disorders have a pooled relative risk of mortality 2.22 times higher than those without. In the United States, for instance, suicide alone accounted for 49,476 deaths in 2022.

These statistics underscore systemic failures in providing adequate healthcare, social support, and addressing the broader determinants of health.

There is a strong and well-documented correlation between premature deaths among people with severe mental illness (SMI) and economic status. Socioeconomic disadvantage is both a cause and a consequence of mental illness, and it plays a major role in driving the excess mortality seen in this population.

If we view deinstitutionalization in isolation from economic policy, it’s easy to assume moral progress. But when viewed alongside decades of austerity, housing disinvestment, and welfare reform, it becomes clear that many of these deaths reflect not just medical neglect, but political and economic abandonment.

Here’s an annotated literature review of the key sources that empirically support the claim that deinstitutionalization often functioned as a bureaucratically sanitized form of passive elimination:

---

1. Lamb, H.R. & Bachrach, L.L. (2001).

Title: Some Perspectives on Deinstitutionalization
Published in: Psychiatric Services, 52(8), 1039–1045
Annotation:
This foundational review outlines the trajectory of deinstitutionalization in the U.S., emphasizing how psychiatric hospital discharges vastly outpaced the development of community-based supports. It documents how poor planning, political expediency, and budgetary retrenchment turned a liberatory ideal into a system of neglect. The authors show how many former patients lacked access to housing, employment, and coordinated care—paving the way for the “revolving door” of hospitalization and homelessness.

---

2. Mechanic, D. (2007).

Title: Mental Health Services Then and Now
Published in: Milbank Quarterly, 85(3), 529–553
Annotation:
Mechanic reviews mental health service delivery over several decades, showing that deinstitutionalization occurred without proper investment in outpatient care. He traces how economic and political incentives led to the erosion of long-term planning. The result, he argues, was a "system without walls" that provided little structure or support for the most vulnerable—a shift that relied on the fiction of community care while structurally disabling it.

---

3. United States Government Accountability Office (2015).

Title: Mental Health: HHS Leadership Needed to Coordinate Federal Efforts Related to Serious Mental Illness
Annotation:
This GAO report provides quantitative data on the failure of interagency coordination in U.S. mental health services. It highlights fragmentation, duplication, and chronic underfunding of community services. The absence of federal oversight contributes to a patchwork of organizations where individuals with serious mental illness frequently fall through systemic cracks.

---

4. Torrey, E. Fuller et al. (2014).

Title: The Shortage of Public Hospital Beds for Mentally Ill Persons
Organization: Treatment Advocacy Center
Annotation:
This advocacy report tracks the reduction of psychiatric beds across U.S. states and connects the decline to increases in homelessness, incarceration, and psychiatric emergencies. Torrey argues that without hospital-level care for acute and chronic psychiatric needs, communities default to more punitive or neglectful strategies—effectively criminalizing mental illness.

---

5. Walker, E.R., McGee, R.E., & Druss, B.G. (2015).

Title: Mortality in Mental Disorders and Global Disease Burden Implications
Published in: World Psychiatry, 14(2), 153–160
Annotation:
This meta-analysis documents that individuals with serious mental illness die 10–25 years earlier than the general population, largely due to preventable conditions. The findings implicate systemic failures in both mental and physical healthcare, reinforcing the view that these lives are neglected structurally, not just individually.

---

6. Bureau of Justice Statistics (2017).

Title: Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011–12
Annotation:
This official dataset reveals that 37% of prisoners and 44% of jail inmates report mental health problems. These statistics support the idea that prisons and jails have become the new default institutions for people with untreated mental illness—a form of transcarceration that mirrors the warehouse function of old asylums but without therapeutic purpose.

---

7. Stern, Alexandra Minna (2005).

Title: Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America
Annotation:
Stern examines how early 20th-century eugenics has morphed into more bureaucratic and neoliberal forms of exclusion. She traces how economic utility increasingly defines social worth, enabling the continuation of eugenic logic under different guises—particularly through cost-cutting health policies that indirectly target marginalized lives.

---

8. Schweik, Susan M. (2009).

Title: The Ugly Laws: Disability in Public
Annotation:
Schweik excavates the history of ordinances that criminalized visible disability and links them to contemporary practices of invisibilizing and marginalizing disabled individuals. The book provides historical continuity between overt forms of social exclusion and the passive but still violent practices of neglect and abandonment today.

---

9. Ben-Moshe, Liat (2020).

Title: Decarcerating Disability: Deinstitutionalization and Prison Abolition
Annotation:
Ben-Moshe provides a deeply theorized, abolitionist critique of deinstitutionalization. She argues that while institutions were closed, new forms of confinement emerged—particularly carceral. Her analysis shows how both disability and criminality are governed through regimes of control and elimination, often disguised as care or reform.

---

10. Butler, Judith (2004).

Title: Precarious Life: The Powers of Mourning and Violence
Annotation:
Butler introduces the concept of “grievable lives”—those whose loss is publicly acknowledged and mourned. Applying this to the context of deinstitutionalization, the deaths and suffering of people with serious mental illness often go unmarked and ungrieved, signaling a social consensus about whose lives matter.

---

11. Mol, Annemarie & Law, John (2002).

Title: Complexities: Social Studies of Knowledge Practices
Annotation:
Mol and Law show how modern systems disperse responsibility across bureaucracies, preventing any clear agent from being accountable for failure. In the context of mental health, this explains how neglect persists under the guise of policy, procedure, and efficiency—leaving individuals unsupported while maintaining the appearance of care.

In Sum:

What was framed as liberation in deinstitutionalization too often became “freedom to fail” in underresourced, indifferent systems. Families and communities were left unsupported, leading to compassion fatigue, scapegoating, or abandonment. The result has been a form of structural violence—passive, distributed, and bureaucratically managed.

The deinstitutionalization wave, especially from the 1960s–1980s, is often cast as a moral victory. But in practice, it replaced total institutions with neglect cloaked as freedom. Community-based services were never adequately funded or integrated, particularly for people with mental illness. This abandonment functions as a passive form of elimination: some lives are neither supported nor grieved. It fulfills the eugenic logic of “removal” without the scandal of active intervention. In this sense, deinstitutionalization echoes the eugenic ideology of disappearance—except now it's bureaucratically sanitized: some lives are not worth sustaining, so they are allowed to fall away.

In many crucial ways this era has seen a "dumbing down" in epistemic terms. In practice it often replaced enclosed cruelty with confused neglect, epistemic shallowness, and invisibilized harm. It coincided with both a degradation of certain forms of knowledge and the persistence or even intensification of stigma.

Stigma continues to be shaped by media that: Equates schizophrenia with violence or unpredictability. Glorifies neurodiversity in “palatable” forms (e.g., autism in tech geniuses) while stigmatizing or ignoring others. Frames mental health as an individual resilience issue, subtly blaming those who “fail” to recover.

Necklacing is a brutal method of execution and torture that involves placing a rubber tire filled with gasoline around a person's chest and arms, then setting it on fire. The person is burned alive, often in a public setting. Tragically, people with mental illnesses have been killed by necklacing, often in contexts where mental illness is misunderstood, stigmatized, or associated with criminality, witchcraft, or possession. While there is limited systematic data due to the informal and extrajudicial nature of such killings, reports from various countries—especially in parts of sub-Saharan Africa, Southeast Asia, and Latin America—document mob violence against individuals perceived as "mad" or "possessed." In some cases, this escalates to necklacing.

Situations Where This Occurs:

• Accusations of witchcraft or possession: People with visible or disruptive psychiatric symptoms may be accused of being witches or cursed, especially in rural or low-resource settings. In some communities, this can lead to public torture or execution—often by burning, including necklacing.

• Fear-based vigilante justice: In unstable areas where formal institutions (police, courts, hospitals) are weak or mistrusted, mobs may interpret erratic behavior as a threat. People experiencing psychosis, mania, or severe trauma may be perceived as criminals or dangerous spirits.

• Scapegoating and dehumanization: During periods of social breakdown, displaced aggression and fear often target the most vulnerable. Mentally ill individuals are especially at risk of being seen as nonpersons or threats to social order.

Examples:

• In Nigeria, South Africa, and Haiti, reports over the years have documented people with mental illness killed in mob justice incidents—sometimes by fire.

• In South African townships in the 1980s and 1990s, mentally ill people were occasionally swept up in necklacing campaigns intended to target informants or "enemies," due to confusion, scapegoating, or the breakdown of social protections.

• Uganda and Tanzania have reported killings of mentally ill persons linked to witchcraft accusations.

Broader Dynamics:

These killings are not only about individual pathology or mob violence—they’re about how society treats difference when under stress, especially when governance, care systems, and cultural understanding fail. Mental illness becomes a signifier of disorder or danger, and without protective frameworks, the result is often elimination.

Would you like to look into any specific country or case? Or relate this to broader questions of deinstitutionalization or state neglect?

You said:

The latter

ChatGPT said:

Thank you for steering it that way—the connection between necklacing (or other mob forms of execution) and the broader dynamics of deinstitutionalization, state neglect, and failed care infrastructures is not only crucial but often deliberately overlooked.

---

❖ Deinstitutionalization and the Collapse of Mediating Institutions

Deinstitutionalization was framed—especially in the West—as a liberation from oppressive psychiatric institutions. But what often replaced institutional care was nothing: no housing, no sustained medical support, no community scaffolding. In the Global South, where such institutions were often fragile or colonial in origin, deinstitutionalization never arrived as reform but rather as abandonment. As economic pressures intensified, and state legitimacy eroded under structural adjustment or corruption, even basic psychiatric care disappeared.

In this vacuum, mentally ill individuals are no longer seen, housed, or held by any civic structure. Instead, they appear in the street, in the village square, or in front of a marketplace—untranslated and unprotected, interpreted by local logics.

And where interpretation is left to fear and stigma, the mad person becomes the witch, the spy, the unclean, the threat.

---

❖ From Uncare to Elimination: The Logic of Unmediated Exposure

This leads to what Giorgio Agamben might call “bare life”—life that can be killed without consequence because it has no political or juridical recognition. People with severe mental illness, especially when abandoned by institutions, live in a state of unmediated exposure to society—no one translates or buffers their presence. They are:

• Not citizens (they cannot vote or speak for themselves)

• Not patients (because care is absent or contingent)

• Not criminals (until labeled as such by the mob)

• Not family (often disowned or neglected)

They become ontologically confusing: alive, but socially dead. And when a society is stretched thin, it resolves such confusion by elimination.

Necklacing, burning, lynching, and disappearance are not simply acts of anger—they are ritual expulsions of that which the social body can no longer absorb or metabolize. They are grotesque performances of boundary enforcement in places where law, care, and speech have failed.

---

❖ Deinstitutionalization as Misframed Liberation

The Western myth is that deinstitutionalization meant progress—freedom from asylums, normalization, reintegration. But when exported or mirrored elsewhere without material and institutional support, it functioned as a moralizing withdrawal: “Let them live freely” becomes “Let them die invisibly.” Or in this case, very visibly.

The disintegration of psychiatric care, without a simultaneous reweaving of social supports and epistemic translations of madness, leads not to liberation but to hyper-visibility without protection—a stage set for public violence.

---

❖ Modern Analogues

In contemporary mental health policy, we still see these logics play out, though usually in subtler forms:

• People with mental illness dying in police custody or on the street because no one was able or willing to intervene.

• Refugees and disabled persons languishing in detention centers without treatment or attention.

• The use of “behavioral” categories to criminalize or expel rather than understand or support.

• The framing of people as “noncompliant,” “treatment-resistant,” or “unshelterable”—a semantic cousin of disposability.

• The fact that accusations of witchcraft or demonic possession are analogues of modern (official or informal) stigma and stereotyping.

---

❖ Final Thought

Necklacing is a horror—but it is not an aberration. It is what happens when the removal of mediation becomes normalized—when the mentally ill are not protected by the state, not sheltered by institutions, not translated by culture, not seen by neighbors.

The real horror is not the tire and the fire. It is the moment before, when no one speaks, no one translates, no one intervenes—because the person has already been rendered non-person.

Would you like this reframed into a more formal or essayistic structure? Or connected to contemporary Western policies that reflect similar disavowals in less dramatic form?

The latter

ChatGPT said:

Excellent—this is a needed direction. Let’s follow the conceptual thread from necklacing as public elimination to contemporary Western policies that function by similar logics of disavowal, abandonment, and euphemized violence, even if they wear institutional or clinical clothing.

---

❖ The Modern Face of Disavowal: How Western Policy Echoes the Logic of Necklacing

In the West, necklacing does not appear. There are no gasoline-filled tires, no cheering mobs. Instead, there are policy papers, budget shortfalls, risk management frameworks, and public-private partnerships. But the effect—the exposure and slow death of the mentally ill—often rhymes.

Let’s trace a few core parallels.

---

1. From Ritual Burning to Procedural Withholding: The Aesthetics of Elimination

Where necklacing is visceral, modern psychiatric disavowal is clinical and bureaucratic. But the endpoint is often the same: death by exposure.

• Involuntary discharge from hospitals due to insurance limits or empty beds.

• Refusal of inpatient care on the basis that a person is not “sick enough” or “does not meet criteria.”

• Law enforcement substitutes for mental health workers—resulting in deaths during “wellness checks.”

• Outpatient compliance models that assume capacity and blame the individual when they fail to show up, medicate, or stabilize.

Each of these is a non-intervention framed as best practice. The person is left on the street, in a shelter, in jail, or in the liminal zone of “community care” that has no community.

4. The Myth of Autonomy as Alibi for Abandonment

Modern policy drapes itself in the language of choice, consent, and empowerment. Deinstitutionalization was sold as giving people freedom. But what emerged is often “freedom to die unassisted.”

• You are “free” to refuse medication—but no one explains your delusions are not freedom.

• You are “autonomous” to live outside—but there is no house.

• You are “empowered” to participate in your care—but the clinic doesn’t call back.

• You are “not sick enough” to be hospitalized—until you die, at which point you are finally sick enough.

This hollow liberal framework fetishizes agency while disavowing its own responsibility. We pretend we are not burning anyone. But the mentally ill still die, not through fire, but through denial of service, euphemized abandonment, and institutionalized invisibility.