Mental health care and its accessibility in Milwaukee County is constantly evolving. The county is currently going through an overall mental health redesign and turning over its acute inpatient mental health services to other organizations.
No matter the time in our city's history, the need for quality mental health care and its challenges have remained constant. Responding to this need is the Behavioral Health Division, a deeply rooted service in the area's history that can be traced back to the 1850s. Johnathan Piel, the Division's unofficial historian, offers their overarching history of operations, resources and facilities.
The first major development in the department was the purchase of a 160-acre Hendrick Gregg farm in Wauwatosa in 1852, which housed a mental health area in addition to physical health. The farm was later repurposed as a health facility, The Milwaukee Regional Health Center, which is still located in the same area today. After a few years of operation and development, there were six dedicated mental health beds before 1860.
"They were repurposing farm houses or livestock facilities into patient areas. They were really of course not purpose built for that, and so they had the challenge of having enough space. These are frankly the same challenges that modern cities including Milwaukee still struggle with today," notes Piel.
By 1865, there were 22 beds for mental health patients. Then, in 1880, The Milwaukee County Insane Asylum, the first-ever facility solely dedicated to mental health in the greater Milwaukee area, was built and serviced 200 patients in its first year of operation. The facility treated both acute or short-term mental illness and chronic or long-term mental illness.
By 1888, a second facility was built within a mile of the original location. This resulted in the designation of two mental health facilities: The Milwaukee County Hospital for the acutely insane and the Milwaukee County Hospital for chronically insane.
The facilities and procedures during this early stage of long-term mental care resembled incarceration according to Piel. The patients were kept physically safe with few other activities and were often referred to as inmates. Short-term care was designed to house patients for three, six or nine months before release and often saw many patients return multiple times.
"The challenge was there's such a linkage between mental health, psychical health, and financial health. And if all three of the legs of that stool weren't propped up, it wasn't enough to just release patients 'cured' in their mental health," says Piel.
By the 1940s and 1950s, laws were set to prohibit patients from performing labor activities, typically referred to as "industry therapy," which had been a primary option for most patients. Instead, more emphasis was placed on recreational activities and practices that are commonly referred to as Occupational Therapy today.
In the late 1960s the Day Hospital was built particularly with a non-institutional appearance according to Piel, with plenty of windows and courtyards to keep patients aware of the world outside of the center. This would later expand into the Milwaukee County Medical Health Complex.
"Every decade reflected an attempt to be able to improve [aspects of care]," notes Piel. "It was called the Day Hospital because it was really outpatient treatment — patients would come there for the day. Over time, they certainly also attached longer term care facilities."
In the 1970s, advocates for the privatization of mental health became prominent and would ignite a conversation that eventually resulted in certain aspects of mental health care being outsourced in recent decades.
Piel describes a reoccurring theme in the history of Milwaukee's mental health. "I've really seen every 20 years almost a rediscovering of certain kinds of practices... There are cycles where we approach something, and then we lose that institutional memory about it and then end up doing it again," Piel says.
Over the decades of care, Piel says the central goals have always been for patients to improve their mental health state, gain stamina, and gain skills for the outside work environment. "I think that we still struggle today, how to be able to shore up all three of those legs, and we have a regulatory environment that further limits our ability to touch on all of those — in addition to levels of funding and staffing and other things that are limitations that we struggle with," he notes.
However, having this historical understanding is beneficial for noticing these types of patterns. "Being able to know where we came from, what has worked and what hasn't worked really ought to be able to help inform us about what we can do in the future," Piel says.
He adds that the city is ready to continue to meet the demands of care, even if the models have to look differently. "I know that there are very well-intended doctors, administrators [and] leaders who are trying to provide good, reliable, consistent mental health care for people."
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