It was also believed that when blacks tried to flee captivity, they were suffering from a mental illness called drapetomania, which Samuel A. Cartwright stated to be a consequence of masters who "made themselves too familiar with slaves, treating them as equals".

Dorothea Dix visited the hospital in 1875, during her travels for mental health reform, and donated pictures and musical instruments.

Patients were classified and assigned to wards for the recent and acute, chronic, demented, sick, tubercular, epileptic, criminal and suicidal.

In 1904, a one-and-a-half-story chapel was built as a multi-purpose space for religious services, dances, concerts, and graduation ceremonies for the hospital's nursing students.

Its simple 80x50 foot Gothic Revival design was conceived by Dr. William Francis Drewry and constructed by G. B. Keeler & Son.

From the opening of the hospital until 1915, the supposed causes of psychosis in those admitted included abortion, desertion, emancipation, marriage, masturbation, and typhoid fever.

Some of the foods grown on the farm were alfalfa, peanuts, wheat, radishes, pumpkins, okra, watermelon, turkey, and milk.

In 1978, Mayfield Cottage was sold to the Caudle family, who moved the structure a mile away to save it from demolition and opened it as a bed-and-breakfast in 1986.

[3] On March 6, 2023, 28-year-old Irvo Otieno died after he was restrained by Henrico County sheriff's deputies at Central State Hospital.

[4] A total of ten people, seven deputies and three hospital employees, were charged with second-degree murder in connection with Otieno's death by suffocation.