Built in 1843, the New York State Lunatic Asylum, later to become Utica State Hospital and locally known as "Old Main", was the first publicly-funded institution to care for and help treat the mentally ill in New York State.

Designed by William Clarke it was one of the finest examples of Greek Revival architecture in its day. Set on 130 acres the original design was to form a quadrangle, four identical buildings positioned at right angles to each other, surrounding a courtyard. Due to financial constraints after the foundations were laid, only one of the four structures was initially built.

Although incomplete at the time, first patients were admitted in January 1843. Dr. Amariah Brigham, the Asylum's first faculty superintendent, published the American Journal of Insanity (later renamed The American Journal of Psychiatry) at the Utica Asylum in 1844. The journal, the first of its kind published in the English language, grew Utica's reputation world wide as a center of psychiatry.

Within two years of opening, the asylum was operating at capacity and wings were added on either end of the main building which were ready for occupancy in 1846.