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On the outskirts of downtown Traverse City, Michigan, just beyond the northern tourist bustle of Front Street but before reaching the vast expanse of shopping centers and strip malls that serve as the consumer mecca for the smattering of towns that dot the upper half of the lower peninsula, is the old Traverse City State Hospital. You'd be forgiven for missing it as the only sign of its existence from the main roads is a bunch of roundish stones that have been cemented together into a giant pyramid-shaped paperweight to mark the beginning of the hospital's grounds. It is out of sight by design, as the Traverse City State Hospital was initially christened the Northern Michigan Asylum for the Insane when it was built in 1885. The building itself, or at least what's left of it, is a monument to the type of sprawling Victorian architecture that fills so many college campuses in the midwest, constructed in a series of interconnecting wings to provide residents with maximum access to sunlight and fresh air. For much of the 20th century the Asylum provided a type of treatment known by the name “beauty as therapy”, in which residents were encouraged to do farm work and experiment with trades like woodworking to find purpose and tranquility in an era before the advent of drug therapies. Dr. James Decker Munson, who served as the facilities administrator for the first 40 or so years of its existence, cultivated such a successful program at the Northern Michigan Asylum that it was significantly expanded in the 1920s to include care for contagious disease outbreaks, the elderly and those suffering from substance abuse. Munson Medical Center, which replaced the hospital on the asylum grounds and now serves as the medical epicenter for Northern Michigan, was later named in his honor.

View from the rear side of Traverse City State Hospital after renovation

Beginning in the late 1950s, Traverse City State Hospital began experiencing a gradual exodus of funding that would eventually lead to its closure. With the passage of The Community Mental Health Act by the Kennedy Administration in 1963 and the introduction of Medicare and Medicaid two years later, deinstitutionalization began to take its toll on the hospital. State funding for mental health care dropped off as federal programs took up the excess slack and the focus on intensive residential treatment was replaced with one that emphasized community-based outpatient treatment and the use of pharmaceutical therapy. After Ronald Reagan lay waste to mental health care funding during the 1980s, the hospital became unsustainable and was forced to close in 1989. Luckily, from an aesthetic standpoint at least, developers have stepped in and begun rehabbing the old buildings and hospital grounds for use as a retail space for art galleries, artisanal food shops and restaurants. The majority of the mental health services that were under the purview of the Traverse City State Hospital have been either eliminated or transferred to a series of private, for-profit facilities and outside organizations that are contracted by the State of Michigan.

The Traverse City State Hospital is basically a microcosm for what has happened in mental health service provision over the past 100 years, minus the whole repurposing old facilities into high-end shopping centers bit. The creation of Medicaid and Medicare in the mid-1960s essentially signaled the death of the mental health system as it was then, creating a fairly rapid shift in funding streams from state and local governments to the Federal government. Just between 1970 and 1980, the number of inpatient psychiatric beds in state and county hospitals was cut in half as third-party payers began to take over the mental health landscape. After deinstitutionalization began in earnest under President Reagan, the transition between the state and local government-centric community mental health model envisioned by the Kennedy Administration began to give way to the public health model that is largely comprised of Federal entitlement programs and private insurance providers. For example, Federal funding and private insurance accounted for about 42% of all mental health treatment spending in 1986. By the time we get to 2005, Federal aide and private insurance is providing more than 55% of all mental health treatment care costs, which have almost quadrupled over the course of 2 decades.

With the implementation of the Affordable Care Act, Medicaid expansion and mental health parity law all taking place at the present, it is difficult to anticipate where we will end up in ten years time. It is a fairly safe bet that Federal spending on mental health will continue to rise at a lightning pace due to the nature of the Medicaid expansion, which places a minimum of 90 percent of the costs on the Federal government while extending comprehensive mental health care to tens of millions of low income Americans. It is also more than likely that the health gap in this country will become exacerbated by this new legislation, an idea which seems counterintuitive considering the entire point of the Affordable Care Act is to reduce barriers to health care and create a more egalitarian health system. However, thanks to the infinite wisdom of The Supreme Court, state governments have been given an irresponsible amount of power in their legal right to refuse Medicaid expansion and essentially tell their constituencies that they will have to forgo medical care because of an ideological tiff between two political parties who don't have their best interest in mind. This latitude which has been given to state governments and which is arguably in violation of the supremacy clause of the Constitution, will create a two-tiered mental health system in which the healthy get healthier and sick continue to be ignored by the system that is supposed to be protecting them. Thus far, 24 states (and DC) have said that they will be participating in Medicaid expansion, while 14 states have stated that they will not be taking part. Of those 14 states, only 3 are in the top half of the nation's health rankings and 5 rank among the bottom 10. It looks like some states are replacing old state funding with Federal funding, while other states aren't replacing old state funding with anything.

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Originally posted to Virally Suppressed on Sat Mar 09, 2013 at 10:13 PM PST.

Also republished by Mental Health Awareness and Community Spotlight.

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Comment Preferences

  •  Excellent diary! (8+ / 0-)

    Ty

    It's difficult to be happy knowing so many suffer. We must unite.

    by War on Error on Sat Mar 09, 2013 at 11:17:34 PM PST

  •  Great history! (4+ / 0-)

    If you think you're too small to be effective, you've never been in the dark with a mosquito.

    by marykk on Sun Mar 10, 2013 at 07:18:43 AM PDT

  •  There is a key piece missing in this diary (5+ / 0-)

    Some background - I have represented patients in their commitment hearings at mental health hospitals.  There are, in fact, buildings like the one in this article, all over the country.  In Florida the facility was large enough to hold over 1,000 patients.   Now most of those buildings are used as office space.

    Why?

    Let me explain.

    Next to the birth of my son, the most amazing I have seen, and expect to see, is what happens to skizophrenics who get back on thier medication.  The first of the anti-psycotic medications was developed in 1959 - and I have seen a completely delusional person in 3 weeks become as sane as you or me because of its use.

    That medication simply did not exist when buildings like the one in this article were built.  The reason many of the mentally ill are not in hospitals like the one mentioned in the article is simple: there is no longer a case for keeping them there, as they are no longer a danger to self or others.  The newer drugs completely changed the legal equation.

    This is not to say that there aren't serious issues.  Some of the mentally ill wind up in prison - which is not where they should be.  Additionally, the support networks required to support the mentally ill (and that are in everyone's interest) are underfunded depending where you live, and those resulted in the mentally ill winding up on the streets in too many instances.

    But the truth is the huge hospitals of the past by and large had little to offer the mentally ill, and I have represented very few patients that did not want to get out of a mental hospital as soon as they could.

    The bitter truth of deep inequality has been disguised by an era of cheap imported goods and the anyone-can-make-it celebrity myth - Polly Toynbee

    by fladem on Sun Mar 10, 2013 at 07:30:26 AM PDT

    •  Yes, many antipsychotics are extremely effective, (6+ / 0-)

      But, if you find me one person suffering from severe and persistent mental illness who takes his/her medications regularly, I can find about two who have stopped taking them and relapsed back into active psychotic behavior.

      If you're interested, I highly recommend giving this article from the New England Journal of Medicine a once over, because, medication adherence rates for psychiatric disorders are dreadfully low. Studies have shown that between 50-60% of schizophrenics don't adhere to their psychiatric medications and as few as 35% with Bipolar Affective Disorder do. And, honestly, I don't blame these folks one bit.

      Most of these anti-psychotics and mood stabilizers, from the old boys like Haldol & Depakote to new age ones like Seroquel & Zyprexa have bloody awful side effects for most users that make living with them and being mentally stable more painful than going it alone.

      The community based mental health treatment facilities that were supposed to pick up the slack from deinstitutionalization of large mental hospitals has never happened for those with severe and persistent mental illness and our homeless shelters, emergency rooms and prisons have become the new stewards of this population.

      If states wanted to spend all of the money they used to spend on Asylums on creating assertive community treatment teams and providing comprehensive assistance for these folks so they could lead autonomous lives, then that'd be great. But, they've simply replaced their old asylum funding with a pittance and let the Fed pick up some of the rest of the bill.

  •  Republished to Mental Health Awareness nt (2+ / 0-)
    Recommended by:
    suspiciousmind, worldlotus

    "Mitt Romney looks like the CEO who fires you, then goes to the Country Club and laughs about it with his friends." ~ Thomas Roberts MSNBC

    by second gen on Sun Mar 10, 2013 at 11:09:55 AM PDT

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