The asylum/institution model was abandoned largely because there appeared to be widespread abuse, neglect, and poor outcomes, which were typified by One Flew Over the Cuckoo's Nest.

The trouble is that people apparently decided that the abuse, neglect, and poor outcomes were due to inpatient status and not anything inherent to the treatments themselves, so in the 40+ years since asylums all closed, we've basically reinvented invisible asylums with a massive apparatus of voluntary, inefficient outpatient programs which are rife with abuse, neglect, and poor outcomes.

Case in point: there's a huge Medicaid scandal in Arizona right now regarding Native Americans. What happened is that there were dudes in vans going to New Mexico, and basically kidnapping natives (mostly Navajo who were off the reservation) and promising them addiction recovery services, mental health treatment, and stuff, if they would only get in the van and cross state lines.

The homes they took them to were unlicensed, mismanaged, and committing fraud, and often dumped the natives out on the street with no resources or way home.

Talk about abusing a doubly-vulnerable population; it's appalling. And to think that there is little stopping someone like me from being caught in that.