Saint Elizabeths Hospital | Southeast Washington

Saint Elizabeths Hospital, located in Southeast Washington, D.C., is one of the most historically significant and storied psychiatric institutions in the United States. Established in the 19th century, it has played a central role in the development of mental health care, public architecture, and civil service in the country.

Founding and Purpose

Established: 1852

Founder: Dorothea Dix, a prominent mental health reformer and humanitarian

Original Name: Government Hospital for the Insane

Location: A large campus on a hill overlooking the Anacostia River in Southeast D.C.

Saint Elizabeths was the first federally operated psychiatric hospital in the United States. Its original purpose was to provide humane care and treatment for "the insane of the Army, Navy, and District of Columbia." This focus on compassion was a major shift from earlier institutions, which often subjected patients to neglect or cruelty.

Name and Symbolism

The hospital's name was informally changed to Saint Elizabeths early in its history, inspired by the colonial-era land tract on which it was built. It was later officially adopted. Despite the "Saint" in the name, there is no religious affiliation with any saint-it simply reflects the original land title.

Architecture and Campus

The original campus was designed by Thomas U. Walter, the same architect who worked on the U.S. Capitol dome.

The layout followed the Kirkbride Plan, a 19th-century model for mental asylums that emphasized natural light, ventilation, and humane surroundings.

At its peak, the campus covered over 300 acres and included dozens of buildings, gardens, cemeteries, and farm structures.

The Center Building, a towering brick Gothic-style structure, became the hospital’s architectural centerpiece.

Its expansive layout, architectural detail, and views of the Capitol across the Anacostia River made it one of the most ambitious psychiatric campuses in the world at the time.

Historical Significance

Saint Elizabeths became a pioneering institution in mental health care:

Civil War era: Treated Union soldiers and later Confederate veterans

Psychiatric innovation: Known for progressive treatment methods in its early years, including occupational therapy, hydrotherapy, and early group therapy

Research and training: Became a national leader in psychiatric research and training for doctors and nurses

Patient diversity: Served military personnel, civilians, federal prisoners, and foreign nationals

It also had a segregated structure, with Black patients and staff initially housed in separate, often inferior facilities. Over time, the hospital slowly integrated.

Famous Patients and Events

Saint Elizabeths housed numerous notable patients, including:

John Hinckley Jr., the man who attempted to assassinate President Ronald Reagan in 1981

Ezra Pound, American poet detained during World War II for pro-Fascist broadcasts in Italy

Richard Lawrence, who attempted to assassinate President Andrew Jackson in 1835

The hospital was also the site of important developments in forensic psychiatry, evaluating and treating individuals found not guilty by reason of insanity in federal criminal cases.

Decline and Redevelopment

By the mid-to-late 20th century, Saint Elizabeths faced many of the same issues that plagued psychiatric institutions across the U.S.-overcrowding, underfunding, and controversy over patient care. As national trends shifted toward deinstitutionalization in the 1960s and 1970s, the patient population began to decline dramatically.

In 1987, the federal government transferred the East Campus of the hospital (which treated D.C. residents) to the District of Columbia, while the West Campus remained under federal control.

By the early 2000s, much of the hospital was shuttered or in disrepair. However, due to its historic significance, Saint Elizabeths was designated a National Historic Landmark in 1990.

Modern Use and Legacy

Today, Saint Elizabeths is divided into two main zones:

1. East Campus (District-Controlled):

Home to the new Saint Elizabeths Hospital, a modern mental health facility opened in 2010.

Provides inpatient psychiatric care for District residents.

Focused on rehabilitation, reintegration, and compassionate treatment.

2. West Campus (Federally Controlled):

Underwent major redevelopment to serve as the headquarters of the U.S. Department of Homeland Security (DHS).

The Center Building, long abandoned, was restored as the DHS headquarters.

The site also includes offices for other federal agencies and new construction carefully integrated with historic architecture.

Cultural and Urban Significance

Saint Elizabeths Hospital represents over 170 years of psychiatric, social, and political history. It reflects changing attitudes toward mental illness, from 19th-century humanitarian reform to 20th-century deinstitutionalization and modern community-based care. It also serves as a powerful example of how historic preservation and adaptive reuse can breathe new life into decaying but significant civic spaces.

In the local D.C. context, the redevelopment of Saint Elizabeths is also central to urban revitalization efforts in the Congress Heights and Anacostia areas, with future plans including commercial space, arts venues, housing, and expanded transit connections.

Saint Elizabeths Hospital remains a poignant and complex symbol-of progress in mental health care, of institutional failures, of racial and class dynamics in urban America, and of the long arc of public service architecture.