Opinion editor's note: Star Tribune Opinion publishes a mix of national and local commentaries online and in print each day. To contribute, click here.
•••
In response to the question of why the system for community mental health care did not get fully built in this state, the Star Tribune's Curious Minnesota team did its best, handicapped as it was by probably not being born at the time and therefore forced to rely on the accounts of finger-pointers.
I watched deinstitutionalization unroll in real time ("Mental health care's long road," May 17). And, yes, the inadequacy of federal funding was part of the problem — but only a small part.
Once first-generation antipsychotics became available (in the 1950s), states across the country saw an opportunity to shed the responsibility for the care of (what seemed like, but really not) an increasing number of folks with serious mental illnesses. If these folks could be discharged to the community (an entirely new concept) and receive outpatient services from federally funded community mental health centers, the states would save a ton of money.
This plan was doomed in several respects:
• As one might expect, the largest expense in operating a state hospital was staffing. Discharging patients proved relatively easy, cutting state jobs, not so much. For example, when Minnesota proposed closing Hastings State Hospital, which primarily served folks from Ramsey County, it held hearings to receive public input — not in St. Paul, where the families of these patients lived — but in Hastings, where the employees lived. The suggestion that hospital staff could "follow" the patients into the community was not well-received. And as patient populations were reduced by 70%, over the decade of the 1960s, staffing was reduced by roughly 20%.
• In addition to mental health services, state hospitals had always provided housing, food, non-mental health care and — often, as in an example cited — employment. Community mental health centers never even contemplated providing any such services.
• These newly created community mental health centers, though hopelessly underfunded, were designed to serve a broad range of folks with a broad range of mental health concerns — and there was a ton of legitimate, unmet need already in the community. And as it turned out, these new service providers, almost exclusively middle-class folks, found it more pleasant to serve folks already getting by in the community, i.e., folks that looked like them.
Not surprisingly, community mental health centers failed to adequately meet the needs of folks discharged from state institutions.
Plus, the community was woefully unprepared; in some cases, openly hostile. In 1970, I was part of a group concerned about a growing welfare-crisis involving what was, by then, hundreds if not thousands of former state hospital patients in our community who were totally unserved. We approached Hennepin County (then, as now, home to one of the largest and most caring human-service systems in the country), to request modest (ridiculously modest by today's standards) funding for a residential facility with services geared toward recently discharged patients. The answer: Regardless of where you might find funding, we don't want people with mental illness even living in Hennepin County.
Most of the individuals discharged from state hospitals during the 1960s are now deceased, but they have been replaced by an even larger number of similar folks, with similar mental health issues. Today, a fortunate few are receiving the services they need to become contributing members of our society — an entirely doable outcome! The less fortunate majority are in and out of prison and/or homeless.
John K. Trepp, of Minneapolis, is retired. He is a former executive director of Tasks Unlimited, a nonprofit organization that supports mental health recovery by encouraging group decisionmaking and community living.
