Many presidents dealt with mental illness during their time in the White House and beyond. But that doesn’t mean that every occupant of the Oval Office has made the most ethical choices about services and treatments for Americans with mental illness. Many presidents have weighed in on the issue, including Donald Trump. And some of their opinions and policies became more controversial than others.

Read on to discover what our former presidents have had to say about mental asylums in America. And get the details on Donald Trump’s opinion.

1. Rutherford B. Hayes

Mother Jones reports that mental asylums in the United States really got their start in 1841. That year, Boston schoolteacher Dorothea Dix visited the East Cambridge Jail and saw the squalid living conditions of the mentally ill. She believed that people with mental illnesses should be cured, not locked away forever. So she lobbied lawmakers for better treatment.

Dix’s efforts led to the establishment of 110 psychiatric hospitals by 1880, during the presidency of Rutherford B. Hayes. Hayes himself took an interest in improving mental asylums. And as governor of Ohio, he even helped reform the state’s mental hospitals.

Next: This president sent the mother of his illegitimate child to a mental asylum. 

2. Grover Cleveland

Grover Cleveland may not have said a lot about mental asylums. (In his first annual message as governor of New York, Cleveland did call for reform at the state’s mental asylums.) But his history with them doesn’t exactly inspire confidence that he appreciated their true purpose. Cleveland was one of the many presidents to father an illegitimate child. He covered up the affair. And he may have had a hand in throwing the mother in a mental asylum.

As Smithsonian Magazine explains, Maria Halpin gave birth to a son with surname Cleveland. Authorities promptly removed the child from her custody. Halpin was then admitted under “murky circumstances” to the Providence Asylum. But managers of the facility didn’t have a right or warrant to detain her, so she was released after a few days.

Next: This president approved of the sterilization of criminals and people with mental illness. 

3. Theodore Roosevelt

Many Americans don’t know about it. But there was an uncomfortably long period of American history when the country practiced eugenics and population control tactics. That included forcing sterilization upon people with mental illness, people living in poverty, and people of color. Many of these operations even took place at mental asylums.

Theodore Roosevelt supported the practice. As New Statesman explains, Roosevelt bluntly said, “I wish very much that the wrong people could be prevented entirely from breeding; and when the evil nature of these people is sufficiently flagrant, this should be done. Criminals should be sterilised and feeble-minded persons forbidden to leave offspring behind them.”

Next: This president called for research on mental illnesses.

4. Harry S. Truman

Mother Jones reports that in 1946, Harry S. Truman signed the National Mental Health Act. The bill called for the establishment of the National Institute of Mental Health to conduct research into neuropsychiatric problems. And Truman advocated for the establishment of more mental asylums and psychiatric outpatient clinics. In 1945, Truman had told Congress:

There is also special need for research on mental diseases and abnormalities. We have done pitifully little about mental illnesses. Accurate statistics are lacking, but there is no doubt that there are at least two million persons in the United States who are mentally ill, and that as many as ten million will probably need hospitalization for mental illness for some period in the course of their lifetime. . . We need more mental-disease hospitals, more out-patient clinics. We need more services for early diagnosis, and especially we need much more research to learn how to prevent mental breakdown. Also, we must have many more trained and qualified doctors in this field.

Next: This president thought the U.S. needed more funding for mental asylums. 

5. Dwight D. Eisenhower

In a message to Congress in 1935, Dwight D. Eisenhower recommended “new and intensified measures in our attack on mental illness,” including more funding for mental asylums. He advocated for more aid to state and community programs, more budgetary support for training programs, and a new program of mental health project grants. Eisenhower explained, “Such projects would aim at improving the quality of care in mental institutions and the administration of the institutions themselves.”

Mother Jones reports that the number of mentally ill people in public psychiatric hospitals peaked in 1955, during Eisenhower’s presidency. But as The Atlantic notes, many psychiatric hospitals at the time served as “warehouses in which, say, schizophrenics would live alongside epileptics. Patients were often abused and rarely rehabilitated.” The publication adds, “When drugs that could control the delusions and psychoses of major mental illnesses came along, they were seen as a cheaper and more humane alternative to long-term, inpatient psychiatric care.” PBS reports that with the advent of those drugs came the initial push toward deinstitutionalization.

Next: This president wanted outpatient clinics instead of mental asylums. 

6. John F. Kennedy

Mother Jones reports that in 1963, John F. Kennedy signed the Community Mental Health Act to provide federal funding for the construction of community preventive care and treatment facilities. His idea? People with mental illness could get care at these facilities while living on their own instead of at mental asylums. The bill was the last piece of legislation that Kennedy ever signed. But between the Vietnam War and the economic crisis on the horizon, the program never got adequate funding.

Kennedy may have had a personal reason for taking interest in the treatment of those living with mental illness. His sister Rosemary Kennedy began having aggressive mood swings at age 23. So her father scheduled a secret lobotomy in 1941. The surgery was relatively new at the time (the first lobotomy had been performed in 1936, according to Mother Jones). The surgeon botched the lobotomy. And afterward, Rosemary could only say a few words, and couldn’t take care of herself.

Next: This president added more fuel to the fire of deinstitutionalization. 

7. Lyndon B. Johnson

Mother Jones reports that with the 1965 establishment of Medicaid by Lyndon B. Johnson, states began to see incentives for moving patients out of state mental asylums and into nursing homes and general hospitals. The reason why? The program excluded coverage for people in “institutions for mental diseases.”

That didn’t stop Johnson from including some lofty rhetoric in a statement he made upon signing the Mental Health Amendments of 1967. He said, “Not long ago, a sick or deeply troubled person was hidden away — treated more as a prisoner than as a patient; locked in a faraway place whose very name struck fear, the insane asylum. Now we are changing all that: taking down the bars of fear; letting in the air of knowledge; emphasizing, for the first time, modern local services; outpatient care; prevention as well as cure.”

Next: This president wanted to continue the federal government’s funding for mental healthcare. 

8. Jimmy Carter

Mother Jones reports that in 1980, Jimmy Carter signed the Mental Health Systems Act. The bill sought to restructure the community mental health center program and improve services for people with chronic mental illness. Salon notes that Carter’s bill proposed to continue the existing federal program. But it would also add some state involvement. The act also included a provision for federal grants “for projects for the prevention of mental illness and the promotion of positive mental health.”

But as Salon notes, reports issued by Carter’s Commission on Mental Health “gave no indication of a pending crisis.” The crisis looming on the horizon? The problems of homelessness, abuse, and crime that would result from the deinstitutionalization of patients discharged from state hospitals in the 1960s and 1970s.

Next: This president ended Carter’s program altogether. 

9. Ronald Reagan

In 1981, Reagan’s Omnibus Budget Reconciliation Act repealed Carter’s community health legislation. It also established block grants for states. Those grants officially ended the federal government’s role in providing services to the mentally ill. Reagan’s policies both as president and as governor of California started a nationwide movement of deinstitutionalization.

According to Salon, Reagan “never understood mental illness. Like Richard Nixon, he was a product of the Southern California culture that associated psychiatry with Communism.” He never exhibited interest in the need for research or better treatment for serious mental illnesses. Consequently, many Americans cite Reagan as the reason why so many Americans with mental illness end up either homeless or in jail.

Next: This president declared the 1990s the ‘Decade of the Brain.’

10. George H.W. Bush

The National Alliance on Mental Illness reports that in 1990, George H.W. Bush proclaimed the 1990s the “Decade of the Brain.” His goal was to focus attention on the benefits of brain research. He also signed the Americans with Disabilities Act (ADA), a bill that prohibited discrimination against individuals with disabilities, including people living with mental illness.

Bush called on the United States to observe the “Decade of the Brain” with progress in the neurologic sciences. Halfway through the 1990s, the effort was criticized for achieving only minimal public support or increases in research resources. But by the end of the decade, scientists had achieved several advances, including the development of the second generation of antidepressants and antipsychotics.

Next: This president addressed disparities in health coverage for mental illness.

11. Bill Clinton

The National Alliance on Mental Illness reports that in 1996, Bill Clinton signed the Mental Healthy Parity Act to begin addressing disparities in health care coverage for mental illness. In 1999, Clinton hosted the first White House Conference on Mental Health. That event signaled the importance of reducing the stigma around mental illness.

But years after he had left the White House, Clinton conceded that over-incarceration in the United States — a problem with a major effect on those living with mental illness — stems partially from policies passed under his administration. His wife, Hillary Clinton, said at the time that the criminal justice system places too much of a focus on incarceration. “Keeping them behind bars does little to reduce crime, but it does a lot to tear apart families. Our prisons and our jails are now our mental health institutions.”

Next: This president increased funding for clinics. 

12. George W. Bush

The National Alliance on Mental Illness reports that in 2004, George W. Bush signed the Mentally Ill Offender Treatment and Crime Reduction Act. That act provides resources for alternatives to incarceration for youth and adults with mental illness and substance abuse disorders. In 2008, Bush also signed a parity act. That bill established that health insurance coverage for mental health and substance abuse treatment should be equivalent to that for other medical conditions.

The New York Times noted at the conclusion of Bush’s tenure in the Oval Office that he also “doubled U.S. financing for community health centers, enabling the creation or expansion of 1,297 clinics in medically underserved areas.” According to the Times, those clinics “made a major push this decade to expand dental and mental health services, open on-site pharmacies, extend hours to nights and weekends, and accommodate recent immigrants.”

Next: Barack Obama had this to say about mental health care. 

13. Barack Obama

Barack Obama may not have said much about mental asylums, specifically. But proposing a measure to increase access to mental health care, Obama said, “We must continue to remove the stigma around mental illness and its treatment and make sure that these individuals and their families know they are not alone.”

Obama added, “While individuals with mental illness are more likely to be victims of violence than perpetrators, incidents of violence continue to highlight a crisis in America’s mental health system.” Experts applauded the increase in funding. But they remained concerned about the popular association between mental illness and gun violence. That association, many say, just doesn’t exist. At least not in the way that many Americans think it does.

Next: This is Donald Trump’s opinion on mental asylums. 

14. Donald Trump

The Atlantic reports that Donald Trump has repeatedly pointed to mental health solutions for America’s gun violence problem. He even says that he would like to reopen the mental asylums. As The Atlantic reports, “Experts say Trump is not wrong to suggest that America’s mental-health-care system should be strengthened, including, perhaps, by reopening mental asylums. The devil, though, would be in the details.”

The Atlantic notes that we couldn’t rely on mental asylums — even extremely well funded and regulated ones — to stop mass shootings. After all, we already have jails and forensic hospitals for people who commit crimes. Meanwhile, just a small percentage of mentally ill patients become violent. “The problem with Trump’s suggestion is that it reinforces the connection between mental illness and violence,” The Atlantic notes.

Next: What should the next occupant of the Oval Office know about mental asylums and mental health in the United States?

15. What should our next president know?

Donald Trump doesn’t have the most nuanced view of mental illness. But what should the president who succeeds Trump know about mental illness and mental asylums in America? As The Atlantic notes, many people with severe mental illness, especially if they’re poor, end up on the streets or in prison. The largest mental health facility in any given state is often a prison. And half of all prisoners have a mental health issue. Additionally, up to a quarter of the U.S.’s homeless population is also mentally ill.

Mental institutions — especially with adequate funding, comfortable facilities, and strict ethical regulations — could be part of the solution. And as for the problem of mass shootings? That will likely require a very different solution.

Read more: 7 Startling Truths About Psychiatric Hospitals Exposed

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