In November, 1769, the Virginia House of Burgesses, at the urging of the then Royal Governor, Francis Fauquier, passed an act "to make provisions for the support and maintenance of ideots (sic), lunatics and other persons of unsound minds.'' This act created a "court of directors," consisting of some of the most prominent Virginians of the time, who were "empowered to purchase a piece or parcel of land ... as convenient as may be to the city of Williamsburg, and to contract for the building thereon a commodious house or houses, fit for the reception and accommodation of such disordered persons." The first building was not completed until almost four years later and the first patient, a resident of Hanover County, was admitted October 13,1773.

This legislation and the construction of this first mental hospital in the Western Hemisphere surely establishes the Commonwealth of Virginia as the first to care about the welfare of those unfortunate individuals who are handicapped with mental illness and mental retardation.

In order to recognize Eastern State Hospital as the oldest institution of its kind in America the General Assembly of Virginia, during its 1970 Session, created this Commission by enactment of House Bill No. 163.