From the late 19th - mid-20th centuries, Willard offered little actual mental health treatment. There was custodial care, physical health care, work and occasional entertainment. With the exception of hydrotherapy-submerging people for long periods of time in cold baths-and electro-shock (beginning in the 1940s), there was no treatment. The introduction of neuroleptic drugs in the mid-1950s helped staff control patients who were crammed into ever-tighter living quarters, but, from the charts, we see little evidence that the drugs improved people's mental and emotional states.

People admitted to Willard were classified according to their ability to work. Patients deemed violent or unable to take care of themselves were placed in locked wards where life was very regimented. Of those willing and able to work, women were employed in cooking, cleaning, and sewing, while men did tasks like grounds-keeping, carpentry, and shoemaking. For more than 100 years, Willard was heavily reliant on unpaid patient labor, which was finally banned in New York in 1973.

Of the 54,000 individuals who passed through Willard during its 126 years of operation, 5,776 were buried in the graveyard tended by Mr. Lawrence #14956. Another 18,000 died at the hospital, and were either buried by their families in their hometowns, or at a community cemetery in nearby Ovid. Nearly half the individuals who entered this sprawling facility left in a casket.