Prior to 1791, the land where the asylum was built belonged to the local Cherokee tribe, who used it for hunting, fishing, and gathering food for the community. In 1791, as part of the Holston Treaty, the land was “bought” by Captain William Lyon. The area then became known as “Lyons View”, popular for its exceptional views of East Tennessee atop a large hill on the banks of the Tennessee River. The Tennessee General Assembly opened the first asylum in Nashville, called the Tennessee Lunatic Asylum, in 1832. In the 1880’s Hon MD Bearden found a large need for an Asylum in Knoxville, as the population continued to grow and disparities became more apparent. The funds were appropriated by the Tennessee governor in 1883. The Lyon sisters, who were the heirs to the property, sold a 300-acre tract of Lyon’s View to the Government for the hospital to be built upon. A board of directors was formed and construction began: "After visiting the country's most important and famous asylums, this board of directors adopted a plan embracing the latest improvements, both architectural and sanitary. The asylum consists of nine buildings: administration, chapel, kitchen, laundry, boiler house, and engine house. The main building is 472 feet long, and the wards consist of 174 rooms capable of accommodating from 250 to 300 patients.” (KGH) Construction finished in March of 1886 and opened its doors, originally with the transfer of 99 patients naturally belonging to the East Tennessee Region from Nashville’s Lunatic Asylum. The hospital underwent a variety of name changes and had locally known names, which are reflected on the death certificates of patients buried here. These names include: Lyons View Asylum / Lakeshore Mental Health Hospital / East Tennessee Psychiatric Hospital. The hospital was open until 2012, providing 126 years of service to patients of East Tennessee. 

Before 1901, wooden markers were used to identify the burial plots of the deceased patients. In 1901, Edward S. Sheppard, the hospital's Steward at the time, contracted marble tablets as headstone markers for a more permanent solution. The Knoxville News Sentinel reported this on December 4th, 1901, stating, “A record of each burial is kept at the asylum and each grave is numbered. Instead of having the name of each person engraved on the tablets, the number of the grave will be used instead. This number will correspond with the number on the records.” This article also claims, at the time of its publication, that there are 125 burials at the cemetery. While at the time, the use of the marble markers seemed permanent, the test of time has proven otherwise. Today, only a handful of the markers remain seen; others have likely been destroyed or buried under the ground due to overgrowth and lack of proper care. The cemetery has changed hands and caretakers throughout the decades, making it challenging to know how well or unwell the grounds have been cared for. Alongside the physical changes within the land and the markers, many of the records identifying who is buried where have been destroyed, lost, or kept closed due to privacy reasons. The graves lie in two areas. The easternmost has straight numbered rows and numbered position stones. In the western part, the rows are semicircular, and positions are not as clearly indicated. The plots were 4 feet by 8 feet.

People institutionalized at Eastern Tennessee Insane Asylum were buried here for a variety of different reasons. Some who passed here had no immediate family and therefore were buried by hospital staff in the cemetery. Others who did have immediate families may also have been buried here due to financial reasons. Removal of bodies to funeral homes from the asylum was costly, and so was the price of a headstone. Therefore, some members chose to have their institutionalized family member buried at the hospital cemetery. Some could afford to have headstones placed, while others could not. Sometimes, in the case of married female patients,  who would be buried at the hospital cemetery  whose husbands would be buried in their usual place of residence,  would place both his and his deceased wife’s name on the headstone, regardless that she would not be buried with him. Other times the hospital records were little at best for some patients for a multitude of reasons such as mental and physical disabilities from the own patients verbal records and lack of information from those bringing the patients in such as; law enforcement, doctors, lawyers, families, spouses, poor houses and other asylums given to Eastern Tennessee State Insane Asylum at the time of the persons inpatient. Therefore, even if the deceased patient did have immediate family, it is possibly unrecorded, and the record of the patient's passing would remain untold to said family. Dr. Brown, a physician at the hospital, is interviewed by the investigating committee. Asking “How are the patients buried when they die?” He responds, “Very decently.  The matrons, supervisors, and others attend to the burial of deceased patients.  When they are without good clothing, they are buried in a shroud.” - Knoxville Daily Journal and Tribune, February 5, 1889 another newspaper quotes, “The burial, as it is custom at the institution, occurred after dark.” -Knoxville Daily Chronicle, May 14th, 1886