The North Dakota State Hospital's History

On March 9, 1883, the Dakota Territorial legislature passed an act for the creation of the North Dakota State Hospital. The act authorized the construction at or near the city of Jamestown, Dakota Territory. The trustees of the new hospital chose Dr. Archibald, an army surgeon, as the hospital’s first superintendent. The trustees charged Archibald with selecting the plans for the hospital’s buildings. He chose a “segregated or detached” building model, otherwise known as a Cottage Plan. Under this plan, the hospital would consist of different buildings for different uses. He thought this plan would lend a certain home-like atmosphere to the campus in contrast to the Eastern institutions of the time.

The hospital opened its doors on May 1, 1885, with the admission of its first two patients from Mandan. Over the next eighteen months, it received 58 patients from Yankton Hospital and 116 patients from the Northern Territory, increasing the average daily census to 106, already beyond the hospital’s capacity. From the beginning, therefore, the hospital struggled with overpopulation. By 1890 patients were sleeping two to a bed in attics and basements. In 1904 patients were placed in a newly constructed chicken coup. Starting that same year, the hospital had to bar female admissions for four years except for those that were the most suicidal.

As early as 1890 the hospital had an organized system of volunteer service. The volunteers, all from the Jamestown area, included chaplains providing religious services and families kind enough to take in patients for holiday meals. These services expanded to include a patient store and a mobile library.
Work was an important and necessary component of hospital life from the beginning. The construction of farm buildings, milking of cows, planting and harvesting crops, and gardening all used patient labor as a means of therapy and as a means of producing enough food for the self-sufficiency of the hospital. As the hospital grew, so did the need for more food, milk, and buildings. The gardens expanded, the herds grew, the milk production increased, and more farm buildings were built. The increased activity provided plenty of work for the able-bodied patients. The monthly yield of the farm just prior to its closure in 1987, (only a fraction of what it was at its peak) was 16,660 pounds of slaughtered beef and 6750 gallons of milk and cream. The yearly crop yield included 300 acres of corn, 500 acres of oats and barley, and 450 acres of tame hay. Four hundred twenty-five animals pastured on 1600 acres of land.

The hospital established occupational therapy services for women in 1896. This service grew from evening work creating rugs and linens to a wide range of vocational activities including sewing institution clothes and bedding, stuffing mattresses, binding books, and publishing material through the Occupational Therapy Press. The program produced a plethora of wicker furniture still sturdy and functional after 70+ years of wear.
Leisure was considered important. An amusement hall, part of the original design of the hospital, served as a concert hall, dance hall, and general assembly. The second Amusement Hall of the 1920s housed a movie theater and bowling alley. Popular during this time were the newly constructed golf course and the active baseball field and tennis courts. The baseball team participated in intra-mural sports with Jamestown teams. An orchestra, composed of patient and staff musicians, performed frequent concerts.

In 1914 a new building opened and provided space and equipment for hydrotherapy as a treatment for mental illness. The use of hydrotherapy was considered unrivaled over all other means of treatment at the time. The treatment included a continuous warm bath, a cold pack, hot packs, a moist hot air bath, a sitz bath, and a needle shower. The next new major form of therapy was Electro-convulsive therapy, not to start at the hospital until the 1940s.

By 1920 the patient population exceeded 1200. During this time the hospital initiated and completed an ambitious set of plans that included removing all restraints except for the most suicidal patients, discharging more liberally, increasing occupational therapy activities, providing vocational rehabilitation for servicemen, using music therapy, rebuilding the Amusement Hall, and hiring a social worker to work with families for follow-up care. And still, the census continued to climb.

In June 1937, Governor William Langer fired the superintendent and appointed Henry Owen. Owen subsequently fired 75% of the institution’s staff and replaced them with new employees loyal to the Non-Partisan League. In some cases, political loyalty to the NPL seemed to be the only job requirement. To keep their jobs, employees had to spy on each other and engage in political campaigning while on the job. An ex-convict was hired, at a monthly salary hirer than the physicians, to gather dirt against other employees.
This scandal, plus the continued rise in the census, left the hospital in shambles. By the mid-1940s it was in its own dark ages. It wasn’t until 1950, when, at the request of the state, the American Psychiatric Association came to visit and changes occurred. The report from the APA prompted visits from the State Health Department and the National Institute of Mental Health. These organizations put forth multiple recommendations for change. These recommendations were put in place with a six-year plan of reorganization and expansion of services, including the introduction of psychiatric medications. As part of the expansion, the hospital created an outpatient clinic. The extent of reform can be seen in a quote from the 1956 annual report to the legislature: “Gone are the cages, strait jackets, leg irons, stern guards, malnutrition, windowless seclusion rooms, unorganized departments, the sixty-hour work week, the naked despondent patient on a back ward, the odors from wards crammed with untidy and helpless men and women.”

As reform continued, the hospital received a full three-year accreditation from the Joint Commission on Accreditation of Hospitals in 1961. Additionally, the efforts to build community mental health services and bridge those services with the hospital resulted in the receipt of the American Psychiatric Association’s highest commendation, the Gold Achievement Award, in September 1969. These efforts resulted in a dramatic decrease in the hospital census and allowed for the treatment of many individuals in their home communities.
As community services grew the hospital census declined. This eventually led to the closure of multiple wards and the abandonment of several buildings. Specialized buildings were built, first the Forensic Unit and then the Lahaug Building. By the early 1990s, the care of patients occurred primarily in the Gronewald-Middleton Building, the Lahaug Building, the Forensic Building, and the Child and Adolescent Center. In addition, transitional living facilities opened for the care and transition of many hard-to-place adults.

The child and adolescent services shrunk to a small core. This led to the movement of the service to one unit with 10 beds. As the population of adult psychiatric patients declined the units were reduced to a core of five. A sixth unit opened, however, in 2005, due to a rise in the census.

The most dramatic change in service was the near elimination of hospitalization for the chemically dependent. With this shift came a re-innovation of service in contract with the Department of Corrections to provide residential addiction care for 60 male and 30 female offenders.

In 1997 the NDSH campus changed again. A prison, now identified as the James River Correctional Center, moved into several buildings. The JRCC, in a cooperative agreement with NDSH, took over the laundry and food service, providing these services for the prisoners and patients collectively. Forensic, Extended Care and Chaplaincy services moved. Another change for the campus was the addition of a Sex Offender Treatment Program for the civilly committed sexually dangerous. This program, originally quite small, has grown to approximately 58 men.

The newest addition to NDSH is the creation of a Treatment Mall. The philosophy of the Mall is to provide a recovery environment separate from the living area in which individuals go during the day and participate in psychosocial rehabilitation programming. The environment is to be as true to an ordinary workday as possible and encourage independence and personal choice. This recovery environment has demonstrated effectiveness in the management of or the recovery from mental illness. It is the best practice environment in which other outcome-based treatments are provided.

The hospital today looks dramatically different than it did even 15 years ago. The original philosophy of care, however, hasn’t changed much in 125 years. This universal philosophy develops partnership, encourages work, when a person is able, and seeks active participation in a process of recovery through the building of skills for living.
The North Dakota Hospital has been erected that the Insane may have a safe retreat, in the care of those who have learned the best mode of treating them, and where they may have every chance of recovery. …..Come what may, the law of kindness must be the governing one in this institution, and all other qualifications will pass as nothing, if the disposition to carry out this law is absent. Those who do not at heart adopt this sentiment are unfit to take charge of the insane, and those who violate this principle are not wanted here. They are unfaithful to their trust, and can never do themselves credit in taking care of such patients, nor aid in promoting the prosperity of this institution.
The 1885 Rules, Regulations, and By-Laws

The North Dakota State Hospital and Museum Project works for the continued existence of the museum and to collect and make public more information about the hospital's history.

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