When Missouri’s second mental hospital opened in the late 19th century, State Lunatic Asylum No. 2 in St. Joseph was designed to provide lots of natural light and fresh air.
Yet as war and economic calamity frayed the nation’s psyche, over-crowding swamped the hospital’s lofty goals. The census of the St. Joseph facility peaked at around 3,000 patients in the 1950s — more than 10 times its intended capacity.
The overcrowding wasn’t limited to Missouri. In 1963, President John F. Kennedy signed the Community Mental Health Act. The aim was to replace a system that often warehoused patients in undesirable conditions with a network of outpatient counseling and housing options.
Many mental health advocates argue that today’s reality does not match those noble intentions. They contend an underfunded community system has taken us back to the days of old, with untreated mental illness landing many sick people in nursing homes and prisons.
Troubles in Kansas
For many critics, Kansas’ Osawatomie State Hospital is Exhibit A for the failure of the current system. The hospital is located about 50 miles southwest of Kansas City.
Late last year, federal regulators yanked the facility’s Medicare eligibility after deeming it overcrowded and understaffed.
St. Joseph in some respects is a barometer for the state of community mental health in Missouri, in the same way Osawatomie is a barometer for Kansas. Missouri converted the old St. Joseph state hospital into a prison in 1999, and the hospital’s replacement sits right across the street, with 108 beds designed to serve the western part of the state.
Although Missouri has avoided any high-profile, Osawatomie-type breakdowns, observers agree that the community-based system in the Show-Me State is similarly underfunded.
A Kansas City Solution?
A wide range of officials hope a new facility in Kansas City, the Kansas City Assessment and Triage Center, will prove to be a cost-effective model for providing emergency services to the mentally ill throughout the state. The center is scheduled to open on Oct. 31.
View video for discussion about the crisis center’s place in the history of deinstitutionalization.
Mark Stringer, director of the Missouri Department of Mental Health, says Missouri has about 3,300 inpatient mental health beds, taking into account both the private and public sectors. He says that number seems to be adequate based upon the state’s population, but he acknowledges the department has ceded emergency inpatient services to the private sector because of budget constraints.
Garry Hammond, the CEO of Family Guidance Center, a St. Joseph-based behavioral health provider serving nine counties in the northwest part of the state, agrees with Stringer. He also says the state’s relatively low reimbursement rates hamper its ability to compete with other providers for qualified staff.
Nonetheless, Stringer says both the General Assembly and Gov. Jay Nixon have been generous with their mental health budgets, which include authorizing a $211 million project to rebuild Fulton State Hospital, the state’s only maximum security psychiatric facility. The project is scheduled to be completed in 2018.
Like others, Stringer applauds the move away from warehousing patients in overcrowded state hospitals.
“Missouri, like other states, did the right thing by downsizing those institutions,” he says. “But we did not create adequate community resources, and so we have been playing catch-up over the last six decades. And we are closer now to where we need to be than we ever have been before, but we still have a way to go.”
Mike Sherry is a reporter for KCPT television in Kansas City, Mo., a partner in the Heartland Health Monitor team.