RURAL ROUTES/Margot Ford McMillen

Sad State of Mental Health

The shooting of Gabrielle Giffords and mental illness of 22-year-old Jared Lee Loughner has opened a public dialogue that the nation has needed for decades. As far as the subject of mental health in juveniles goes, we're all groping about in the merest light of the merest candles. It's not even well understood if mentally ill kids grow up to be mentally ill adults, even though scientists have been wondering for decades. Now, they need to begin by identifying what treatments work, what hasn't worked, and how to expand care to our neighbors in need.

Back in the Kennedy years, there was money for mental health care. Missouri's governor Warren Hearnes was committed to building a residential youth center for troubled high schoolers. In 1968, the General Assembly appropriated $3,800,000 to build a six-building center as part of the existing Fulton State Hospital, an asylum in the best sense of the word at that time. I have interviewed many of the folks that worked in that institution as I co-wrote a book, Evolution of a Missouri Asylum (University of Missouri Press, 2007). Sad but true, it's one of the few comprehensive studies of the history of mental health care that exists.

At Hearnes, residents could employ a range of services — academic classes, therapy sessions, art and dance classes in new studios, a fully-equipped garage for the boys. The state-of-the-art building was necessary, because the state asylum had begun admitting youths in the late 1950s and by 1962 had 175 patients under the age of 17-and-a-half, packed into a pre-Civil War building with antiquated heating and no cooling. In the old building, there was little diversion, and the rejected and isolated teens were a handful.

Of all the programs tried by the Hearnes Center, which took in children as young as 13 and occasionally even younger, people remember most fondly the Foster Grandparents, hired with War on Poverty funds. These 10 or 15 folks came to the center on a community bus to talk to the kids, rock the youngest in rocking chairs, help them learn to do arts and crafts and bake cookies.

Pretty simple stuff, and there's been no follow-up that I know of to see where the kids ended up. Nor was there follow-up on the kids that lived in the drafty old Civil War building. One of them became a writer for the Kansas City Star and left some valuable memoirs about his stay. Others, and this is anecdotal only, are lifelong residents of the Hospital. It is now mostly forensic and the huge majority of residents have committed crimes to get there.

Despite funding cuts in the Reagan years, when John (Let the Eagle Soar) Ashcroft was governor, staff kept Hearnes going, and even retained the foster grandmothers until 1991 when there was a change in philosophy. Advanced pharmaceuticals were now available and the entire youth center was moved to become part of a medical facility. At this center, doctors diagnose problems and assign pharmaceuticals and therapy, then release clients, often to homes where people are afraid, don't understand the problems, can't help. This is pretty much the system today. Even when there is money for medications, mental health sufferers can't always keep track of where the clinics are, how often they should visit, how many pills to take and when to take them. And, as everyone is sick of hearing, when mental health conditions are controlled the sufferers often assume they are cured and can quit taking meds.

The Hearnes Center was dismantled. The hours of videotape that had been shot in its movie studio were abandoned. The buildings have been used for one thing and another. Most recently, the state announced that it will become home to a minimum-security prison population.

So did the residential model help people? Or did it just make people dependent on the state for their care, food, housing? It’s hard to say since the follow-up hasn’t been done. For years, even before Hearnes, people living in asylums all over the nation had been responsible for something — their own community. They comforted each other, raised their own food, made their own clothes, furniture, rugs and even mattresses. They played music, made art, wrote newsletters. Many of them were there for lifetimes, abandoned by families.

Obviously, there are no simple answers. Nobody is even sure — 100% — why some people become mentally ill. The best answer seems to be that babies are born with a predisposition and, if they are unlucky, something kicks it off. It could be a bad peer group, a trauma or even a virus.

To learn more, visit the website of the National Alliance on Mental Illness (nami.org). These folks have chapters in most major communities, and sponsor research and support into all kinds of mental illnesses. Maybe this time we can get something done.

Margot Ford McMillen farms and teaches English at a college in Fulton, Mo. Email: margotmcm@socket.net.

From The Progressive Populist, February 15, 2011