From the establishment of the South Carolina State Hospital over 175 years ago, to the beginning of community mental health services in the 1920's, to the evolution of a complex mental health care delivery system, South Carolina has achieved an impressive record in its efforts to meet the needs of its mentally ill citizens.
As far back as 1694 the Lord Proprietors of the Carolinas decreed that the indigent mentally ill should be cared for locally at public expense. In 1751 the colonial government similarly recognized the mental health needs of slaves. In 1762 the Fellowship Society of Charleston established an infirmary for the mentally ill. But it was not until the 1800s that the mental health movement received legislative attention at the state level.
According to legend, when Colonel Samuel Farrow, a member of the House of Representatives from Spartanburg County, traveled to Columbia to attend sessions of the legislature, he noticed a woman who was mentally distressed and apparently without adequate care. Her poor condition made an impact on him and spurred him on to engage the support of Major William Crafts, a brilliant orator and a member of the Senate from Charleston County.
The two men worked zealously to sensitize their fellow lawmakers to the needs of the mentally ill, and on December 20, 1821, the South Carolina State Legislature passed a statute-at-large approving $30,000 to build the S.C. Lunatic Asylum and school for the deaf and dumb. This legislation made South Carolina the second state in the nation (after Virginia) to provide funds for the care and treatment of people with mental illnesses.
Robert Mills, a renowned architect, was chosen to design the new S.C. Lunatic Asylum. In 1822 the cornerstone was laid for the Mills Building, which took six years to complete. The building's many innovations included fire-proof ceilings, a central heating system, and one of the country's first roof gardens. South Carolina's asylum was one of the first in the nation built expressly for the mentally ill and funded by a state government.
Citizens were wary of sending their loved ones to the asylum, and so, it was not until December 12, 1828, that the first patient was admitted. A young woman from Barnwell County, she was accompanied by her mother who worked as a matron while her daughter was a patient at the hospital.
The hospital admitted patients wealthy enough to pay for their own care, as well as the middle class and paupers. Although a few blacks, mostly slaves, were admitted during the first 20 years, they were not officially permitted until 1848.
Despite its innovative architecture, many problems arose within a few years after the asylum opened. Complaints ranged from narrow halls and staircases and small activity rooms to flooding on the ground floor. Another issue was expansion of the asylum grounds.
By the 1850s, the average patient paid $250 annually. A separate room and eating area cost another $100. Paupers were admitted for an annual fee of $135, which was billed to the patient's home district. As more paupers were admitted, it became harder to collect fees, and the asylum grew more dependent on state funding. Due to the large number of people being admitted land was needed for new buildings and for patient recreation and gardens. Some asylum leaders believed the institution should be moved to the country. Largely because the legislature was unwilling to fund a new complex, it remained at the original location. Land was purchased next to the complex, and more buildings were erected. The headquarters for the South Carolina Department of Mental Health remain on these grounds even today.
Men and women were housed separately, originally on different floors, but later in separate buildings. When a new building was completed in 1858, male patients moved into it, and the women remained in the Mills Building. Despite the new building, the asylum reached its capacity of 192 by 1860. Many families preferred to care for their mentally ill relatives at home, while others wanted them closer to home even if it were in the county jail or the poor house. Only after the state assumed direct responsibility for all mentally ill in 1871 did county jails readily give up their patients.
During the Civil War, funding problems grew worse. Dr. John W. Parker, the superintendent, opposed a plan to turn his complex into a prisoner-of-war camp. Although the Confederate Army did not get the asylum, the grounds were used as a prison camp for Union officers from October 1864 to February 1865.
Despite worsening conditions late in the war, the asylum became a refuge for many Columbia residents when the city burned during Union General William T. Sherman's occupation in February 1865. With dwindling provisions, Parker did his best to provide for his patients and for the destitute citizens.
Like the rest of the South, the asylum struggled to survive in the aftermath of the war. Despite the lack of funds, the superintendent accepted more patients and often used his own money to provide them with food and other necessities.
J.F. Ensor, a Maryland native and former Union Army surgeon, became superintendent in 1870 and tried hard to find adequate funds for the institution. Several citizens from around the state contributed, and he received a $10,000 subscription from some Philadelphia Quakers, which helped repair the buildings. More than once, when local businesses could no longer give him credit, Ensor supplemented the institution's meager budgets with his own funds.
As the population grew, it became virtually impossible to treat patients. The asylum became largely a dormitory to house the mentally ill.
In 1870 Ensor reported that the rundown asylum rooms "were mere cells of chink in the wall, dark and illy ventilated" and that there was not an adequate means of diagnosing patients. These problems were solved to the best of his ability. By 1874 Ensor had added central heating, plumbing, new furniture, pianos and books.
While Ensor made some strides in providing for patient's physical needs, overcrowding remained a problem. This accelerated when the state government assumed the cost of patient care from the counties in 1871.
With slavery abolished, African-Americans became a larger part of the asylum's population. The admission of blacks not only added to the patient population, but led to another problem-providing separate facilities for the races. Temporary structures built before 1860 for blacks desperately needed replacement. Facilities for whites also were overcrowded.
While trying to accommodate this population increase, Ensor was forced to cut staff to have funds to buy food and meet other needs. Sometimes this was not enough. Even though the state was now required to pay for patient care, some asylum residents were sent home if they had no money to pay for their care. Nevertheless, the population increased from 245 in 1870 to more than 300 by the time Ensor resigned seven years later.
Notable changes before 1900 included the founding in 1892 of a nursing school, which did not close until 1950, and changing the hospital's name in 1896 to the S.C. State Hospital for the Insane.
Although hospital finances became more stable in the 1880s, the legislature instructed the superintendent to economize wherever he could. While most states were increasing their annual per capita spending, South Carolina was reducing hers. The cost for each patient in 1877 had been $202. It was reduced to $140 by 1888. Nine years later, the per capita rate had fallen to $107.80, one of the lowest in the nation.
Image 1: The original drawings of the S.C. Lunatic Asylum, designed by Robert Mills, the United States' first native-born architect.
Image 2: This drawing of Camp Asylum was done by a prisoner, one of the 500 Union
officers imprisoned in the camp from October 1864 to February 1865.