St. Elizabeths Hospital

St. Elizabeths Hospital is a psychiatric hospital operated by the District of Columbia Department of Mental Health. It was the first large-scale, federally run psychiatric hospital in the United States. Housing several thousand patients at its peak, St. Elizabeths had a fully functioning medical-surgical unit and offered accredited internships and psychiatric residencies. It has since fallen into disrepair and the grounds are mostly abandoned, although the east campus is still operational and it opened a new facility in 2010.

The Department of Homeland Security announced in March 2007 plans to relocate its headquarters, along with most of its Washington, D.C.-area facilities, to the abandoned federally owned western campus of St. Elizabeths, beginning in 2010.

History
The hospital was founded by the United States Congress in 1852, largely as the result of the efforts of Dorothea Dix, a pioneering advocate for people living with mental illnesses. It opened in 1855 as the Government Hospital for the Insane, and rose to prominence during the Civil War when it was converted temporarily into a hospital for wounded soldiers. During this time, the hospital temporarily housed animals which were brought back from expeditions for the Smithsonian Institution, because of lack of housing for the animals at the yet to be built National Zoo. In 1916, its name was officially changed to St. Elizabeths, the colonial-era name for the tract of land on which the hospital was built. The hospital had been casually known by this name since the time of the Civil War, when&mdash;in their letters home to loved ones&mdash;patients of army hospitals temporarily located on the grounds were reluctant to refer to the institution by its full title.

At its peak, the St. Elizabeths campus housed 8,000 patients and employed 4,000 people. Beginning in the 1950s, however, large institutions such as St. Elizabeths were being criticized for hindering the treatment of patients. Community-based health care, as specified in the passage of the 1963 Community Mental Health Act, led to deinstitutionalization. The act provided for local outpatient facilities and drug therapy as a more effective means of allowing patients to live near-normal lives. The patient population of St. Elizabeths steadily declined.

By 1996, only 850 patients remained at the hospital, and years of neglect had become apparent; equipment and medicine shortages occurred frequently, and the heating system was broken for weeks at a time. By 2002, all remaining patients on the federal western campus were transferred to other facilities. Although it continues to operate, it does so on a far smaller scale than it once did. As of January 31, 2009, the current patient census was 404 in-patients.

Approximately half of St. Elizabeths patients are civilly committed, the other half are forensic (criminal) patients. Forensic patients are those who are adjudicated to be criminally insane (not guilty by reason of insanity) or incompetent to stand trial. Civil patients are those who were admitted due to an acute need for psychiatric care, without court involvement. Civil patients can be voluntarily or involuntarily committed. A new civil and forensic hospital was built on the East Campus by the District of Columbia Department of Mental Health and opened in the spring of 2010, housing approximately 297 patients. Civilly committed patients and forensic patients had traditionally been housed in separate facilities (RMB and John Howard Pavilion respectively), until the new hospital opened. Most of St. Elizabeths' patients, both civil and forensic, are now housed together in the new facility. The new hospital also houses a library, a velvet-curtained auditorium, multiple computer laboratories, a small museum in the lobby, and a group of large decorative glass butterflies suspended from the ceiling.

In 2007, the U.S. Department of Justice and the District of Columbia reached a settlement over allegations that the civil rights of patients housed at St. Elizabeths were violated by the District. As of April 16, 2008, St. Elizabeths is in "substantial noncompliance" with the terms of the Settlement Agreement.

Patients
Well-known patients of St. Elizabeths include would-be presidential assassins Richard Lawrence (who attempted to kill Andrew Jackson) and more recently John Hinckley, Jr. who shot Ronald Reagan, as well as the successful assassin of James Garfield, Charles J. Guiteau (until his execution). Other notable residents were Mary Fuller, James Swann, Ezra Pound and William Chester Minor.

According to Kelly Patricia O'Meara, St. Elizabeths is believed to have treated over 125,000 patients, though an exact number is not known due to poor recordkeeping. Additionally, she believes that thousands of patients are buried in unmarked graves across the campus, although records for the individuals buried in the graves have been lost. She believes that the incinerator on site also brings up a few questions as to what may have happened to the bodies. The General Services Administration, current owner of the property, considered using ground penetrating radar to attempt to locate unmarked graves but has yet to do so. More than 15,000 known autopsies were performed at St. Elizabeths between 1884 and 1982, and a collection of over 1,400 brains preserved in formaldehyde, 5,000 photographs of brains, and 100,000 slides of brain tissue was maintained by the hospital until it was transferred to a museum in 1986, according to O'Meara. In addition to the mental health patients buried on the campus, several hundred American Civil War soldiers are interred at St. Elizabeths as well.

Contributions to medicine
Several important therapeutic techniques were pioneered at St. Elizabeths, and it served as a model for later institutions. Carl Jung, for example, studied African-American patients at St. Elizabeths to examine the concept of race in mental health. Walter Freeman, onetime laboratory director, was inspired by St. Elizabeths to pioneer the transorbital lobotomy. During American involvement in World War II, the Office of Strategic Services (OSS, predecessor to the CIA) used facilities and staff at St. Elizabeths hospital to test "truth serums". OSS unsuccessfully tested a mescaline and scopolamine cocktail as a truth drug on two volunteers at St. Elizabeths Hospital. Separate tests of THC as a truth serum were equally unsuccessful.

Facilities and grounds
The campus of St. Elizabeths sits on bluffs overlooking the confluence of the Potomac and Anacostia Rivers in the southeast quadrant of Washington, D.C. It is divided by Martin Luther King, Jr. Avenue between the 118 acre east campus (owned by the D.C. Government) and the 182 acre west campus (owned by the Federal Government). It has many important buildings, foremost among them the Center Building, designed according to the principles of the Kirkbride Plan by Thomas U. Walter (1804–1887), who is better known as the primary architect of the expansion of the U.S. Capitol that was begun in 1851.

Much of St. Elizabeths' campus has now fallen into disuse and is in serious disrepair. It has been named one of the nation's 11 Most Endangered Places in 2002 by the National Trust for Historic Preservation. Access to many areas of the campus, including the abandoned western campus (which houses the Center Building) is restricted.

Revitalization plans for western campus
After several decades in decline, the large campus could not be maintained. In 1987, hospital functions on the eastern campus were transferred from the United States Department of Health and Human Services to the District of Columbia government, with the federal government retaining ownership of the western campus. Several commercial redevelopment opportunities were proposed by the D.C. government and consultants, including relocating the University of the District of Columbia to the campus or developing office and retail space. However, the tremendous cost of bringing the facilities up to code (estimated at $50–$100 million) kept developers away.

With little interest in developing the site privately, the Federal Government stepped in. Control of the western campus&mdash;home of the oldest building on the campus, the Center Building&mdash;was transferred to the General Services Administration in 2004. The GSA improved security around the campus, shored up roofs, and covered the windows with plywood in an attempt to preserve the campus until a tenant could be found.

After three years of searching for an occupant, the Department of Homeland Security (DHS) announced on March 20, 2007 that it would spend approximately US$4.1 billion to move its headquarters and most of its Washington-based offices to a new 4500000 ft2 facility on the site, beginning with the United States Coast Guard in 2010. DHS, whose operations are scattered around dozens of buildings in the Washington, D.C. area, hopes to consolidate at least 60 of its facilities at St. Elizabeths and to save $64 million per year in rental costs. DHS also hopes to improve employee morale and unity by having a central location from which to operate.

The plans to locate DHS to St. Elizabeths have been met with criticism, however. Historic preservationists argue that the move will destroy dozens of historic buildings located on the campus and that other alternatives should be considered. Community activists have also expressed concern that the planned high-security facility will not interact with the surrounding community and do little to revitalize the economically depressed area. In 2007, the District of Columbia reached a deal with the Department of Justice and agreed to fix widespread health and safety hazards in the hospital.

A ceremonial groundbreaking for the DHS consolidated headquarters took place at St. Elizabeths on September 11, 2009. The event was attended by Senator Joseph Lieberman, DHS Secretary Janet Napolitano, DC Delegate Eleanor Holmes Norton, DC Mayor Adrian Fenty, and acting GSA Administrator Paul Prouty.

As of April 2012, the relocated Coast Guard headquarters was forecast to open in May 2013, and a ceremony was held in July 2013 at the site before it is to be officially opened.

Popular Culture
The hospital was referred to in an episode of the television series, "Bonanza”. The episode was named, “The Unseen Wound”, featuring Leslie Nielsen as a sheriff, playing a former Civil War era Army officer who falls victim to PTSD, although it was not referred to as such in the script.

Portions of the west campus can be seen in the film, "A Few Good Men."

NPR interns toured the east and west campuses, and shared their experiences in 2010.