1847: Missouri General Assembly votes to establish an asylum for the insane in central Missouri. Several counties bid to have the institution. Callaway County won after producing $11,500 and 500 acres of land.
1851: Fulton State Hospital, then called the Missouri State Lunatic Asylum, opens. It was the first public mental hospital west of the Mississippi River and took in its first 67 patients that December. (At this time and for the next several decades, there were no standard definitions for psychiatric diagnoses either statewide or nationally, nor any widespread agreement about effective treatments. Doctors theorized that mental illness could be caused by fever, epilepsy or even disappointments in love.)
1882: Hospital officials open a new, separate hospital building for the criminally insane. Before 1882, the criminally insane were housed alongside noncriminal patients.
1910: The hospital requests hydrotherapy equipment after hearing about the success of the treatment in Europe. Hydrotherapy, which involved patients being bound in wet sheets and placed in a tub that ran water for hours, was used as a treatment tool into the 1960s. It fell out of favor nationwide when physicians became concerned that patients resisted the treatment and that the treatment was sometimes used as punishment.
1940: The maximum-security Biggs Building (now the Biggs Forensic Center) opens. It included patient wards, a kitchen, a dining room and a hydrotherapy facility. Fulton’s overall patient population peaked at 2,476.
1941: Electroshock therapy, introduced in the United States a year earlier, is adopted at Fulton.
1954: Thorazine, an antipsychotic, appears on the U.S. market. Within a year of its release, it is used on more than 8 million patients nationwide.
1956: A fire destroys the Fulton hospital’s administration building and two wings that housed about 250 patients. No one died in the blaze, though many patient and hospital records were lost. The fire caused more than $1 million in damage.
1962: Ken Kesey publishes "One Flew Over the Cuckoo’s Nest," a fictional novel that criticizes aspects of institutionalization for those deemed mentally ill, including lobotomy and electroshock treatment.
1966: Hospital doctors end practice of lobotomies. Prior to 1966, doctors performed lobotomies on patients as a last-resort treatment. Doctors at Fulton favored aggressive treatments such as electroshock therapy and insulin shock therapy, instead of more palliative care. Doctors hoped new treatments and medications would get patients well enough to go home.
1974: Staff shortages, coupled with fire and safety code violations at the hospital, lead the Joint Commission on Accreditation of Hospitals (now called the Joint Commission on Accreditation of Healthcare Organizations) to revoke the hospital’s accreditation. The patient population averaged around 1,200 at the time. The population declined as hospital officials increased the hospital's outpatient treatment options and transferred geriatric patients to nursing homes.
1982: A trend toward deinstitutionalization and outpatient treatment sweeps the nation. Missouri officials ask hospital officials to retain only the sickest patients and move others to federal programs at other hospitals to save the state money. The deinstitutionalization was to cut the patient population at Fulton from 1,200 to 650. The hospital has its Joint Commission accreditation reinstated after addressing staffing shortages and lowering the patient-staff ratio. The hospital remains accredited in 2014.
1984: The hospital tears down its oldest units, the pre-Civil War North and South wards. The four-story buildings were costing the state $40,000 a month in heating costs. Apart from one floor of patient living space in the South Ward, the buildings had stood empty since the 1960s. At the national level, the American Psychiatric Association released a report on the state of the mentally ill homeless population in America. The report concluded that many patients released during periods of deinstitutionalization between 1955 and 1983 struggled to adjust to life in their communities and eventually became homeless.
1990: New drugs treating schizophrenia, bipolar disorder and depression become increasingly common. The targeted treatments help patients nationwide control symptoms and focus on rehabilitation.
1990-2000: Following a period of deinstitutionalization in the 1980s, the hospital's mission becomes primarily forensic, meaning it primarily served individuals sent there through the criminal justice system. Hospital management added 25 forensic beds that were once held at Nevada (M0.) State Hospital (now called the Southwest Missouri Psychiatric Rehabilitation Center and located in El Dorado Springs) and moved its 25-bed nonforensic acute care program to the Mid-Missouri Mental Health Center (now part of MU Healthcare) in Columbia.
2008-11: Patients considered less dangerous are transferred to minimum-security hospitals elsewhere in the state, reducing Fulton’s patient population from 471 to 300 maximum and intermediate security beds. Hospital officials were also working with the state on a plan to rebuild the hospital. The transfers lowered the expected cost of a hospital rebuild from $340 million to $211 million.
Information compiled by Claire Boston from a variety of news reports, state General Assembly records, historical documents, hospital information and the book, "Evolution of a Missouri Asylum: Fulton State Hospital, 1851-2006."