On November 6, 1766, Sir Francis Fauquier, Governor General of His Majesty’s Colony of Virginia, gave his annual speech to the House of Burgesses. These words of the Governor General ultimately resulted in the first state psychiatric hospital:
“It is expected I should also recommend to your consideration and humanity, a poor, unhappy set of people, who are deprived o their senses and wander about the country terrifying the rest of their fellow creatures. A legal confinement and proper provision ought to be appointed for these miserable objects.”
On October 12, 1773, “The Public Hospital for Persons of Insane and Disordered Mind,” opened its doors for “idiots, lunatics and persons of unsound minds.” Later relocated to Williamsburg and renamed Eastern State Hospital, this is the oldest hospital in the United States that has exclusively treated the mentally ill. The Hospital’s first patient arrived on April 28, 1774. The patient was charged 15 pounds a year.
The institution changed names over the years, known as the “Public Hospital,” the “Lunatick Hospital,” and even the “Mad House.” The legislature officially changed the name on March 6, 1841 to Eastern Lunatic Asylum, and on February 22, 1894 to Eastern State Hospital.
On June 7, 1885, the original facility burned to the ground. Eventually rebuilt, by 1935 Eastern State Hospital has a census of 2,000 patients. Without any further space to expand, between 1937 and 1968, all patients were relocated to a new hospital in Williamsburg. In 1985, the original hospital was rebuilt on its excavated foundations, opening to the public as a museum.
Like most mental institutions in the United States, after World War II the treatment of patients evolved as psychiatric drugs for the treatment of certain mental conditions became more available and effective. The concept of creating community-based care became known as “deinstitutionalization” in the 1960s.
In January 2011, Eastern State Hospital was criticized for what was described as “barring” its doors and turning away new patients. Since 2004, the Hospital reduced its capacity from 523 to 300 beds, with the removal of 85 beds in 2009 alone. In a report by Inspector General Douglas Bevelacqua, due to the lack of residential programs, many patients were essentially “stuck” in the hospital. “Admissions and discharges represent the front door and the back door to a state facility, and, if either the entrance or exit is blocked, it creates pressures for the entire public sector safety net system,” Bevelacqua explained.
Although Eastern State Hospital has taken great efforts to improve the care for its patients, without a proper infrastructure to transition patients from the hospital into the community, there will always be a struggle to treat the mentally ill.