[3] In 1903 the Asylum was renamed the Utah State Mental Hospital, and in 1927 it adopted its current name in an effort to eliminate the negative stigma associated with the word “mental.” Long-term patients at the hospital engaged in work therapy, which gave them something to do and also made USH self-sustaining.

The hospital originally sat on 600 acres of land, and housed a dairy, a hay barn, and a piggery, as well as chickens, rabbits, and pigeons.

It was not uncommon to see mattresses lining the hallways, and the large surplus of patients made it difficult for staff members to focus their attention on individuals.

USH eventually adopted the practice that it still follows today: only those with severe mental illness are admitted for ongoing treatment.

USH now provides numerous therapy options, as well as a forensics unit to rehabilitate patients who have committed criminal acts or are accused but not competent to stand trial.

Some treatments involve physical and occupational therapy, while others, such as pediatric playgroups, community cooking, and outdoor youth activities, contribute to overall mental and emotional well-being.

[4] The governor of Utah is in charge of USH, but day-to-day operations fall under the direction of the hospital's superintendent.

The superintendent works primarily with Utah's Division of Substance Abuse and Mental Health (DSAMH).

The superintendent reports all major matters concerning hospital operations to the governing body during regular meetings.

The superintendent is responsible for hiring the members of the executive team and serves as a liaison with DSAMH, DHS, courts, the state legislature, and the governmental offices with which USH interacts.

The forensic-services division consists of four maximum-security psychiatric-treatment units and serves about 100 male and female patients.

Despite increased public awareness in recent years, there is still a negative stigma attached to mental health issues.

In addition, the stigma may affect the amount of funding that the hospital receives in comparison to other state institutions and projects.

The hospital also works with acute-care facilities such as the University Neuropsychiatric Institute and Salt Lake Behavioral Health.

USH cannot provide care without Medicaid funding, so it is essential that administrators understand and abide by the regulations.

Utah State District Court judges decide which individuals need to be admitted to USH and when they are ready to be discharged.

As superintendent, you and your colleagues will have to decide which of NAMI's initiatives you want to adopt and to what extent DSAMH and USH should implement them.

The Haunted Castle started off as a "closed" Halloween celebration event developed by the patients, but success with the activity eventually caused it to grow to a more public performance.

Additionally, many patients not able to interact with the public were allowed to help with construction/deconstruction of the facilities used for the spook alley.

The Utah State Hospital used popularity from the event to help raise public awareness of mental illness.

All proceeds from the Haunted Castle went into the Utah State Hospital's recreational therapy program to subsidize improved activities that directly benefited the patients.

The activity was permanently closed largely due to efforts by the National Alliance on Mental Illness (NAMI) who objected to the activity because they felt it served to stereotype the patients by linking mental illness with monsters and violence in the public's mind.

Several doctors, therapists, and patients at the hospital cited that the activity produced therapeutic results unachievable elsewhere which should be taken into account, but the Utah State Legislature determined that NAMI's objections were warranted.