“In Philadelphia, the sovereign Commonwealth of Pennsylvania maintains a dilapidated, overcrowded, undermanned mental ‘hospital’ known as Byberry. There, on the stone wall of a basement ward appropriately known as the ‘Dungeon,’ one can still read, after nine years, the five-word legend: George was kill here 1937.” –
Life Magazine, 1946
In 1903, the Commonwealth of Pennsylvania enacted the “Bullitt Bill,” which required each county to build and maintain a facility exclusively for the care of mentally ill patients, who couldn’t afford treatment. The Blockley Almshouse on the west bank of the Schuylkill River (present site of the Children’s Hospital of Philadelphia) was an institution built during the Quaker revival of the 1830s. After the Bullitt Bill was activated, Blockley quickly became the city’s ‘dumping ground’ for individuals who had nowhere to go, such as the homeless, TB sufferers, alcoholics and those deemed mentally ill and were referred to as inmates. In 1960, Blockley was experiencing difficulty with maintaining the growing population, as buildings were too outdated to accommodate the facility’s patients.
Meanwhile, the City of Philadelphia purchased farmland in the northeast section of the county for its Holmesburg Prison farm. The inmate run farm was meant to supply food for other public institutions in the city and became known as ‘Byberry farms’.
The doctors of the insane ward at Blockley experimented at Byberry farms, conducting what became known as the ‘colony’ plan. The plan was originally meant for Tuberculosis patients, transferring Blockley’s TB unit to Byberry, where there was more room. The experiment was considered a success, as TB patients received fresh air and the exercise they needed, making them happier as a result. Soon, more patients were sent to Byberry leading to an increasingly overwhelming number of individuals at the farm. To combat this, the city planned to open a new hospital, but the city’s surveyors decided that it would be easier to expand Byberry Farms.
By 1911, with $261,000 in city grants, Byberry Farms had expanded into a multi-building campus effectively relieving overcrowding in other mental facilities in the area. The population of patients grew so fast that the facility couldn’t entice enough staff to work there. Soon, facility administrators were hiring anyone who needed a job, despite a lack of qualifications. At the same time, close to 3,000 conscientious objectors of World War II, who chose not to fight for religious reasons, were sent to work at mental hospitals around the country. It was largely due to the accounts of some of these individuals that the abusive conditions at Byberry were brought to light.
While some of the staff was dedicated to caring for the patients, a number of bad employees mistreated and exploited patients. In 1919, two orderlies confessed to strangling a patient “until his eyes popped out”, blaming their actions on PTSD, which they claimed they acquired during World War I. They weren’t prosecuted and were kept on staff after receiving a pay raise) Also due to understaffing, there was an extremely low orderlies to patients ratio, which caused housekeeping to fall behind. This resulted in residents often left unbathed and naked, and instead of tending to the patients, staff put them in four-point restraints, sometimes for months at a time.
Conditions were so deplorable for the 6,000 patients housed there, that a photographer, disguised as an attendant, snuck in and took photos exposing how horrible the situation was –water was running down dormitory walls, urine puddled beneath beds, patients sitting on floors in soiled clothing because there were no chairs, and overcrowded, dirty rooms! Shortly after the newspaper published the story, the state took over Byberry and renamed it Philadelphia State Hospital. Yet despite new buildings and amenities, such as a bowling alley, the hospital was still understaffed which enabled the neglect to continue.
In the 1950s, 10 patients died as a result of neglect. Between 1960 and 1970, another 10 died.
During a surprise September 1986 visit, inspectors from the federal Health Care Finance Agency cited the hospital for a shortage of nurses and complained about the housekeeping of the facility, due to an inadequate supply of toilet paper and rooms smelling of urine. In 1987, a report was provided to the state written by a staff member of the Mental Health Association of Southeastern Pennsylvania, based on interviews with unidentified hospital employees. These employees, some of whom had been pleading with officials for assistance for years, alleged that patients were overmedicated to compensate for inadequate staffing, put in restraints too often and beaten by staff members. Other allegations included the pulling of teeth without Novocain and a physician so arthritic, he couldn’t help a choking patient. Because of staff shortages, daily activities of living (i.e. showering, shaving and changing clothes) were often neglected. From these events, the Governor at the time initiated an investigation of the hospital. In May of that year, an appointed task force called the Blue Ribbon Committee evaluated the hospital’s treatment of patients to look into allegations of abuse.
Cases of patients killing other patients began to increase, as Byberry also housed many criminals who were sent there to undergo psychiatric testing in lieu of prison. One female patient was raped, killed and discarded on the property by a fellow patient in 1987. The staff only discovered her body after other residents were found carrying around her teeth. More dead patients were found on the property, including one patient who had been missing for close to five months. It appeared that there were a few residents who simply ‘went missing’ and the staff didn’t have time (or didn’t care enough) to look for them.
By December, a press conference was held concerning the closing of the hospital based on “atrocious” and “irreversible” conditions. The new Governor, Robert Casey, Sr., ordered the closure of the hospital. Yet, even with the controversy surrounding the facility, many patients’ families were opposed to the closure, believing that many people didn’t understand how severe their relatives’ illnesses were. There was rampant fear that the people who lived there would wind up on the streets.
Midway through the closure process, advocates had been promised that the funding originally allocated to Byberry would go towards patient care. In 1989, advocates were given a budget of only $16 million – millions less than was needed to care for the people in the community. Shortly thereafter, three discharged patients died by suicide causing Gov. Casey to delay the closure. Due to these deaths and budget concerns, there was less confidence regarding the closure of the facility. However, many individuals thought closing the facility would be the right course of action for the City. Psychiatrists and former patients formed the Coalition for a Responsible Closure to ensure the availability of sufficient resources for the remaining 530 patients who would now have to find new homes. On June 21, 1990, the hospital closed permanently, and Philadelphia had an entirely new system of alternative care based on a new budget of $50 million – advocated for by the Coalition.
Philadelphia was the first city to close a state hospital and relocate residents to the community instead of other institutions.
The Byberry closure was a pioneering moment in transitioning people to community-based services. Since then the city has revitalized its efforts towards supporting those with mental illness, implementing research-based practices and improving the effectiveness of treatment.
Philadelphia has since taken a position at the forefront of mental health awareness, partnering with the interNational Association of Peer Supporters (iNAPS) in 2016 and hosting the International Initiative for Mental Health Leadership in 2016 and 2017. Additionally, the City’s efforts to normalize mental health disorders (through such initiatives like the ‘Get a Check-Up from the Neck Up’ campaign, which hosts mental health screenings in public spaces and #IWillListen Day, which is based on the belief that through listening and understanding everyone can play a role in reducing the stigma associated with mental illness), has drawn International praise.
Philadelphia is a great example of learning from the past in order to have a greater impact on the future.
- Asylum Projects. Philadelphia State Hospital.
- Dowdall, George. Byberry (Philadelphia State Hospital). The Encyclopedia of Greater Philadelphia.
- Kelly, Erin. Inside Philadelphia’s Byberry Mental Hospital House of Horrors. ati. 2018.
- Philadelphia State Hospital. The Story of Byberry, an American nightmare. 2017.
- Spikol, Liz. They Survived Byberry. Philly Mag. 2015.