Instituions are full of terrible abuse. Freezing to death on the streets is better than institutions - that is how bad instituions end up being in practice.

I don't have a good answer to the problem.

It seems there has to be some amount of institutional supervision that would make them at least not as bad as freezing to death in the streets.

But one of the big problems is that almost all of them forbid drugs, the very high they want, so they're a non-starter.

You probably need something like "drug towns" in the California desert that provide comfortable places to overdose to death. Good luck running on that!