[5] In 2007, the state of Oregon approved a $458 million plan to rebuild the main hospital to a downsized 620-bed facility,[a] which was completed in 2013.

[11] The newly built, state-funded hospital opened as the Oregon State Insane Asylum on October 23, 1883, and was constructed based on the Kirkbride Plan for a total of $184,000 (equivalent to $6,016,800 in 2023).

[12] Dr. Simeon Josephi was appointed superintendent of the hospital from its opening until May 1887, and strived to base his treatment methods on those used by Dr.

[16] In 1900, the hospital began to expand its campus, with two additional women's wards and four men's being added to the main building.

These tunnels allowed the hospital to move patients between buildings without the public observing and are marked by purple-colored[b] glass prisms embedded in the roads to provide lighting.

[20] While the narrow gauge railroad is no longer used, the tunnels were once used daily to deliver food, laundry, and other items—and occasionally patients—between different buildings.

[19] Few spurs or sidings were found on the railroad, so cars were simply stopped on the track where it was necessary to load or unload them, and then pushed away.

[23] The most common causes of insanity reported by the hospital at the time were "excessive living", liquor, narcotics, and venereal disease.

The disgrace felt by patients, as well as the humiliation of their relatives and friends, would be largely obviated by a correct understanding of the character and objects of the institution, and this would be conserved by the change suggested.

[16] In March 1966, the hospital added the Salem Rehabilitation Center to its campus with the intention of training long-stay patients into work relationships.

[30] The following year, in 1976, the hospital established the Child and Adolescent Secure Treatment Program for children, treating patients from age eight to eighteen.

[37] By the turn of the twenty-first century, the hospital began to experience criticism from the public over its aging facilities and patient care.

[39] Additionally, the newspaper reported systematic problems resulting in drug addicts and alcoholics being wrongly admitted, as well as severe understaffing and failure of the hospital to properly investigate and prosecute patient assaults against staff members.

[40] The same year, the hospital's Child and Adolescent Secure Treatment Program was dismantled,[35] and the Oregon Advocacy Center filed a federal suit alleging that overcrowding and understaffing posed a risk to both patients and staff.

[41] Another controversy at the hospital involved the fate of over 5,000 copper canisters of human cremated remains that had been kept in the basement of the original building over a period of decades.

[43][44] In 2007, the hospital was granted permission from the state to release the names of the deceased in hopes of returning the unclaimed remains to proper family members.

[46] In 2008, the United States Department of Justice filed a report which criticized the quality of care provided to patients by the hospital.

[49] Perez, who was listed as 5 feet 8 inches (1.73 m) and weighing over 300 pounds (140 kg), went missing on October 17, 2009, and was later found deceased in the hospital; an autopsy confirmed his cause of death as coronary artery disease.

[47] Salem mayor Janet Taylor has called for the number of beds to be reduced to 320 or fewer, and another hospital facility to be built in or near Portland.

Recovered items included earthen dishes, glass windows, a canning jar and a lamp chimney.

Also in 2022, a "contract employee" at the hospital was found abusing a patient - punching the patient several times in the head; however, a training document obtained by The Lund Report hinted the contract employee may have been an inexperienced member of the Oregon National Guard mobilized to assist in hospital operations due to continued overcrowding.

[62] Harris, head of Oregon Health Authority's Addictions and Mental Health Division,[63] held responsibility for state hospitals in Salem, Portland and Pendleton, in addition to the staff who work with county governments to deliver statewide mental-health and addiction services.

[40][66] In 1976, photographer Mary Ellen Mark and writer Kay Folger Jacobs were commissioned by The Pennsylvania Gazette to do a story on the hospital.