St. Elizabeths Hospital

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St. Elizabeths [sic] 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 recently opened a new facility.[4]

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.[5]



The hospital was founded by 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 as it was converted temporarily into a hospital for wounded soldiers.[6] 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.[1]

At its peak, the St. Elizabeths campus housed 8,000 patients and employed 4,000 people.[6] Beginning in the 1950s, however, large institutions such as St. Elizabeths were being criticized for hindering the treatment of patients. Community-based healthcare, which included local outpatient facilities and drug therapy, was seen 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.[6] 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.[7] Approximately one-half of St. Elizabeths patients are civilly committed, the remaining patients are forensic patients.[8] 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 "state-of-the-art" 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 total patients. Civilly-committed patients and forensic patients had traditionally been housed in separate facilities (RNB 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.

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