Back in the 70's and prior, mental health facilities were barbaric. "One Flew Over the Cuckoo's Nest" brought to light these travesties, and many were shut down.

Later, republicans then shut down more by defunding as well. What effectively happens is people are shunted to other communities where better services are offered. Lookup "Greyhound therapy", where city govt's pay for bus service to 'somewhere else'.

Now, the primary caregiver is the penal system. And remember, we still do not have single-payer medical, so unemployed/homeless are still without.