The Long Shadow of Institutionalization: How History Warns Against Trump and RFK Jr.’s ‘Wellness Farms’

How the resurgence of institutionalization threatens marginalized communities under the guise of public health and wellness.

The image depicts a large, institutional-style building with a symmetrical, fortress-like design, surrounded by lush greenery and neatly arranged trees. The structure features long, uniform rows of windows and central towers, evoking historical asylums and state-run facilities. Silhouetted figures, appearing small in scale, walk towards the entrance, casting long shadows in the sunlight, reinforcing a sense of control, confinement, and surveillance. This visual echoes themes of institutionalization, historical abuses, and the potential dangers of reinstituting such spaces under the guise of wellness and rehabilitation.

Content Warning: This blog discusses historical trauma, including forced institutionalization, eugenics, medical experimentation, psychiatric abuse, and coerced labor, which may be disturbing or triggering.

The past has a way of whispering its warnings, but only if we are willing to listen. The history of institutionalization in the United States is a brutal and cautionary tale, particularly for disabled people, Black, Indigenous, and people of color (BIPOC) communities, LGBTQ+ individuals, and women. For more than a century, the U.S. has subjected marginalized groups to forced confinement, eugenics-driven sterilization, and abusive medical treatments in institutions that claimed to “cure” them; masking its cruelty with words like “treatment” and “care” while justifying the deprivation of freedom in the name of health. Now, the Trump administration’s “Make America Healthy Again” (MAHA) initiative, under the leadership of Robert F. Kennedy Jr. as Secretary of Health and Human Services (HHS), threatens to resurrect these harmful legacies under the guise of rehabilitation and wellness.

The History of Institutionalization and Its Atrocities

Throughout the 19th and 20th centuries, institutionalization was the dominant approach to addressing disability, “mental illness,” and social deviance. It was driven by the medical model of disability, which frames disabled people as problems to be fixed or hidden rather than as individuals with rights and agency. Further, as Douglas Baynton argued, disability has been used historically to justify the oppression and disenfranchisement of other marginalized groups:

• Race and Eugenics: Many institutions disproportionately targeted Black, Indigenous, and other people of color. The forced institutionalization of Black individuals was common during segregation, where they were denied medical treatment and subjected to unethical experimentation. Eugenics policies, which sought to “improve” the human race through selective breeding, led to the forced sterilization of thousands of disabled and BIPOC individuals under state-sanctioned laws that persisted well into the 1970s.
• LGBTQ+ Oppression: LGBTQ+ individuals were deemed “mentally ill” and sent to asylums where they were subjected to electroshock therapy, chemical castration, and conversion therapy. Institutions frequently targeted transgender individuals, forcing them to undergo cruel medical experiments.
• Women and Gender Control: Women who defied gender norms, including those labeled as “promiscuous,” unmarried mothers, and survivors of abuse, were often confined in psychiatric institutions or “girls’ reform schools,” where they were sterilized or subjected to forced labor under abusive conditions.

These institutions operated on a simple, devastating premise: that some people — particularly disabled people, BIPOC individuals, LGBTQ+ people, and those who defied societal gender norms — were better off hidden away. Eugenics-driven policies led to the forced sterilization of thousands. Asylums subjected residents to electroshock therapy, forced labor, and medical experimentation. The system did not heal — it harmed.

One striking example is the U.S. Narcotic Farm in Lexington, Kentucky, which was presented as a revolutionary addiction treatment facility. Instead, it became a site of government-run drug experiments, where prisoners and patients alike were subjected to inhumane testing. These “treatments” weren’t about care. They were about control.

Despite the gradual movement toward deinstitutionalization in the mid-to-late 20th century, many of the ideologies that fueled these abuses remain embedded in American policy. The push toward reinstitutionalization is not a relic of the past — it is a looming threat in our present.

‘Make America Healthy Again’: The Dangerous Return to Institutions

And now, in 2025, it’s happening again. Under Trump’s second administration, the “Make America Healthy Again” (MAHA) Commission, led by RFK Jr., is promoting drastic shifts in public health policy. While MAHA claims to address addiction, mental health, and chronic illnesses, its approach relies on dangerous, unscientific means that resemble past institutional models.

Among the most alarming proposals is RFK Jr.’s “wellness farms” initiative, which would place individuals with psychiatric disabilities — including people with substance use and mental health conditions — and chronic illnesses in isolated farm settings, ostensibly to rehabilitate them through labor and natural living. Kennedy has framed this as an alternative to incarceration for drug users, but history tells us that such programs quickly devolve into coercive institutions where marginalized people are forcibly confined and exploited.

The Problems with ‘Wellness Farms’

• Coerced Confinement: While Kennedy claims these programs would be voluntary, history suggests otherwise. The criminalization of drug use and “mental illness” has repeatedly led to the forced institutionalization of poor, disabled, and BIPOC individuals. Courts may use “wellness farms” as an alternative to incarceration, effectively mandating confinement and stripping individuals of true choice.
• Exploitation and Labor Abuse: Many historical institutions justified their operations by making residents perform unpaid labor. Similar programs today could force disabled individuals, including those with psychiatric disabilities, to work under exploitative conditions, reminiscent of past asylum and prison labor schemes that disproportionately harmed BIPOC communities.
• Lack of Evidence-Based Care: Effective support for substance use, mental health, and chronic illness must prioritize human rights, autonomy, and dignity. True care is non-coercive, voluntary, and community-based, centering peer-led, harm reduction, and trauma-informed approaches rather than forced confinement and labor on farm-based facilities. RFK Jr.’s anti-vaccine and anti-medication rhetoric suggests that these facilities may deny participants access to essential, evidence-based care, replacing it with ineffective, pseudoscientific interventions that strip individuals of choice and autonomy.
• Threat to BIPOC and LGBTQ+ People: Given the history of medical racism and queerphobic psychiatric practices, “wellness farms” could easily become a modern-day tool for racialized and gendered oppression. BIPOC individuals struggling with addiction already face harsher sentencing and minimal access to care and resources. LGBTQ+ individuals, particularly transgender people, have historically been forced into rehabilitation programs that seek to “fix” their identities rather than support their well-being.

The Kennedy Family Legacy and Its Contradiction

Robert F. Kennedy Jr.’s MAHA initiative and “wellness farms” are fundamentally at odds with the Kennedy family’s history of disability rights advocacy.

President John F. Kennedy spearheaded deinstitutionalization efforts, pushing for community-based care rather than isolating disabled individuals in large institutions. His administration’s Community Mental Health Act (1963) marked a historic move away from the warehousing of people with disabilities in asylums and other restrictive settings. RFK Jr.’s proposal to place people in “wellness farms” reverses this progress, reviving a model that closely resembles the institutions his uncle sought to dismantle.

Additionally, the forced lobotomy and institutionalization of Rosemary Kennedy, RFK Jr.’s aunt, was a personal and public tragedy that shaped the family’s advocacy for disability rights. Rosemary’s mistreatment was a stark example of how institutionalization could destroy lives, leading the Kennedy family to push for the end of forced institutionalization and the development of disability rights protections. RFK Jr.’s push for institutional-style “rehabilitation” ignores this painful history.

Eugenics influenced many institutional policies of the 20th century, viewing disability and “mental illness” as defects to be “fixed” or hidden away. While RFK Jr. does not explicitly promote eugenics, his distrust of mainstream medicine, vaccines, and pharmaceutical treatments aligns with the historical ideologies that sought to “rehabilitate” disabled people through non-medical, coercive lifestyle changes rather than providing them with the proper care and autonomy they deserve. This echoes past moralistic and eugenic arguments that institutionalization and controlled environments could “purify” individuals with disabilities or chronic illnesses.

Legal and Ethical Battleground

The rise of “wellness farms” as an alternative to incarceration raises serious constitutional, disability rights, and labor concerns. These proposed facilities risk violating due process protections, disability rights laws, and federal labor standards. The legal precedent is clear: individuals cannot be arbitrarily confined, segregated from their communities, or subjected to exploitative labor under the guise of treatment.

Due Process Violations

The Fourteenth Amendment’s Due Process Clause guarantees that people cannot be deprived of their liberty without due process. Addington v. Texas (1979) set the precedent that involuntary commitment of people with “mental illness” requires “clear and convincing evidence” that an individual poses a danger to themselves or others. If these “wellness farms” are used as an alternative to incarceration, they could violate constitutional protections against arbitrary confinement.

Disability Rights Protections

The Americans with Disabilities Act (ADA) mandates that disabled individuals have access to community-based services in the least restrictive, most integrated setting possible, as a result of the Olmstead v. L.C. (1999) decision, so long as certain conditions are met. Under Olmstead, community-based placement is required if (1) the individual agrees to it, (2) treatment professionals agree, and (3) it does not fundamentally alter the state’s ability to administer services to other constituents. Any system that forces disabled people into segregated, farm-based facilities rather than providing real services and support is a blatant violation of disability rights.

Labor Law Concerns

If these facilities mandate labor as part of treatment, they could face legal challenges under the Fair Labor Standards Act (FLSA), which protects against forced, unpaid labor in institutional settings. If individuals in “wellness farms” are mandated to work without proper compensation, this would constitute a violation of federal labor protections. Additionally, many disabled workers have historically been exploited under Section 14(c) of the FLSA, which allows employers to pay subminimum wages to disabled workers. This policy has trapped disabled individuals in poverty and has been widely criticized as outdated and discriminatory. Programs like “wellness farms” risk replicating this exploitative model by providing little to no real economic opportunities for participants while justifying their labor as part of their “rehabilitation.”

Reinstitutionalization isn’t just a policy failure — it’s a legal and ethical crisis.

Reinstitutionalization in the Present: The Push to Isolate Disabled People

While MAHA and RFK Jr.’s proposed “wellness farms” represent a federal push toward reinstitutionalization, state and local policies have already been setting the stage for this trend.

• New York City: Mayor Eric Adams’ Mental Health Directive — In 2022, Adams authorized police and emergency services to involuntarily hospitalize individuals exhibiting severe “mental illness,” even if they posed no immediate threat to themselves or others. This policy effectively criminalized homelessness and expanded the scope of involuntary commitment, raising significant concerns about civil liberties.
• California: Governor Gavin Newsom’s Legislative Actions — The CARE Courts initiative allows judges to mandate treatment for individuals with mental health conditions, while SB 43: Lanterman-Petris-Short Act expands the definition of who can be involuntarily committed. Additionally, Proposition 1, passed in 2024, allocates billions of dollars toward mental health institutions rather than community-based services.

Such policies reflect a growing governmental preference for forced treatment, confinement, and institutionalization over voluntary, evidence-based, cost-saving, community-based care.

A Call to Reject Reinstitutionalization

History has shown us the devastating consequences of institutionalizing people under the guise of health, safety, and public order. From the eugenics movement to the horrors of asylums, institutionalization has always been a tool of oppression. These past injustices are not relics of history — they are warnings.

Reinstitutionalization is dangerous because it repeats the failures of the past, leading to abuse, exploitation, and social isolation rather than meaningful rehabilitation. When individuals are removed from their communities under the pretense of “care,” they lose autonomy and become vulnerable to systemic mistreatment. Historically, institutionalization has disproportionately harmed BIPOC, LGBTQ+, and disabled individuals. The expansion of involuntary commitment laws — alongside new policies like MAHA and “wellness farms” — threatens to once again push these communities into confinement under the guise of “treatment.” This shift also risks eroding critical disability and civil rights protections.

The notion that these facilities will be voluntary is misleading. History has shown that judges, police, and state agencies frequently coerce individuals into institutions “for their own good,” disguising forced confinement as “choice” when, in reality, there are no real alternatives.

One of the most compelling arguments against institutionalization is the economic burden it places on governments and taxpayers. Research consistently shows that providing Home and Community-Based Services (HCBS) is far more cost-effective than maintaining institutional settings. Beyond cost savings, HCBS also leads to better health outcomes, increased independence, and a higher quality of life for disabled individuals. By shifting resources away from outdated, costly institutions and investing in community-based solutions, states can reduce public spending while ensuring individuals receive care in the least restrictive, most dignified settings possible.

However, initiatives like Trump’s MAHA agenda and RFK Jr.’s “wellness farms” threaten to revive the horrors of institutionalization, repackaged as policy solutions. But forced confinement, even under the pretense of “help,” is not care — it is control. True public health solutions must prioritize autonomy, affirm identity, and center evidence-based, community-driven support systems. Instead of resurrecting harmful, outdated models of institutionalization, we must invest in care that upholds dignity, self-determination, and justice.

The Future We Must Fight For

We know how this story ends if we don’t intervene — we’ve seen it before. The trauma of forced institutionalization lingers across generations, and the pain of those who suffered in the shadows of asylums and reform schools remains unhealed. The alternative to Kennedy’s vision is not apathy — it is real, evidence-based solutions. Instead of reviving harmful, outdated models, real solutions lie in the sustained investment of community-based, non-carceral care, including:

• Expanding access to harm reduction programs and community-based treatment for substance users.
• Investing in mental health services that prioritize autonomy and consent.
• Ensuring disabled people have the right to live in their communities with full support.
• Divesting from carceral mental health crisis response models, including those that involve police, forced psychiatric interventions, and involuntary hospitalization.
• Supporting peer-led, community-driven initiatives, such as voluntary crisis respite centers.
• Expanding access to permanent supportive housing, recognizing housing as a human right.
• Resisting policies advancing psychiatric incarceration, including Newsom’s CARE Courts, Adams’ involuntary hospitalization directives, and RFK Jr.’s “wellness farms.”
• Addressing structural inequalities like economic instability, systemic racism, and healthcare inequities, which drive mental health crises far more than a lack of institutionalization.

The fight against institutionalization is not just history — it is happening now. We cannot afford to stay silent. Now is the time to organize, mobilize, and fight against reinstitutionalization once and for all.

Additional Resources

• Check out this recording from one of our past panels: “The Politics of Psychiatric Reinstitutionalization” to learn more about reinstitutionalization.
• Read our “First 100 Days Race & Disability Guide” to learn about current threats to racial and disability justice in the new Trump administration. The Guide offers a comprehensive, detailed, and accessible look at these changes and their potential long-term impact on the nation.
• Explore Kyanda Bailey’s blogs for further analysis on race, disability, gender, and healthcare disparities: (1) “Dynamics of Race and Disability in Healthcare Disparities” and (2) “Breaking the Silence: Maternal Health and Black Disabled Women”

The Northwestern Pritzker Law Center for Racial and Disability Justice (CRDJ) is a first-of-its-kind center dedicated to promoting justice for people of color, people with disabilities, and individuals at the intersection of race and disability.

Learn more about CRDJ by visiting the Center for Racial and Disability Justice webpage.