In 1824, New York state's Monroe County founded its first poorhouse to care for "the raving maniac, the young child, the infirm old man, and the seducer’s victim." Although poorhouses (also known as almshouses) were milestones in caring for the indigent, they were often rife with problems; the mentally ill, criminals, orphaned children, and those with any kind of disability were all placed under one roof without any kind of specialized treatment. This institution was the footprint of what was to become Rochester State Hospital.
In 1843, the first state funded asylum for the insane was opened in Utica, NY. Many asylums would follow after the valiant efforts of Dorthea Dix, who pushed for the humane treatment of the mentally ill and moving them out of the almshouses and into specialized state hospitals. In the mid-1840s she visited the Monroe County House at Rochester, and reported of the good condition of the building and residents. She described the facility as being well arranged and neatly kept, and of the patients being confined in reasonably sized cells with a bed. These positive reports allowed Monroe County to operate the almshouse instead of having to send patients to the state asylum at Utica.
A division of the almshouse was opened in 1857 to cater for the mentally ill population, named the Monroe County Insane Asylum. The $40,000 addition held 48 inmates and was reputed to be a good institution governed by a kindly superintendent (Dr. Lord), with housework, crafts and farm chores as activities, as well as indoor games, music, and dancing for entertainment. However, by the 1870s, moral treatment had fallen into disuse as overcrowding became a major issue.
In 1890, New York state passed the State Care Act, providing for the establishment of state funded psychiatric hospitals; in counties with existing asylums, the state offered to buy and operate them. On July 1, 1891, Monroe County sold the asylum to NY state for $50,000 where it became Rochester State Hospital. An additional $140,000 was spent to expand the institution from 300 to 500 beds by constructing a group of buildings in 1902. By 1916, the hospital was already caring for 1,505 patients with only a capacity of 1,268 beds.
Instruction in rug weaving, embroidery, reed weaving, washing and ironing was administered with success even in "hopeless" cases, as described in an early annual report. The hospital operated a school of nursing from 1890 to 1973. In 1960, RSH had about 800 admissions for the year. The hospital was re-named as the Rochester Psychiatric Center after the mid-1970s; although the facility still operates this day, some buildings were closed in the mid-1990s; mainly the Walters Building (originally known as the Orleans Building) and the Terrence Building, a massive 15-story medical center.
