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From asylums to current care models

August 8, 2014
by James M. Hunt
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The first known mental health hospital was in Cairo, Egypt in the first century. Until the mid-19th Century the strategy was to separate the mentally ill from the rest of society and contain them in facilities that were far from humane, by any standards.

In the mid-19th Century, two individuals, Dorothea Dix and Thomas Story Kirkbride, MD, working independently championed a movement to actually provide treatment and cure those with mental illness. Dr. Kirkbride’s book "On Construction, Organization and General Arrangements of Hospitals for the Insane" led to the design and construction of over 60 hospitals that were designed by many different architects. 

These hospitals are the first known architectural expression that the mentally ill can recover and return to society. The concept was that incoming patients would be admitted to the units in the back and be moved progressively to units closer to the front as they moved through their treatment. Eventually, they would walk out the front door. All patient areas had a lot of natural light and ventilation.

Today, these “Kirkbride” hospitals are viewed as very undesirable and oppressive. Many are being replaced, and some are being demolished.  The replacements provide a great improvement in therapeutic environment. This appears to be an evolutionary process. Many of the same words and phrases that were used to praise the Kirkbride buildings over their predecessors are being used today to proclaim how far we have come. 

The images do change dramatically while the words stay the same. It will be interesting for future generations to look back on the hospitals we are building now and see if they have found ways to greatly improve the facilities we are building today.

Kevin Turner of Perkins and Will and I will be presenting a discussion of these and other elements of the history and future of mental health building design evolution at the Behavioral Healthcare Leadership Summit in St. Louis on August 25 in Session BH 13.  Come join the discussion about both the past and where behavioral healthcare design is going in the next few decades.


Jim Hunt

Behavioral Healthcare Design Consultant

Jim Hunt

James M. Hunt, AIA, is a practicing architect and facility management professional with over 40...

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