The South Carolina State Hospital, originally established as the South Carolina Lunatic Asylum, was authorized by the General Assembly in 1821, with its landmark Mills Building completed in 1827 in Columbia. Designed by nationally prominent South Carolina architect Robert Mills, the monumental brick structure represents an important early expression of institutional architecture and Classical Revival design. Its symmetrical composition, elevated basement, arcaded porticos, carefully planned wings, and fire-resistant construction reflected Mills’s innovative approach to creating a therapeutic environment rather than a prison-like institution. Patient rooms were arranged to receive sunlight and fresh air, demonstrating contemporary reform ideas concerning the treatment of mental illness.

The hospital opened its doors to patients in December 1828 and became one of the earliest publicly funded mental hospitals in the United States. Additions made in 1838 and 1842 by architect Samuel Sloan expanded the original Mills design while maintaining its overall architectural unity. The institution became an important center in the development of mental-health care in South Carolina, although later historical research has documented significant differences between the reform ideals of its founders and the experiences of many people institutionalized there. The Mills Building was listed in the National Register of Historic Places in 1970 and designated a National Historic Landmark in 1973, recognizing its exceptional architectural, medical, scientific, and social-historical significance.