The Old and the New Eastern State Hospital in Lexington, Kentucky

In 1766, the first U.S. public psychiatric hospital, Eastern State Hospital, was opened in Williamsburg, Va. Another Eastern State Hospital, shown above, has continuously functioned in Lexington, Ky., since 1824. After nearly two centuries, a new state-of-the-art, patient-centered hospital opened on Sept. 10, 2013.

In the late 1700s, Kentuckians who developed severe mental illness were sent to Williamsburg. In 1816, a group of public-spirited citizens in Lexington planned a hospital for the poor, disabled, and “lunatic” members of society. In 1822, the General Assembly of the Commonwealth of Kentucky passed the “Act to Establish a Lunatic Asylum.” Ten acres of land, along with the unfinished hospital building, were purchased, and thus the second-oldest state mental hospital in the United States was established (1). After the opening in 1824, the name changed several times but became “Eastern State Hospital” in 1912.

Lexington’s Eastern State Hospital included a 400-acre farm and was an isolated institution, separate from the surrounding community. Many employees lived on the grounds in cottages, dormitories, separate rooms in the main hospital building, or wards with the residents. The hospital residents and staff grew and prepared most of the food consumed. A dedicated train station provided the remaining food, supplies, and coal for the on-site boilers. In 1956, over 300 acres of the farm were sold to IBM and later became Lexmark. As late as 1967, the hospital had 1,000 patients in residence. In the 1990s, the few remaining long-term patients were progressively discharged and the hospital became solely an acute-care psychiatric hospital, with 1,600–2,000 admissions per year from a catchment area in central and northern Kentucky. In 1995, the state asked the Bluegrass Regional Mental Health/Mental Retardation Board, which was operating community mental health centers, to run the hospital as well.

Lexington’s third century of public psychiatric care has begun in a scenic new location less than a mile from the original location. A land swap was proposed in 2008 that included the state, Bluegrass Community and Technical College, and the University of Kentucky. The old Eastern State Hospital grounds, including the administration building, are being transferred to Bluegrass Community and Technical College. The main administrative building and a laundry building will be preserved. The University of Kentucky provided the 30-acre site on which the new hospital was built.