In the eighteenth century, compared to the horrible conditions of the Workhouses and Poorhouses, Victorian Lunatic Asylums were models of social responsibility. One such asylum was the Bethlehem Hospital, a purpose built institution constructed for mentally ill and insane patients in 1776. Located at Moorfields in the nation’s capitol of London, it was locally known as Bedlam Hospital. The artist William Hogarth created a series of eight paintings known as “The Rakes Progress”, which provided a visual image of the conditions that many people believed existed in such asylums during the 18th and 19th centuries, though these images may not necessarily be accurate.
Attitudes towards the mentally ill and their care began to change towards the end of the 1700’s, and physicians began to recommend greater personal freedom for their patients, as well as to implement therapeutic exercises and advocate employment for them. The Lunatic Act of 1808 instigated further improvements to mental health patients, as magistrates were permitted to allocate funds to asylums from the tax coffers. At least twenty new asylums were thus funded by public monies between 1808 and 1845, the few that existed beforehand being funded by private charities.

In 1845 an amendment to the Lunatic Act designated the responsibility for providing for paupers and lunatics to individual counties, creating the Lunacy Commission which would oversee and implement the process. The Commission would be responsible for visiting and inspecting future and existing asylums, while the amendments also laid out new procedures for patient care, which were further tightened in 1890 by the Lunacy Act.

The Victorian era saw a particularly large increase in the number of people with mental health issues, and consequently a rise in the amount of asylums constructed for their care. Records show that in 1847 there were approximately 5,200 patients in 21 mental health institutions throughout England and Wales. By the start of the First World War in 1914, the number of asylums had increased to 102, while patient numbers had soared to well over 100,000.

The new asylums of the early 20th century were surprisingly modelled after the English country house estate. Sprawling, well manicured grounds housing spacious, airy, immaculate buildings in rural settings were the order of the day, as the Lunacy Commission demanded that ample land be provided for exercise, recreation and therapeutic activities such as gardening and even agricultural employment. The grounds were often designed by famous landscapers, and even sports fields were included in some. Finally the asylum was beginning to be seen as a place of respite and recovery, rather than a dumping ground for the insane.

As quickly as conditions improved for the mentally ill however, they speedily declined. Though the honourable aims of the reformers, mainly rehabilitation and release had been somewhat met, by the early 20th century saw they had become severely compromised. The number of patients continued to soar, especially of those diagnosed as chronically insane, the elderly, and pauper lunatics. Poor pay and difficult conditions led to high staff turnover (not dissimilar to modern times), and the difficult economic climate led to overcrowding, lack of doctors, and overall poorer conditions. It would be another 50 years before mental health care standards would undergo significant improvements.