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Nick Johnston worked in a huge psychiatric hospital in Illinois in the 1960s. He remembers one of his first patients telling him that her husband was using his political connections to have her wrongly imprisoned.
Such abuse is part of the complex and sometimes shameful legacy of public institutions for people with mental illness across the country. And that’s part of why Johnston — who later ran an outpatient mental health center in St. Cloud — has long supported efforts to develop community-based alternatives to institutions.
But patient advocates say the community care system — from group psychotherapy to home treatment centers — was never fully built in Minnesota or the United States. That prompted Johnston to ask Curious Minnesota, the Star Tribune’s reader-powered reporting project, if that was the case. in part because state funding was not reinvested when Minnesota institutions closed.
“How much of the money saved,” he asked, “was used for the creation and operation of community mental health centers and services?” »
The precise answer to this question is tricky because the history of deinstitutionalization has spanned several decades, so the savings have not been achieved all at once. What is clear, however, is that closing institutions has not freed up enough state money to create a fully functioning community system, said Tony Lourey, a former DFL lawmaker and former department commissioner. of Minnesota Social Services.
The federal government promised funds as early as the 1960s to create a network of new community mental health centers, but funds were tight even before support was actually reduced during the 1980s, said Sue Abderholden, director executive of the patient advocacy group NAMI Minnesota. Critical gaps in non-hospital care remain today, Abderholden said, even as increased state and federal funding over the past 25 years has brought the community system closer to its goal.
“We’re spending a lot more and providing a lot more services,” she said, “but we’re still not meeting the need.”
Institutions come under scrutiny
Minnesota established its first public hospital for people with mental illness in St. Peter in 1866. As the population grew, several more hospitals were added, including facilities in Rochester, Fergus Falls, Hastings, and Anoka.
The building that housed Fergus Falls State Hospital still stands, a massive structure spanning a third of a mile. For decades, it was a largely self-sufficient microeconomy, with farms that fed the 1,600 to 1,800 patients who lived there, said Chris Schuelke, executive director of the Otter Tail County Historical Society. The patient population peaked at around 2,000 people during the Great Depression and grew over time to include many patients with developmental disabilities.
“It’s huge,” Schuelke said of the building.
The years following World War II were controversial over the facilities. The Minneapolis Tribune published a scathing expose on poor living conditions in 1948. Governor Luther Youngdahl made a highly publicized campaign for change, including a 1949 media event in which he burned women’s straitjackets. force, leather straps and other devices that had been used to restrain patients at the hospital. Anoka Public Hospital.
“His goal was to elevate Minnesota’s psychiatric institutions from among the worst in the nation to a model for the future,” wrote Susan Foote, a retired University of Minnesota public health professor, in her book “ The Crusade for Forgotten Souls.
The push for reforms has led to significant improvements, Foote said in an interview. But some did not survive Youngdahl’s tenure.
In 1963, President John F. Kennedy outlined his vision for a better mental health care system based on care in community settings rather than institutions. It builds on the successful introduction of the first antipsychotic drugs in the mid-1950s, which already allowed many patients with serious mental illnesses to live outside public hospitals.
With the passage of the Community Mental Health Act, the federal government began providing $150 million to build and staff 1,500 community mental health centers. Each facility was intended to serve areas with populations between 75,000 and 200,000, providing inpatient and outpatient services, day treatment, emergency care, and ongoing patient consultations. The hope was that the entire country would be covered by the mid-1970s.
“The mentally ill…no longer need to be alienated from our affections or sheltered from the help of our communities,” Kennedy said after signing the law.
On the street and in prison
The legislation accelerated deinstitutionalization across the country. In Minnesota, public hospitals that once treated more than 10,000 mentally ill patients had about 3,000 in 1970.
Community mental health centers were going to become one-stop shops that would provide everything from clinical care to crisis services, Abderholden said. But federal funding cuts only meant half…
News Source : www.startribune.com
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