The issue of Black people and mental health has always been complicated due to mistrust, racism, inadequate health insurance and other factors, but it is also in many respects an untold story. In a new book, “Madness: Race and Insanity in a Jim Crow Asylum,” Peabody and Emmy-award winning journalist Antonia Hylton seeks to uncover some of the roots of the relationship between the African American community and the mental health system. Hylton, an NBC News correspondent, focuses on Crownsville Hospital, in Anne Arundel County, which was formerly known as Maryland’s Hospital for the Negro Insane. It opened in the 1910s and operated until 2004.

Hylton paints a disturbing picture of the 1,500-acre campus built by the Black patients. They cleared the land and built roads, offices and dormitories. Once it was completed, the patients tended the farmland and harvested the crops, did the laundry and cooked — all for no pay.

At its height, about 2,700 Black men, women and children were committed to Crownsville. Many patients died at Crownsville, and Hylton writes about how they were cared for by only a handful of doctors and mainly uneducated and untrained staff.

Hylton paints a picture of prison-like conditions for the patients at Crownsville. Hylton did an interview for The Baltimore Banner with journalist and broadcaster Gwendolyn Glenn. The interview has been edited for length and clarity:

Antonia Hylton: In the early days, you would see something that looked like a work colony with the majority of the patients laboring very hard, for hours and hours with very little in the way of treatment. There was not much in the way of treatment, period, in those days. You had unruly patients strapped to chairs, left alone in seclusion cells or rooms, but for any patient who could be put to work, that was really the goal of this all-white staff.

Gwendolyn Glenn: You write that not only were the patients living a plantation-like life at Crownsville, but the conditions they lived in were unsanitary. Describe them.

Hylton: As more patients arrived from every corner of Maryland, many of those buildings became incredibly overcrowded and filthy. … Often, patients were sleeping two to a twin bed, head-to-foot. People described very loud noises, very intense smells, and it was really difficult accessing basic things like restrooms and clean water. … Much of the all-white staff had openly bigoted views of the patient population and so they didn’t do a whole lot in terms of cleanup and support.

Glenn: Those horrific conditions continued until the ban on hiring Black staff was lifted and small improvements began to happen, correct?

Hylton: It wasn’t until the late 1940s and 1950s when some Black employees start arriving that some of this starts to change. When Black people first get jobs as aides, assistants, nurses and doctors, they come in and find that the white population that’s been doing this work in many cases can’t read or write and some lied about certain degrees and had never gotten proper training at all and had been allowing patients to live in filthy and subhuman conditions. The Black staff start to bring clothing from home for patients and helping patients borrow shoes so that they didn’t have to walk in the snow barefoot. … I tell the story of a [Black] woman named Marie Gough, who came to the hospital in the ’50s ... and she was horrified to find that her white supervisors had just thrown buckets of water on patients, without washcloths to scrub with. She and others start to get into the showers themselves and scrub patients and comb their hair to detangle their curls and braid it in many cases — humane sort of early steps that start to change the institution that were so critical to patients building up their self-worth.

Glenn: Crownsville was built for Black patients, but it was surrounded by a lot of white residents who did not want the hospital there because they wrongly felt all the patients were violent.

Hylton: The white neighbors who lived around it become very obsessed with and concerned about Black males inside the institution and the threat of sexual or physical violence. There were a lot of news reports in mainstream news organizations where they would emphasize and racialize the patients. They would sensationalize their escapes or riots and incidents and then downplay the same things that would occur at all-white institutions by saying they chose to leave instead of using the word escape. In white-owned media, Crownsville is this frightening, violent, horrible place and in the historically Black-owned newspapers, it has that horror but … they often put the blame for violent incidents on the management of the hospital and the lack of funding that the hospitals received instead of placing it on individual patients.

Glenn: You also document that many of the patients were not mentally ill. Some were sent there when jails were overcrowded or when they were involved in protests.

Hylton: I tell the story in one chapter of three civil rights protesters who are labeled as insane and brought to Crownsville for the crime of trying to eat at a white-owned restaurant. … I tell the story of a guy in the ’50s who ends up at Crownsville for years because one white supervisor at the institution overhears him using a British accent and doesn’t believe there can be Black people with British accents, and so he brings him to Crownsville. In some ways, the mental health care system has been weaponized against Black Americans and so there’s that history that I think lingers even in our modern-day health outcomes.

Glenn: You interviewed more than 40 former patients and staff from Crownsville. How did you find them?

Hylton: I spent years cultivating relationships because this is not the kind of thing we can call people up and say, hey, tell me about being a patient there. So, I really had to prove myself and get to know one family at a time and each new family or nurse or person that I met would open a new door for me. … I was welcomed into homes of health care workers and then I was able to touch photographs and look at letters that very few people have been able to read.

Glenn: It [took] you 10 years to write this book, with part of that due to resistance you faced in getting access to Crownsville’s archives.

Hylton: I had to get letters of recommendation and kind of wage a forceful campaign to finally get permission to enter and when I did, I was shocked to find that so little from those early years had been preserved. Some of the records had been destroyed, mistakenly or purposely. And other files just had never been kept at all because of that divide — this generation of white staffers there who cared so little, that they hadn’t really cared to dignify patients with record keeping in the first place.

Glenn: On a personal level, you write a lot of personal stories about various relatives of yours. What did you take away personally from this journey to Crownsville?

Hylton: I learned a lot about prioritizing my own mental health and taking care of myself, because this was a hard book to write. At the very same time, as I was doing all the reporting, I had to take care of a loved one who was in the middle of a mental health crisis, so there were lots of times when I needed breaks to take a step back from the work and just say I’m not going to do this for a few weeks. I also think that I’ve learned that there are a lot of people who are very invested in all of us throwing our hands up and just believing that there’s nothing we can do … but you know, I think if we talk more about mental health, then we destigmatize these issues more and people start gathering more and discussing what they want and would like to do. If we all stay in our silos, we live in the shame and the stigma. If we let these stories stay in, it’s going to be very hard for us to find people who are as committed to building something better. And so I wrote this book and I put my personal story out there and my family out there so people knew their narrator, knew who they were going to go on this ride with but also so that they felt less alone. And, maybe, if they wanted to start talking about something they’ve been going through or something, their family is navigating, OK, well, I’m going to do it. I’ll put my heart out on the page, and you can give it a try next.

Glenn: Crownsville closed in 2004 — the buildings are still standing in Anne Arundel County. What is its legacy and how does Crownsville connect to how African Americans feel about mental health today?

Hylton: It is a story about why Black communities have been so alienated by these systems and I think it’s a story that will help many people feel less alone and help them better understand some of the generations in their family that might have struggled to access this care. And they’ll start to see why they feel so disconnected from or rejected from these systems, but the other piece of the story is, when you look at all these amazing health care heroes, that come into this institution that was not made with their humanity in mind and they transform it anyway. They fight tooth and nail day in and day out to save patients’ lives anyway. I think the legacy of Crownsville is to remind us of the power and the potential of having people who know you, live near you, and love you, take care of you. And when we look at what we’ve all been left with today, the good news is choices can be changed. We can look back to Crownsville as a road map to see where we went wrong, to build something better for the future, and so that’s what I tell people. There is the pain and the horror and the lost trust. And then there are the heroes and the reformers and the people who are trying to shine a light and point us in a new direction toward a new way.

Gwendolyn Glenn is a host for NPR-affiliate WFAE and writes for other local and national media outlets.