The Lunacy/Lunatics Act 1845 (8 & 9 Vict., c. 100) and the County Asylums Act 1845 (8 & 9 Vict., c. 126) formed mental health law in England and Wales from 1845 to 1890. The Lunacy Act's most important provision was a change in the status of mentally ill people to patients. Background Prior to the Lunacy Act, lunacy legislation in England was enshrined in the County Asylums Act of 1808, which established institutions for poor and for criminally-insane, mentally ill people. The institutions were called asylums and they gave refuge where mental illness could receive proper treatment. The first asylum owing to the County Asylums Act opened at Northampton in 1811. By 1827 however only nine county asylums had opened and many patients were still in gaol as prisoners and criminals. As a consequence of this slow progress the Lunacy Act 1845 created the Lunacy Commission to focus on lunacy legislation. The Act was championed by Anthony Ashley-Cooper, 7th Earl of Shaftesbury. Shaftesbury was the head of the Commission from its founding in 1845 until his death in 1885. The Lunacy Commission was made up of eleven Metropolitan Commissioners. The Commission was monumental as it was not only a full-time commission, but it was also salaried for six of its members. The six members of the commission that were full-time and salaried were made up of three members of the legal system and three members of the medical community. The other five members of the commission were all honorary members that simply had to attend board meetings. The duty of the Commission was to establish and carry out the provisions of the Act. Provisions The Act established the Commissioners in Lunacy to inspect plans for asylums on behalf of the Home Secretary (s.3). The Act required asylums, other than Bethlem Hospital, to be registered with the Commission, to have written regulations and to have a resident physician (s.42). Under the Act, patients lost their right of access to the courts to challenge their detention. Detention could only be reviewed by the commissioners or county visitors. The Commission had many roles in carrying out the act. It established a network of public county institutions. It monitored the conditions in the asylums and the treatment of the patients. It made a point of reaching out to patients in workhouses and prisons and getting them to the proper institutions where they could