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At a glance: Iowa’s four historic mental health institutions
There are four mental health institutions that serve Iowa through the state Department of Human Services, all built during the late 1800s when most advocates believed in a “moral treatment” philosophy of care made famous by Philadelphia psychiatrist Thomas Story Kirkbride. Each of the facilities — Mount Pleasant, Independence, Clarinda and Cherokee — have distinct service areas and have developed their own specialty of care within the state.
A state task force is preparing to tour the facilities and meet with local residents in an attempt to evaluate levels of care and cost effectiveness. Specifically, the task force will need to consider if the state would benefit from closing one of the facilities, a duty steeped as deeply in history as it is in state economics.
Kirkbride, a founding member of the organization that would later become the American Psychiatric Association, promoted standardizing not only care for those with mental health issues, but for the architectural design of the facilities in which such persons would be housed. Kirkbride believed that surroundings played a large role in the treatment of those described at the time to be “insane” or “feeble-minded.”
Kirkbride buildings were often sprawling structures that would allow patients to be segregated first by gender and then by degree and intensity of illness. In particular, the philosophy related to the architecture believed that nature — fresh air, sunlight — was an important element to treating mental illness, and many of the asylums based on his philosophy were constructed well outside of urban areas and on large lots where residents would be required to help not only with facility maintenance, but with ground-keeping, farming and other tasks.
The end result was state purchases of large tracts of rural land and construction of hulking brick and mortar facilities. Some of the structures closely resemble castles of Old Europe.
The Mount Pleasant facility is the oldest of the four state-run facilities that serve individuals affected by mental illness. The state made its first appropriation for the location and erection of the facility in 1855. Kirkbride himself recommended Boston architect Jonathan Preston to design the structure. The 50,000-square foot building formally opened as “The Iowa Lunatic Asylum, Mount Pleasant” on March 6, 1861.
“This is first permanent building erected in the state,” a reporter for the Burlington Hawkeye wrote at the time. “It is of large size. We have not the exact dimensions before us, but it is sufficient to say that when fully completed it will accommodate between 300 and 400 patients and will compare creditably with similar structures in other states…
“Before diminishing the subject, we think simple justice to the Directors and builder, and to all parties concerned, under the circumstances, renders it proper for us to say something further in regard to this building and the manner in which the public have been expended upon it. When we look at its extent, at its massive walls and firm foundations that nothing short of an earthquake could move, at its innumerable rooms and dormitories, all the partition walls being of brick — at its miles of iron pipe for heating purposes, hot and cold water and gas — at is pipes and flues in every part of the building for purposes of ventilation — at its engine and boilers, kitchen and laundry, et cetera, et cetera, our wonder was that so much had been done for the sums appropriated by the State. … We hope, now that it is open and receiving patients, that all citizens of the State who can make it convenient to do so, will visit the Asylum. They will find it a very pleasant place to spend an hour or two, and, notwithstanding its grated windows, and unfortunate inmates, having a cheerful, orderly and happy look.”
Within a year, however, The Hawkeye, began to publish articles on the overcrowded conditions within the asylum, violence and skyrocketing expenses. (According to the American Medical Association, the facility had 11 miles of iron pipes, 425 rooms above the basement, 900 doors, 1,100 windows, a 2,100-foot Artesian well and cost the state $600,000 to construct.) The facility had treated nearly 1,100 people, many of them from other states, during its first 21 months of operation.
In those early years, all of Iowa’s facilities were used for long-term care. Many patients who entered the wards likely never again lived outside an asylum.
According to the Department of Human Services, peak capacity was reached in 1946 at more than 1,500 patients. Since that time, however, and with the invention of better medications and different therapies, most patients’ stays are between 30 and 120 days.
For some time the grounds have been shared by the Mount Pleasant Correctional Facility, a medium-security prison designed to provide treatment to male offenders with character disorders and substance abuse issues. In 1999, a separate facility opened for women offenders who also had such specialized needs.
The Mount Pleasant facility currently provides inpatient treatment to adults, and it is the only dual-diagnosis program — psychiatric and substance abuse — run by the state. Although substance abuse patients throughout the state come to Mount Pleasant for treatment, it’s primary service area is limited to 15 counties in southeast Iowa.
The second of Iowa’s facilities began in 1868 with a state allocation for land and structure in Independence. The state hired S. Shipman of Madison, Wis., to serve as the architect and the building was given an Italian flair, complete with a mansard roof. It was built from limestone quarries in Epworth, Farley and Anamosa, which was considered to be quite an extravagance despite its local availability, and contained several fire-prevention amenities.
Construction began in 1869, and a portion of the building was opened in 1873, although the entire structure was not opened until 1884. Full cost for the structure, which contained 24 wards and could hold 600 patients, neared $1 million — nearly twice the cost of the Mount Pleasant facility.
Originally known as the “Iowa Hospital for the Insane, Independence,” it is now called the Independence Mental Health Institute, and, according to the Department of Human Services, it provides inpatient psychiatric treatment for adults, adolescents and children. The facility’s specialty, however, is its work with children and adolescents.
This facility currently serves 28 counties in eastern and northeastern Iowa, and children and adolescents from 43 counties primarily to the east of I-35.
The facility in Clarinda, originally named the “Clarinda Asylum for the Insane,” was began with state appropriations (of $50,000, although many more appropriations followed) in 1884 primarily to relieve over-crowding at the other two facilities. Construction began in July 1885 with plans from Des Moines architects William Foster and Henry F. Liebbe, and patients were accepted beginning in 1888. In the beginning, Clarinda was a male-only facility that sat on 513 acres. By 1933, according to the Clarinda Chamber of Commerce, the complex occupied 1.055 acres.
Clarinda, just like all four of Iowa’s facilities, has also been mentioned in conjunction with American eugenics, which was comprised primarily of compulsory sterilization laws for those deemed “mentally deficient” or criminal. Roughly 1,900 people were sterilized in Iowa, and, although the law allowing the procedure was passed in 1911, most of those occurred between 1941 and 1953, after the 1929 creation of a State Eugenics Board. The 1929 legislation called on the superintendents of state institutions to submit quarterly reports to the eugenics board that listed viable candidates for sterilization, which included members of the general public who were provided free legal counsel, according to author Nancy Ordover.
In 1980 the Clarinda Correctional Facility, a medium-security, all-male prison serving primarily chemically dependent, mentally retarded and socially inadequate offenders, was established on the grounds.
Today, the facility at Clarinda offers a wide range of diagnostic and treatment services through is Acute Psychiatric Program. It is also well-known for its geropsychiatric work, providing nursing home beds for individuals with mental illnesses such as Alzheimer’s. The acute program serves 15 counties in southwestern Iowa. The geriatric program serves the entire state and is the only one of its kind at the state-run facilities.
Just six years after Clarinda opened, the state asked architect Liebbe to plan another hospital in western Iowa. The “Cherokee State Hospital for the Insane” opened in 1902 and was the last of Iowa’s large state-run mental hospitals. Similar to the Mount Pleasant facility, the hospital in Cherokee had a peak population of roughly 1,700 patients in the mid-1940s.
The Cherokee facility, like nearly all state hospitals at that time, was host mid-century to infamous lobotomist Walter Freeman. The man had perfected the technique of completing a lobotomy with a device similar to an ice pick that could be pushed through the thin bone in an individual’s eye sockets and into the brain. Freeman felt that this type of procedure could be especially helpful in the state-run asylums because it did not require drilling holes into the skull or a surgeon.
Freeman, who enjoyed the attention of the media and often invited reporters to watch his surgeries, was performing one such lobotomy at the Cherokee facility when he stepped back to have his photo taken. As a result of Freeman’s camera mugging the patient died, the instrument plunging too far into the brain.
Today, the facility provides both inpatient and outpatient care to adults, adolescents and children. It serves adults in 41 northwestern Iowa counties, as well as children and teens in 55 counties primarily west of I-35. The vast majority of the patients admitted to Cherokee are there by order of the court. A correctional facility is also on the site.