Tucked against the foothills east of Provo, Utah State Hospital is located on 600 grassy acres where, on a balmy day in March, a half-dozen patients are out for a stroll.

It's nothing like the tumultuous insane asylums of bygone eras depicted in Hollywood movies such as "One Flew Over the Cuckoo's Nest," in which Jack Nicholson's character is cruelly subjected to electroshock therapy and, eventually, a lobotomy.

At Utah State Hospital, staffers smile, the patients seem cheerful and skylighted ceilings fill the corridors with sunlight.

"What goes on here is extremely positive," says hospital Superintendent Dallas Earnshaw, noting that mental illnesses have biological causes. "It doesn't have to be scary or stigmatized."

Headline-grabbing cases like the recent treatment battle of alleged Elizabeth Smart kidnapper Wanda Eileen Barzee - who is fighting forced medication before the Utah Supreme Court this week after four years at the hospital - are exceptions.

Six months was the median length of stay last year on the hospital's forensic unit, which houses about two dozen killers who share housing with defendants accused of shoplifting, stalking, forgery and substance-abuse-related crimes.

Patients doing civil commitments spent just over five months at the hospital. And the majority of patients willingly accept treatment and medications.

"Many patients say, 'This is the first time I've felt peace. I'm not bothered by the voices anymore,' " Earnshaw says. "Most come in, get treated and are released."

The hospital has 100 beds for so-called "forensic" patients, who are charged with or convicted of crimes.

The forensic unit is monitored by cameras and two staffers in a locked control booth. Guards are not posted, and security appears minimal. Earnshaw says violence is rare. Doctors work to make some forensic patients well enough to stand trial, while staff members school them in how the court system works.

Even though they may still have symptoms of mental illness, a patient may be deemed competent if he or she understands the court process, the potential penalties and can interact with his or her attorney.

Another category of forensic patients are there because they have been found "guilty and mentally ill" and are being treated prior to transfer to the prison.

The emphasis is different for the hospital's 72 children, ages 6 to 17, and the nearly 200 adults sent there on civil commitments. For the civilly committed, the hospital provides treatment, education and training to allow patients to successfully return to their communities.

The hospital's "Treatment Mall" has classes ranging from ceramics and physical recreation to money management and vocational rehabilitation.

"We are trying to get them back home," Earnshaw says. "One of the biggest misconceptions is that the patients are dangerous and locked up and restrained, and that they are here for the rest of their lives.

"Most people are surprised at how active they are in treatment and classes and learning, and that they can sit and talk and interact."

Doctors are adept at quickly zeroing in on the right medication for each patient, Earnshaw says. The focus then turns to teaching them to manage their medications and understand why they need to keep taking them.

Earnshaw said some mentally ill people don't take their medications for a variety of reasons, including a perception that they are not ill, concerns about side effects and an inability to pay for them.

Because mental illness still carries a certain stigma, Earnshaw said, some patients would rather be considered "bad than mad."

shunt@sltrib.com

Opened in 1885 as the Utah Territorial Insane Asylum, the hospital was "a human warehouse," according to literature prepared by hospital historian Janina Chilton.

"Therapeutic care was almost unknown," says Chilton, and many forms of treatment would, by today's standards, be considered punishment.

Chilton has collected a variety of treatment devices from the hospital's past, including a coffin-like barred bed for patients with sleeping disorders and a 25-pound chunk of metal that was worn around an ankle to prevent escape.

Those and other devices will be part of a museum Chilton said the hospital hopes to open on the grounds this summer.

During its first 70 years of operation, given the lack of medical knowledge, "the facility was little more than a human warehouse," according to Chilton. By the mid-1950s, the hospital's population exceeded 1,500, and patients slept in crowded wardrooms and hallways.

But in 1956, new medications like Thorazine revolutionized the field of psychiatry by reducing or eliminating psychotic thinking in some patients, and insulin therapy and electroshock therapy were discontinued.

During her four years at Utah State Hospital, Wanda Barzee, one of Elizabeth Smart's alleged kidnappers, has refused all treatment. Her husband, Brian David Mitchell, also has made no progress during his three-year stay.

Mitchell, a self-proclaimed prophet, and Barzee supposedly planned to make then-14-year-old Elizabeth a plural wife after allegedly kidnapping her from her home in 2002. Barzee has taken vows of silence that make the doctors' jobs especially challenging. Mitchell, who has also refused treatment, sings and yells when he appears in court.

Both defendants are now engaged in court battles over whether they can be forcibly medicated with anti-psychotic drugs to attempt to make them competent to stand trial.