History

On April 23rd, 1869, the 300 bed St. Louis County Insane Asylum opened its doors, admitting on its first day 127 patients transferred by wagon train from an over-crowded state hospital in Fulton and 80 from the County Poor Farm. The Asylum was the second in the State, the first being Fulton State Hospital, which opened its doors in 1851, and was notable for not being just first in Missouri, but the first psychiatric hospital west of the Mississippi. It took the suicide of Missouri’s 7th governor, Thomas Reynolds, in 1844 to get the enabling legislation passed for Fulton’s construction, after the crusading efforts of Dorothea Dix had fallen on deaf ears in 1841.

Work began on December 1st of 1864 on 23 acres purchased from the County Poor Farm for a total of $7,012, in what was then St. Louis County, on the most elevated land in the metropolitan region. In fact, even today, the only structure that rises further above sea level than the dome of the hospital is the St. Louis Arch.

The design and construction was under the direction of architect William Rumbold, who designed and built the dome building. Mr. Rumbold’s vision was that of Imperial Roman with marble pillars for the front portico and the cast iron dome. The facility as a whole was designed in accordance with what has been described as the Kirkbride Model, involving a central dome and flanking multi-story wings, allowing fresh air, light and a view of the asylum grounds. Mr. Rumbold also designed the dome of the Old Courthouse in downtown St. Louis, site of the famous Dred Scott trials, and consulted on the dome of the Capital building in Washington, D.C.

By 1866, three years before the facility was completed, the building already had cost overruns which made it the most expensive facility west of the Mississippi, costing $750,000.00 when the annual income was a mere $150 -$200.

During construction, the bricks for the building were made on site, with a time capsule comprised of a leaden box filled with memorabilia buried within the cornerstone. The crew worked six days a week for almost 3 ½ years to drill a well that was 3,843 feet deep (that is just shy of ¾ of a mile!) and the 2nd deepest well drilled for water in the world . This well yielded a very high grade of coal. The coal was mined out, and the hole was filled in with waste. The waste was removed via a sewer that was over 100 feet deep, and ran 15,000 feet from the Dome Building to a connecting line near what is now the intersection of Highway 44 & Vandeventer. The sewage was pumped east toward the Mill Creek watershed, because of a law the prevented any pollution from going into what was deemed the “pristine River Des Peres.”

The Asylum complex also included two poor houses, a “Hospital for Social Evils” (on the northwest corner of Arsenal and Sublette) for prostitutes, an orphanage, and the St. Louis Chronic Hospital. Later, an Isolation Hospital was built for people with contagious diseases. The only remnants of those facilities are the present day hospital, and the Truman Restorative Center, formerly a combination of the Isolation and Chronic Hospitals.

The model of treatment at the hospital’s inception was known as the “Moral Model.” It emphasized the opportunity for patients to escape the pollution, rigors, and stresses of city life, and seek the comfort and sanctuary available in a pastoral asylum setting, in which patients could look down upon rolling grassland, have fresh air and sunshine on their faces, participate in meaningful and restorative work, and above, be treated with dignity and respect by the staff who cared for them and all of whom lived on grounds in an almost familial arrangement. Hospital employees lived among our clients, in on campus housing, including our nurses and our physicians. Our superintendent living on campus as well, right underneath the dome on the 5th floor, together with his family, and several assistant physicians lived on the top floor of the wings, or in cottages in the northeastern section of our campus. We know from the history of the time and the hospital’s first medical records, that this model of treatment was often very successful, and that many patients recovered, never to return.

The hospital was considered one of the city’s jewels in the latter half of the 19th century, its construction preceding other notable St. Louis landmarks like City Hall, not to mention more modern landmarks like the Arch. When visiting dignitaries came to St. Louis, whether from out-state Missouri, other States, or other countries, they were often winded and dined within the building. This included formal dances on the 5th floor of the wings, opening up into a formal space right beneath the central dome itself – the remnants of that grandeur still visible in the crown molding and plaster right below the dome itself. Young debutants from the upper classes, on the eve of their formal presentation to society, would hold their debutante balls on those same dance floors, with many of the higher functioning patients having the opportunity to participate in those festivities, dancing with the young ladies themselves. In sharp contrast, some of the adjoining spaces in those wings were used for patient overflow, or to house chickens that would help feed the patients and staff.

The library of the Missouri Institute of Mental Health, the largest collection of mental health journals and texts in the country, is still housed on the campus. It sits now in the location of the former hospital cafeteria, where superintendents would preside over luncheons for the employees, often presenting formal lectures while their wives played the piano.

In 1876, the city of St. Louis separated from St. Louis County, under what was known as the “Scheme of Separation,” an uncoupling of the metropolitan region that is debated to this very day. As a result, the name of this facility changed to “The St. Louis City Insane Asylum.” The Scheme included a clause which the County of St. Louis retained the right to send patients to the former county institution until such a time as when the county had its own psychiatric institution.

By 1890, our campus was regarded as the premier showpiece in the St. Louis metropolitan area, and a model of the western world’s ability to take care of its more vulnerable. The Dome Building became a must see for foreign dignitaries and tourists alike, the elevation of the site making it a premier look-out point. In fact, civic and social leaders would often dress up and have dances with the patients in the ballroom located on the 5th Floor of the Dome Building. Later, debutantes were presented to society in gala events held in the Dome Building Lobby.

A 70 bed cottage was built for 70 patients in 1884. However, the hospital did not follow the cottage model until the 1990s. Instead, construction on the hospital’s 8 wings (B through K) was begun in 1907, as an annex to the original building, and was called the “Million Dollar Annex”, adding capacity for 200 more patients and 300 additional staff. In 1910, the name of the facility was changed yet again to the “City Sanitarium.” By that time, the facility functioned as a self-contained city. The Hospital had its own power plant, with an engine that was specifically designed and built for the hospital in 1889, and remained operational until 1998. It burned coal, gas, and oil, and provided enough steam to heat the hospitals and the poorhouses that existed along Arsenal Street, with the capacity to power a town of up to 10,000 residents. The hospital also had its own water supply, a bakery, a potter’s field (currently underneath the Hampton Inn Apartments), and farms which were used to grow the majority of the hospital’s food supply. In the early 1920s, additional construction took place to add separate housing quarters for the staffing attendants, thereby opening up additional space for patients. Due to the pressures of continued growth and expansion of the patient population, as a result of cost-shifting from local alms houses, jails and prisons, the hospital’s population continued to grow in the 1930s, moving the facility away from the Moral Model, and the hope for recovery and cure, toward a custodial institution in which patients were detained and sheltered, often for the balance of their lives. In 1940, there were 3,944 patients in the facility, and at the height of hospital’s operation in the 1950’s and early 1960’s, the population of patients grew to more than 4,400.

In 1948, the City of St. Louis sold the Sanitarium to the State for $1.00, in House Bill #457 and the General Assembly renamed the facility the “St. Louis State Hospital”. Dr. Louis Kohler took over the hospital in 1951, when it was at 120 percent of capacity. He established an out-patient clinic and a three-year residency program for psychiatrists. On October 22, 1962, the Louis H. Kohler Building was erected. An example of Mid-Century Modern, the building was designed by architect Marcel Boulicault (Boo-Li-Coe), who also designed the Jefferson Building and the Employment Security Building, located in Jefferson City, MO. It originally included 4 floors with wings on each side. However, in 1968, a contract was awarded at the cost of $2.4 million to add 2 additional floors to the Kohler Building. Unfortunately, the building was never well received since it completely blocked the view of the Dome building, and in the winter of 1998, the building was torn down. Restoring the beautiful grandeur of the original Dome building far outweighed the marvels of the Mid-Century Modernistic architecture.

The Hospital Auxiliary was found as an official volunteer program in 1954, and remains an active viable resource for the hospital, raising funds on behalf of patients and the staff who serve them. The membership is comprised of family of current and former patients, community advocates, as well as current and retired hospital staff.

In 1964, the Missouri Institute of Psychiatry, now the Missouri Institute of Mental Health (MIMH), was established by the new director of the Division of Mental Diseases, Dr. George Ulett. MIMH was affiliated with the UMC School of Medicine and its new Department of Psychiatry, was located in the Kohler Building, and operated research wards and an animal lab for much of the Kohler building’s life, along with one of the nation’s finest psychiatric libraries. MIMH, now fully identified with the University of Missouri – St. Louis, moved from the campus in the summer of 2014 to establish a closer working relationship with other university departments.

Children were always a part of the services here on this campus, and included a wing within the hospital that housed and treated children up to the mid 1970’s. On July 5, 1976, the first children’s mental health care facility in the state was built as an annex on campus. Five years later, on July 1, 1981 the Division of Psychiatric Services constructed the Hawthorne Children’s Psychiatric Hospital in a separate building that is currently used by Gateway Elementary School. It was deemed that this building was not the safest environment for the children, and in 1990, Hawthorne moved to its current location on Pennsylvania Ave.

For much of its history, St. Louis State Hospital had been a “full service” psychiatric facility, with acute, intermediate and long-term psychiatric beds, gero-psychiatry unit, a child and adolescent unit, a substance abuse unit, an emergency room, and an outpatient clinic with satellites stretching as far south as Farmington and as far west as New Haven, Missouri. Beginning in the 1960’s, the hospital began to downsize, reflecting the nation’s effort at deinstitutionalization of individuals with severe and persistent mental illness, in an effort to promote greater community integration. With the advent of new medications, and community based service alternatives that are now available to assist in the care of our clients, the hospital reduced its scope of care as well as the number of patients served, shrinking from 4,400 patients to its current census of 180 clients. Today, the Department of Mental Health successfully treats the vast majority of its 76,000 clients in the community, with only 1,100 in institutional settings.

The 4 story wings that had stretched across the campus from Sublette to the west and Brannon to the East had become old and dilapidated, as had the 6 story Kohler Building and were too large and too difficult to maintain for the hospital’s new mission and smaller population. A new building, more in keeping with modern efforts at psychosocial rehabilitation was envisioned, designed and constructed, beginning in 1994. A similar process took place for Malcolm Bliss Mental Health Center, previously located next to the old City Hospital, and for a brief period, both facilities were co-located on the campus of St. Louis Psychiatric Rehabilitation Center while awaiting completion of the new facilities for each hospital.

In the fall of 1997, the St. Louis State Hospital moved across the lawn into its new quarters at 5300 Arsenal, while Malcolm Bliss moved to its new location at 5351 Delmar Avenue and is renamed Metropolitan St. Louis Psychiatric Center. The completely new facilities at both locations allow for state of the art care for individuals with severe and persistent mental illness. For St. Louis State Hospital, this included a new mission as a forensic psychiatric hospital providing long-term inpatient treatment to individuals who had been committed as a result of a criminal offense involving mental illness.

To reflect this new philosophy of care, the facility made its final name change to the St. Louis Psychiatric Rehabilitation Center (SLPRC) upon opening. The facility was opened to accommodate 212 clients, housed in a series of four 25-bed wards, and fourteen 8-bed cottages. Today, SLPRC has 180 beds, having leased two of its 8-bed cottages to two community providers, with 2 others currently vacant.

Revitalized by its new mission and new facilities, SLPRC is recognized in 1999 by the Landmark Association as one of 11 “most enhanced sites” in the metropolitan region. Recognition follows for its treatment efforts, first by HCFA in 1999 (now the Centers for Medicare and Medicaid Services) as “one of the best facilities of its kind”, and then by Joint Commission for the Accreditation of Healthcare Organizations (now The Joint Commission), first in 2000 and then in 2003, as within the top 5% and top 3%, respectively, of all hospitals in the United States.

In its present operation, St. Louis Psychiatric Rehabilitation Center remains committed to providing the very best evidenced based practices for the recovery from serious and persistent mental illness and for the eventual reintegration of our clients into their home communities, so that they can live, learn, work and play and have the lives the rest of society takes for granted.