Minnesota has closed 10 of 11 state mental hospitals

Iowa administrators could look to their northern neighbor for advice on how to shift their mental health system away from large institutions.

Minnesota has been one of the most aggressive states in closing old-style mental hospitals and replacing them with smaller facilities and community-based services. Since 1978, Minnesota has gone from having 11 large state mental hospitals to just one. The remaining one, which has about 110 beds, was built about 20 years ago in the Twin Cities suburb of Anoka, said Anne Barry, deputy commissioner of Minnesota's Department of Human Services.

Barry said Minnesota's experience showed the wisdom of adding alternative services as the state shut down large mental institutions. The state has set up seven smaller "subacute hospitals," around Minnesota. Those facilities each have just 16 beds.

The smaller facilities can provide a less institutional feel, and they qualify for federal money under Medicaid that isn't generally available for large mental hospitals. "They have made a huge difference for us," Barry said.

At the same time, the state has aggressively pursued other methods of helping people with mental illness, such as providing crisis services in outpatient settings or in short-term facilities, Barry said. These approaches are similar to what Iowa is aiming to do with its new regional mental health authorities.

Sue Abderholden, executive director of the Minnesota chapter of the National Association on Mental Illness, said the state's transformation has had complications, and services still can be hard to access for some people. But she said most mentally ill Minnesotans are much better off under the new system than under the old one. Critics were afraid that closing the institutions would mean patients would go without care, she said, "but there was nothing special about those walls."

Abderholden said states such as Iowa should make sure alternative services are in place before closing large mental hospitals. But she also said states shouldn't let fear of change become an excuse to maintain an outdated, institutional approach to handling the mentally ill. "I'd hate to hold people hostage," she said.

Besides its Anoka mental hospital, Minnesota also has a large facility at St. Peter for people whose mental illnesses have led to crimes.

Minnesota no longer has any large institutions for people with intellectual disabilities, such as autism or Down syndrome. Iowa still has two, at Woodward and Glenwood.