The South Carolina Lunatic Asylum, located in Columbia, was established by the General Assembly in 1821. It did not open, however, until 1828 due to delays and cost overruns. Its founding was the work of a small group of lawyers, legislators, and doctors, among them Samuel Farrow, William Crafts, and Dr. James Davis, who became its first visiting physician. It is the third-oldest state mental institution in the United States. The original building, named after its architect, Robert Mills, is the nation’s oldest surviving state mental hospital structure and a National Historical Landmark. In the early twenty-first century it was occupied by the Department of Health and Environmental Control.
The asylum’s founders, influenced by early nineteenth-century British and French ideas of moral treatment and therapeutic optimism, hoped to create a curative institution for patients of all classes. At first, however, the asylum had difficulty attracting patients, and it nearly shut down after a few years. Finances were also a problem. The fees of wealthy patients were intended to subsidize the care of the poorer ones, and counties paid for the care of their pauper (indigent) patients. But this system never worked particularly well, and the state had to provide subsidies periodically. Before the 1860s the number of resident patients was small, never exceeding two hundred. Nearly all were white, and in general nearly half were able to pay for their care. In 1849 the General Assembly passed an act allowing the admission of black patients, both slave and free, but the act had minimal effect. In 1865 only five black patients were in residence.
After the Civil War blacks were admitted to the asylum on the same basis as whites, and widespread poverty greatly increased indigent admissions. From 1871 the state paid the costs of the care of pauper (now called state “beneficiary”) patients, which led to a large increase in their numbers. The number of patients was more than one thousand by 1900 and more than two thousand by 1920; nearly all were beneficiaries, and nearly half were African Americans. The asylum changed in other important ways after 1865. Without openly abandoning its curative goals (indeed, in 1892 it opened a training school for nurses, and in 1896 it was renamed the South Carolina State Hospital for the Insane), it gradually adopted a custodial function, caring for large numbers of patients deemed primarily chronic and incurable. Conditions at the hospital deteriorated badly around the turn of the century due to grossly inadequate funding and an unworkable administrative structure. Two major legislative investigations, in 1909 and 1914, revealed many of the problems, which included unsanitary conditions and horrific mortality rates, especially for black patients. In 1915 Governor Richard I. Manning instituted major reforms at the hospital, which modernized it and reduced mortality rates considerably. Like many other state hospitals, however, South Carolina’s continued to suffer from underfunding, unsanitary and overcrowded facilities, and a custodial culture.
In 1913 the state began to build a separate hospital for black patients several miles from downtown Columbia at State Park. The black patients were transferred to this facility by 1930. The patients remained segregated until the mid-1960s, when State Park became a geriatric facility and was renamed Crafts-Farrow State Hospital. Meanwhile, the Depression of the 1930s and World War II worsened overcrowding and understaffing. By the 1950s, however, when the patient census had reached almost four thousand, new drugs, the phenothiazines, provided hope that many patients could function outside the hospital. By the 1960s and 1970s the anti-psychiatry and civil rights movements, community care initiatives, and Medicaid led to deinstitutionalization, a gradual process by which the number of patients in the hospital dropped markedly. In 1996 the hospital was down to 410 beds. By 2003 the average hospital census was under 200, and the Department of Mental Health announced plans to close the facility.
Craft, Susan. Changing Minds, Opening Doors: A South Carolina Perspective on Mental Health Care. Columbia: South Carolina Department of Mental Health, 1994.
McCandless, Peter. Moonlight, Magnolias, and Madness: Insanity in South Carolina from the Colonial Period to the Progressive Era. Chapel Hill: University of North Carolina Press, 1996.