The first recorded Lunatic Asylum in Europe was the Bethlem Royal Hospital in London, it has been a part of London since 1247 when it was built as a priory. It became a hospital in 1330 and admitted its first mentally ill patients in 1407. Before the Madhouse Act of 1774, treatment of the Insane was carried out by non-licensed practitioners, who ran their Madhouses as a commercial enterprise and with little regard for the inmates. With the establishment of Mad House Act, licensing was required for each property in order to house insane patients, with yearly inspections of the premises taking place.
Patients lived within the confines of the hospital and their personal privacy was minimal. Wards were able to house up to 50 patients, in very close proximity and little personal space. The daily regime was strictly regimented, with little room for variation and often under the watchful eye of staff. During the early years of the Asylums, wards were locked and security was kept high as attendants were fined for every patient that escaped on their watch.