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Maine's Latest Psychiatric Hospital

September 01, 2005
Maine Insane Hospital/Augusta Mental Health Institute
L ocation: Augusta, Maine
Capacity: Designed for 30 patients
Cost: $20,000
Opened: 1840

Riverview Psychiatric Center
Location: Augusta, Maine
Capacity: Designed for 92 patients
Cost: $22 mill ion
Square Feet: 125,000
Opened: 2004
It was 1840 when the doors opened to the Maine Insane Hospital , later renamed the Augusta Mental Health Institute (AMHI). Nearly ten years passed from the time the state legislature appropriated $20,000 for the construction to the day the first patient arrived. It would be 164 years before the last patient would leave and a new facility wou ld take its place. This is the story of the transformation of a mental health “institution” from state-of-the-art in the 1840s t o state-of-the-art at the turn of the 21st century.

Ahead of Its Time
Originally built to care for ju st 30 patients, AMHI was constructed on a pastoral setting overlooking the Kennebec River in the recently relocated capital of Augusta. The hospital was carefully sited within clear view across the river from the statehouse so each successive governor and members of the legislatu re would never forget the hospital or those cared for there.

The mid-19th century saw a number of majestic American asylums construct ed, and they became a source of great pride within their communities. The new hospital in Augusta was a national model with state-of-the-art technology: It had a ventilation system, a central heating system, gas lighting, and running water. Male and female patients had dedicated wings. Neighboring residents of New Hampshire were inspired to follow suit two years later. They opened a similar facility also located a st one’s throw from the state capitol.

During the period when AMHI was built, a revolutionary new treatment concept was introduced —moral management.” The premise was that the environment could play an important role in the treatment of people with men tal illnesses. Shackles, chains, and dark cells were being replaced with picturesque settings and grand institutions. After centuries of bru tal treatment of people with mental illnesses, this treatment philosophy finally started to make an attempt at improving patients’ dai ly conditions. Treatment methods in Maine that first year touted “prayer and Bible reading, farm labor, good food, and clean living co nditions.”

Unfortunately, it didn’t take long before a national overcrowding crisis became epidemic. Like most asylums of the 19th century, the limitation of current treatment methods mixed with constant overcrowding. The outcome was often dismal. It wasn’ ;t long before the original compassionate missions gave way to the reality of being overwhelmed by the sheer numbers of a diverse patient po pulation. Like the situation at similar facilities in other states, the census at AMHI grew until eventually 1,800 individuals crowded onto the original pastoral setting. Across the border in New Hampshire, the census peaked at 2,700 patients.

Initially the Civil War cause d a flood of new patients suffering from what we now know as post-traumatic stress syndrome. On top of that, the asylums became a depository for the poor, for elderly that families couldn’t care for, and for social outcasts. Overcrowding continued to escalate through the 19 50s.
Same Vista, but a New View
In 1 988, New Hampshire built a new inpatient mental health treatment center to replace the facility constructed soon after AMHI was built. In 20 00, Maine consulted JSA, Inc., who had designed the new facility in New Hampshire, to help plan a new national model, once more in Augusta. Directly across the lawn from AMHI, still within direct view of the state capitol, the new facility has opened recently: Riverview Psychiatr ic Center, so named because every bedroom has a view of the Kennebec River valley. In June 2004, the last patient moved out of the original gray granite building (AMHI will be reused in some other capacity by the state).

Riverview represents the next generation of treatmen t centers, designed with sensitivity to create healing environments while being always mindful of staff and patient safety. Creating therape utic environments that respect the dignity of the individual patients was paramount in the design philosophy at Riverview. The goal was not to create a large institutional facility, but instead to treat the center as a village of diverse components that individually addressed eac h functional need while maintaining a human scale.

A large inner courtyard supplies treatment areas and major corridors with sunlight and creates opportunities for outdoor dining, relaxing, or gardening. Larger, secure, and easily monitored, yet discreet, courtyards off th e residential wings allow frequent chances to step outside for a breath of fresh air or to get some exercise.

The unique functional a reas are treated as “separate but connected” buildings. There is an administrative office building, a recreation center, pitched -roof housing, a support/service building, a public meeting center, etc. The scale, mass, and materials of each of these diverse areas inten tionally change to reflect the use within.

The inpatient housing is discreetly located away from th e public areas. Each patient has a private bedroom with a picturesque view of the river valley; rooms are grouped in eight quiet, well-super vised units. Choices of accessible day spaces also are available within the residential wings.

The key environmental aspect of contem porary mental health design is to provide a comfortable, normalized environment without compromise to safety and security. The concrete bloc k or glazed tile walls of the past have been replaced with impact-proof, Mylar- or steel-mesh–backed drywall that looks like any wall in your home but is impenetrable. Barred windows are gone, replaced with clear but unbreakable safety glass. A central security hub discreet ly keeps watch and quietly controls movement throughout the center.

A key problem encountered in 19th-century institutions was how to positively and therapeutically occupy patients’ days. Offering a treatment mall with art studios, a library, a teaching kit chen, a computer lab, quiet lounges, a hair salon, a greenhouse, as well as medical and dental services, is the modern-day solution. There i s also a large, bright café with indoor and outdoor dining, a gymnasium and exercise room, a chapel, and a large multipurpose activity hall.

“Contemporary standards of care are much more cognizant of the needs of individuals. It’s the little things like ha ving the autonomy to move about, from one’s room to the courtyard for some sunshine, or having the freedom to walk to the café fo r a meal, that have made a huge difference in client and staff morale,” says David S. Proffitt, Riverview superintendent.

“Our goal is to create an environment of support and hope for our patients,” remarks Marya Faust, director of special initiatives and program manager for Riverview. “This place is all about respect for people who have mental illness and providing them an environment where they feel safe and cared for. The natural la ndscape reflected in the artwork and design brings the outside in and promotes healing.”

“This new building is a powerful statement about the state’s commitment to improving services for people with mental illness and reducing the stigma associated with m ental illness,” states Maine Gov. John Baldacci. “Architecture plays a strong role in shaping the environment and expectations. This building is about hope, recovery, light, and respect.”

So how has the transition been across the great lawn fr om the old fortress-style hospital to the brand-new, state-of-the-art Riverview facility? “Many patients have sought me out directly t o tell me how much they like the new building,” remarks Proffitt. “With a light, clean, engaging environment, you’re going to feel better. When clients’ expectations are positive, they are going to expect great success.” It’s that positive atti tude that leads to hope, healing, and recovery. BHM

Todd Hanson, AIA, is a Principal at the JSA, Inc. , office in Portsmouth, New Hampshire. JSA is a nationally recognized architecture, planning, and interior design firm and winner of more th an 50 awards. Hanson can be reached at (603) 426-2551, and more information on JSA is at ww
To send comments to the author and editors, please e-mail hanson090 To order reprints in quantities of 100 or more, call (866) 377-6454.
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