In July 1852 a fire broke out in the ventilation system, spreading rapidly into the attic and the center of the building. After $70,000 repairs, the Main was ready to open its doors once again.

Dr. Brigham found existing types of restraints for highly disturbed patients unacceptable and invented what was later coined the "Utica Crib". It was an adult-sized bed, completely enclosed on four sides with a id on top. The sides and lid were made of spindles, which allowed air flow. The crib was used util 1887 when then Superintendent Dr. G. Alder Blumer ordered the last one removed from the wards.

In 1978, 135 years after opening, patients were transferred to other buildings and Old Main was closed. In 2004 a portion of the first floor of the main building was refurbished for reuse as a Records Archive and Repository for the New York State Office of Mental Health.
Portions from "Utica's Architectural Treasures", by Julie Howarth, 2004