The Lunacy Act itself was amended several times after its conception. The most notable of these were the 1808, and the 1853 County Asylum Acts. Like the Lunacy Act, there had been several drafts of this act passed before 1845 and several afterward as well. The Lunacy Act established the Lunacy Commission and the County Asylums Act set forth most of the provisions as to what was to be monitored within the asylums and helped establish the public network of the county asylums. The two acts were dependent on each other. The Lunacy Act of 1845 was passed through Parliament simultaneously with the 1845 County Asylums Act. It monitored the treatment and mental condition of patients whom the Commission could not remove from prisons and workhouses. It also focused on 'single lunatics' who were not connected with any prisons or workhouse but needed psychiatric care. It made a point of reaching out to patients in workhouses and prisons and getting them to the proper institutions where they could be treated. It monitored the conditions in the asylums and the treatment of the patients. It established a network of public county institutions. The Commission had many roles in carrying out the act. Detention could only be reviewed by the commissioners or county visitors. Under the Act, patients lost their right of access to the courts to challenge their detention. 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). The Act established the Commissioners in Lunacy to inspect plans for asylums on behalf of the Home Secretary (s.3). The duty of the Commission was to establish and carry out the provisions of the Act. The other five members of the commission were all honorary members that simply had to attend board meetings. 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 Commission was monumental as it was not only a full-time commission, but it was also salaried for six of its members. The Lunacy Commission was made up of eleven Metropolitan Commissioners. Shaftesbury was the head of the Commission from its founding in 1845 until his death in 1885. The Act was championed by Anthony Ashley-Cooper, 7th Earl of Shaftesbury.

As a consequence of this slow progress the Lunacy Act 1845 created the Lunacy Commission to focus on lunacy legislation. By 1827 however only nine county asylums had opened and many patients were still in gaol as prisoners and criminals. The first asylum owing to the County Asylums Act opened at Northampton in 1811. The institutions were called asylums and they gave refuge where mental illness could receive proper treatment. 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.

Six of lunacy