An Evolution in Patient Care: The History of the St. Joseph State Hospital
When the doors of State Lunatic Asylum №2 opened for the very first time on November 9, 1874, in Saint Joseph, Missouri, they were opened with the best of intentions. The construction was necessitated by the steady increase in the patient population in State Lunatic Asylum №1 and the new belief that the mentally ill should not be imprisoned. Built to house two hundred and fifty patients, the large structure was remodeled early on following a fire in 1879, and in the process adopted the Kirkbride plan. The signature Kirkbride wings were added, staggering off of the main building. This new type of hospital design, created by mental health advocate Thomas J. Kirkbride, allowed for maximum sunlight and flow of fresh air for patients and was one of many that were to change the way society treats the mentally ill.
At that point in time, asylums that followed the Kirkbride plan were essentially safe havens for the mentally ill. The buildings were always to be two to three miles outside of the city to allow for wide-open spaces. Mentally ill patients were expected to come and wind down by enjoying leisurely walks or lounging on the lawns. They were also encouraged to read, garden or play recreational games such as billiards. There was also a farm on the property, in which the patients would work and help provide food for not only themselves and hospital staff, but the surrounding community as well. This gave patients a sense of purpose and belonging. Following the Kirkbride regiment, it was always anticipated that patients would eventually return home. In 1899, Asylum №2 adopted the name of St. Joseph State Hospital and the patient population began to grow so large that three other state hospitals in Missouri had to be constructed in the cities of Nevada, Farmington and St. Louis.
By the 1930s and 1940s, the population of St. Joseph State Hospital had grown to nearly three thousand. Lack of funding, staff shortages and overcrowding were major issues for state-funded hospitals at that point in time. The Great Depression led to many overcrowded hospitals filled with patients who couldn’t care for themselves. In the midst of World Wars I & II, there was a severe lack of funding and well-trained doctors and nurses. This would potentially be the worst time in the hospital’s history, as the lack of trained professionals and overcrowded conditions led to the use of barbaric treatments such as electroconvulsive therapy, lobotomies and insulin-coma therapy. If you want another paragraph you could talk more about the treatments and explain what they were meant to do versus what they actually did to the patients. You could also explain in detail, try not to be too graphic, what the treatments consisted of and why they are considered barbaric in today’s view on mental health and patient treatment.
Within the 1960s and 1970s, mental health care reform increased the rights of patients as far as informed consent and voluntary commitment. New laws regulated the number of hours patients could work and the amount they were paid for said work. Although work therapy had proved to be beneficial to the patients in the past, some patients were eventually exploited and forced to work with no thought given to the therapeutic benefits of the work. Room and board were provided for patient laborers, but no actual wages. Some patients were even kept in the hospital longer than necessary because of how well they worked. This was all of course before the reformation of the law and the shift in funding from the state to the federal level.
Brought about by advances in medicine, changes in patients rights laws and cuts to funding, the Deinstitutionalization Movement of the 1980s and 1990s dramatically changed the treatment of the mentally ill. With the advent of Medicaid, funding for the mentally ill was shifted from the state’s responsibility to a shared partnership with the federal government. This encouraged the closure of many state hospitals and promoted a switch in patient care from large, state-funded hospitals to community hospitals, private clinics, and in many cases, jails or prisons. Many communities have been unsuccessful in their attempts to maintain these facilities for the mentally ill, resulting in a scarcity of services.
In 1997, the St. Joseph State Hospital relocated across the street from the grounds of the original campus. The facility was renamed The Northwest Missouri Psychiatric Rehabilitation Center and now operates as a forensic treatment center. This means that they assess and treat forensically committed persons only. After being partially demolished, what was left of the Kirkbride building was converted into a prison known as Western Reception Diagnostic and Correctional Center. The large windows designed to allow maximum sunlight and airflow have all been bricked up or replaced with smaller windows, which leads us to today. Over one-third of the prison population is diagnosed as mentally ill and prisons are the number one provider of antipsychotic medication. This fact begs the question: have we truly made any progress in the treatment of the mentally ill since the days of Thomas Kirkbride?
