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—in their letters home to loved ones—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 one-half of St. Elizabeths patients are civilly committed, the remaining patients are forensic 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.
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