Howie's daily column is sponsored by Lyric Kitchen Bar.
Minnesota used to believe, without apology, that some problems required institutions. Not programs. Not pilot projects. Not scattered grants. Institutions.
Drive past the old grounds in places like Moose Lake, Fergus Falls, Willmar or St. Peter and you can still feel it — the physical footprint of a state that once made a long-term commitment to people who could not care for themselves. The buildings were not perfect. The system was not perfect. But it was a system.
And then, piece by piece, Minnesota walked away from it.
Today, the consequences are no longer abstract. They are visible on sidewalks, in emergency rooms, inside county jails and in the quiet exhaustion of families trying to manage severe mental illness without meaningful support. The question is no longer whether something is broken. The question is whether we are willing to admit what we dismantled — and whether we have the nerve to build something back.
Because for all the progress Minnesota likes to cite, we have never truly replaced what we closed.
From the 1940s through the 1960s, Minnesota operated a network of state hospitals designed to house and treat people with severe mental illness and developmental disabilities. These were not short-term interventions. They were places where people lived, received care and — in many cases — remained for years.
By the 1970s and 1980s, that system came under intense pressure. Nationally, the deinstitutionalization movement gained momentum, fueled by legitimate concerns: overcrowding, underfunding, and, in some cases, inhumane conditions. New psychiatric medications created hope that people could live in community settings. Courts reinforced patients’ rights, limiting involuntary commitment. Advocates pushed for something better.
Minnesota followed that wave.
State hospitals closed or downsized. The promise was clear and, at the time, compelling: people would receive care in their communities, closer to family, in less restrictive environments. Counties, nonprofits and outpatient systems would take the lead. The era of large institutions would give way to something more humane, more modern.
It was a good promise. It was never fully kept.
What replaced the state hospital system was not a cohesive alternative. It was a patchwork. Funding shifted. Responsibility fragmented. Beds disappeared faster than services were built. Over time, the most difficult cases — people with severe mental illness, addiction, cognitive disabilities or some combination — fell through widening gaps.
And when systems fail, other systems absorb the fallout.
Hospitals became holding areas. Jails became de facto mental health facilities. Shelters became long-term housing for people never meant to live that way. Families became frontline caregivers without training, resources or relief.
And increasingly, the streets became the default.
It is too simple — and too convenient — to say that homelessness is purely a housing problem. Housing matters. Deeply. But anyone paying attention understands that a significant portion of chronic homelessness is tied to untreated or undertreated mental illness.
There was a time when many of those individuals would not have been left to navigate that alone.
They would have been in the system Minnesota once operated.
That does not mean the answer is to recreate the past wholesale. The old state hospital model had real flaws, and any honest conversation has to acknowledge that. Institutionalization without safeguards can become neglect. Isolation can become harm. Those lessons matter.
But so does the lesson of what happens when you remove structure without replacing it.
Minnesota today has fewer long-term psychiatric beds than it needs. Waitlists are common. Patients in crisis can spend days — sometimes longer — boarding in emergency departments, waiting for placement. Law enforcement officers, often the least equipped to handle mental health crises, are routinely the first responders.
This is not a system designed on purpose. It is what happens when a system is allowed to erode.
So the question comes back, quietly at first and then more urgently: Should Minnesota rebuild a version of its state hospital system?
Not as it was. But as it could be.
A modern approach would look different. Smaller, regional facilities. Integrated medical and psychiatric care. Strong oversight and patient protections. Clear pathways in and out, rather than indefinite confinement. Coordination with housing systems so that discharge does not mean a return to the street.
Most importantly, it would acknowledge a basic reality: some people need structured, long-term care. Not for weeks. Not for a revolving door of short stays. For as long as it takes to stabilize, and in some cases, for life.
That is the part policymakers are often reluctant to say out loud.
Because it raises hard questions about cost, about civil liberties, about the role of government. It forces a state that prides itself on independence to admit that not everyone can make it alone.
But ignoring those questions has not made the problem go away. It has simply relocated it.
Would rebuilding a state-supported institutional system solve homelessness? No. Nothing that complex has a single solution. But would it address a significant piece of it — particularly among those struggling with severe, persistent mental illness?
Yes. It would.
And more than that, it would restore a level of honesty to the conversation.
Minnesota likes to think of itself as a place that works. In many ways, it still does. But systems do not run on reputation. They run on decisions — and on the willingness to revisit those decisions when they stop working.
The state once made a decision to dismantle its institutions, believing something better would take their place.
Decades later, the better system remains incomplete.
At some point, the question is no longer why we left the old model behind. It is whether we are willing to build the one we were supposed to replace it with.
