The sounds of laughter and conversation filled the tiny gymnasium. People hugged and shook hands, greeting old friends and familiar faces. Books of photos and news clippings, yellowed and faded with age, lay open on several tables; on others, sheet cakes, large plates of fruits and vegetables and bowls of pink punch. A slide show flickered on a worn brick wall painted white.
It might have been a high school reunion, except that the venue, at the end of a long corridor behind a locked steel door, was in the belly of an acute psychiatric care facility on Hospital Drive.
In 1967, the Mid-Missouri Mental Health Center became the first federally funded comprehensive community mental health facility in the nation. On Friday, current and former staff members gathered to celebrate the 40-year history of Mid-Mo, as the center is known.
Maeline Rolley said a lot has changed since she started working at Mid-Mo, 32 years ago, as a housekeeper.
“Overall, I say I have enjoyed working here,” she said, “but you miss the people you knew when you started.”
When President John F. Kennedy signed the Mental Retardation and Community Mental Health Centers Act of 1963, it marked a shift in how the government and society approached the treatment of the mentally ill. A community mental health movement, led by reformers, doctors and social scientists, had sought an end to overcrowding and destructive practices at large, state-managed psychiatric hospitals, such as lobotomies.
Treating mental illness in smaller, community-based centers, close to the patient’s home and in conjunction with other services, is more humane and effective than long hospitalizations in relative isolation, said Felix Vincenz, chief operating officer for the Missouri Department of Mental Health’s Division of Comprehensive Psychiatric Services.
“We tend to think of mental illness as something that happens to someone else,” Vincenz said. “The challenge is to recognize that when we think of serving the mentally ill, we are talking about people we love and care about.”
Mid-Mo has three inpatient psychiatric units that provide short-term intensive care for adults. Services for children, age 6 to 18, include inpatient and partial hospitalization. Bob Reitz, Mid-Mo’s chief executive officer, told Friday’s gathering, which included state Sen. Chuck Graham, D-Columbia, that the center has cared for more than 10,000 people since it opened and has trained thousands of students and medical professionals from MU.
But for many people, including some former and current employees, celebrating the past only reminds them that the mental health system in Boone County is at a breaking point.
“It’s overcrowded, the staff has decreased, a lot of people don’t like to work here because of the pay,” Rolley said. “It’s the state system. It’s not that great.”
Mid-Mo can no longer provide the same comprehensive services it did for years. The drug and alcohol programs have been moved to Fulton State Hospital and services for children have been reduced. The center’s 69 beds are often full, forcing administrators to send people who are considered an imminent risk to themselves or others to other facilities in Missouri, such as the Metropolitan Psychiatric Center in St. Louis.
Vincenz said it is not uncommon for Mid-Mo to be on “diversion” status “every hour of every week.”
Diverting patients poses significant challenges for both mental health professionals and those they are trying to help, saidsays former state Rep. Tim Harlan, of D-Columbia, who is president of the Missouri chapter of National Alliance on Mental Illness.
“We have deputies that come from Kirksville to have a patient treated here,” Harlan said, “and they have to turn around and drive somewhere else because it’s full.”
According to the 2004 Mental Health Needs Assessment, commissioned by the Boone County Mental Health Board of Trustees, the central Missouri region, which includes Boone County, has less than 22 acute psychiatric specialty beds per 100,000 residents — the lowest rate in the state. In the last 10 years, three mid-Missouri private psychiatric hospitals, in Columbia, Jefferson City and Mexico, have closed, which has had a profound impact on care for children. There are only 10 acute psychiatric beds for children in the 31-county central region, according to the county’s needs assessment.
Lynn Barnett, superintendent of Student Support Services for Columbia Public Schools, said budget cuts and the ongoing privatization of psychiatric services has limited options for families with children suffering from mental illness.
“They used to have additional resources,” Barnett said. “They had an Early Childhood Program for Mental Health that was quite extensive and assisted area public schools. Then they privatized due to costs of health care and Medicaid services.”
Missouri is one of many states that contract with for-profit companies to deliver care to Medicaid recipients and indigent clients with mental illness. According to research by the National Alliance for the Mentally Ill, however, too many companies have offered a “litany of broken promises,” from failure to cover anti-psychotic medications to limiting hospital care to inadequate case management.
Mid-Mo’s outpatient services were privatized in 1997, and recently switched hands, from University Behavioral Health to Burrell Behavioral Health, a Springfield company. Todd Schaible, Burrell’s president and chief executive officer, said his company is committed to developing a comprehensive program that includes school-based programs.
“Our track record shows a commitment to mental health services and the ability to develop them,” Schaible said.
Perhaps the biggest underlying challenge, according to mental health professionals, is the persistent lack of state funding for mental health care. In the beginning, Mid-Mo was funded largely through federal grants. In 1981, the federal government began requiring states to match federal money for mental health and substance abuse programs, and community mental health centers have been largely dependent on state funding ever since.
“It’s no secret matter that for many years the Department of Mental Health has faced budget cuts,” Reitz said. “We’ve been running a very tight ship budget wise for quite some time.”
In fiscal year 2007, the Missouri Department of Mental Health received more money that it ever had before — $1.04 billion, compared to $971 million in fiscal 2006. Despite this increase, said Marla Smith, the interim chief operating officer for Mid-Mo, who has worked at the center for 15 years, the department is still strapped for funding because the “increases haven’t kept up with the pace of life.”
“We are spending a lot more for the same kinds of services,” Smith said. “It’s just like running a household. It takes more money this year to pay for food and gas and utilities than it did last year.”
Some mental health professionals, including the Boone County Mental Health Board of Trustees, support a mental health tax to fund a “Community Mental Health Fund” that would subsidize new services and supplement existing programs in Boone County.
“A tax is long overdue,” said Cindi Keele, executive director of the National Alliance of Mental Illness in Missouri.
While many at Friday’s celebration fear that apathy toward the plight of the mentally ill would doom such a tax at the polls, they were proud of their personal commitments to serving Missourians with mental illness.
After much of the crowd had trickled out of the gymnasium, a slim, short-haired woman paged through a book of old pictures and news clippings. Robyn Boustead worked as an aide at Mid-Mo for three years after its opening back in 1967, when she was an MU student.
Her eyes danced from picture to picture, shining with recognition and the recollection of a time when she used to take 15 patients to the Missouri Theatre every Thursday night on a shuttle bus, with free passes the theater provided for Mid-Mo.
“It truly was a community health center back then,” she said.