I don't think most people with mental disorders are institutionalized at some point, but some people with severe enough ones are. I know a hell of a lot of people who are worse off than I am and never end up getting help. The issue is that even when the state mandates things for these people... you can't possibly provide lifelong intensive babysitting for every nutty person in the country. Regardless of how fair it is or how much it helps/hinders them, everyone is ultimately responsible for their own actions. If you kill someone, they're still dead, even if you have multiple personality disorder and were raped and have daddy issues. If a grown person doesn't want to take their medication, and nobody is there to force them, ain't nothin the state can do either. All they can do is wait until the person either breaks the law or hurts themselves bad enough to wind up in the hospital again.