This paper surveys the early history of the National Center for Mental Health, a psychiatric institution in Mandaluyong City, Metro Manila, which was founded in 1928 as the Insular Psychopathic Hospital during the American colonial rule. As a historical inquiry, this study collects information from a range of primary sources, including government reports, statistical data, bulletins, and correspondences. The study also focuses on three chronological themes: the circumstances surrounding the hospital’s establishment in the late 1920s; the efforts by colonial and later Commonwealth authorities to expand its capacity during the 1930s; and the state of the institution during and after the Second World War. As evidenced by enduring problems such as chronic overcrowding and inadequate facilities, this paper contends that the various initiatives aimed at developing the Insular Psychopathic Hospital into a modern psychiatric facility were largely unsuccessful. However, this failure was not specific to the hospital or the Philippines; rather, it reflected the trend of mental health facilities declining in different areas of the world, which subsequently caused mental health professionals to reconsider the asylum model as an effective approach in treating mental diseases.