Bryce State Mental Hospital

Bryce State Mental Hospital opened in 1861 in Tuscaloosa, Alabama, USA, and is Alabama's oldest and largest inpatient psychiatric facility. The hospital currently houses 464 beds for acute care, treatment and rehabilitation of full-time (committed) patients. Of those, 40 beds are certified by Medicaid for adolescent inpatient care. The Harper Geriatric Hospital, a separate facility on the same campus, provides an additional 100 beds for inpatient geriatric care.

History
The planning for a state hospital for the mentally ill in Alabama began in 1852. The new facility was planned from the start to utilize the "moral architecture" concepts of 1830s activists Thomas Kirkbride and Dorothea Dix. Architect Samuel Sloan designed the imposing Italianate building after Kirkbride's model plan. The construction was an important source of employment in Reconstruction-era Tuscaloosa. The facility was added to the National Register of Historic Places in 1977.

Dix's reformist ideas, in particular, are credited as the driving force behind the construction of the "Alabama Insane Hospital," which was later renamed for its first superintendent, Peter Bryce, a 27-year-old psychiatric pioneer from South Carolina. His tenure was marked by absolute discipline among the staff of the hospital. He demanded that patients be given courtesy, kindness and respect at all times. The use of shackles, straitjackets and other restraints was discouraged, and finally abandoned altogether in 1882. Various work programs and other activities were encouraged, including farming, sewing, maintenance and crafts. Between 1872 and the early 1880s, some of the patients wrote and edited their own newspaper, called The Meteor. These writings provide a rare inside look at life in a progressive mental institution in the late 19th century. At that time, Bryce's management and commitment to "scientific treatments" was recognized around the country as in a class of its own.



Decline
During the 20th century, however, the patient population expanded while standards of care fell to abysmal levels. Alabama Governor Lurleen Wallace was appalled after viewing the facility in February of 1967, and earnestly lobbied her husband, George Wallace (who held the actual power of her governorship) for more funds for the institution.

In 1970, Alabama ranked last among U.S. states in funding for mental health. Bryce Hospital at that time had 5,200 patients living in conditions that a Montgomery Advertiser editor likened to a concentration camp. That same year, a cigarette tax earmarked for mental health treatment was cut. 100 Bryce employees were laid off, including 20 professional staff. Members of the Department of Psychology at the University of Alabama attempted to file suit on behalf of the laid-off workers, but Federal Judge Frank M. Johnson ruled that the courts had no standing to intervene on behalf of fired employees. He left open, however, the possibility of a suit filed on behalf of patients, whose quality of care was affected.

Wyatt v. Stickney
Ricky Wyatt, a fifteen-year-old who had always been labeled a "juvenile delinquent" and housed at Bryce despite a lack of any indications of mental illness, became the named plaintiff in the class-action lawsuit that was filed on October 23, 1970. His aunt, W. C. Rawlins, was one of the employees that had been laid off. Together they testified about intolerable conditions and improper treatments designed only to make the patients more manageable. In 1971 the plaintiff class was expanded to include patients at Alabama's two other inpatient mental health facilities, Searcy Hospital (Mt. Vernon) and Camp Partlow (Coker). The resulting court-ordered agreements formed the basis for federal minimum standards for the care of people with mental illness or mental retardations who reside in institutional settings. In 1999 a new settlement agreement was made recognizing a great deal of progress. The case was finally dismissed on December 5 2003 with the finding by Judge Myron Thompson that Alabama was in compliance with the agreement.

The standards elaborated in that agreement have served as a model nationwide. Known as the "Wyatt Standards," they are founded on four criteria for evaluation of care:
 * Humane psychological and physical environment
 * Qualified and sufficient staff for administration of treatment
 * Individualized treatment plans
 * Minimum restriction of patient freedom.

The case of Wyatt vs. Stickney came to a conclusion after 33 years, through the tenure of nine Alabama governors and fourteen state mental health commissioners. This was the longest mental health case in national history. The State of Alabama estimates its litigation expenses at over $15 million.