Most of what remains at Mayview State Hospital has been abandoned for years. The rusting rail line, the cottages that housed physicians, and the echoing brick buildings once lived in by thousands of patients are reminders of an era that soon will pass into history. Allegheny County's only remaining state hospital for people with mental illness closes tomorrow.
Just how much has changed in these waning days at Mayview is vivid in movie footage from the 1930s.
On the screen, a movie clatters jerkily as a camera pans through wards where spare, white beds are chockablock. The lens pauses on the turretted face of a Victorian building long ago demolished. Grainy footage shows men and women staring dimly from rows of chairs in an airy parlor.
The camera recorded patients being packed in cold and warm compresses -- treatments from an era before antipsychotic medications. Patients are shown working the farm fields to produce the once self-sustaining hospital's food, hopping in sacks, and pillowfighting from atop barrels during hospital game days.
"We'd be put in jail today. We would be accused of patient abuse," said the Rev. George DeVille, an amateur historian and former chaplain at Mayview. "You couldn't get away with that today to save your life. I mean it was a different time."
Very different. In due course, the stories captured on that faded 16 mm film will be of a world vanished.
It was a time when hospital picnics could include raucous games and patients were set to work growing their own food, and doctors and aides used straitjackets and warm baths and sheer force of persuasion to help a population that once included the mad, the elderly, the depressed and, in its beginnings, the plain impoverished.
"They had a coal mine. They made their own steam. Electricity. They had a farm and probably grew about 60 percent of all the food they ate. They canned the food. They grew their own wheat and made their own bread," said Father DeVille. "It was certainly self-sufficient."
The era when mental patients dug the coal for the institution that sheltered them ended long ago. In later years, reforms in mental health law closed down the farms and canneries, and patients no longer worked the laundry after experts drew an uncrossable boundary between work and treatment.
"When they took the work away, it was very troubling to some of the patients. They were satisfied where they were," Father DeVille said.
In turns, as treatment philosophies changed, the hospital, with 80 buildings dotting 1,001 acres in South Fayette, began to wither. Today a handful of buildings still run. At last measurement, the grounds encompassed 335 acres.
Mayview is passing, and not altogether quietly.
State officials insist the closure represents progress, a new day. Critics suggest that some of the mentally ill sent into the community won't flourish as promised.
"It's absolutely a wonderful thing that this hospital is closing," said Mary Jeanne Serafin, the hospital's chief executive officer and a longtime veteran of both Mayview and the now closed Woodville State Hospital.
"What we know today about people who have mental illness is that they really do much better, they recover much better in an environment that is inclusive of the community and that they get other kinds of supports and services in the community that were not able to be duplicated in this environment because of its isolation from the community."
That isolation, now coming to an end, was once thought Mayview's strength.
It entered the world in 1893 as Marshalsea, so-named for the famous London debtors prison in which Charles Dickens' father was once held.
Built as a successor to Pittsburgh's almshouse and relocated from the banks of the Monongahela, Marshalsea became a place to which the poor, the orphaned, the unwed pregnant, the tubercular, were sent, living alongside the city's insane, mentally retarded and members of the population who were merely inexplicable.
Most of the remaining old buildings at the South Fayette site are vacant; only a few dozen patients are left, and soon, they will be gone. The hospital is the remnant of a time when experts believed people with mental illness were best cared for in large institutions, often in rural settings.
Many around the state closed as medications improved and government policies and court decisions increasingly directed people with mental illness to live in group homes or other community settings.
Father DeVille, who served as chaplain at Mayview from 1992 to 2000 and at Woodville State Hospital in Collier in the three preceding decades, remembers patients who were largely forgotten in that system of care, where lengths of stay often lasted years. But for him, the Mayview closing still evokes some nostalgia.
"It's strange, but I fell in love with the patients. Even when they beat me up," he said.
They did that, sometimes. The hospital began long before the days of psychotropic drugs. Cold packings, and thermal baths and steam cabinets were common. Two former Mayview nurses, Marion Franks and Josephine Walsh watched the film with Father DeVille 15 years ago, and their comments were recorded. They reeled off names and, sometimes, recalled folks who were defined by their task at Mayview.
The man who gave water treatments to calm patients flickered on the screen.
"We called him Hydro Miller," Mrs. Franks said.
Some patients were packed into heating machines, their heads jutting out and wrapped in ice to prevent seizures. The treatment was meant to kill syphillis, an incurable disease 75 years ago. An ultraviolet lamp treated skin ailments.
"We did very well for what we knew, you know what I mean?" Mrs. Walsh said.
What they knew changed exponentially as the mysteries of the mind were unlocked by medical science. Mayview moved from an almshouse to a hospital in a transition that mirrored changes in society, developments in medicine and the arc of history.
As Pittsburgh grew in the early years of the 19th century, an economic depression followed. The city needed a poorhouse. A building was completed in the newly incorporated City of Pittsburgh. It held a population of 30.
By 1846 the city was scouting sites for a new almshouse. Roughly 150 acres were acquired along the banks of the Monongahela and a three-story brick building was built to hold 300. It lasted until the end of the century. With a burgeoning population and a conviction that rural settings were healthier, especially for tuberculosis patients, the city made plans to build well outside its boundaries.
Land along the Monongahela was valuable. In fact, after opening Marshalsea, the city sold its almshouse acreage to the Carnegie Steel Company for $450,000.
The city bought the George Neal Farm in what is now South Fayette, and set up a rail station.
A separate building for the insane was erected, and in 1899, a physician was assigned to the insane department.
"They didn't really care about political correctness and it was the poorhouse," said Father DeVille, who assembled the hospital's history from its early days in the city. "People, too, were very unhappy at supporting the poor."
By 1900, the hospital's reputation as a place of sorrow was firmly established.
The Home Monthly, a publication of the time, described the inmates at Marshalsea this way: "Poor wrecks of humanity they are -- some mental, some physical, some moral wrecks -- stranded, at last dependent upon the city for enough to keep a miserable broken body and a poor shrunken soul together. ... If there is to-day a discontented man or woman in this city I prescribe a trip to Marshalsea. The blood may flee from the face at times and pity clutch at the heart strings."
So thoroughly did this name stick that Father DeVille remembered it from his days stationed at St. Rosalia Parish in Greenfield.
"I often wondered. All the old people referred to Mayview as Marshalsea. They never changed the name."
Years later, a contest was held to find a more suitable name. There were four finalists. The winner was Mayview.
Those days came back to Marion Franks and Josephine Walsh that day in 1993, as Father DeVille recorded their reactions as the old Mayview, the lost world, played out on a screen in front of them.
A nursery of small children flickered onto the screen. Mayview records show that, until 1940, unwed mothers were sometimes sent to the institution. Birth records at the hospital carried notations such as "mater amentes" (mother insane) or "illegitimus."
"I guess every once in a while, somebody had a child there," Mrs. Walsh said. Her voice drifted off.
"I wonder what ever became of them."
What will become of the Mayview population of today is also a matter of speculation, and the subject of sometimes strained debate between a state Department of Welfare committed to moving those with mental illness into the mainstream of community life, and families and advocates who worry that the discharges will consign their loved ones to overly restrictive halfway houses or neglect.
A series of deaths and other serious incidents -- known as "sentinel events" -- has underscored the worry.
In the space of 24 hours in October 2007, two former Mayview patients died violently.
Anthony Fallert, who had been released from the hospital in Spring of 2006, wandered from a South Side residence operated by Mercy Behavioral Mental Health. His body was found a day later in the Monongahela River. Authorities believe he had leapt or fallen from the Birmingham Bridge after leaving the facility.
In the year after his release from Mayview, Mr. Fallert had lived at facilities in Clarion County and New Kensington and with his mother in Allentown.
The day Mr. Fallert's body was being pulled from the river, another former Mayview patient, Ahson J. Abdullah, was struck by a train as he walked on the tracks near his home in Braddock.
Mr. Abdullah, who had been in and out of jail over the course of his life, had been a patient at Mayview's forensic unit, which handles mental health cases referred by the courts.
In all, state officials say 44 sentinel events have taken place among the region's mentally ill and critics suggest it could run higher. At the same time, the Department of Public Welfare says that of the 44 events cited, only three involved patients released from Mayview since the closure was announced Aug. 15 of last year and only 10 of the 44 cases had any prior history with Mayview.
Driving the move out of institutional settings is a philosophy diametrically opposite to the one that led to the construction of Mayview and its sister institutions at the end of the 19th century.
"Every person deserves the opportunity to be in the community and it's our obligation to provide them with the supports they need in order to make that successful," said Joan Erney, deputy secretary of welfare.
Ms. Erney oversees the state's Office of Mental Health and Substance Abuse Services.
Living life in the community, post-Mayview, is likely to take several forms, ranging from outpatient mental health services for patients in small group homes to Long Term Residential Services -- homes for a dozen or so patients in residential neighborhoods. In those settings, former Mayview patients would receive 24-hour care from health professionals as they are eased back into the community.
Patients who relapse, or require institutional care, would be referred to any of a number of hospitals, ranging from Western Psychiatric Institute & Clinic to, if needs be, Torrance State Hospital in Westmoreland County. Mayview's forensic services patients, about 20 in all, have already been transferred to Torrance.
Barry W. Fisher, who chairs the state hospital committee of the Pennsylvania Psychiatric Society, said the closures of Mayview and several other state hospitals is part of a general shift from institutionalizing patients and moving those with mental illness into the general community. That shift, he said, has gone back and forth since the 19th century.
"What they will tell you is that state hospitals are the old way of doing things," he said. "The dirty little secret is there are some patients who need state hospitals."
Among the strongest critics of the closure is Suzanne Vogel-Scibilia, a psychiatrist in Beaver County and past president of the National Alliance on Mental Illness.
"Every state that's done this has had problems," she said.
The crux of the dispute revolves around whether communities are equipped to receive the patients, either in small group residences or more strictly supervised Long Term Supported Residences. State officials say former Mayview patients will receive priority on in-community mental health treatment.
Some, such as Dr. Vogel-Scibilia, worry that this influx -- which has spread over the past two years as Mayview began to empty -- will displace others in need of service.
"I can't get intensive case managers for my patients," she said. "People wait weeks or more to get in with a psychiatrist. There's a huge number of people to be seen and very few doctors."
The view isn't shared by Gerard Mike, administrator of Behavior Health and Developmental Services of Beaver County, the county's mental health agency.
He acknowledges a shortage of psychiatrists nationwide, but insists that people in his district who require a psychiatrist get one.
"There are those individuals who only want to see a doctor and I don't know that there's enough doctors to go around for everyone who only wants to see a physician," he said.
Psychiatric patients seeking an intenstive case manager -- a person assigned to actively monitor their progress and treatment -- must meet the criteria to qualify for one.
"Not everyone referred for case management is eligible for intensive case management," Mr. Mike said.
At present, he said, Beaver County doesn't expect problems, if only because of an influx of funding and an expansion of in-community treatment services.
The future, he said, will depend on maintaining the quality of services for a population that no longer will head to Mayview, but to treatment centers in the community.
Some communities have proven resistant to taking on the facilities intended to replace Mayview. This year, residents of Baldwin Township packed meetings to protest the planned reopening of the former Rolling Hills Manor Assisted Living Center.
Mercy Behavioral Health, which has a contract with the state to house 14 former Mayview patients, sought borough approval to reopen Rolling hills as a long-term care center, one of the LTRS facilities, as well as patients in need of critical mental health care.
Residents openly worried that the facility would make the neighborhood unsafe.
In the end, the township zoning board rejected Mercy's application after an attorney hired by the residents argued that the residential area permitted a nursing home but that the long term residence wouldn't meet that definition and should be consigned to a commercial district.
"When people buy homes and people choose to live where they live, zoning is a part of it," said the lawyer, John Arminas. "In a residential district, certain things are permitted and certain things are not."
In short, he said, the zoning law did not anticipate such a residence.
"This is the first place we have encountered this level of community opposition," said Mary Fleming, chief executive officer of Allegheny HealthChoices Inc., which was hired to act as a facilitator in the Mayview closing.
Ms. Fleming said the resistance underscores common misconceptions about those with mental illness, who she says are more likely to be victims of crime than perpetrators.
Rolling Hills, she said, "will be a locked facility. In many respects it's more restrictive than the hospital for many people."
Absent approval from Baldwin, Mercy Behavioral plans to open a single unit at the former Mayview as its long term residence service until something in a community is found.
In that sense, Mayview will linger, more fading out than closing abruptly.
Since the closure was announced last year, 259 of Mayview's employees have left for other state jobs or had job offers elsewhere. Some staff were asked to consider jobs at Torrance.
At a hospital that once housed 4,000, and where hundreds of friends and family members once poured out of trains on visiting day, picnic bundles in hand to visit patients, the patient census last week stood at 37.
Six were awaiting discharge that week alone.
Pennsylvania's experiment with ending institutionalization for its mentally ill was about to begin in earnest.
At his rectory in the Washington County town of Muse, Father DeVille wondered at the changes he credits to pharmaceuticals and philosophy.
Sometimes he meets former patients, always cautiously asking "Where do I know you from?" to avoid asking possible strangers if they were once in a mental hospital.
"I wouldn't say that they lead complete -- how to say it -- successful life, but it's more successful than it was in the hospital," he said. "It's a little above marginal, but they're surviving. And it's a better life."
TOMORROW. Where will the patients leaving Mayview go and how will they be treated? Post-Gazette Staff Writer Dennis Roddy contributed to this report. He can be reached at 412-263-1965 or firstname.lastname@example.org First Published December 28, 2008 5:00 AM