The land for the asylum on Blackwell's Island was sold to New York City by a wealthy family in 1828. During this era, wealthy white elites begin using their wealth to institutionalize and "contain poor communities that were perceived as criminals, diseased and insane" (Boardman, 2007). This is often presented as a form of charity.

Dr. John McDonald, who is involved with the design of the asylum, suggests four classifications for patients: "the noisy, destructive, and violent," "the idiots," "the convalescents," and an intermediate class for “those in the first stages of convalescence and such incurables (who) are harmless and not possessed of bad habits." He also believes in a barrier-free design, permitting patients to move around freely. The hospital is never fully built, opening with only two wings.

Thousands of poor and "mentally ill" people will be admitted between 1839-1894 before it closes. In 1973, Blackwell's Island is renamed "Roosevelt Island" after President Roosevelt because he lived with polio.