In 1969, The Northwest Center in Mt. Airy opened its doors during a time of hope that American society could do better for those struggling with mental health and developmental challenges.

Now more than half a century later, a major ongoing renovation of the building near the intersection of Germantown and Mt. Airy Avenues, as well as the services it provides, could help bring that vision closer to reality for area residents.

The story begins during the administration of President John F. Kennedy, when political leadership of both parties in Congress sought to shift a significant portion of mental health care from institutional settings– think state-run asylums– to more community based care. The Community Mental Health Act of 1963 led to the opening of outpatient facilities like the Northwest Center, which later became Merakey, a not-for-profit developmental, behavioral health, and education provider whose 700 locations make it one of the largest networks in the country.

But proper public funding for such community-based models has not consistently materialized, experts say, leaving Americans in need of care vulnerable and often pushing those with mental illness into homelessness or prisons.

“I think (the shift) was well-intentioned… The psychiatric hospitals were not great. A lot of the state hospitals were not great… there were a lot of instances of abuse and neglect,” said Dominic Sisti, associate professor of medical ethics and health policy at the University of Pennsylvania. “But there was a promise of community health that didn’t fully materialize, and that left a lot of people without emergency care when they were in crisis.”

Now, Merakey is attempting to solve a tiny piece of the puzzle. The nonprofit has created Merakey Total Health, an independent but affiliated entity that will focus on providing primary care suitable to clients with mental health or developmental challenges. The major overhaul of the building at 27 E. Mt. Airy Avenue will create new office space for physicians to see patients on the first floor, while Merakey’s existing outpatient therapy services will remain housed on the second floor. Plans call for the facility to fully reopen in September. 

Sarah Threnhauser, CEO of Merakey Total Health, says the decision follows recognition of a gap in how America cares for those with mental or behavioral challenges. She pointed to a 2022 New York Times article that highlighted research showing many primary care doctors struggle to care for patients whose needs go beyond run-of-the-mill physical ailments, due to a lack of training or financial and time constraints.

“A lot of the time their buildings are not able to accommodate people with disabilities, their providers don’t have that traditional training that they need. And it’s just harder to find access to basic primary care services,” Threnhauser said.

While the physicians at Merakey Total Health will be able to take on any new patients from the community, the building’s new physical accessibility and trained staff will be specifically equipped to care for Merakey’s core clientele.

“A person’s physical and mental health are really intertwined,” Threnhauser said. “There’s an incredible need for primary care services.”

Sisti adds that another common challenge is financial. Many people with severe challenges utilize Medicaid over private insurance when accessing medical care. But signing up for and remaining eligible for Medicaid requires navigating voluminous paperwork and having a consistent telephone number or mailing address. Those can be big hurdles to clear for an individual experiencing homelessness, struggling with addiction, or exiting prison.

Threnhauser says Merakey will also have staff capable of assisting individuals in navigating such bureaucracies. Sisti in turn sees a lot of good to come out of housing all of those services under one roof.

“Having primary care right there on the spot… that’s a good way forward,” Sisti said. 

Kyra Koons, a clinical supervisor for Merakey, hopes it will also mark progress. In addition to managerial responsibilities, Koons also directly provides therapy to clients, seeing firsthand the struggles and triumphs of residents of Northwest Philadelphia. Their challenges run the spectrum, from fully functional clients who just need to talk on occasion, to those with more severe diagnosis and histories of addiction who require weekly care.

She’s been heartened by what she sees as recent improvements in how our society views mental health.

“It’s just as important as your physical health, and really it’s linked,” Koons said. “ And there’s a changing narrative that needing or wanting support with mental health is not a weakness or character defect… really it’s a sign of strength.”

And she sees the creation of a more holistic strategy like the one on Mt. Airy Avenue as a sign of tangible progress that has her “excited for our clients and our community.”

Still – each of these professionals has a message for society at large: they need more resources and more prioritization.

Threnhauser says Merakey Total Health hopes to obtain designated federal funding, achieve financial sustainability, and then be able to expand the model to other facilities. 

Sisti thinks about the wider picture. The United States has a “major crisis on our hands,” with a growing number of individuals, including the middle class and children, suffering from mental health issues. The crush is overwhelming providers, leading to lag times to see specialists that can run as long as a year.

“We have no mental care system that’s coherent,” Sisti said.

He’s watching places like California, which through a planned ballot referendum and other means is seeking to spend billions of dollars to finally build out robust community resources promised but undelivered for decades.

“This is one step in the right direction,” Sisti said. “We need a health care system that sees mental health as the same as any other kind of health, and treats it that way.”