Editing Patton State Hospital

{{infobox institution
| name = Patton State Hospital
| image = Patton.jpg
| image_size = 250px
| alt = Patton State Hospital
| caption = Patton State Hospital
| established = 1890
| construction_began = 1893 
| construction_ended =
| opened = 1893
| closed =
| demolished =
| current_status = [[Active Institution|Active]] 
| building_style = [[Kirkbirde Planned Institutions|Kirkbride Plan]] (Demolished)
| architect(s) = 
| location = Highland, CA
| architecture_style = 
| peak_patient_population =
| alternate_names =<br>
*Highland Insane Asylum
*Southern California State Hospital 
*Southern California State Homeopathic Hospital 
*Highland State Hospital
}}

==General Information==
Patton State Hospital is a major forensic mental hospital operated by the California Department of Mental Health. It is located in San Bernardino, California, a community of approximately 181,000 people. The hospital was first opened in August 1, 1893. In 1927 it was renamed Patton State Hospital after a member of the first Board of Managers, Harry Patton of Santa Barbara.

Patton State Hospital is currently a forensic hospital with a licensed bed capacity of 1287 for individuals who have been committed by the judicial system for treatment. Currently the hospital is fully accredited by the Joint Commission on Accreditation of HealthCare Organizations (JCAHO). The Joint Commission's Board of Commissioner's approved a proposal to conduct all regular accreditation surveys on an unannounced basis beginning January 2006. Joint Commission standards deal with organizational quality of care issues and the safety of the environment in which care is provided.

The hospital currently provides psychiatric care and treatment to judicially committed, mentally disordered adult individuals. The Individuals served are assigned to a living unit, which is part of one of the seven Treatment Programs. The hospital is currently going through changes regarding how treatment is provided to the Individuals we serve. Currently treatment is delivered through a centralized approach, where the Individuals served and the staff, from throughout the Hospital, come together to participate in services within Psychosocial Rehabilitation (PSR) Malls. Mall interventions are provided, as much as possible, in the context of real-life functioning and in the rhyme of life of the Individual. Thus, a PSR mall extends beyond the context of a building or place and its services are based on the needs of the Individual, not the needs of the program, the staff members or the institution.

PSR Mall are designed to insure that each Individual receives intensive and individual services to promote his/her increased wellness and ability to thrive in the world. All decisions regarding what is offered through each mall are driven by the needs of the Individuals served. Mall services are provided in an environment that is culturally sensitive and strength based. The concept of recovery shall be the guiding principal and operation framework for the mall system.

Each Individual served has a treatment team that they work with in developing the individual Wellness and Recovery Plan. The teams include a Psychiatrist, Psychologist, Social Worker, Rehabilitation Therapist, Registered Nurse, and Psychiatric Technician.

Patton State Hospital is located at the base of the San Bernardino mountains, 60 miles east of Los Angeles and 60 miles west of the low desert Palm Springs resort area. A diversity of attractions characterize San Bernardino, seat of the largest land mass county in the United States. The City of San Bernardino houses the California Theater of Performing Arts, a civic light opera, the San Bernardino Symphony Orchestra, diverse outdoor recreation and major air transportation access. Housing costs in San Bernardino are substantially lower than those of many other Southern California urban areas. Year-round mountain recreation is only thirty minutes away in the 11,000 foot high San Bernardino range which includes the popular ski resorts of Mt. Baldy, Big Bear, and Wrightwood. Lake Arrowhead offers year-round recreation and aquatic sports, blending the quaint charm of this mountain village with a modern entertainment and shopping complex. To the northeast is the serenely beautiful California high desert, the Mojave, with Las Vegas less than a four hour drive. <ref>[http://www.dmh.ca.gov/Services_and_Programs/State_Hospitals/Patton/default.asp http://www.dmh.ca.gov/Services_and_Programs/State_Hospitals/Patton/default.asp]</ref>

==History==

In 1889 the California legislature approved the construction of Patton in order to provide care to those deemed mentally ill in southern California. The Grand Lodge of the Free and Accepted Masons of California laid the cornerstone of the original building on December 15, 1890.  At the time of its establishment, Patton was seen as a state-of-the-art mental healthcare facility designed along the Kirkbride plan; a popular plan for large asylums in the 19th century. The Kirkbride, as the main building was called, was an elaborate and grandiose structure with extensive grounds which was meant to promote a healthy environment in which to recover. 

The Kirkbride model was designed by Thomas Story Kirkbride, an asylum superintendent and one of the founders of the Association of Medical Superintendents of American Asylums for the Insane, the precursor to the American Psychiatric Association. Kirkbride’s book, On the Construction, Organization and General Arrangements of Hospitals for the Insane, published in 1854, became the standard resource on the design and management of asylums in the mid to late 19th century.  The Kirkbride plan consisted of a linear design with a central administration building and long wings on either side that radiated off the center building. This design allowed for “maximum separation of the wards, so that the undesirable mingling of the patients might be prevented.”  The wings also allowed for separation of male and female patients, and for separation of patients based on the severity of their illnesses.  Patton’s Kirkbride was one of the last hospitals designed along this plan. The next California state hospital to be built, Metropolitan State Hospital in Norwalk, was opened in 1916 and, from its establishment, was built along the ward and cottage system. It did not include a Kirkbride building.
 
Patton opened and received its first patients on August 1, 1893, under the name Southern California State Asylum for the Insane and Inebriates. The name would later change to Patton State Hospital in 1927 and was renamed after Harry W. Patton, a member of the board of supervisors.  Patton was designed to be a homeopathic hospital but there was little staff could do to treat or cure patients with mental illness at the time. Patton’s first superintendent, M.B. Campbell, was hired to head the hospital because he was a doctor of homeopathic medicine.  In 1897 a Lunacy Law was passed in California that created a Commission in Lunacy to oversee the state hospital system. This law also changed the name of its state “asylums” to state “hospitals.”  
In the late 19th and early 20th centuries, many working class families often brought about the confinement of their own “disturbed and disturbing relatives and neighbors. The insane, the poor, the delinquent, and the criminal were... a formidable burden to their own families and neighborhoods.”  State institutions provided a means for families and neighbors to unburden themselves at little to no cost. The state hospitals were funded entirely by the state and, because there were no community-based treatments available for those deemed insane, the state hospitals were the only option for commitment and care of the mentally ill. In addition, counties and communities found it easy to send troublesome individuals who might be afflicted with a mental illness to the state hospitals and, from the 1870s to the 1920s, “California had the highest rate of insane commitments in the nation.”  This resulted in one in every 281 Californians being committed to a state hospital by the turn of the century, leading all the hospitals to be overcrowded for nearly their entire histories up to the late 20th century. Massive immigration to California and a relatively unsettled locale likely contributed to this trend.  

By 1904 Patton had over 800 patients.  To ease overcrowding, the state hospitals in California used deportation, parole, probation, and sterilization as the means to reduce patient populations.  The need to release patients was a driving factor behind California’s trend of sterilizing over 11,000 mentally ill state hospital patients from the passage of its Asexualization Act in 1909 through 1950. Sterilizations at Patton made up nearly half of that total at 4,585 patient sterilizations.  No other state in the U.S. sterilized as many people as the state of California. Some medical practitioners believed that sterilization of mental patients was therapeutic, but most doctors who were involved in sterilizing patients did it for eugenic purposes. It was thought that sterilizing patients would keep them from passing on their illnesses to their progeny and would keep future generations from further overcrowding the hospitals.  Sterilization of mental patients would decrease dramatically after World War II, but would not officially end in California until 1979. 

Patton’s grounds were expanded in the first decade of the twentieth century to include a 400 acre farm and ranch which provided nearly all the food the hospital required to feed its patients and staff. Patton had a dairy, piggery, and chicken farm by 1916, and grew almost all its own fruits and vegetables, had orchards, and eventually built a cannery. The hospital also constructed several industrial shops in its early decades and this further contributed to the hospital’s trend of self-sustainment. Patton added a mattress shop, shoe shop, furniture shop, and sewing room in 1912. Most patients worked alongside the staff on the farms and ranches, and in the shops, laundry, and kitchen. This was seen as therapeutic and came to be referred to as occupational or industrial therapy. As a self-sufficient town, Patton also had its own post office and, to this day, has its own postal code.  

As the hospital grew and expanded, several new buildings were constructed on the grounds. In 1908 the beginning of the establishment of patient cottages began. This marked the beginning of the cottage system at Patton. Each cottage would house forty to seventy-five patients, separated by sex.  In 1928, all the wards and cottages would be renamed with letters for men and numbers for women.  In addition, most of Patton’s staff lived on the grounds until relatively recently in Patton’s history. Administrators, nursing staff, doctors, other clinical and medical staff, and laborers of all kinds lived in cottages, houses, and duplexes on Patton grounds. Families of staff also lived, worked, and grew up on the grounds. New housing for both patients and staff was almost always under construction. Kitchen and laundry staff and the patients that worked with them had to provide meals and laundry service to the entire staff as well as the patients. 

Earthquakes in 1906, 1916, 1923, and 1933 caused major damage to the original buildings. This eventually led to the destruction of the Kirkbride building and the establishment of more modern buildings in the 1950s.  The need for another state hospital in the southern half of the state resulted in the opening of Metropolitan State Hospital in Norwalk which accepted its first patients in 1916.  

By 1910, hydrotherapy began to be employed to treat patients at all the state hospitals in California. These therapies were widely utilized in the early to mid-twentieth century throughout the Western world. Hydrotherapy consisted of continuous baths, wet sheet wraps, and sprays.  In the 1916 report of the California State Commission in Lunacy it was reported that hydrotherapy had also become the preferred treatment for inebriates in state institutions.  In 1928 Patton’s administrators announced that all forms of mechanical restraint at the hospital had been abolished and that “Hydrotherapy, through the providing of adequate equipment, bas been substituted [for mechanical restraint] with marked results.” 

By 1916, Patton had abandoned homeopathic medicine for biomedical causation and treatment of mental illness. George H. Kirby, a clinical psychiatrist at Manhattan State Hospital and a representative of the National Society for Mental Hygiene made a survey of methods of care in the California state hospitals that year and reported, “The medical work at our hospitals is unquestionably advancing along more scientific lines.”  His comment reflects the move towards more biomedical approaches, often utilizing experimental therapies.
In 1921 the Department of Institutions replaced the Commission in Lunacy. This department oversaw the state hospitals as well as homes for the feebleminded.  By the early 1920s there were nearly 12,000 patients in California state hospitals, 2,188 of whom were at Patton.  In 1927, Not Guilty by Reason of Insanity was added to the California penal code and the state hospitals began receiving patients committed under this new law.  
	
Patton’s staff and administrators have long been dedicated to remaining on the cutting edge of available treatments so new therapies were introduced regularly and usually embraced enthusiastically. Malaria fever therapy was one of those therapies. This treatment was introduced to Patton in 1928 for treatment of general paresis caused by syphilis. It consisted of injecting malaria-infected blood into a patient with syphilis in order to cause a fever that, in some cases, would cure the patient. Malaria fever therapy was used in the state hospitals until the late 1940s when penicillin became widely available for the treatment of syphilis.  There were many other therapies the hospital would embrace in the hopes of providing effective treatment to patients. Patton utilized insulin shock therapy and then electroconvulsive therapy (ECT) in the early 1940s. Insulin shock therapy was utilized at Patton from 1941 to 1947. Also in 1941, Patton physicians and scientists at the California Institute of Technology in Pasadena, California, began experimenting with electroconvulsive therapy machines, three years after the procedure was developed in Italy. Widespread use of this technology in California did not begin until the mid-1940s.  

Another controversial treatment that occurred at Patton was lobotomy, which was introduced at Patton in 1947. Three types of lobotomy were performed at Patton: the Mackenzie procedure, the prefrontal lobotomy, and the transorbital lobotomy. Lobotomies were generally reserved for violent and intractable patients. The transorbital lobotomy was developed by Walter Freeman who traveled around the country teaching this method at many mental hospitals. He visited Patton in 1951 and demonstrated the use of his technique while he was there. A total of 171 lobotomies were performed at Patton, 29 of which were performed by Walter Freeman. Lobotomies were discontinued at Patton in 1956, shortly after Chlorpromazine became available for use in state hospitals. Chlorpromazine and other antipsychotic medications had similar effects to those caused by a lobotomy. For this reason, Chlorpromazine was sometimes referred to as a “chemical lobotomy.”  The development of Chlorpromazine for use in treating the mentally ill marked the beginning of the availability and use of effective psychiatric medications. The introduction of Chlorpromazine ushered in the era of psychopharmacology and Patton embraced this treatment from the mid-1950s on.  

Throughout most of its history, as discussed above, Patton also provided occupational, industrial, and recreational therapies and hydrotherapy.  
The Great Depression had a significant impact on the state hospitals. Overcrowding increased dramatically and, by 1936, Patton’s patient population reached 154 percent of its capacity; the most overcrowded the hospital would ever be.  A year later the Department of Institutions opened Camarillo State Hospital and hundreds of patients were transferred to Camarillo from Patton. By 1938 Patton’s overcrowded conditions had dropped but Patton was still at 120 percent of capacity.  The overcrowding continued during World War II and for a few years after the war because shortages of building materials greatly restricted the development of new facilities needed to keep pace with rising admissions. The severe overcrowding led to deplorable conditions for patients and treatment was difficult to provide. Dayrooms were converted to sleeping quarters, patients were sleeping on mattresses on the floors, basements and even dining quarters were filled to capacity with beds for the patients. At one point, over 300 patients were forced to sleep outdoors. Fire hazards were a significant concern and conditions were unsafe for the patients.  Patton had its own fire department for most of its history that responded to emergencies and oversaw safety hazards but there was little that could be done to make conditions safer until more facilities for patients could be provided. 

In an effort to further ease overcrowding in the state hospitals, the state of California began to look for alternatives to commitment in the state institutions. Some of these alternatives included family care homes, urban psychopathic wards, community mental health programs, and outpatient clinics.  In order to streamline the system, the Department of Institutions split into three groups in 1945: the Youth Authority, the Department of Corrections, and the Department of Mental Hygiene. The state hospitals and other mental institutions fell under the purview of the Department of Mental Hygiene.  A year later the National Mental Health Act was passed. This act provided for research into mental illness, training of psychiatric personnel, and establishment of community mental hygiene clinics. 
 
In the mid-1940s, California governor Earl Warren toured the state hospitals and was appalled by the conditions in which patients were forced to live. At the same time, Al Ostrow of the San Francisco News also toured the state hospitals and reported the deplorable conditions in a series of articles titled “People in the Dark.” Ostrow’s report along with Warren’s determination to see these conditions improve led to significant appropriations for improvement and expansion of the state hospitals through a post-war building program.  The aims of this program were to replace outmoded facilities, reduce overcrowding, and provide up-to-date care and treatment facilities.  This would lead to the addition of several new buildings at Patton in the early to mid-1950s and to the opening of three new state hospitals in California: DeWitt, Modesto, and Atascadero. By the end of the 1950s Patton had added a new administration building (this replaced the last remaining portion of the original Kirkbride building which was demolished in 1955), an auditorium, a state-of-the-art receiving and treatment building, a large unit for the tubercular patients, three new patient units, a new kitchen and a cafeteria. 
 
The increase in facilities resulted in a further increase of the patient population at Patton, which peaked at over 5,500 patients in the mid-1950s. In 1958 the population of patients in the ten California state hospitals peaked at 37,489.  Contributing to the increase in patient population was the passage of the Health Officer’s Admission Law in 1948. This law was passed so that the mentally ill would not have to undergo the trauma of being committed by the court but the drawback of this law was that it made it even easier to commit patients to mental institutions.  

Patton’s atmosphere changed for the better in 1946 when Dr. Otto L. Gericke became superintendent of Patton. Gericke’s impact on the hospital was significant. He approved the publication of the Patton Progress, a weekly patient-written newspaper that quickly became popular even beyond the grounds of the hospital. He began placing suggestion boxes in all the patient wards in an effort to improve life for the patients. The hospital began to hold numerous events and holidays and added more recreational programs. Patton held open house events that invited the community onto the grounds and for many years took part in the annual Orange Show, providing exhibits and displays about Patton and mental health in an effort to improve relations with local community and to increase awareness and battle the stigma associated with mental illness. Gericke’s superintendency lasted over 26 years. He retired in 1972.                                               

During Gericke’s time at Patton, significant changes took place in the state hospital system. Beginning in the 1950s with the introduction of chlorpromazine, the availability of effective psychopharmaceuticals allowed some previously intractable patients to be able to function outside the hospital.  In addition, three acts of the California legislature played a significant role in what would become known as the deinstitutionalization movement. The first piece of legislation was the Short-Doyle Act, passed in California in 1957. This act created a funding structure for an enlarged community mental health system. It expanded outpatient resources for mental health care and contributed to the rapid decrease in state hospital patient population.  The Short-Doyle Act was followed by the federal Community Mental Health Centers Act, passed in 1963, which led to the further development of the community mental health care system. This act increased grants to improve preventive and community care and was meant to improve treatment in state hospitals. The third piece of legislation that further drove deinstitutionalization was the Lanterman-Petris-Short (LPS) Act, passed in California in 1968. This act ordered the release of all harmless mentally ill patients. The act also established a new process for the involuntary commitment of mentally ill patients only if they were deemed a danger to themselves or others, or if they were gravely disabled. This new commitment process was established in an attempt to balance civil rights and public safety. The LPS Act also linked treatment to the community mental health system and removed financial obstacles to using community services. 

Other events contributed to the rapid patient depopulation at Patton. In 1963 eighteen buildings, mostly cottages, at Patton were ruled unsafe by the fire marshal causing Patton to find ways to expedite the release of the harmless mentally ill.  Patton’s administrators utilized systems to assist soon-to-be-released patients with their transition out of the hospital and into the wider population. In 1965 Patton established a Community House  as well as a Leave Planning Center to assist patients with the transition.  In addition, Medicare and Medicaid laws, passed in 1965, allowed for elderly patients to be transferred to nursing homes for care. 

By 1966 Patton’s patient population had dropped by thirty-five percent.  Further depopulation occurred when Ronald Reagan was elected as governor of California in 1966. In the face of civil libertarians, the patients’ rights movement, and California’s economic issues, Reagan began to dismantle the state hospital system.  He ordered a decrease of 550 psychiatric technicians from state hospitals, 237 of whom worked at Patton.  Psychiatric technicians played a highly significant role in the care, treatment, and monitoring of patients and this decrease had far reaching implications on the ability of the state hospitals to provide proper care.

There were also inevitable issues with releasing patients so quickly. The community care system was not prepared for the influx of former state hospital patients. Following the deaths of seven former Patton patients in a fourteen month period, death certificates were mailed to all members of the legislature with a letter arguing that patients were being prematurely released from the hospital. In addition, the county coroner requested that 160 patients be returned to Patton when it was discovered that they were being treated in unlicensed community facilities without medications and proper supervision. It was discovered that the County Mental Health Unit received incentives for each patient day that was not used. The board of supervisors authorized the transfer and asked the state to stop transferring patients out of Patton until the community was adequately prepared to receive patients.  

In 1973, Reagan announced a plan to phase out all the state hospitals, causing the closure of Modesto, Dewitt, and Mendocino State Hospitals, and the conversion of Agnews and Stockton State Hospitals from institutions for the mentally ill to institutions for the care of the developmentally disabled, but the goal of completely abandoning the state hospital system was never reached. Plans to phase out the remaining state hospitals were halted by the state legislature after several murders committed by mental patients occurred in the early to mid-1970s.  

As California’s state hospitals emptied and several of them closed, the farming and ranch operations were phased out by 1968. Patients also no longer worked in the industrial shops and many of those shops were closed. As the mentally ill population at Patton began to decrease, Gericke agreed to admit people with developmental disabilities beginning in 1962 in an effort to keep the hospital open.  Patton also began to admit Mentally Disordered Sex Offenders (MDSO’s) and received its first maximum-security patients in 1968. These changes kept Patton from closing.  

Gericke’s retirement in 1972 marked the end of an era. Patton had changed from a general mental health facility to a forensic facility and a provider for the care of the developmentally disabled. Patton closed off considerably from the wider community and began to change into a maximum security facility.  The Patton Progress was phased out along with several other recreational therapy programs. Gericke’s policy of maintaining a staff photographer was also abandoned due to patient privacy concerns.

Many changes to the system occurred in the late 20th century. The Department of Mental Health replaced the Department of Mental Hygiene in 1973.  Admission rates at Patton decreased by sixty percent between 1971 and 1975, and by 1976 Patton’s mentally ill patient population dropped to 823.  In the early 1980s the developmentally disabled patients were phased out and by 1983 Patton was a forensic-only facility. All patients from then on would be committed by court order, mostly as Incompetent to Stand Trial (IST) or Not Guilty by Reason of Insanity (NGI). In that same year the California Department of Corrections became responsible for patrol of the perimeter of the grounds, uniforms were issued for patients and officers, and plans developed to fence the perimeter. This led to the placement of security fences around the hospital grounds and patient wards by 1985.  In 1990 Patton consisted of twenty-six units in five buildings and was licensed for a maximum of 1,348 beds. The census in 1990 revealed that the patient population consisted of 1,024 patients of which 893 were male and 131 were female. The total number of employees at that time was 1,564. 
Today Patton is overseen by the Department of State Hospitals which was established in 2012 to streamline the state hospital system. There are currently five stand-alone hospitals and three facilities located in prisons in the state hospital system. Patton is currently the largest state hospital in the country. Patton’s history is typical of the California state hospitals and provides a narrative through which one can understand the history and development of mental health care in California from the late 19th century to the present. Patton opened the first museum in the California state hospital system on April 17, 2015. The museum has inspired administrators at Metropolitan State Hospital, which is now working on establishing its own museum.

== Images of Patton State Hospital ==
{{image gallery|[[Patton State Hospital Image Gallery|Patton State Hospital]]}}

<gallery>
File:Pattonp1.jpg
File:Pattonstate2.jpg
File:CApatton1952.jpg
</gallery>

==Cemetery==
There are approximately 2,022 former patients buried in a field with a dirt road that runs up to it. These were patients whose bodies were left unclaimed or whose families were unknown. Today it is well marked as cemetery ground and there is a mass grave marker dedicated to the patients which can be seen approximately 50 yards from the street. The grounds are located inside the property fence in the north-west corner. 
The cemetery was full by 1930. After that when people died and were unclaimed, their bodies were donated for research to what is now Loma Linda University.

==Museum==
Public tours are scheduled to begin in June, 2015. For those interested in touring the museum, call (909) 425-7687 or email pshmuseum@dsh.ca.gov. 

== References == 
<references /> 
[[Category:California]]
[[Category:Kirkbride Buildings]]
[[Category:Active Institution]]
[[Category:Institution With A Museum]]
[[Category:Institution With A Cemetery]]
[[Category:Past Featured Article Of The Week]]