Mental health care and availability in Milwaukee County continues to grow. The government is also working to reform health care and provide medical care for patients with mental illness to other institutions.
No matter what time in our city’s history, the need for quality medical care and its challenges have not changed. Responding to this need is the Behavioral Health Division, a service rooted in the region’s history that can be traced back to the 1850s. Johnathan Piel, the Division’s unofficial historian, provides a full history of their services, resources and facilities.
The first major development in the department was the purchase of Hendrick Gregg’s 160-acre farm in Wauwatosa in 1852, which contained a mental health facility as well as a physical health facility. The farm was later converted into a medical facility, The Milwaukee Regional Health Center, which is located in the same area today. After several years of work and development, there were six dedicated insane asylums before 1860.
“They were repurposing agricultural or ranching buildings into sick bays. They really weren’t built for that purpose, so they had a problem with having enough space. This is a problem that modern cities, including Milwaukee, are dealing with today,” says Piel.
By 1865, there were 22 beds for the mentally ill. Then, in 1880, The Milwaukee County Insane Asylum, the first mental institution in the greater Milwaukee area, was built and served 200 patients in its first year. The center provided treatment for acute or short-term mental illness and chronic or long-term mental illness.
By 1888, a second building was built about a mile from the original site. This led to the creation of two psychiatric hospitals: the Milwaukee County Hospital for the Insane and the Milwaukee County Hospital for the Chronic Insane.
The resources and processes that occur during this phase of long-term care are similar to arrests according to Piel. The patients were physically protected with few other activities and were often referred to as prisoners. Short-term care is designed to allow patients to stay for three, six or nine months before being discharged and often sees many patients return several times.
“The problem was that there is such a connection between good health, good health, and economic health. And if all three legs of the stool were not supported, it was not enough to just release the ‘cured’ patients from their mental health,” says Piel.
By the 1940s and 1950s, laws were passed to keep patients from working, so-called “remedial drugs,” which were the first line of treatment for many patients. Instead, more emphasis was placed on recreational activities and practices that are called Occupational Therapy today.
In the late 1960s the Day Hospital was built mainly with a non-institutional style according to Piel, with many windows and courtyards so that patients could see the world outside the center. This will expand to the Milwaukee County Medical Health Complex.
“Every decade shows an attempt to change [aspects of care], “Piel says. “It was called the Day Hospital because it was really a medical service – patients came there that day. Over time, they added a long-term care facility as well.”
In the 1970s, advocates for the establishment of mental health became known and started discussions that led to the deregulation of some aspects of mental health care in recent years.
Piel describes a recurring theme in Milwaukee’s mental health history. “I’ve really seen all 20 years of almost rediscovering certain kinds of behavior… There are cycles where we approach something, and then we lose the cultural memory of it and then we do it again,” says Piel.
Over the years of care, Piel says the central goals have always been for patients to be able to change their mind, become stronger, and have the ability to function outside. “I think we are still struggling so far, how we can raise all three legs, and we have a regulatory environment that limits our ability to touch all of them – including money and staff and other things that are the deficits that we struggle with,” he said.
However, having this historical knowledge is beneficial in identifying these types of species. “Knowing where we came from, what worked and what didn’t work should help inform what we can do next,” says Piel.
He adds that the city is ready to continue meeting the needs of care, even if the models should look different. “I know there are well-intentioned, caring doctors out there [and] leaders who are trying to provide good, reliable, sustainable public health services. “