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Would it be possible to reinstitutionalize the seriously mentally ill today? Experts agreed it would be unrealistic to return to mass institutionalization.

The law likely wouldn’t allow it, given several U.S. Supreme Court decisions that raised the threshold for involuntary commitment, including O’Connor v. Donaldson in 1975 and Addington v. Texas and Parham v. J.R. in 1979. "It would probably be impermissible to continue to hold someone who has been successfully treated with medication, unless it can be shown they will go off their meds once released," Vanderbilt’s Slobogin said.

Even if mass institutionalization were to return, it’s unlikely to reduce violence enough to outweigh the financial and societal costs, said Linda A. Teplin, vice chair for research in the department of psychiatry and behavioral sciences at Northwestern University’s Feinberg School of Medicine. Because the vast majority of people committed would be nonviolent, she said, it would neither be cost-effective for reducing crime nor beneficial for the health of the people who would be institutionalized.

"Substance use, inequality and lack of opportunity, and access to guns are the major drivers of violence," rather than mental illness in a vacuum, Cohen said. Blaming serious mental illness "is just a diversion tactic."