The Austin State Hospital (ASH) was established as the State Lunatic Asylum by act of the Sixth Legislature in 1856 and began operation in May 1861 with twelve patients. It is the oldest hospital in Texas for the care and treatment of the mentally ill. Initially, asylums in Texas were operated under individual boards of five members, appointed by the governor, with each board developing its own standards. In 1913 the legislature placed its mental hospitals under individual boards of managers. In January 1920 state hospitals were placed under the Board of Control. The name of the Austin asylum was changed to Austin State Hospital in 1925. In 1949 control of the hospital was transferred to the Board for Texas State Hospitals and Special Schools. In 1993 it was operated by the Texas Department of Mental Health and Mental Retardation.
The early asylum movement grew from the belief of curing the mentally ill by providing an ideal environment for care. The hospitals were designed to be self-sufficient and located remotely while providing direct therapeutic benefit. The plans called for window ventilation and water accessibility as top priorities. Enclosed grounds facilitated the structured patient lifestyles, but patients often worked or attended recreational activities in the complex gardens. The building plans were not fully developed at the time of its opening, and a growing numbers of patients put strain on the facility. African American patients were housed in the basement, against the wishes of designer Thomas Kirkbride and hospital Superintendent Beriah Graham. The outdated hospital facilities proved challenging during the early twentieth century. Windows served as the only airflow source, but they were later locked to prevent suicide attempts. Staff primarily focused on keeping residents comfortable and cool.
Throughout the hospital’s history, the ASH staff emphasized a precise routine of work, exercise, and activity. Highly functional patients occasionally joined the hospital staff. ASH residents contributed by completing chores, such as laundry or mopping. After the turn of the century, patients began working on farms during harvest season. In 1942 a state dairy and hog farm was established on 308 acres owned by the state, seventeen miles from Austin, to provide milk and meat for Texas mental institutions. An additional 1,140 acres was leased. In 1945 twenty-five to thirty of the ASH patients worked as unpaid laborers on the farm. The hospital made several recreational activities available to the patients to improve health. ASH residents played sports, especially baseball, and attended social events, such as dances and movie nights. The staff taught musical therapy sessions and provided religious services to patients.
In 1945 the hospital had 2,810 beds, 2,774 patients, and 360 nonmedical staff employees, and the medical staff consisted of the superintendent, assistant superintendent, nine assistant physicians, and one dentist. In 1940 the hospital was designated an independent school district and began providing education for school-age psychiatric patients. During the 1950s, the ASH segregated their admissions process by gender and race. The integration process occurred slowly between 1958 and 1965. In 1961 the hospital had a rated capacity of 2,608 patients, and service had been expanded by outreach clinics and follow-up services for furloughed and discharged patients. In 1964 it expanded, within its own grounds, to incorporate patients from the Texas Confederate Home.
The ASH had an average daily population in 1968 of 3,313, and 900 elderly patients were maintained on furlough in private facilities. The institution provided surgical services for residents and for persons from the Austin State School, the Travis State School and the Texas Confederate Home (before it was closed in 1967). In 1958, the ASH established a psychiatric residency program. An adult out-patient clinic was operated by the hospital, with referrals to the Travis County Mental Health and Mental Retardation Clinic and to various county community health centers around the state. Admissions of younger patients, alcoholic patients, and drug abusers increased in 1970, and the average daily census was 1,994.
Prior to 1950, high numbers of patients at ASH received a diagnosis of schizophrenia or mania. While ASH resisted psychotherapy treatments, physicians at the hospital used electrocompulsive shock therapy extensively for a variety of illnesses. This therapy quickly became the most widely used treatment at the hospital and was occasionally used as a punishment. Meanwhile, ASH patients with tertiary syphilis received fever therapy. The doctors also utilized psychotropic drugs to treat the patients. Resident pathologist Dr. Coleman de Chenar developed a collection of brains from patient autopsies throughout the decade for further research.
The United States Public Health Services conducted a survey of state mental institutions in 1949, and reported Texas as the lowest state according to the standards set by the American Psychiatric Association. As a result, the Texas Society for Mental Hygiene reorganized as the Texas Society for Mental Health and strongly advocated for mental health reform. Throughout the 1960s, Congress provided federal grants to states to fund community-based treatment centers, while activist groups expressed concern for the wellbeing of residents in mental health facilities. The legislature obtained federal funds in 1965 for Texas Comprehensive Community Mental Health-Mental Retardation Centers (MHMR) and established a new department to implement the legislation. The following year, all Texas hospitals fulfilled standards for Medicare compliance. RAJ v. Jones (1971) began national conversations surrounding the treatment of patients with mental illnesses, including individualized treatment, patient rights, use of psychotropics, and adequate community services.
By 1986–87, with changes in the philosophy of treatment, there was an average of only 711 residents, while the Austin MHMR center served 7,100. By 1992–93 inmates had decreased to 450, and the MHMR center served 9,000. In 1990 the hospital served thirty-four counties in Central Texas with an annual admittance of 3,500 patients but a daily average of only 518. In 1990 renovation was begun on the original administration building, the third oldest state building in Texas. It was expected to take from four to six years and to cost $4 million.
The ASH developed a complete redesign of the facility led by the Dell Medical School of the University of Texas at Austin. Unveiled in early 2019, the ASH plans furthered the former campus as a world-class center for brain health. State Senator Kirk Watson described the facility as “the M.D. Anderson of the brain,” referencing the prestigious cancer center in Houston. As of 2019, funding for the renovations were still pending approval from the state legislature. The plans required roughly $300 million to build a comparable new hospital, but opponents criticized the long history of overcrowding at the facility. The renewed focus centered on effective treatment and quality of care, rather than residential service, which many of the patients depended upon for daily needs. The ASH redesign team addressed the need for therapeutic housing for low-income patients in prospective plans.
The renovation of ASH buildings had historical consequences. Several buildings planned for demolition held deep ties to African American experience on the campus. The women’s dormitory and dining hall were the only surviving buildings that previously served the African American population. The Texas Historical Commission recognized both buildings as eligible for inclusion in a National Register Historic District in downtown Austin, but cannot otherwise protect the buildings from destruction. Additionally, Preservation Texas conducted research on both buildings on behalf of the project stakeholders and sent a petition to the Texas Legislature and Human Services Commission.