Most people were sent to Willard under court orders or other involuntary measures. The criteria for commitment prior to the 1950s were rather loose and merely required a doctor's certificate that the person was mentally ill and in need of hospitalization. Who were these individuals and where did they come from? Upstate New York and the New York City metropolitan area were equally represented. Many were foreign-born and arrived in the U.S. as single individuals, leaving families in Italy, the Ukraine, Poland, Germany, France, Scotland, and other mostly European countries. They majority were Caucasian and Christian, many had extensive work histories, some were married and had children, and a few had college degrees. Most patients stayed at Willard for several decades, averaging more than thirty years. Among the suitcase-owners, the record is held by a woman who arrived in 1899 at age 26 and died at Willard seventy-five years later, at the age of 101.