Mental Health Records may consist of a variety of documents that historically were referred to as lunacy papers in the courthouses of Virginia localities and municipalities.

A fiduciary is an individual who enters into a confidential and legal relationship which binds them to act on behalf of another. Guardians are legally invested to take care of another person, and of the property and rights of that person. Thus, some records referred to as insanity papers are housed with fiduciary records and not with mental health records.

By 1792, Virginia's General Assembly enacted very strict laws governing the practice of inoculation. The new act required a license from the county court to administer vaccinations. It also included a penalty of $1,500 or six months of imprisonment for anyone willfully spreading smallpox in a manner other than that specified by the act.

During its session begun in November 1769, the House of Burgesses passed an act establishing a hospital in Williamsburg for the mentally ill. The Eastern Lunatic Asylum (now Eastern State Hospital) was the first institution in America constructed as a mental hospital. The first patients were admitted in October 1773.

In January 1825 the Virginia General Assembly passed legislation providing for the construction of an asylum in the western part of the state. The institution, which became known as Western Lunatic Asylum, was constructed close to the town of Staunton, west of the Blue Ridge Mountains, and was the second mental health facility built in the Commonwealth of Virginia. The buildings and surrounding gardens were designed to embrace the idea of "moral therapy" for mentally ill patients by providing an aesthetically pleasing and tranquil atmosphere in which patients lived comfortably, exercised and worked outdoors.

Western Lunatic Asylum opened in 1828, accepting both male and female patients suffering from a variety of mental disorders. It should be noted that the hospital underwent a short-lived name change between 1861 and 1865, when it was known as Central Lunatic Asylum. (It should not be confused with an asylum of the same name later built in Petersburg, Virginia to house African American patients). From 1865 to 1894 the name was again Western Lunatic Asylum. However, in 1894 the General Assembly passed legislation changing the name to Western State Hospital.

In March 1882 a 300 acre tract of land was purchased by the City of Petersburg and given to the state for the purpose of constructing a permanent mental health facility for African Americans. Construction of the new facility near Petersburg was completed in early spring 1885. This later included a special building to house the criminally insane apart from the rest of the hospital population. An early institutional history notes that treatment at Central Lunatic Asylum during the 1890s was humane and emphasized the value of work and the benefits of recreation. However, practices at the facility also included seclusion, mechanical restraints, and the administering of hypnotics.

In 1894, Central Lunatic Asylum was officially renamed Central State Hospital. This piece of legislation also altered the names of the other mental health facilities in Virginia in and attempt to inspire a more positive image of the institutions, and of mental health treatment in general. It is important to note that another state institution located in Staunton, Virginia went by the name Central Lunatic Asylum between the years of 1861 and 1865. Its name later was changed to Western Lunatic Asylum, and is a separate facility with no connection to the Richmond/Petersburg hospital for African Americans.

In March 1884 the Virginia General Assembly appointed a board of commissioners to select a site for a new lunatic asylum for white citizens to be built west of New River near Marion, Virginia. Dr. Harvey Black became the first superintendent of Southwestern Lunatic Asylum when it opened in May 1887. Dr. Robert J. Preston and Dr. John S. Apperson served as assistant physicians, and Mr. C.W. White was appointed as steward to oversee the day-to-day business operations of the hospital. The patient population grew steadily and over time several buildings were added to the hospital's campus including a tuberculosis treatment building, a building for the criminally insane, the Davis Clinic, and the Harmon Building. For much of its early history, the hospital was mostly self-sufficient through the utilization of its own farm for meat, milk, and vegetables. Other early hospital superintendents include Dr. Robert J. Preston (1888-1906), Dr. Daniel Trigg (1906-1908), Dr. J.C. King (1908-1915), Dr. E.H. Henderson (1915-1927), and Dr. George A. Wright (1927-1937). The hospital has gone through two name changes in its history. In 1894 the General Assembly passed legislation changing the name from Southwestern Lunatic Asylum to Southwestern State Hospital. In 1988, the name was changed to Southwestern Virginia Mental Health Institute.

Chesterfield County was named for Philip Dormer Stanhope, fourth earl of Chesterfield, British statesman and diplomat, and was formed from Henrico County in 1749. The county seat is Chesterfield Court House. Part of Henrico County was added to Chesterfield in 1922.