Many people sent to Willard were deemed incurable and in need of life-long institutionalization. This determination was never made formally, but, especially if a person was transferred from another state hospital, it was likely that they would never leave. At admission, most of the suitcase owners were in situational crises - death of a spouse or child, sudden unemployment - that could have been dealt with outside an institution.

While everyone admitted to Willard was given a diagnosis, the exact nature of their mental or emotional distress was rarely addressed in their records. The person's life circumstances, traumatic events, and the painful experiences that stood behind the labels were hardly engaged in any type of therapeutic discourse. Instead, these diagnoses were used to assign the person a poor prognosis, which was used to justify lifelong incarceration at public expense. The myth that these "disorders" were incurable dominated the mental health system in those years (and still does today, in large measure). This is true despite ample evidence that was available, even in the late 19th century, that recovery was possible, given the right approach and understanding.