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In 1848 Dorothea Lynde Dix, a noted advocate for hospitals, asylums, and jail reforms, appealed to the General Assembly to establish a state hospital for the insane. Dix was especially concerned that the indigent insane were often housed under inhumane or dangerous conditions, or left unrestrained and a possible menace to themselves and others. A bill to establish a hospital for the protection and cure of the insane was introduced, almost defeated, and then reconsidered at the request of James C. Dobbin, a representative from Fayetteville. With a nearly unanimous vote, the General Assembly of 1848-1849 provided for the establishment of the North Carolina State Hospital for the Insane. Six commissioners were appointed to select a site within three miles of Raleigh on which to build a hospital for up to 250 patients. The General Assembly appointed nine members to the Board of Trustees and authorized them to appoint a superintendent of the hospital. As the Insane Asylum of North Carolina, the hospital admitted its first forty patients in March 1856. A patient might be admitted as a result of direct commitment by a court or transfer from jail; by an inquest initiated by a citizen; or as a paying patient, whose friends, relatives, or the government of another state paid for commitment and treatment. The order of admission gave precedence to indigent patients over the rich, and recent cases (considered more likely to be curable) over those of long standing. The act stated that any insane person who was placed in any jail for safekeeping was to be immediately (within two weeks) transferred to the hospital once it was opened. An additional act of 1848 stated that criminals pending indictment could be examined by a jury and committed to the hospital if they were found to be insane. A citizen who believed that someone was insane and in need of treatment could file a statement with a justice of peace. The statement must also be signed by a physician and one other witness. After an inquest to verify the statement, the physician and justice could file a form with the clerk of the county court. The clerk would then contact the superintendent of the hospital to arrange admission. Paying patients, whether resident or out-of-state, were admitted as space permitted, and their quarterly fees had to be paid in advance. The hospital had originally been funded by special levies of land and poll taxes and a per patient county assessment. The General Assembly of 1856-1857 abandoned the land and poll taxes in favor of annual appropriations. Counties, however, were still required to pay for their committed, indigent patients. The General Assembly of 1858-1859 set a $144 per annum limit that counties would have to pay per patient. Paying patients were charged a minimum of $200. This act also increased the Board of Trustees to fifteen instead of nine. The General Assembly of 1868-1869 replaced the Board of Trustees with a Board of Supervisors appointed by the governor. The governor was the ex officio chairman of this five-member board. The board prepared an annual report on the affairs of the asylum for the Board of Public Charities. The Board of Public Charities was to inspect the asylum at its pleasure and report any suggestions or remarks to the General Assembly. The General Assembly of 1868-1869 relieved counties from being assessed to support their patients in the asylum. The asylum was to be entirely supported by appropriations from the public treasury, and income and fees would go to the general fund. An average of 160 patients was used as the basis for the asylum's budget, with additional funding of $250 per patient approved for release above this number. In 1869-1870 counties were authorized to charge the state for expenses in maintaining an insane person who was entitled to be accepted by the asylum but was denied admission. The General Assembly of 1870-1871 repealed the 1869 act, which authorized the board of supervisors, and reenacted the previous statute's description of the board of trustees (fifteen members appointed by the General Assembly). In 1875 the General Assembly appropriated funds to build an additional asylum near Morganton, which opened in 1883 as the Western Insane Asylum. The General Assembly also funded "a branch asylum for the colored insane" to be located in Wilmington. The funds for this branch were not expended, however, until 1877 when they were used to begin construction of the Eastern North Carolina Insane Asylum at Goldsboro, which opened for black patients in 1880. The Western Insane Asylum and the North Carolina Insane Asylum divided the state into an eastern and a western district for white patients. Between 1877 and 1881 there were three revisions regarding the board of directors. The board was reduced to nine members (1877); the governor was made ex officio chairman of a board of seven directors (1879); and then a nine-member board, nominated by the governor and confirmed by the Senate, was created (1881). The name of the institution was also changed in 1879 to the North Carolina Insane Asylum. In 1897 the asylum at Raleigh was renamed the Central Hospital for the Insane. The office of superintendent was abolished and the board elected a principal and a resident physician for the hospital. In another act of 1897, the General Assembly created the Department for the Criminal Insane within the state penitentiary at Raleigh. Insane inmates and dangerous patients were transferred to the department from state and county custody, and housed separately from the other penitentiary inmates. All patients in the department were under the care and authority of the principal of the Central Hospital for the Insane and were not subject to convict rules and regulations, nor clothed in convict garb. The General Assembly of 1899 revised, consolidated, and amended the insanity laws. This twenty-four page act restated and refined most of the existing statutes concerning the state mental hospitals and their operation. The Central Hospital for the Insane was renamed the State Hospital at Raleigh. The Department for the Criminal Insane, although still a part of the State Hospital at Raleigh, was renamed the State Hospital for the Dangerous Insane. The scope of the mental hospitals now included the provision of care and treatment for inebriates. Inebriates were committed to the hospitals in the same manner as the insane patients, but for specific terms of three to twelve months. Another act passed in 1899 stated that the State Hospital at Raleigh was to provide care and treatment for insane and inebriate Croatan Indians in a separate department within the hospital. In 1909 an act was passed authorizing all white epileptics to be cared for and treated at the State Hospital at Raleigh if they were afflicted to the extent that they were a public charge. In 1917 the General Assembly abolished the boards of the three separate mental hospitals (Raleigh, Morganton, and Goldsboro) and placed them all under the control of a consolidated board of directors, the Hospital Board. From this nine-member board, three-member executive committees were formed to manage the affairs of each hospital independently. The full board met in each of the hospitals in April to prepare a report on the institution for the General Assembly. Board members were appointed by the governor and confirmed by the Senate for six-year terms. The General Assembly of 1919 transferred the State Prison buildings and grounds to the State Hospital at Raleigh. Patients from the three mental hospitals and the Caswell Training School were transferred to the former prison facilities and placed under the supervision and direction of the State Hospital at Raleigh. The State Hospital for the Dangerous Insane was abolished in 1923, after its patients had been incorporated into the hospitals at Raleigh or Goldsboro. The General Assembly of 1921 restored a separate board of directors to each of the state mental hospitals, abolishing the Hospital Board. The State Hospital at Raleigh was managed by a board of nine directors who were nominated by the governor and confirmed by the Senate. In 1943 the boards of the State Hospital at Raleigh, the State Hospitals at Morganton and Goldsboro, and the Caswell Training School were replaced by a unified board of directors, the North Carolina Hospitals Board of Control. Fifteen board members were appointed by the governor, and the secretary of the State Board of Health served ex officio. The board was empowered to make necessary bylaws and regulations for the institutions and to employ a superintendent of mental hygiene and a business manager. The superintendents of the four institutions made monthly reports to the superintendent of mental hygiene. Outpatient mental hygiene clinics were established at the institutions and at medical schools and other hospitals. In 1959 the General Assembly authorized the Hospitals Board of Control to employ a commissioner of mental health to replace the superintendent of mental hygiene. The superintendents of the hospitals reported monthly to this officer. This act also removed the racial restrictions in admitting patients to the different hospitals, and the admission of an individual patient to a specific institution was now at the discretion of the Hospitals Board of Control. The State Hospital at Raleigh was renamed the Dorothea Dix Hospital in 1959. In 1963 the General Assembly created the Department of Mental Health and the State Board of Mental Health to replace the Hospitals Board of Control. The Dorothea Dix Hospital was placed under the Division of Mental Hospitals within the department. The head of the Department of Mental Health, the commissioner of mental health, appointed a medical superintendent for each hospital. Under the Executive Organization Act of 1971, the Department of Mental Health and the State Board of Mental Health were transferred to the newly created Department of Human Resources. Although the Department of Mental Health retained its statutory powers and continued to function as an independent agency, managerial and executive authority was transferred to the secretary of the Department of Human Resources. The Executive Organization Act of 1973 created the Commission for Mental Health Services and the Division of Mental Health Services within the Department of Human Resources. The commission established rules, standards, and regulations for the service providers including the state hospitals for the mentally disordered. In 1977 the division and commission titles were changed to the Commission for Mental Health and Mental Retardation Services and the Division of Mental Health and Mental Retardation Services. The division title was changed in 1979 to the Division of Mental Health, Mental Retardation, and Substance Abuse Services. In 1981 four commissions for mental health and substance abuse were consolidated as the Commission for Mental Health, Mental Retardation and Substance Abuse Services. Hospitals for the mentally disordered continued to be administered under the division and commission within the Department of Human Resources. The Mental Health, Mental Retardation, and Substance Abuse Act of 1985 rewrote the mental health law. Treatment was to be provided in the least restrictive setting, if appropriate. State mental hospitals, including the Dorothea Dix Hospital, were still under the control of the Department of Human Resources through the division and commission. In 1989 the act was retitled the Mental Health, Developmental Disabilities, and Substance Abuse Act and the division and commission titles were changed to include "developmental disabilities" instead of "mental retardation." The Dorothea Dix Hospital continues to provide clinical and rehabilitative services to adolescent, adult, and geriatric patients as a part of the unified and coordinated system of mental health care and rehabilitative treatment administered by the Department of Human Resources. REFERENCES: P.L., 1848-49, cc. 1, 2, 57. P.L., 1852, cc. 73, 74. P.L., 1854-55, c. 2, s. 2. P.L., 1856-57, c. 3. P.L., 1858-59, c. 2. P.L., 1868-69, c. 67. P.L., 1869-70, cc. 13, 167. P.L., 1870-71, c. 228. P.L., 1874-75, cc. 249, 250. P.L., 1876-77, cc. 214, 278. P.L., 1879, c. 161. P.L., 1881, c. 133. P.L., 1883, c. 156. P.L., 1897, c. 265. P.L., 1899, cc. 1, 355. P.L., 1907, c. 191. P.L., 1909, c. 910. P.L., 1917, c. 151. P.L., 1919, cc. 63, 295. P.L., 1923, c. 165. P.L., 1925, c. 306. P.L., 1943, c. 136. S.L., 1959, cc. 1002, 1028. S.L., 1963, c. 1166. S.L., 1971, c. 864, s. 15. S.L., 1973, c. 476, s. 129-133. S.L., 1977, c. 681. S.L., 1979, c. 358, s. 27. S.L., 1981, c. 51. S.L., 1985, c. 589. S.L., 1989, c. 625. G.S. 143B-147 through 143B-150, 122C-1 through 122C-348, 35A-1101 through 35A-1361 [1992]. Dix, Dorothea Lynde. MEMORIAL SOLICITING A STATE HOSPITAL FOR THE PROTECTION AND CURE OF THE INSANE. Raleigh: Seaton Gales, Printer for the State, 1848. McCulloch, Margaret Callender. "Founding the North Carolina Asylum for the Insane." NORTH CAROLINA HISTORICAL REVIEW 13, no. 3 (1936): 192. Murray, Elizabeth Reid. WAKE: CAPITAL COUNTY OF NORTH CAROLINA. Raleigh: Capital County Publishing, 1983. Pp. 428-429. |
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