Metropolitan State Hospital was the final large scale state hospital built in Massachusetts, the last in a long line of institutions built in the Bay State over the course of a century. Metropolitan State Hospital was built to alleviate crowding and extend the care provided at Boston State Hospital in a location that was more convenient to the Boston area. Its design would join the psychopathic hospital (now Mass. Mental Health Center) and the "asylum" on one isolated site, continuing the now-standard 'hospital' model of care for people with a mental illness.
While the mental health system as a whole was overburdened, the most urgent need to be addressed was the metropolitan area including Waltham. For a number of years state officials engaged in Intense debate over possible solutions. The Trustees of the newly acquired Boston State Hospital advocated for expansion of their facility to a 5,000 patient capacity, but were unable to convince the State Board of Insanity of the merits of that proposal. Instead it was decided that a second metropolitan area hospital would be built.
Introduced to the state legislature in 1912, the board authorized spending in January of 1915. A site that was in close proximity to the Walter E. Fernald State School was immediately acquired. Plans were prepared for a 1,900 patient facility to be built on the cottage/colony plan. No action was taken for several years due to the Trustees of Boston State Hospital continue to argue for their own expansion and the first World War diverted state attention and funds. Finally, in 1927, the State legislature responded by appropriating $1,500,000 for preparation of the Waltham site. The ground breaking ceremony took place on December 27, 1927 at the Administration Building cornerstone laying ceremonies were held on October 17, 1928. Construction costs were kept down by the use of the plain red brick buildings of early American colonial type. As the first campus developed in the automobile age, Met State did not require immediate adjacency to railroad facilities. As the most recent of the State's institutional treatment centers for the insane Metropolitan State Hospital represented the third and final stage in the evolving form of hospitals for the mentally ill. Like its predecessors, the Kirkbride and cottage/colony, it responded to increases in patient populations within the constraints of a publicly funded budget which both often failed.
The original site plan for the hospital was remarkably similar prior to demolition in 2006. The site plan is described as forming two axes. One consisted of staff accommodations and administration, while the other consisted of patient-care facilities. The first axis was to include a Married Couples Dormitory that was never constructed, and several single family dwellings, five of which were constructed. There is also a tennis court and a baseball diamond to the northwest of the Male Dormitory. The second axis placed a Medical Building between chronic and acute care facilities where it could most easily serve both. The acute care building was not constructed until 1957. Two dormitories for disturbed patients were supposed to be built southeast of the mortuary but were never constructed. A farm group near the present Gaebler Children's Center including dormitories and a dairy barn was partially constructed, but are now gone. Most of the red brick Colonial Revival style buildings on the Metropolitan State Hospital property were designed by architect Gordon Robb, and many served as models for post-1930 construction at other campuses.
The Massachusetts State Board of Insanity began selecting patients from the several thousand metropolitan area residents who had been committed to other hospitals by 1929. The first ever patients to arrive were 36 men from the Grafton State Hospital who arrived on December 26, 1930. Others, from the hospitals at Westborough, Danvers, Worcester and Medfield soon followed. Within a year of opening, Metropolitan State Hospital accommodated 1,150 patients in the continuing treatment class. By the end of 1932, the number of patients totaled 1,230. With completion of the Medical/Surgical Building in August of 1934, the capacity reached 1,560. The 1945 Governor and Council's Report cited a population of 1,995 with an additional 281 patients "out on parole" which was 410 over capacity of 1,585. The staff numbered at 234. The Medical/Surgical Building not only served inpatients, but also was accepting patients from the neighboring Fernald State School.