The first hospital in Newcastle for public mentally ill patients (ie paupers) was Wardens Close Lunatic Hospital, which opened in October 1767, on a site near the present day Newcastle Breweries. Patients were admitted on application to the Committee, who acted on the advice of the hospital physician. A report to the City Council in 1824 found that in effect the hospital had been run as a private asylum for the benefit of the physician in charge, so the Council decided to take action. They appointed Dr Noel Smith in charge of the asylum and John Dobson, the town architect, was to design and execute the doctor's suggestions. As a result, 6 spacious airing courts were provided, the central court was enclosed transforming the 'cold, dreary cells' into reasonably comfortable apartments, more land was used for gardens, and the whole hospital was enclosed within boundary walls. Private patients were also accepted and the numbers were limited to 80 instead of 100. By 1827 there seemed to be a policy of non-restraint and emphasis was placed on the patients being occupied, including with gardening, games, sewing, reading and music.
However, by the 1850s, overcrowding was a serious problem and the asylum closed in April 1856. For some years following, Newcastle pauper lunatics were boarded out at other institutions, including Gateshead Fell Asylum and Durham County Asylum. When, in 1865, the latter refused to renew the contract, Newcastle Corporation rented Bensham Asylum which had been unoccupied for two years. The first superintendent was James Crichton Browne, whose patients on opening numbered 54. However, serious overcrowding immediately resulted when a further 47 patients were transferred from Dunston Lodge Asylum, when the capacity was only 90. Still, though, the emphasis was on non-restraint and 'moral treatment', ie work and recreation.
The Corporation promised a new asylum at Coxlodge, where they had purchased a 50 acre farmstead for the purpose. The Farm Ward opened in April 1866, when 30 'harmless' patients were transferred there from Bensham. The foundation stone for the new asylum was laid there on August 1866 and it opened, as Newcastle upon Tyne Borough Lunatic Asylum, in July 1869, with 159 patients. By 1882 when it changed its name to Newcastle upon Tyne City Lunatic Asylum, the average number of patients had risen to 265. In 1884, therefore, the Commissioners in Lunacy gave permission to extend the hospital and the East and West Pavilions were completed in 1887, providing accommodation for an additional 80 patients.
Still, however, numbers rose until in 1891 they exceeded 400. Again the City Council decided to enlarge the hospital to accommodate another 350 patients. Architects were invited to compete for the commission of a new separate building to the east of the existing hospital, to include a recreation hall and chapel, a residence for the Medical Superintendent, a new entrance lodge and 10 cottages for married attendants. 18 sets of plans were submitted and those of J W Dyson were accepted. It was not until the end of 1894, however, that the foundations were completed and 4 July 1900 that the new institution opened to a favourable reception from the press. The Medical Superintendent's house, though, was never built.
Extensions were again carried out in 1913 when two villa blocks for 40 patients each, and a Nurses Home were built.
In 1914 patients were evacuated and the hospital became Northumberland No 1 War Hospital for wounded soldiers, who were brought there by train. It was not handed back until 1921.
In 1923 the verandah for Ward 9 was constructed and in 1925 a cinema room was added to the recreational facilities. Conditions in the 1920s, however, seem to have been generally grim for both patients and staff, with a poor diet and clothes, a strict regime and a lack of heating.
Although a new admission hospital was suggested in 1931, no further extensions were built before the hospital was taken over by the National Health Service in 1948, when it changed its name to St Nicholas Hospital. Overcrowding continued to be a problem into the 1950s since the Interim Treatment Centre which opened in December 1950 was dedicated to therapeutic and diagnostic techniques, rather than a residential unit. Finally, in July 1954, the foundation stone was laid for the admissions unit planned in the 1930s, to provide another 118 beds, including two convalescent villas. This opened on 29 September 1956 as the Collingwood Clinic, where all new patients were admitted and had their treatment initiated. The programme produced for its official opening expressed the wish that 'the great majority will depart recovered or relieved without seeing more than a glimpse of the old building', but recognised that 'perhaps a tenth of the total will need to spend longer at St Nicholas than...... Collingwood Clinic can accommodate'. The aim of the Clinic was to have small wards, rather than the huge 80 or more bed wards of the main hospital, allowing the staff to know the patients intimately, 'by which means alone success in treatment of the long stay patient can be assured'.