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October 28. 2012 10:46PM

New Hampshire Hospital marks 170th anniversary


Moblie phones are not allowed but there are two pay phones in each wing of the New Hampshire Hospital. (DAVID LANE/UNION LEADER)


The New Hampshire Hospital marks its 170th anniversary today. (DAVID LANE/UNION LEADER)


Paul Shagoury, who's the chief psychologist at New Hampshire Hospital, talks about the Bancroft Building, the second oldest on the campus in Concord. (DAVID LANE/UNION LEADER)


Paul Shagoury, who's the chief psychologist at New Hampshire Hospital, gives a tour of the facility on Friday. (DAVID LANE/UNION LEADER)


Paul Shagoury, who's the chief psychologist at New Hampshire Hospital, exits from the basement of the main building of the New Hampshire Hospital in an area that used to be connected by a series of underground tunnels. (DAVID LANE/UNION LEADER)

CONCORD — There have been many changes over the last 17 decades in the way doctors treat New Hampshire's mentally ill. But ask the state's top psychologist to rank them in terms of importance, and he'll say the most significant development has nothing to do with improvements in diagnosis or drugs — he credits a change in attitude.

“I think it was the point of realization that a life apart is not a better life,” said Dr. Paul Shagoury, chief psychologist for New Hampshire Hospital in Concord. “The idea that those suffering from mental illness shouldn't be segregated, that they could be a part of the greater community around them, and benefit from it, was an important turning point.

This month, the New Hampshire Hospital (NHH) commemorates its 170th year of caring for the mentally ill in the Granite State. NHH marks the anniversary today, the day in 1842 the hospital opened its doors to its first patient.

When NHH first opened, it was called the New Hampshire Asylum for the Insane, and was the 17th such hospital in the United States, and the seventh in New England. The anniversary will be marked with historical remembrances, and recognition for the thousands of patients and staff who have become part of its story over the decades since its doors opened.

“The last 170 years have brought a great number of changes in the understanding and treatment of mental illness,” said Department of Health and Human Services Commissioner Nicholas Toumpas. “However, there are two challenges that remain as great today as they were in 1842; those are the deep and dire needs of those afflicted with mental illness, and the attempts of a caring community to meet those urgent needs with kindness and compassion.”

Since the first patient walked through its doors in October 1842, Shagoury says the facility has treated just over 83,000 individuals. The hospital currently has 145 patients on site, but that number was as high as 2,700 in the 1950s.

In the beginning

The road that would lead state officials to establish the New Hampshire Hospital began with a report made to the New Hampshire legislature in 1836. According to Shagoury, the report described the results of a study conducted the previous year by legislators at the behest of Gov. Samuel Dinsmore.

“The Report on the Insane in New Hampshire was undertaken to gather information on the number of mentally ill throughout the state,” said Shagoury. In 1836, Shagoury said, the report shows that among the 193,569 inhabitants of New Hampshire, the number of “insane” individuals was reported to be 312.

The report to the legislature was effective — in 1836 officials designated funds for the construction an “Asylum for the Insane,” and a committee of trustee's was appointed. Shagoury said records show that two cities competed fiercely to become home to the asylum — Portsmouth and Concord.

“Portsmouth argued two points,” said Shagoury. “First, that it was the best fish market in the world, and that fish was the cheapest and best food for insane persons. And second, that Portsmouth was 'in the neighborhood of Genteel Society,' as record show. Concord officials took a different approach — residents approved designating land (120 acres — the present campus between Fruit, Pleasant and Clinton Streets) for the facility. In January, 1841, the trustees officially chose Concord, and construction began. The cost of the project was approximately $20,000. Treatment of mental illness was focused on “moral treatment,” defined by Shagoury as the idea that people with mental illness would get better if they were treated with kindness and compassion, fed well and allowed to work hard.

Patient population climbs

Shagoury said that according to an entry in the facility's inaugural Annual Report, the first patient admitted to NHH was a 35-year-old married farmer from Tuftonboro. He was admitted in the grips of what records term “a religious excitement,” and was treated under the Moral Treatment program. He was released after two-and-a-half months in an “improved” condition, never readmitted and presumed “cured,” according to Shagoury.

The patient population jumped from 47 in 1843 to 225 patients in 1857. That year, a new Asylum superintendent, Dr. Jesse Bancroft, was appointed. He and his son, Dr. Charles Bancroft, served as supervisors at the hospital for the next 60 years.

When Dr. Charles Bancroft retired in 1917, NHH had transitioned to a state institution, with a population of more than 1,200 patients. New buildings were constructed — the Thayer building in 1907, the Walker in 1917, the Brown in 1924 and the Tobey in 1930, many of which exist today and house state offices. Shagoury said records show that in 1938 more than 2,000 patients lived at NHH, and the Annual Report to the legislature in 1939 declared the facility “overcrowded.” The hospital looked to expand to a second campus, within 10 miles of Concord, but the proposal was rejected by state officials.

According to Shagoury, the population at NHH climbed every year until the high-water mark in 1955, when over 2,700 patients resided there.

“At times in the 1940s and early 1950s, every psychiatrist had on average more than 250 patients to treat,” said Shagoury. “It became impossible to provide any type of individual care.”

A dramatic change

Shagoury said major changes began to take place in the 1950s. Over the next 30 years, the patient population of NHH dipped from 2,700 to less than 500. By 1990, the population was less than 300, representing a total decrease of more than 90 percent.
Shagoury credits the changes to new treatments being developed.

“New medications like Thorazine were being introduced,” said Shagoury. “They were very effective in alleviating the worst symptoms of severe mental illness in many patients. By the 1960s they were in wide use, and that meant patients now had the chance to live outside the hospital.”

In 1963 the Community Mental Health Centers Act was passed by Congress, opening the door to what Shagoury termed a “bold new approach” to mental illness that included a wide range of services in the community. In 1968, Medicare allowed the disabled mentally ill to receive an income — meaning many could afford to live outside the hospital, leading to what Shagoury called “deinstitutionalization.”
The current NHH building was opened in 1990, and a contractual agreement with Dartmouth Medical School put in place management services there. Shagoury said it now houses 145 patients a day, on average.

Old mixed with new

Today, a quick walk around the grounds of the Governor Hugh J. Gallen State Office Park in Concord allows visitors to see many of the asylum's original structures, which now house state officials instead of patients suffering from mental illness. One of the few buildings not in use is the Bancroft Building, the second structure ever constructed on the site, erected in the 1880s. In its current state of disrepair, it more closely resembles a haunted house than a hospital.

“Sometimes I can feel the ghosts watching when I go past this place,” said Shagoury.

The current hospital facility features a greenhouse (where patients tend plants that are frequently sold in the gift shop), a Fresh Air area (where patients can access the outdoors in a quiet, restful setting), and a child and adolescent area (a newly-renovated wing of this section is expected to open for young patients on Tuesday).

Community mental health centers offer regular day-to-day treatment for those with mental illnesses. The average stay for a patient is now about a week. Each patient receives a team of caregivers, consisting of a psychiatrist, registered nurse, mental health worker, doctor, social worker and recreational or occupational therapist.

Shagoury feels the future of the hospital, and the care it provides, is a bright one.

“The hospital is a reflection of society's attitude toward mental illness,” said Shagoury. “The anniversary is a celebration of the efforts over everyone here who, over the years, have worked to help those with suffering with it live a fuller life.”


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