Ep. 45: History of Napa State Hospital, Part 3 (1943-1975)

Episode 45 covers the history of the new hospital buildings: how they were used during WWII and how they evolved to eventually house 4,991 patients. Find out why the Navy was using tree bark from the hospital grounds, learn why visitors are not allowed into state hospitals today, and discover how then-Governor Ronald Reagan kickstarted deinstitutionalization.

Much of the information in this episode is drawn from the Napa County Historical Society website and the Images of America book Napa State Hospital by Patricia Prestinary. All other sources are listed in the episode transcript.

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Transcript

Hello, hello, hello, and welcome back to Behind the Walls of the World’s Psychiatric Hospitals! I’m your host, Dr. Sarah Gallup, and today we’re going to finish the history of Napa State Hospital. You’ll notice the timeline is a little wonky because in the last episode, I wanted to discuss the end of the Castle era, which ended with its demolition in 1950. This week I’m going to back up a few years to other events that were happening around the same time but would have clouded the narrative of the Castle. Suffice it to say that the 1940s were busy years for Napa State Hospital, and I want to make sure that I cover as much as I can that was happening during that time.

As with the previous episodes, I’m drawing much of my information from the Napa County Historical Society website, as well as the Images of America book called Napa State Hospital by Patricia Prestinary. All other sources will be listed in the episode transcript.

So come on in and get comfortable as we go behind the walls of Napa State Hospital…

As I mentioned in previous episodes, WWII created a number of challenges for the hospital. The Castle was wearing down, and construction of new buildings – specifically the new administration building, the Q Building, and the S Building – were delayed due to shortages of both construction materials and workers.

The Children’s Center was completed in 1943 by Superintendent Dr. Theo K. Miller. I briefly mentioned this in the last episode and asked why this center was prioritized over other urgent needs in the hospital. I still don’t have an answer for that, but clearly the need was there. According to Patricia Prestinary, the children’s unit was established “to meet the needs of kids referred by the Juvenile Courts or Youth Authority who had displayed atypical or violent behavior at an early age” (105). What wasn’t as understood in the 1940s was the role that traumatic experiences could play in the development of those atypical or violent behaviors. I’m generalizing here, of course, but a teenager in 1943 would have grown up during the Great Depression. Poverty itself can be an incredibly traumatic experience, which sometimes leads to problematic behavior. Add in the possibility of a parent who struggled with alcohol abuse and the potential for problematic behavior in their children increases even more. Today we have a better understanding of how traumatic experiences in early childhood affect a person’s mental and physical health, but there is still a long way to go.

At the time that the Children’s Center was established in Napa, it was one of only six children’s programs in the United States (Prestinary 105). It also had the highest ratio of staff to patients in the entire hospital. There was one staff member for every nine children. “Two part-time doctors, three teachers, a full-time psychologist, two part-time psychologists, and two full-time doctors in training” (Prestinary 105). I wasn’t able to find how many children were able to be a part of this program, but given the number of clinicians listed above, I’m assuming there were at least 100.

The Q Building was finished sometime in the early 1940s and was originally intended to be a hospital for patients with tuberculosis (Prestinary 82). However, it was also around this time that new antibiotics were developed that effectively cured tuberculosis (Prestinary 114), so it ended up not being used as an isolation building at all. Instead, after the US entered WWII, the Q Building ended up being used as a military hospital called Mare Island Naval Hospital annex. The Navy also ended up using other nearby natural resources, namely cork trees on the hospital grounds. Since cork was used for products like insulation, the U.S. debarked some of the cork trees. As Patricia Prestinary notes, “The cork was unusable, but the event provided a great public relations opportunity for Napa State Hospital” (80). So…hooray, I guess? The Q Building would remain in the control of the Navy until it was officially returned to the hospital in 1946 (Prestinary 81).

The very large S Building was also finished during WWII. It originally began as additional residential areas for patients being relocated from the Castle. The main section of the S Building was – and still is – shaped like a rectangle. In the center is a large courtyard area with trees, a walking path, and quite a bit of grassy areas. During WWII, patients who lived in the S Building were tasked with making camouflage netting – just one of many ways the hospital helped with the war effort (Prestinary 80).

In 1945, the Department of Institutions became known as the Department of Mental Hygiene (Prestinary 63). As with previous name changes, this was an attempt to destigmatize mental illness and institutionalization in general. The hope was that mental illness would be seen as something to be cured – not something to simply warehouse. This was also the time when major changes came to treating mental illness. Lobotomies and electroshock therapy replaced the older forms of treatment like hydrotherapy and insulin shock therapy. Dr. Walter Freeman, the psychiatrist who streamlined and promoted the use of lobotomies, spent time at Napa State Hospital and “donated a collection of articles to the research library” (72). Lobotomies continued to be used at Napa and throughout the U.S. until the early 1960s.

In 1947, the San Francisco News published a series of articles on the “deplorable” conditions found in California state hospitals (Prestinary 84). The author, Al Ostrow, was able to inform the public about the overcrowding at state hospitals and the types of treatment being provided for patients who could not afford better care at private institutions. Readers responded favorably to the exposé, which focused attention back on improving care at institutions around California (84).

And what perfect timing. Following the exposé, the newly-constructed T Buildings at Napa State Hospital were finished and ready to admit patients. On March 5, 1948, the T Units were dedicated during a ground-breaking ceremony. Like their name implies, the T units are lower-case T or cross-shaped. There are 18 units within the three T Buildings. Now that these were complete, Napa State Hospital would be one of the largest institutions in California (Prestinary 86).

And, just an aside because it’s my show, I worked on a unit in the Q Building for the first six months of my internship and on a unit in one of the T Buildings for the second six months of my internship. My office was in one of the old dorms in the S Building, so it was wayyyy bigger than the three of us interns needed. We would occasionally guess how many patients lived in our office at one time. I remember guessing there had probably been 50 or 60 patients – assuming that they had bunk beds in order to really fill the room. But Prestinary points out that the wards held up to 35 beds (100), so not quite as many as I had guessed. Still, it was hard to imagine about 17 beds lined up on either side of the walls. There wouldn’t have been a lot of wiggle room left over.

We also had one little half bathroom in our office – just a toilet and a small sink – that we had to remember was once the only toilet for all the patients living in that dorm. There’s a picture of one of these S Building dorms in Patricia Prestinary’s book – I can tell it wasn’t our office, but it gives an idea of how large and plain the rooms were (and still are). 

By 1949, changes had clearly been made at the hospital regarding the quality of patient care, and the local newspaper wanted to make sure the public knew about it. Remember that only two years earlier, Al Ostrow had written the scathing exposé on the state of all California state hospitals. Now, the local newspaper was boasting about the high rates of cures at Napa.

In a very poorly-edited copy of the Napa Sunday Journal, dated May 29, 1949, it was reported that 54% of patients admitted to Napa State Hospital would be cured and discharged within two years. What the article glosses over quite quickly is that 82% of patients would be…gone from the hospital within two years. 54% would be “cured” and discharged; the other 28% would die. That seems like a lot. And even though there’s no other context, I have to imagine that at least some of those deaths were folks who had been admitted for late-stage dementia or other serious medical issues.

The writer of the article attributes the increase in cures to the multi-modal treatment approach offered at Napa: “occupational therapy, recreational therapy, electric shock therapy, music therapy, medical and surgical therapy, hydrotherapy, psychotherapy, and others.” I like that the more invasive procedures are just kinda snuck in there in between music therapy and hydrotherapy. Like, yes, we shock their temples, but we listen to some swell jazz! And sure, we cut into their brains with an ice pick but…warm baths! Doesn’t that sound nice?

Probably as a result of public discussion following the 1947 exposé, training of attendants increased in the years that followed. The article from the Napa Sunday Journal points out that “great stress is laid on the absolute necessity of kindness to patients.” It goes on to include some of the main points in the employees’ code of ethics: 

-       It will be my duty to see that every patient and visitor is treated with the same courteous consideration I would show a guest in my home.

-       I will study and make notes of the wishes of my patients and report them to my superiors.

-       I will do unto patients as I would like them to ‘do unto me,’ if our situations were reversed.

-       I will be especially careful not to hurt the feelings of patients.

These are wonderfully aspirational, and I wish I could say that every staff member followed these tenets perfectly. But we also have to remember that this is at the height of institutionalization. There were so many patients at Napa in 1949 that “studying and making notes of the wishes of my patients and reporting them to my superiors” probably wasn’t as feasible as they would have liked. I’m sure most tried to do their best – at least, I hope so – but that would have been a monumental task.

The extra staff training coincided with the formation of the California Society for Psychiatric Technicians. This organization helped set a standard of care for attendants – now called psych techs – who worked with folks with mental illness and developmental disorders. According to the new rules, psych techs were required to have 300 hours of instruction and six months of on-the-job training before being formally approved (Prestinary 101). This organization still exists today, although it is now called the California Association of Psychiatric Technicians or CAPT. Today’s standards are a little more rigorous than in 1950. The process takes about 18 months, which includes 576 hours of educational theory and 954 hours of clinical rotations, so at least 1530 hours of formal training. Plus there’s a qualifying exam before PTs can be licensed and continuing education that needs to be completed every two years (“Becoming a Psych Tech”). So there’s plenty of training before a psych tech begins working full-time.

Also in 1950, California started a family care program. This was pretty innovative at the time. In an attempt to treat state hospital patients in the community, private citizens were paid $25 per month to provide homes and foster care for patients (“A Brief Timeline of Napa State Hospital, 1875-1975”). That would be a little over $300 per month today. I wasn’t able to find how many patients from Napa were able to take advantage of this program, but hopefully, some of them were. And remember, this is 1950, so they were still over a decade away from the start of deinstitutionalization.

But there still seemed to be a recognition that some patients didn’t need to be at the hospital. At Napa, patients could engage in all sorts of activities – painting, music, games, various hobbies – in order to keep them busy and help build connections with others. It was believed at the time that these activities gave patients a chance to “relieve in useful ways the pent up feelings that are basic to their illness” (qtd. in Prestinary 108). And this is a lovely thought, but we know today that you can’t simply craft and paint the depression away. It may help, but it’s often not a primary form of treatment.

The patients who were seen as having the best chances of recovery and who had been ill for the shortest amount of time were given “the total push,” which was an intensive combination of all forms of treatment. According to Dr. W.A. Oliver, who was the director of clinical services at the time, “because of limited funds and personnel, only 160 patients out of 4,400 at the hospital [were] getting the ‘total push’” (qtd. in Prestinary 108). So only 3% of patients were actively being prepared for discharge.

More patients, however, were able to participate in vocational services. In 1954, 600 patients worked at the hospital as part of their treatment (Prestinary). I should also add that they still weren’t being paid for their labor at this point.

On December 12, 1954, the new Receiving and Treatment building was formally dedicated. This building was constructed where the old Castle had been demolished only four years earlier. It was a symbol of modernization for mental health treatment and a focus on patient rehabilitation and reintroduction to the community (Prestinary 117). Today, the Receiving and Treatment building is known as the A Units, where the hospital’s civilly committed patients reside. Napa is one of two state hospitals in California that has multiple units dedicated to treating long-term, non-criminal patients.

Okay, back to the 1950s…state hospitals around the country were more or less trying to salvage their reputations as warehouses for the mentally ill by pulling back the curtain and showing the public what treatment was like. In 1954, it was reported that about 60 volunteers from the Red Cross and other civic organizations donated 5,300 hours of volunteer aid each month to recreational and occupational therapy projects (Prestinary 103). I know we talked about volunteers coming into Oregon State Hospital during the 40s and 50s to host parties and whatnot, but my current safety-oriented mind cannot fathom doing this today. It’s a lovely thought, but there’s so much that could go wrong.

People sometimes ask me if the public can come to my hospital and tour the units, and I usually stare blankly and say, “No.” For one, we have a little law called HIPAA that protects patients from getting their information to the public; allowing random people to walk through would certainly violate their right to privacy. For another, some of our patients are still managing their symptoms and struggling with aggression, paranoia, fear of strangers. It could put both patients and visitors in really compromising or dangerous situations. 

I could list a hundred other reasons why this would be problematic today. And yet, this is what they did in the 50s. In April 1957, Napa State Hospital opened its doors to the public in honor of Mental Health Week. Throughout the week-long open house, about 200 visitors toured the wards, listened to panel discussions, watched films, and learned about various local social services and community mental health facilities (Prestinary 110). One patient made a large poster display that outlined ways people in the community could help patients while they’re in the hospital and once they transition back to the community.

Here is what the poster suggested for helping patients transition back to the community: 

-       Make them feel welcome – at home, at church, at work, at play.

-       Have him join patient groups

-       Join relative groups

-       Employ former patients

-       Support mental health programs (Prestinary 110)

Most of these are still applicable today. I encourage my patients who are discharging to find support groups or AA/NA meetings. It’s usually harder than they realize to move back to the community, and having these supports can often mean the difference between staying out and getting arrested again.

The poster also offers ways that people can become more aware and involved as a citizen. I think most of this is still relevant today. It says:

-       As a citizen, be informed about mental health – join your mental health society.

-       Support mental health legislation, support preventative groups, support good schools (join your PTA), and become a volunteer (Prestinary 110)

I would still support this sentiment today. I don’t want to deviate too much because goodness knows I could really go off on a rabbit trail here, but I do agree that being properly informed about mental health is essential. And there are plenty of ways that people get misinformation that only perpetuates negative stereotypes and stigmatizes folks with mental illness. If you want good information, a good place to start – at least, in the U.S. – is with NAMI, the National Alliance on Mental Illness. The NAMI website, N-A-M-I.org offers information for family members and caregivers, videos, news reports, and ways to get involved in advocacy. It’s a great resource and a good place to begin, if you’re curious about getting more information about mental health. 

If you’re in Australia – because I have a bunch of you listening in the Melbourne area – it looks like Mental Health Australia would be an equivalent of NAMI. I briefly looked at their website – mhaustralia.org – and it looks like it offers similar information and crisis services. If there are other sites or organizations in Australia that I should know about, please let me know.

Okay, I deviated a little bit – but not as much as I could have! – so back to Napa we go. After all the new buildings had been completed, there was ample room to house new patients. In 1960, the hospital reached its peak patient population with 4,991 patients (Prestinary 113). Now, again, I worked at this hospital with the same buildings still in use, but only 1200 patients. And it was still plenty full. I cannot imagine having four timesas many patients there; I just cannot.

And hospital overcrowding was an issue around the country at the time. Politicians and administrators were talking about what to do with the patient populations at these hospitals. In California in 1961, the Department of Mental Health created a 10 year plan that would focus on reducing the length of treatment and returning patients to their home communities (“A Brief Timeline”).

If you’ve been with the show since the beginning, you know what’s coming next, so say it with me: the Community Mental Health Act of 1963. This was pivotal to kickstarting deinstitutionalization on a federal level. If you’re relatively new to the show, the Community Mental Health Act of 1963 was put forth by President John F. Kennedy. JFK’s own sister Rosemary had had an involuntary lobotomy years earlier that was botched, and she was essentially institutionalized and abandoned by her family. And Kennedy was so upset by how that situation all played out that he advocated for patients who did not need to be institutionalized to be returned to their families and communities. The Act would essentially direct federal funds to shift from state hospitals to community mental health programs. It had very good intentions. Kennedy signed the bill into effect on October 31, 1963. Only three weeks later, he would be assassinated, and all those good intentions went with him. Most of the community mental health centers that had been promised were never built. 

But funds were still taken away from the state hospitals, leaving them understaffed and underfunded. Patients were relocated to the community as best as possible, but many of the community services just weren’t enough. 

People often ask me today if I’d like to see asylums return, and the answer is no. The main problem with the old asylums was that so many people were there who should never have been there. And there was no criteria other than a doctor’s opinion about how to get out. It was a messy system at best, and I’m glad we’ve moved away from it. But I do appreciate the intents of politicians like President Kennedy and President Carter who advocated for increased funding to be directed toward community mental health programs. Had their programs been able to be fulfilled as intended, I think mental health services would be a lot better off today. Of course, that’s speculative, but we can strive to do better moving forward.

I am all sorts of all over the place today. The 1960s, of course, was a turbulent decade. There were layers of political and cultural changes occurring at once. In the midst of the chaos, deinstitutionalization was changing the state hospitals. At Napa, the once economically prosperous dairy was no longer bringing in the dollars it once was. Some of the cattle herd was moved to Mendocino State Hospital. Because of the changes in federal funding, the dairy was closed in 1967 and much of the pastureland and orchards were sold.

Activists through the 1960s continued to fight for the rights of folks with mental illness and developmental disabilities. I discuss this advocacy work in detail in episode 8 on Fairview Training Center. As a result of the advocacy, Napa State Hospital began a program specifically designed for folks with developmental disorders in October 1968. Many of those patients would reside in the S Building where my office was located. This program would continue until August 1987.

In 1967, another major change came to California’s mental health system. Then-Governor Ronald Reagan signed into law the Lanterman-Petris-Short Act, or LPS Act. The primary intent of the law was to “end the inappropriate, indefinite, and involuntary commitment of mentally disordered persons, people with developmental disabilities, and persons impaired by chronic alcoholism, and to eliminate legal disabilities” (“Lanterman-Petris Short Act”). 

The LPS Act initiated short-term involuntary holds for people struggling with mental illness. Even if you’re not from California, you may be familiar with the term 5150 hold, thanks to the song by Van Halen. But a 5150 hold allows a facility to involuntarily hold a patient who presents as an immediate threat to self, others, or grave disability for up to 72 hours for evaluation and treatment. If, at the end of those 72 hours, the person is still deemed to be imminently dangerous, the hold can be extended to 14 days under a 5250 hold. These are usually conducted in emergency departments and acute psychiatric facilities. In state hospitals, like Napa, patients can be committed under LPS conservatorship for one-year intervals. That means that every year the patient needs to be re-evaluated to determine if they still need to be involuntarily hospitalized. This essentially prevents someone from going years and years at the hospital unnecessarily. These folks don’t necessarily need to have committed a crime to be conserved, but they are considered a risk to themselves or others due to their mental illness. They may also be considered gravely disabled, which is essentially unable to care for themselves; in other words, if we were to release someone with grave disability to the streets, they would likely die without intervention. 

As with most mental health laws, the intent of the LPS Act was good, but of course, there were serious downsides that persist today. Any time there’s a threshold that needs to be met in order to be involuntarily hospitalized, there are people who need help but who don’t quite meet that threshold. It could be someone who is actively seeking treatment but isn’t an imminent danger to themselves or others. It could be someone who lies and is able to get out of a hold. There is a very fine line when you’re talking about taking away someone’s rights, even temporarily. You want to make sure you have a good reason to hold that person. And, unfortunately, I have seen the gamut: from unhoused people feigning suicide on a cold night in order to have a place to stay to people who desperately sought help, were turned away, and ended up committing a felony. It’s an imperfect system, for sure, and I wish I knew how to make it better.

I’m going to jump ahead to 1975, when Napa State Hospital celebrated its centennial on November 17th. A plaque was dedicated to Napa Asylum for the Insane, and interest in the history of the hospital was revived. According to historian Ellen Brannick, “The history committee’s first meeting appropriately took place in an old hydrotherapy room in the Receiving [B] Ward” (qtd. in Prestinary 116).

And that’s actually where I’m going to end the history of Napa State Hospital. Like I mentioned in the previous episode, since Napa is still a fully-functioning hospital, I want to respect the patients who have been there in recent decades. 

What I will say is that today the hospital has a maximum capacity of 1,255 patients (“DSH-Napa”). Almost half of the patient population is committed pursuant to Penal Code 1026, Not Guilty by Reason of Insanity (“DSH-Napa”). Those folks have been convicted of a crime and are serving their sentence at the hospital rather than in prison because their mental illness played a role in their offense or offenses. They are generally long-term patients and their days consist of attending mental health groups, meeting with their treatment team members, going to work at the hospital, and socializing with peers.

About one-third of the patient population at Napa State Hospital today is committed pursuant to Penal Code 1370, Incompetent to Stand Trial (“DSH-Napa”). These folks are pre-adjudication. They have been charged with offenses but are unable to stand trial because their psychiatric symptoms interfere with their ability to aid and assist their attorney or understand the charges against them. So while they’re at the hospital, they learn all about how the court system works, who is involved in the courtroom, and what the charges are against them. They do a lot of work, and they have to memorize a lot of information. I often wish I could quiz people in the community with information 1370 patients need to know because I’m sure many of them would be stumped.

Like I mentioned, there are also patients conserved under LPS conservatorship. Some of these folks were incompetent to stand trial but the severity of their mental illness makes it impossible for them to ever go to trial, so they roll over to a different type of conservatorship. 

Today the hospital grounds are much smaller – only about 138 acres (“Napa State Hospital”) – but all the buildings I mentioned in this episode are still there. The Children’s Center is long gone, but the building is used for training and education. The campus is still known for its many different types of trees, and there’s even a self-guided walking tour of all the trees!

There’s now a large razor-wire fence that surrounds the forensic side of the hospital for folks charged with or convicted of crimes. But my favorite part is that apparently when they were putting up the fence, a pair of peacocks was accidentally trapped inside. Now, the campus is home to – I don’t even know how many, maybe 50? – peacocks. I have a wee bit of a fear of birds, but I loved seeing the males with their iridescent colors and plumage. But my favorite was watching the juvenile males (that I called pea-teens, hardy har) try to impress the females. But juvenile males don’t have their plumage quite yet, so they mostly look like they’re walking around in fluffy diapers. It doesn’t impress the ladies. But it’s really cute watching them try to shake their tail feathers; they’re super awkward and adorable.

Anyway, thank you for listening to my podcast about peacocks, I guess. I hope you enjoyed this series on Napa State Hospital. I know I learned a lot from it. Next week I’m going to bring you a true crime story of a patient who used to be at Napa. So if you’re someone who likes true crime, that one is for you.

Also, I’m still working on building my Patreon page – thank you for your patience. I would love to get your thoughts on what to include for bonus content. There’s been an interesting conspiracy theory that has come up during my research on Napa State Hospital that I was thinking of digging into and putting up on the Patreon page. So if that would be of interest to you, please let me know.

I also had a sort of silly idea: I use newspapers.com for some of my research and every once in a while I come across short articles that are so bizarre and random that I just want to share them with you all. So if you’d be interested in listening to these news clippings from 1897 or 1923 or whenever, let me know. That may be something that would be fun to record.

Thank you all so much for listening! Thank you to everyone who has joined the Facebook group and Instagram pages! Thank you to mercds531 for your rating and review on Apple Podcasts – I appreciate it so much!

And as always, “Do the best you can until you know better. Then when you know better, do better.” Until next time…

“Becoming a Psych Tech: Step-by-step guide on preparation and schools.” California Association of Psychiatric Technicians, 2024. https://www.psychtechs.net/professional-resources.php?page=preparation&lang=eng

“Brief History of Napa State Hospital, 1875-1975.” Napa County Historical Society. https://napahistory.org/programs/local-history/timelines-of-napa-county-history/brief-history-of-napa-state-hospital-1875-1975/

“Department of State Hospitals – Napa.” Department of State Hospitals. https://www.dsh.ca.gov/Napa/#patient

“Lanterman-Petris-Short Act.” Wikipedia. https://en.wikipedia.org/wiki/Lanterman–Petris–Short_Act

“Napa State Hospital.” Wikipedia. https://en.wikipedia.org/wiki/Napa_State_Hospital

“Percentage of Cures High at Napa State Hospital.” Napa Sunday Journal, 29 May 1949.

Prestinary, Patricia. Napa State Hospital. Charleston, SC: Arcadia Publishing, 2014.