History of the Division of Mental Diseases
In 1847, twenty-six years after her admission to the Union, Missouri made the first provision for the state care of her “mentally deranged” citizens by authorizing an "asylum for the insane" at Fulton. When this asylum opened its doors four years later, it became the first state institution west of the Mississippi River to provide shelter for the insane. An independent board managed the institution. In her subsequent history, Missouri established three additional institutions for the mentally ill. St. Joseph State Hospital was established by an act of the Missouri General Assembly in 1872. The first patient was admitted in 1876. Fire destroyed the original institution on January 25, 1879. It was rebuilt and reopened on April 1, 1880. Nevada State Hospital was created by an act of the 33rd Missouri General Assembly on March 19, 1885. The original building was completed and the first patient admitted October 17, 1887. Farmington State Hospital was established by the Missouri General Assembly in 1889 and opened to receive patients, January 1, 1903. It was one of the first cottage plan institutions to be built in the United States. Each institution was managed by an independent board. It was during the year 1903 that the designation "State hospital" was adopted to replace the earlier label, "asylum for the insane."
The St. Louis State Hospital traces its origin to 1861, ten years after the first Missouri State Hospital at Fulton was opened. At this time work on the hospital was begun by the County of St. Louis. The Civil War intervened and the main or center building was not completed until 1869, when the hospital was opened as the County Lunatic Asylum. In 1875 the historic separation of the City of St. Louis and County occurred. The "Asylum" was now called the "City Sanitarium." But the city was feeling the burden of supporting an institution of this size, and as far back as 1879, a recommendation was made that the State assume responsibility. It was not until 1948, however, upon receipt of one dollar, that the city turned the institution over to State control.
The Missouri State School was established by an act of the 40th General Assembly in 1899 and opened in 1901, with three buildings and sixty male patients. The city of Marshall gave 288 acres of land for the institution which, until 1925, was known as the Missouri State Colony for Feebleminded and Epileptic. The 69th General Assembly authorized the purchase of 82 additional acres. Through the more than half-century of its existence, the institution has expanded until it is now comprised of three units at Marshall, Carrollton and Higginsville. The 70th General Assembly in 1959 designated the three units as the Marshall State School and Hospital, the Carrollton State School and Hospital, and the Higginsville State School and Hospital, with all three units operating under one superintendent. The Carrollton unit was the former State Children's Home and the Higginsville unit occupies the site of the former Confederate Home.
A Board of Managers was created by a law passed in 1921 by the 51st General Assembly, placing under its management the following institutions: Fulton State Hospital, St. Joseph State Hospital, Nevada State Hospital, Farmington State Hospital, Missouri State School (Marshall) Missouri State Sanatorium ( Mt. Vernon). This latter institution was under the management of the Division of Health from 1907 - 1921. It was then placed under the Board of Managers in 1921 and remained there until the 1945 Constitution of Missouri returned it to the management of the Division of Health.
The St. Louis Training School was established by ordinance on July 27, 1922, and was opened formally on June 5, 1924. It was transferred to the State on July 19, 1948 and became known as the St. Louis Training School. The name was changed to the St. Louis State School and Hospital by the 70th General Assembly in 1959.
On July 1, 1946, the duties formerly discharged by the Board of Managers were assumed by the Division of Mental Diseases of the Department of Public Health and Welfare. The Division of Mental Diseases was established as a result of legislation enacted in accordance with provisions of the Constitution of 1945.
A State Mental Health Commission was created on August 29, 1957, by the enactment of Senate Bill No. 59, 69th General Assembly. This Commission was composed of five members appointed by the Governor and with the advice and consent of the Senate (Senate Bill 124, 73rd General Assembly changed the number of Mental Health Commission members to seven members). The Commission serves in an advisory capacity to the Director of the Division of Mental Diseases and assists him in establishing the best possible operations. The Director, who is appointed for a term of four years by the State Mental Health Commission, administers, supervises and coordinates the State Mental Health Program.
The Central Office, Jefferson City, is the administrative center of the Division of Mental Diseases. Here leadership in program planning and overall management is provided. Consultants in the several professional disciplines allied to psychiatry and mental health administration assist in planning the Division's program of diagnosis, care, treatment, rehabilitation and research.
The Missouri Division of Mental Health -- An Overview
Any discussion of the Missouri Division of Mental Health in 1972 should include three interacting factors--the traditional treatment of the mentally ill, ever-expanding present needs, and the new directions which have taken place within the Division during the past ten years.
The 18th Century of the "asylum approach" to the treatment of the mentally ill was considered an innovative and enlightened method of restoring mental health to individuals in the then sparsely populated nation. Large custodial complexes, often completely self-sufficient, were constructed to bring about the "cure" of the young nation's "insane" population. Isolation from the complexities and evils of society was considered the panacea for the evils of insanity.
As the nation grew in size and complexity, the number of mentally ill increased at least proportionately. Overcrowding became commonplace in the institutions. This meant that new methods had to be devised to "control" the patients and to "protect" society in the surrounding areas. Discipline often became more important than recovery. New wings were added and added, but hope for cures was all but lost. At best the institutions, with few exceptions, were sheltered environments for the sick; at worst--the proverbial "snake pits."
With the advent of new methods of attacking the causes of mental illness, dramatic breakthroughs were made in the treatment of the mentally ill. Through the development of the psychiatric profession and different kinds of psycho-therapy, new hope appeared for the mentally ill. Yet the old institutions remained.
The institutions remained not just physically in the form of brick and mortar. They remained as concrete symbols of long-prevailing attitudes toward the treatment of the mentally ill-people to be feared, ostracized from the community, locked up, hidden and isolated.
Any progress made in the treatment of the mentally ill has been done in the face of such superstitions. The general public is not accustomed to thinking in terms of recovery; traditionally, the public was content if the "problem" was swept under the rug, out of sight, out of mind.
But the problem refused to evaporate. Institutions, no matter how many wings were added, will still be overcrowded as long as the population of the nation continues to increase, as long as the emphasis is on custodial care and not remedial care. The present need is for care which keeps the individual in contact with the resources of his community, which educates the community to its responsibility to take care of its own.
With this in mind, it is interesting to note the changes which have taken place in the Missouri Division of Mental Health during the past ten to 12 years. Treatment of the state's mentally ill and mentally retarded has shifted from an atomized, custodial approach to an integrated, intensive treatment designed to keep the patient, whenever possible, in touch with his home community.
Though there still are many gaps in the overall structure, a coordinated network of services is growing and spreading out over the state to better serve people when and where they need the services.
The old state hospitals remain physically at Fulton, St. Joseph, Nevada, Farmington and St. Louis. Each of these institutions has inherited the problems inherent in an old, outmoded physical plant, not only expensive to heat and maintain, but also difficult to adapt to modern techniques of treating the mentally ill. The old and infirm will always find it difficult to walk any great distances, to descent or climb long staircases. It will always be difficult to create a warm, humane atmosphere in buildings built with bars in the windows and metal doors for "maximum security."
But something new has been added. Each state institution has inaugurated a program approach to specific problems. A unified and systematic approach is apparent, spreading the possibility of recovery. There is inter-institutional communication, exchange of data through new computer techniques, and a state-wide interchange of expertise.
The three community mental health centers at Kansas City, Columbia and St. Louis have added a new dimension to the institutionalized treatment of the state's mentally ill. New treatment techniques are continually being developed; more and more trained professionals are being turned out of the university environments whose influence is gradually spreading throughout all the state institutions.
The three regional mental health centers have enabled thousands of Missourians to receive treatment which did not exist or was inaccessible only ten years before. Each center offers intensive psychiatric care to residents in its catchment area. Referrals of individuals with specific needs to facilities with specialized programs to meet those needs help speed the recovery of those who traditionally would have remained lifetime wards of the state.
But the Division's three regional mental health centers are just the beginning of a carefully planned network of community mental health centers. Under the Missouri plan for Community Mental Health Programs, the state has been divided into 36 mental health areas. It is hoped that in time at least basic services will be established in each of these areas.
The term "Community Mental Health Services" does not necessarily infer facilities that are owned and operated by the Division. Under United States Public Law 81-164, federal funds are now available on a matching basis to communities, large and small, for the purpose of building and operating their own facilities. In time a comprehensive network of public and private mental health services could be provided for the entire state, serving the needs of all Missourians.
In many cases, the Division's role has simply been to help a community with its application for these federal funds and its plan for their use. In fact, it has been part of the plan to use Division resources to spark community action wherever possible and, when one community has been successfully encouraged to provide its own mental health services, to shift the Division's resources to another community in need. But it is important to note that there is integrated planning, utilizing all available resources to create one network of services to close the gap wherever there is a need.
Continuously backing up all the new facilities, however they may be funded, are visiting teams of mental health professionals on a regular "circuit riding" assignments from the appropriate geographic sections of each of the five state hospitals.
Finally, it should be noted that underlying the development of community centers throughout the state has been the steady expansion of operations at the three Regional Mental Health Centers. The programs carried on in these institutions have resulted in a steady buildup of Missouri's reserves of trained mental health workers. This has permitted even more rapid progress than expected toward the Division's fundamental goal of assuring that adequate community services are extended to all the people of the state.
Likewise, the state's facilities for the mentally retarded remain at the St. Louis State School-Hospital, Higginsville, and Marshall. But the emphasis has changed within the past ten years. No longer are children plucked from their community to travel great distances to a large institution. Nine regional diagnostic clinics, built at strategic locations all over the state have begun a new era in Missouri's treatment of the mentally retarded.
Originally designed to serve only the mentally retarded children in their respective areas, they have evolved, in many instances, into educational resource centers, providing valuable services for slow learners and low achievers, performing below their ability level because of emotional problems or learning disabilities.
The result of the developments of the past ten years is a vital growing network of services for the mentally ill and the mentally retarded.