It is a complicated story, but the movement to close the asylums was originally supposed to have gone fist-in-glove with the community mental health movement. This supremely humane reform effort was co-opted by the budget mavens, however, who did the former without supporting the latter. Among other things, the story of homelessness in America is in large measure the story of the bereft and abandoned deinstitutionalized mentally ill turned out to the streets with no provision for fending for themselves. In fact, this current proposal for a new hospital grew out of Governor Romney’s budget-slashing effort to close one of the remaining three hospitals in further deinstitutionalization. Indeed, the new hospital will replace two crumbling existing ones and will result in an overall reduction in the number of state hospital beds in Massachusetts. Nevertheless, it is the first new expenditure for the sickest of the chronically mentally ill in a long time in this state. I am no fan of mental health bureaucrats, but the Department of Mental Health under its current commissioner Elizabeth Childs MD seems truly dedicated to its constituency. It is at the forefront of the nationwide effort to eliminate involuntary medication, seclusion, and restraints from the practice of hospital psychiatry as well.