The first twenty patients were admitted in March 1911, and the facility began to grow and develop, initially as a male only institution. Paths and gardens were laboriously constructed with manual labour, and new buildings were added. Patients and staff spent ten years painstakingly building the rubble causeway and bridge to the mainland that was finally completed in 1957. Over the decades, the hospital outgrew the small island and expanded onto the adjacent mainland, where a chapel and other facilities were constructed, mainly in the 1950s and 1960s.