Chronicles of an Institution

A Brief History of the North Dakota State Hospital

Early History The North Dakota territorial legislature authorized a "hospital for the insane" in 1883. On May 1, 1885, the State Hospital opened, four years before North Dakota was granted statehood. The state hospital and the University of North Dakota are the only institutions to predate statehood. The first superintendent was Dr. O. Wellington Archibald, previously a US Army surgeon at Fort Abraham Lincoln near Mandan North Dakota. He chose the Cottage Plan design for the hospital. This detached building plan allowed for the addition of buildings, as was needed, with the expectation that each building appear like a home instead of a large, prison-like institution. The new institution was praised by authorities of the time. Crowding, however, forced the institution to expand repeatedly. The number of patients grew from 106 in 1886 to 819 in 1912, and then to 1,288 by 1920. This over-census was to become a chronic condition through the 1950s, at extreme levels even by 1890 when patients were sleeping two to a bed in attics and basements and at its worst when in 1914 patients were placed in the newly constructed chicken coup. Work was an important and necessary component of hospital life from the beginning. The construction of farm buildings, milking of cows, planing 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. Occupational therapy services for women were instituted by 1896. These services expanded in the 1920s to include the production of rugs, linens, and wicker furniture.

Corruption Scandal
In June, 1937, Governor Bill Langer - one of North Dakota's most controversial political figures - fired Superintendent J.D. Carr, appointing Henry G. Owen in his place. Owen then fired 75% of the institution's staff, hiring their replacements due to their contributions to the state's governing Non-Partisan League and other political connections. A January 30, 1939 report in the Fargo Forum detailed the results of state special examiner Clyde Duffy's report on his investigation into the political abuses, and their costs both financial and in quality of patient care. Duffy quoted a hospital employee "The new employees didn't know how to treat the patients. They called them bad names, cussed and swore at them. Some said they would run away and some did run away."

"Dark Ages"
With a population that exceeded 2,000 in 1940, the Hospital was in a state of crisis. A 1949 Fargo Forum article detailed a report from the American Psychiatric Association complaining of overcrowding, poorly-qualified staff, and a general lack of organization. The complaints prompted visits from the state health department and the National Institute of Mental Health. All these agencies called for immediate changes to improve the conditions of the hospital. The Legislature responded with an increase in appropriations and an extended period of reform under Dr. R.O. Saxvik, beginning in 1953. The extent of his reforms can be seen in a quote from his 1956 annual report: ""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, the tuberculosis patients in disorganized treatment areas, the neglected surgical problems and the bedlam of disturbed units".

By the mid 50s psychiatric medications and improved psychosocial rehabilitation were made available. These treatments made possible the beginning of deinstitutionalization. By the 1960s community mental health centers were opening. Community care and stabilizing medications allowed for the discharge of hundreds and the rapid treatment of the newly admitted patients. This revolution led to a decrease in census but a dramatic increase in the admission and discharge rates. By 1974 the hospital population was down to 600 and continued to decline to an approximate 240 by the 1990s. In 1997, with the addition of sex offender treatment program, and then in 1999, with the addition of the Thompkins Rehabilitation Center, the census increased to an approximate 250, where it remains.

Adding the Prison
Several of the hospital's buildings - vacant since deinstitutionalization - were converted to a medium-security prison facility beginning in 1998.

Currently, the hospital provides:

  • Child and Adolescent Services - inpatient mental health and educational services for clients, ages 9 to 17, with behavioral and/or emotional disorders.

  • Adult Psychiatric Services - adult inpatient care for serious mental illnesses.

  • Transitional Living - a psychiatric "halfway house".

  • Chemical Dependency Services - treatment for chemical abuse and addiction, especially when exacerbated by mental illness.

  • Sex Offender Treatment and Evaluation Services for high risk offenders