The need to confine and restrain psychotic patients at the turn of the last century saw the building of a few large asylums which soon became overcrowded with the growth of the population. These asylums were the only service available to the mentally ill until 1959 when the trend to decentralise began with the building of general hospital psychiatric units.

The history of Horton Hospital is best seen in the context of the socio-economic history of the late 19th century. London, as a result of the Industrial Revolution, had grown enormously so that the existing metropolitan mental hospitals could no longer cope with sheer numbers of mentally disordered arising within its boundaries. The Metropolitan Asylums Board, whose responsibility it then was, looked for suitable land within easy – but not too easy – reach of London. Epsom at the turn of the century was an exceedingly fashionable area boasting a number of large and elegant “Derby Houses” (some of which still exist, although now put to rather more plebeian use) to which the aristocratic racing fraternity transferred themselves for the races. It was known that this wealthy and influential body would oppose the sale of the private estate of Sir Thomas Powell Buxton in the parish of Horton, roughly one square mile in size, for the purpose of building mental hospitals. What added even more bitterness to the pill was that the hospitals were to house “pauper lunatics”, a sobriquet with obviously undesirable social connotations. The negotiations for the sale were carried out in secrecy and the fait accompli, when it was announced, created an outcry. But it was too late. In retaliation the “toffs of the turf” including, ironically perhaps, the Royal Family, transferred their establishments and training facilities mainly to Newmarket which grew in importance as Epsom declined.