Geel's history is steeped in legend with a bit of mystery and no small amount of controversy.

Local lore is that a princess named Dymphna escaped her native Ireland around 600 A.D. and fled to Geel to hide from her father. He had gone mad after his wife died and developed incestuous intentions for his daughter. When Dymphna refused his advances, the story goes, he cut off her head. Her bones are said to be buried in the graveyard near a church named in her honor. (A disinterment several years ago proved the bones were those of an animal, raising doubts in the minds of many about the Dymphna story.)

Dymphna was canonized in 1247, some 600 years after her death, and is considered the patron saint of people with mental disorders. In those days, mental illness was considered a punishment from God, and people were encouraged to visit the shrine to pray for forgiveness. In time, word spread that people with mental afflictions were welcome in Geel.

Whether this was merely a medieval marketing plan to swell the ranks of the town is still debated.

Whatever it was, it worked. People came from all over that part of Europe seeking help.

At first, the nuns at the convent of St. Augustine cared for the patients in a "sickhouse" they had built near the church. When all the beds were taken, the nuns appealed to the people of the town to take in a patient or two. By the mid-1800s, one of every five residents of Geel was a mental patient, according to the history of the convent, which now doubles as a museum.

Eventually, concerns that some patients were being mistreated and used as cheap farm labor prompted the government to take over the hospital and the program. By the late 1930s, there were more than 3,700 patients living with families or at the hospital campus just off the town square. The program played a role in hiding Jews from the Nazis during World War II.

Today there are just over 300 boarders. The older residents worry their tradition may be fading.

Lieve Van de Walle, who once ran the program, attributes the decrease to fewer families living on farms or with one parent at home during the day. It's also because psychiatric patients have more options, including living independently.

Hospital administrators vow the program will continue.

"We will always have this kind of care in some form or another," said Van de Walle, now manager of the system's child psychiatric rehabilitation unit.

'Wisconsin Model'

The approach is akin to a foster care program for adults.

The program is administered through the regional psychiatric hospital. Patients are screened to see if they are appropriate for family life. No one with a history of violence is permitted. Neither are those with a history of drug or alcohol abuse.

Those who are too ill or who are dangerous to themselves or others stay at the hospital.

Families are screened, too. They are checked to be sure they don't have criminal histories and are trained on what to expect. The hosts who participate in the program are paid for their help — the equivalent of $730 per patient a month, though it does not cover all the costs.

"We don't do it for the money," Smit said.

The area around Geel is divided into three zones, and teams are assigned to each. Each team has a doctor, social worker, occupational therapist and a nurse. Families are considered partners in their guests' care. They regularly consult with the district nurses, who stop in at least once a month to check on how things are going.

If a problem arises, the family or the guest can request that a change be made. It is not unusual for a boarder to spend some time back at the hospital when illness flares, or if the host and the boarder need a break from each other for a few days.

The hospital sponsors a day center where patients can play billiards or bumper pool, watch TV, take art classes, eat lunch or just visit. A bicycle repair shop on the hospital grounds allows some of the boarders a chance to earn extra spending money.

The current care model in Geel is based on the Assertive Community Treatment model, an approach developed in Madison in the late 1960s.

"We call it the Wisconsin Model," Van de Walle said.

Cities all over the world have adopted the model. Milwaukee has such a program for children and teens, but none for adults. Milwaukee's adult mental health system is a mishmash where care is not coordinated and focused mostly on mental health emergencies.

For her 2008 book "Geel Revisited," Van de Walle did case studies on 19 of the boarders. She found that people in these arrangements were more likely to fare better when they are integrated into family life. They lived longer, and their sense of well-being was stronger.

Even patients who would seem to be beyond help can live full, dignified and secure lives, Van de Walle said.

"They have the sense that they belong and they were no longer lonely," she said.

Staying for decades

Smit and her husband moved to Geel in 1999 and began taking in boarders a few years later, after learning about the tradition from neighbors.

"It's really quite simple, and quite beautiful," Smit said. "We help them, and they help us."

Most boarders stay with a family for decades. One woman had been with her family for more than 70 years.