The Colorado Mental Health Institute at Pueblo (CMHIP) is Colorado’s original and largest public psychiatric institution. It has a long and complicated history of housing and rehabilitating adults and children living with mental illness, physical and developmental disabilities, neurological disorders, and addictions. It began in 1879 as a Victorian-era insane asylum that practiced moral rehabilitation (getting patients to commit to morality as the path to a better life). By the mid-twentieth century, it had become a modern psychiatric hospital with a massive 306-acre property providing custodial care to more than 6,000 patients. Currently the Colorado Department of Human Services (DHS) operates the campus as a forensic hospital. CMHIP endures as a barometer of Colorado’s attitude toward mental health as the fields of psychiatry and pharmacology have evolved and experimented with different treatment philosophies, sometimes at the expense of the patients.

Founding

In 1879 Senator George M. Chilcott of Pueblo sponsored a bill for a state inebriate and insane asylum. Chilcott argued that since other urban populations of a similar size could support an asylum, the state should stop hospitalizing individuals at Eastern institutions. At the time, lawmakers and social reformers in support of Colorado’s asylum were most concerned with treating alcoholism. Influenced by the temperance movement, many people disdained the societal consequences of alcohol, while physicians started to insist that alcoholism, as a disease, could be cured.

Fearing a tax hike, lawmakers disputed who should pay the initial cost of $8,000, until Chilcott donated forty acres of his own land near Pueblo as an endowment. The Colorado State Insane Asylum opened on October 23, 1879, as a field hospital with eleven patients.

Early Years

The asylum’s first permanent building opened on November 20, 1883, under the care of Superintendent Pembroke R. Thombs. By law, the governor appointed the superintendent, who controlled the hospital and its wards but reported to the State Board of Lunacy Commissioners. The superintendent delegated power among an assistant physician, steward (accountant), matron (domestic affairs), druggist (pharmacist), and two chief nurses. Thombs, a retired Union Army surgeon, served as superintendent for twenty years until his resignation in 1899. That year, the State Board of Charities and Correction investigated the asylum for faulty bookkeeping, patient neglect, and improper burial of the dead.

During his tenure, Thombs had saved money by burying patients in unmarked graves on the campus. In 1992 construction work unveiled what may have been one of Thombs’s unmarked graves, and the state archaeologist exhumed the remains of 131 patients. Many of the skeletons indicated late-stage syphilis, a common and then-incurable disease that caused dementia, among other ailments.

Early Twentieth Century

After the investigation, Governor Charles S. Thomas appointed A. P. Busey as the new superintendent. Busey inherited his predecessor’s problems with overcrowding and sought legal remedies. In 1900 the Colorado legislature allowed Busey to parole patients back into the community—an unusual privilege for asylums at the time. In addition, Busey pushed unsuccessfully for the segregation of epileptics and the “feebleminded” and for insane criminals to be sent to the penitentiary in Cañon City. This failed attempt at segregation foreshadowed the complex and often codependent relationship between the penal system and the mental health care system in the coming century.

In 1917 Superintendent H. A. LaMoure renamed the facility Colorado State Hospital (CSH) to reflect a new era of modern medicine at the institution, including a surgical unit, convalescent wards, and infirmaries. That same year, the legislature passed a statute declaring that the Colorado Board of Corrections could not enforce a limit on “insane persons” cared for by the state. This new law caused the hospital to grow, and by 1923 the hospital population was at 2,422, an increase of 65 percent since the year before the law was passed.

Throughout the early twentieth century, CSH continued to grow while remaining perennially underfunded, creating predictable problems. The struggling CSH became known as “the state’s dumping ground” because patients rarely left. Under pressure to expand, in 1924 LaMoure purchased the Woodcroft Sanitarium, a private mental hospital in Pueblo established by Hubert Work, for $200,000. Lawmakers soon dubbed Woodcroft “the White Elephant Annex” because it proved to be such a terrible investment. CSH was able to temporarily house only seventy-five elderly patients on the small campus because seasonal flooding from the Fountain River continued to damage the already dilapidated structures. CSH officially closed the annex in 1937, and during World War II the army adopted the site as a venereal disease ward.

The 1930s saw an expansion of federal aid and local involvement as CSH grew into an iconic state institution and one of the largest hospitals in the country. From 1935 to 1940, CSH received multiple contracts from the Public Works Administration to renovate the campus; they funded new dormitories, a cafeteria, a tunnel system between buildings, a detention center, a storehouse, and a hydrotherapy building. Some Pueblo citizens resented the hospital’s shiny new campus but acknowledged that construction boosted the town’s economy. Furthermore, in 1935 Superintendent Frank H. Zimmerman started a training program for psychiatric aides to address the lack of trained nurses. This program was later transferred to Southern Colorado Junior College (now Colorado State University–Pueblo) in an effort to diversify the city’s workforce as jobs at Colorado Fuel and Iron  declined.   

Mid-Twentieth Century

Similar to many psychiatric institutions of the era, Colorado State Hospital functioned as a self-contained city and supported rehabilitation through work. At its advent, CSH kept dairy cattle to produce milk for patients. Staff and able-bodied patients also farmed produce; raised poultry and pigs; and operated a cannery, a greenhouse, a bakery, a mattress shop, a laundry facility, and a coal powerhouse. These programs provided patients with training and meaningful work, but as with similar prison programs today they also served as a source of cheap labor.

In addition to vocational work, the hospital practiced a diverse—and now controversial—range of treatments. First, CSH used three types of shock therapy: Metrazol and insulin (introduced during the interwar period) as well as electro-convulsion, or ECT (introduced during World War II). Metrazol and insulin artificially induce seizures that reduce psychotic episodes, while ECT uses electricity to produce seizures that lessen symptoms of mental illness but also cause memory loss. Second, in line with nationwide eugenics practices, CSH routinely sterilized “feebleminded” women because, doctors argued, it abated licentious and nervous behavior. In 1955 former patient Lucille Schreiber sued Superintendent Zimmerman for sterilizing her as a teenager. Third, the world’s first antipsychotic drug, chlorpromazine, developed in 1952, forever changed CSH’s psychiatric care because it allowed physicians to control outbursts with pharmaceuticals instead of physical restraints, ending the need for lifelong hospitalization.

Deinstitutionalization Movement

CSH grew continuously until the early 1960s, when a cultural transformation reversed the trend. Returning World War II veterans suffering from trauma inspired new awareness of mental illness. Beginning with President Harry Truman—who proposed universal health care in 1946—the federal government and states enacted many laws to help returning veterans over the next decade. In 1946 Congress passed the National Mental Health Act, which created the National Institute of Mental Health (NIMH), a federal institute for research on mental illness. In the early 1960s, NIMH provided federal funding to Colorado—one of the first states to receive such funding—to establish more mental health services. This funding coincided with a grassroots movement to destigmatize physical and developmental disabilities, which reduced the need for massive state institutions to hide away disabled family members for fear of ostracization.

Deinstitutionalization—moving patients from institutional care to the general population—proceeded alongside decentralization—spreading care throughout multiple smaller divisions or institutions. Under Governor Stephen McNichols, the state built the Fort Logan Mental Health Center in 1961, a new facility to serve the Denver metro area. This new campus relieved much of the burden on CSH, the only other psychiatric hospital in the state. The following year, under the direction of Superintendent Willis H. Bower and Clinical Director Leonardo Garcia-Bunuel, CSH decentralized. With the help of soldiers from Fort Carson, CSH moved 5,000 patients into twelve semiautonomous divisions separated by age, diagnosis, and geographical region. The hospital began to focus on early diagnosis and specialized treatment to shorten the length of hospital stays, preventing expensive, long-term custodial care. Patients began to use a network of community health clinics rather than being placed in a single asylum in Pueblo.

The deinstitutionalization movement also brought legislative changes regarding patients’ rights. On July 1, 1975, a new set of behavioral-health laws took effect that safeguarded patient autonomy and encouraged voluntary treatment over civil commitment, shifting commitment standards to be based on immediate perceived danger to others (homicide) or self (suicide). The rules mandated a seventy-two-hour evaluation before hospitalization, forbade short-term treatment of more than three months, and reinstated legal rights for restored-to-reason patients. Previously, once individuals had been declared legally insane, they could not vote nor obtain a marriage license without a court petition.

From Patient to Inmate

Although intended as humanitarian reforms, deinstitutionalization and decentralization also had unintended consequences. The shift from a single state institution to several community clinics fragmented and, arguably, reduced mental health-care access. CSH now operates 494 beds, down more than 90 percent from its peak, even though inpatient care through civil commitment often remains the most direct way to provide psychiatric treatment for individuals experiencing distortions of reality, especially schizophrenia. The reduction of health-care access was exacerbated by insufficient funding. Since the 1970s, funding to maintain community clinics has lagged behind growing demand, especially after President Ronald Reagan repealed federal funding for clinics in 1981, shifting the responsibility back to states. As mental health-care access declined, chronic mental illness became criminalized as individuals with untreated mental illness often ended up homeless and/or self-medicating with illegal drugs. An overreliance on incarceration has transformed prisons into the new asylums, only with worse treatments and outcomes.

Meanwhile, the old asylum became a prison. In 1991 Colorado State Hospital changed its name to the Colorado Mental Health Institute at Pueblo. Following a nationwide trend, the Colorado government (specifically, the Division of Youth Corrections, Department of Corrections, and DHS) set up a robust prison network on the institute’s campus. First came the Youthful Offender System complex, a detention facility for minors (1994), and the San Carlos Correctional Facility, a maximum-security facility for inmates with mental illness (1995). The La Vista Correctional Facility, a medium-security facility for women, followed in 2006. Finally, the Robert Lee Hawkins High Security Forensic Institute, a hospital ward for individuals facing criminal charges, came in 2009. CMHIP has become a forensic hospital, primarily treating individuals with pending criminal charges in need of competency evaluation as well as individuals found not guilty by reason of insanity.

Legacy

For almost a century and a half, Colorado Mental Health Institute at Pueblo has performed a Sisyphean task of addressing serious mental health challenges on a statewide scale. Many employees feel a strong loyalty to CMHIP, and the hospital has played an integral role in the Pueblo economy. Former employees take pride in the hospital, such as Nell Mitchell, a nurse of thirty-six years, who founded the CMHIP Museum in 1985. Unfortunately, decades of inadequate funding, high turnover and staffing shortages, and societal ignorance regarding mental illness have harmed some of Colorado’s most vulnerable citizens.