The first two patients were admitted to what was then called "Southwestern Lunatic Asylum" on May 17, 1887. By 1906, there were 507 patients treated at an annual operating cost of $71,693.96. Several improvements were made to the facility to alleviate over crowding: In 1908, a tubercular building was erected and housed 50 patients. In 1930, a 100-bed building was erected (known as the Harmon Building). In 1935, a building for the criminally insane was added with an average annual population of 138 inmates. Additionally, twelve hundred acres were rented out for farming.
By 1935, the facility became known as "Southwestern State Hospital." The average patient population had also grown to 1,339. By 1964, there were 1,493 patients -- staff numbered just 513. As deinstitutionalization took place, the patient population decreased to 1,266 in 1972 and by 1981, there were just 500 patients. In 1986, demolition commenced on the original Henderson Complex and construction of Southwestern Virginia Mental Health Institute (SWVMHI) began.
On March 9, 1990, all adult and geriatric patients were moved into the new SWVMHI. Sixteen adolescent beds remained in a separate building. And even though the status of the facility changed from hospital to institute, SWVMHI continued to serve as the primary hospital for patients requiring substance detoxification, and as backup to Catawba Hospital and Southern Virginia Mental Health Institute for adult and geriatric patients.
SWVMHI has formally housed forensic patients since around 1935. In the late 1960's, the Finley Gayle Building was constructed for the criminally insane, a secure building similar in construction to that of Central State Hospital's Forensic Unit. In the early 1980's, the population was divided and the Department of Corrections began receiving adjudicated patients/inmates, and SWVMHI kept the patients who had not been adjudicated (e.g. those in local jails awaiting trial, those sent here for restoration of competency and those deemed "not guilty by reason of insanity," or NGRI.) The Department of Corrections eventually took over the maintenance of the Finley Gayle building and it is now known as Marion Correctional Treatment Center.