Central State Hospital (Georgia): History, Current Status, and Legacy

Table of Contents#

1. Origins and the Progressive Era (1842–1900)
2. Peak Operation and Crisis Years (1900–1960)
3. Deinstitutionalization and Decline (1960–2010)
4. Current Status (2010–Present)
5. Cultural and Historical Legacy
6. Frequently Asked Questions
7. References

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Origins and the Progressive Era (1842–1900)#

Chartered in 1837 and opened to patients in 1842 as the Georgia State Lunatic, Idiot, and Epileptic Asylum, CSH was established as part of the national "moral treatment" movement, which rejected the common practice of locking people with mental illness in jails, attics, or unregulated poorhouses. Milledgeville was chosen as the site because it was Georgia’s state capital at the time, making the facility centrally accessible for families across the state.

• Early operations prioritized humane care: patients had access to outdoor recreation, farm work on the facility’s 1,000+ acres of agricultural land, and structured social activities, which was radical for the era.
• By 1870, the facility was renamed Central State Hospital to reflect its regional service mandate, and it had expanded to serve 500 patients, making it the largest public mental health facility in the American South.
• For most of the 19th century, CSH was widely celebrated as a model for progressive care, with state leaders from across the South visiting to replicate its operational model.

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Peak Operation and Crisis Years (1900–1960)#

The turn of the 20th century brought overwhelming demand for CSH’s services, driven by post-Civil War trauma, rapid urbanization, immigration, and the rise of the eugenics movement, which advocated for the institutionalization and forced sterilization of people deemed "unfit" for society.

• By the late 1950s, CSH averaged over 11,800 inpatients, making it one of the largest psychiatric hospitals in the world (contending with New York’s Pilgrim Psychiatric Center for the title). It employed just 1 full-time psychiatrist for every 5,000 patients, and 80% of its staff were untrained laborers.
• Horrific conditions were exposed in a 1959 exposé by Atlanta Constitution reporter Jack Nelson, titled The Shame of Georgia, which won the 1960 Pulitzer Prize for Local Reporting. Nelson documented overcrowding so severe patients slept in hallways and shower stalls, routine physical and sexual abuse by staff, untreated medical conditions, and more than 3,000 unmarked graves of patients on hospital property.
• Records later confirmed that more than 3,200 people were forcibly sterilized without consent as part of Georgia’s state eugenics program, which operated from the late 1930s through 1963. Many of these procedures were performed at Milledgeville State Hospital (CSH’s name at the time).

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Deinstitutionalization and Decline (1960–2010)#

The public outcry from Nelson’s exposé, combined with the rise of psychotropic medications that allowed many patients to live outside institutional settings, and the 1963 federal Community Mental Health Act, triggered a decades-long deinstitutionalization process at CSH.

• State officials began moving patients to smaller community mental health centers across Georgia, though underfunding of these community programs meant thousands of former CSH patients ended up homeless or in the state’s criminal justice system, a gap that persists today.
• By 1980, CSH’s inpatient population dropped to 3,000. By 2010, only 200 patients remained on campus, and more than 90% of the facility’s 200+ buildings were abandoned and boarded up.
• In 1997, a cemetery restoration project began at Central State Hospital, creating a nationwide movement to memorialize patients buried at state psychiatric facilities. The project has worked to identify the names of patients buried in unmarked graves and install permanent memorials for them. As of 2024, the project has identified more than 6,000 of the estimated 25,000 people buried on CSH property.

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Current Status (2010–Present)#

Today, the CSH campus is split between active mental health operations, historic preservation work, and mixed-use economic redevelopment:

1. Active clinical services: The Georgia Department of Behavioral Health and Developmental Disabilities operates a 182-bed maximum secure forensic facility on campus—the Payton B. Cook Building—as well as Central Care Community Services, which provides staff-supervised residential homes in the community. The forensic facility serves individuals referred from the state’s criminal justice and corrections systems, including those needing pre-trial evaluations, restoration to competency, and treatment under Not Guilty by Reason of Insanity commitments.
2. Redevelopment: The Milledgeville-Baldwin County Development Authority purchased 1,500 acres of the unused CSH campus in 2015 for the Central State Campus Redevelopment Initiative. As of 2024, 22 historic buildings have been repurposed for office space, a regional film studio, small business incubators, a veteran care center, and educational programs run by nearby Georgia College & State University. The project has created more than 1,100 local jobs to date.
3. Public access and preservation: The preserved cemetery and a small historic museum on campus are open to the public. Seasonal guided tours of the historic abandoned buildings are offered by local preservation groups, though most derelict structures are closed to visitors due to safety hazards.

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Cultural and Historical Legacy#

Central State Hospital is widely viewed as a critical case study for both the failures of large-scale institutional mental health care and the gaps of poorly implemented deinstitutionalization. Its history has directly shaped modern Georgia mental health policy, including the 2022 Georgia Mental Health Parity Act (HB 1013), which requires many private health insurance plans and all Medicaid health insurers in Georgia to cover mental health care at the same level as physical health care. Survivor advocacy groups also continue to push for formal state apologies for the forced sterilizations and abuse that occurred at CSH, as well as ongoing funding for the cemetery preservation project.

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Frequently Asked Questions#

Q: Can I visit Central State Hospital in Milledgeville?#

A: Active clinical areas are restricted to patients, staff, and approved visitors, but the historic cemetery, memorial sites, and small on-site museum are open to the public free of charge. Guided tours of abandoned historic buildings are offered seasonally by local preservation groups for a small fee.

Q: How many people were treated at Central State Hospital over its history?#

A: State records estimate that more than 200,000 people received care at CSH between its 1842 opening and 2024.

Q: Has Georgia ever apologized for the eugenics practices at CSH?#

A: As of 2024, the Georgia state legislature has not issued a formal apology for forced sterilizations at CSH, though multiple resolutions have been introduced to do so since 2015.

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References#

1. Georgia Department of Behavioral Health and Developmental Disabilities. (n.d.). Central State Hospital (CSH) Milledgeville, GA. Retrieved from https://dbhdd.georgia.gov/be-caring/central-state-hospital-csh-milledgeville-ga
2. Payne, David H. (2006, last edited 2025). Central State Hospital. New Georgia Encyclopedia. Retrieved from https://www.georgiaencyclopedia.org/articles/science-medicine/central-state-hospital/
3. Hargrett, Elizabeth. (2019). Eugenics in Georgia. New Georgia Encyclopedia. Retrieved from https://www.georgiaencyclopedia.org/articles/government-politics/eugenics-in-georgia/
4. Visit Milledgeville. (n.d.). Cedar Lane Cemetery at Central State. Retrieved from https://www.visitmilledgeville.org/listings/cedar-lane-cemetery-at-central-state/41919/
5. Georgia Trust for Historic Preservation. (n.d.). Central State Hospital. Retrieved from https://www.georgiatrust.org/places-in-peril/central-state-hospital/