Willard Asylum admitted its first patients in 1869. Many of the early residents arrived after years of incarceration and mistreatment in dismal almshouses, some after allegedly failing to improve in other state institutions. Before long, Willard grew into a sizeable village, relying heavily on unpaid patient labor to sustain its operation. Its farm, bakery and kitchens provided most of the food for inmates and staff. Its industrial shops produced clothing, shoes, even the pine caskets used to bury patients in the hospital=s cemetery. Factory-sized brick buildings housed patients, while the more opulent residences were designated for doctors and other staff.

In 1890, the Asylum was renamed Willard State Hospital, and instead of serving as a place of last resort for the entire state, it started accepting patients mostly from the adjacent counties. By the early 20th century, however, people from other parts of the state were again sent to Willard. The patient census rose steadily, with over-crowded wards and deteriorating conditions. The hospital's original purpose as a bucolic rural retreat was lost in the grim realities of institutional life.

By 1950, New York operated 30 state hospitals with more than 120,000 patients. Willard's census reached an all-time high of 4,076 in 1955, and conditions within the institutions were harsh. In the mid-1950s, state hospitals began to use newly developed antipsychotic drugs to control patients crammed into ever-tighter living quarters. In the early 1970s, political and economic factors including new laws that promoted patients' rights and forbade unpaid patient labor resulted in a shift away from long-term institutionalization. The facility was again renamed, becoming Willard Psychiatric Center. By 1974, Willard's census had declined to less than a thousand, and the patient population dwindled to a few hundred by the time the facility closed in 1995. More than 50,000 patients were admitted to Willard during its 126-year history, and nearly half of those died there.