Over the years, the hospital has been the subject of a number of scandals regarding the treatment of its patients and the quality, and effectiveness of the care provided.

As a result of these scandals, the vast increase in scientific and medical understanding of mental illnesses and the methodologies of effective treatment thereof, the hospital has undergone numerous transitions in the past century.

The report details the search and evaluation for a site to construct an insane asylum in eastern Washington State by the Board of Commissioners and how Medical Lake was the preferred location.

For instance, Eastern State Hospital partners with several colleges and universities in the region to offer graduate program experiences for students.

It also protected them from the community, as mental illness was heavily ostracized and stigmatized in those days; though there is still a significant stigma today, it is much less than around the start of the 20th century.

Many of these new buildings were the result of Works Project Administration spending during the Depression, which sought to both create jobs and to ease the overcrowding.

Daisy Lewis, an attendant, gave an insulin shot to a woman who didn’t recognize her husband nor daughter and was "completely oblivious to reality."

The overuse is clear in the hospital’s statement: "During a two year period in the early 1950s, over 1,100 patients received one of the convulsive therapies; altogether, about 15,000 treatments were administered."

In World War II, treatments turned into "work therapy" for all those not residing in locked wards, or roughly 80% of the total patient population.

Patients worked between two and eight hours a day on a variety of tasks, including baking, farming, sewing, gardening, cobbling, landscaping, housekeeping, cooking, and many others.

Treatment began to incorporate Freudian theory of the causes of mental illness, and focused on an individual patient’s thought processes, formative experiences, and genetic factors.

On the front lines, these groups developed methods for first-response, short-term crisis therapy for those in distress to allow them to return to the battlefield.

While some saw the new use of pills to treat mental illness as little more than "chemical strait jackets," they allowed a large number of patients to be released and begin their reintegration into the community.

Treatment of the mentally ill today is increasingly done on an outpatient basis, and ESH focuses predominantly on more severe cases, as well as providing a space for group therapy and workshops.

Hospital employees took a group of 31 forensic ward patients on a supervised field trip to the Spokane County Interstate Fair.

While the fairgrounds were not shut down during the search, upon hearing of the escape, fairgoers were angered by the decision to bring a criminally insane patient to such a populated community event.

At the time of his arrest, Paul was reportedly carrying a backpack with food, clothing and personal items as well as a guitar, sleeping bag and hand scythe.

Outrage ensued amongst community members and law enforcement officials in the area because they claimed a man with Paul's criminal history and condition should not be permitted to go on the hospital field trips.

In 1990, Paul escaped from Eastern State Hospital and upon his detainment assaulted a Spokane County sheriff's deputy.

But while the worry and angst was alleviated with Paul's recapture, the anger and bewilderment of community members and authorities remained center stage.

For their part, Eastern State Hospital officials justified its decision to allow for Paul's inclusion in the field trip by pointing to his recent behavior.

Then-head of Eastern State Hospital Hal Wilson called Paul "a fairly model patient" and claimed "he's not acted out in any way".

Richard Kellogg, director of the Washington State Division of Mental Health Systems, said none of the seven employees were fired for their role in the incident, however.

The patients that are part of a civil commitment are allowed privileges such as, open campus, short term unsupervised leaves and more.