Science Time Line 1939
Community Care

Science Time Line 1940

26.7.1945: Election results: Labour Government (to 1951

1940s and 1950s: Historical Background to Community Care
The therapeutic asylums planned in the 1840s failed monumentally, the monuments being a network of large asylums full of long-stay patients with little or no hope of rehabilitation. In post war Britain the National Health Service inherited these asylum which still stood in open countryside outside the towns, or had been engrossed by the expanding suburbs.

Post war Britain provided a new moral culture for disabled people. Eugenics and social darwinism were discredited by their association with the Nazi policies and extermination camps. The fears of "racial degeneracy" that had shaped pre-war public policy for mental defectives were no longer acceptable. In the absence of an acceptable conceptual framework, mental defect became a health issue. The 1946 National Health Service Act defined a hospital as an institution for "the reception and treatment of persons suffering from illness or mental defectiveness" (section 79) and transferred local authority hospitals to the Minister of Health (section 6).

Science Time Line 1946

The 1946 National Health Service Act stripped the Board of Control of nearly all its functions except those of providing an inspectorate of mental hospitals, especially with respect to compulsory detention.

The stigma of disability was intense. In the early 1940s, for example, a mother who attempted to meet other parents of handicapped children to form a playgroup had her advertisement refused by her local paper because of the "shame and disgrace" of having a handicapped child. In 1946 The Association of Parents of Backward Children (now Mencap) was formed by parents concerned about the lack of support to help them maintain a child at home, and the isolation and poor facilities of the deficiency hospitals that were the only alternative.

25.11.1947 Foundation of the National Association for Mental Health (now MIND). This was a combination of existing organisations, partly merged in 1939 as the Mental Health Emergency Committee for war-time coordination. Its components were the Central Association for Mental Welfare (1898 National Association for the Care of the Feeble Minded), the National Council for Mental Hygiene (founded 1918) and the Child Guidance Clinic (founded 1927). The Association worked closely with the Ministry of Health and Board of Control.

Pre-frontal Leucotomy in a thousand cases Pre-frontal Leucotomy in a thousand cases by Isabel Wilson and E.H. Warland published by the Board of Control.

Science Time Line
See 1930 and 1966.

1948 National Health Service Act came into operation

The National Health Service (NHS) took over from county councils and boroughs the major responsibility for mental health. The reforms of the 1920s and 1930s had only touched the edge of the mental health system. The main inheritance of the National Health Service was a system of over 100 asylums, or "mental hospitals", with an average population of over 1,000 patients in each.

The integration of the mental hospitals into the National Health Service was possibly the most decisive factor leading to a general move away from institutional policies in the 1950s. See 1959. Andrew Scull (1977, chapter 5) refers to studies of individual English mental hospitals, including Mapperley Hospital, Nottingham where inpatient numbers fell from 1948 due to changes in administrative policy, including avoiding admission altogether and early discharge of those who were admitted. In-patient numbers at Mapperley fell from 1,310 in 1948 to 1,060 in 1956.

1950

1951

25.10.1951 Conservative government

Science Time Line 1953

1953 Mental £millions. Almost half the National Health Service's hospital beds were for mental illness or mental defect. Hospitals generally were in old buildings, but those for mental illness included some of the worst buildings. From 1953 the government set aside substantial, if inadequate, sums of money for their improvement - The Mental £ millions. Spending on this sector in West Yorkshire reached a peak of 37% of the hospital budget in 1955/1956. Government thinking appears to have been precipitated into community care policies by the prospect of spending even larger sums on renovating the old asylums.

Autumn 1953 Lancet article described the three British mental hospitals with open door policies: Dingleton Hospital, Melrose, Scotland (since 1948), Mapperley, Nottingham and Warlingham Park Hospital, Croydon. [ External link to chapter in David Clark's book describing visits.] In 1954 out-patient nurses were appointed at Warlingham Park to visit out- patients and in-patients who had been discharged. External link.

1954

Royal Commission on the Law Relating to Mental Illness and Mental Deficiency (1954 to 1957), under Lord Percy, appointed.

1954: Peak of numbers resident in English and Welsh Mental Hospitals. In the hospitals that pioneered community care, the numbers had been falling since 1948. Now the movement to avoid hospital admission and shorten in-patient stay began to effect overall numbers.

In September 1954, Jack Archer, a leading character in the popular wireless soap The Archers, was admitted to a mental hospital after becoming more and more depressed. He came home to his family in time for Christmas. He was a much happier person.

Chlorpromazine. This drug started being sold in 1954 or 1955. In America it was called Thorazine, in the United Kingdom, Largactil. It was the first of the anti-psychotic phenothiazines. In a "psychotic", as opposed to a "neurotic" illness, the patient is held to have lost contact with reality. The phenothiazines controlled the symptoms of many patients without having the sedative effects of previous drugs. They controlled, not cured, and were sometimes called "chemical straight-jackets". Use of phenothiazines could make the established movement towards community care easier and less risky. Their effect, in this respect, became clearer with the introduction of long acting phenothiazines in the 1970s.

1955

1955 onwards: Substantial sums of money for construction of new hospitals

Goffman in St Elizabeths
Science Time Line 1956

1957

May 1957: Royal Commission on the Law Relating to Mental Illness and Mental Deficiency (1954 to 1957) reported

The key themes of the Percy Report were:

That mental disorder should be regarded "in much the same way as physical illness and disability" (paragraph 5)

That hospitals for mental illness should be run as nearly as possible like those for physical disorders.

1958

On the wireless, the Archers had featured a mental hospital in 1954. The Hurt Mind 1958 was the first television programme to do with a mental hospital. Christopher Mayhew persuaded the BBC to record this film. The camera's were not allowed to film patients' faces, only their hands or feet. Christopher Mayhew was the only one who was allowed to be filmed in person.

1959

By 1959 only 12% of admissions to mental illness hospitals were compulsory, and the trend was towards shorter periods of in-patient treatment and towards outpatient treatment. Whilst in 1930 there had been practically no outpatients, by 1959 there were 144,000 attendances at outpatient clinics. ( Maclay, W.S. 1961, p.98)

It is the above change that people are generally referring to when they speak of the therapeutic revolution of the 1950s.

The 1959 Mental Health Act Two years after the Percy Report, the 1959 Mental Health Act sought to create a legal framework within which the hospital treatment of mental disorder could approximate as closely as possible to that of physical illness. Its two main objectives were: To allow admissions for psychiatric reasons to be, wherever possible, as informal as those for physical reasons. To make councils responsible for the social care of people who did not need in-patient medical treatment. The 1959 Mental Health Act abolished the Board of Control. The 1959 Mental Health Act excluded promiscuity or other immoral conduct (alone) as grounds for detention. Section 4 (5) of the 1959 Act says: "Nothing in this section shall be construed as implying that a person may be dealt with under this Act as suffering from mental disorder ... by reason only of promiscuity or other immoral conduct" The 1890 Lunacy Act's grounds for confinement were that the person is a "lunatic, idiot or person of unsound mind". The 1959 Act uses a similar catch-all phrase: "any other disorder or disability of mind" - but the exclusion clause restricts it. Between the 1890 Act and the 1959 Act there was a great expansion in the power to confine people on moral grounds. This was under the 1913 Mental Deficiency Act which brought in the concept of moral defect and feeble minded. The 1957 Percy Report explained that, in practice, these concepts had been applied to people of normal intelligence who behaved unconventionally.

Dr Russell Barton's Institutional Neurosis outlining the symptoms of a disease that often (but not always) developed as a result of being in an institution. (See dictionary)

1960s

In the 1960s there was a breakdown in the taboo of silence about mental health in the press and TV. Pioneers of this were TV programmes such as Man Alive which showed people with conditions usually regarded as taboo talking about their own experiences. Another famous example was an Observer reporter, John Gale, who had a mental breakdown, re-covered and was re-instated to his position as a feature and news reporter. He described his subjective experiences in an Observer feature in 1966.

Along with the new openness about mental illness came the possibility of open debate. In America, The Myth of Mental Illness (1961), by Thomas Szasz was published. It contained a theoretical basis for arguing that the states of mind described as "mental illness" are not "illness" but actions for which the mentally distressed person must be held responsible. [See Mental Health and Civil Liberties].

In France Michel Foucault's Histoire de la Folie told the history of unreason in an age of reason in a way that the English speaking world was not yet ready for.

1960

Kathleen Jones Mental Health and Social Policy 1845-1959. See 1955 and 1972

January 1961 Long term planning of hospital services begun March 1961: Enoch Powell's Water Tower Speech: The full scope of the community care policy for the mentally il adopted in the 1960s was revealed in 1966 when the Minister of Health, Enoch Powell, opened a conference of the National Association for Mental Health with a speech on how his forthcoming Hospital Plan would affect psychiatric services. The Percy Report contrasted community care with hospital care. Phrases like in the community have generally been used to mean outside hospital. However, from the Water Tower speech until the 1980s, community care policy was to have as its central feature, the transfer of hospital treatment from isolated mental hospitals to local hospitals. The two main features of the policy were: That hospital treatment should be in Psychiatric Units in District General Hospitals. That as much care and treatment as possible should be provided outside hospital. April 1961: Official opening of Balderton Subnormality Hospital by Enoch Powell. [See policy] January 1962: The Hospital Plan April 1963: Health and Welfare [The community care equivalent to the Hospital Plan.

1964 Labour Government

1966 statistics
In 1966 there were 107 mental illness and 66 mental handicap "hospitals and units with 200 or more beds". (Hospital Statistics 1975, pp 5+7).

In 1966 Borocourt Subnormality Hospital was a well equipped one. Few subnormality hospitals had anything but Victorian type institutional wards, but the largest Borocourt one had only 30 beds. In the late 1960s Oxford Regional Health Authority spent 1.25 million pounds at Borocourt on nine completely new wards, upgrading old wards and building a school, a gymnasium and a workshop.

1966

5.6.1966 Mental Health Week
The Observer Colour Supplement began a three part coverage on changing attitudes to madness down the centuries. The third part was John Gale's personal account.

1967-1969 HOSPITAL SCANDALS:

The 1960s concentrated attention and resources on the treatment of short term mental illness. There was a corresponding neglect of long-stay patients, along with a failure to implement the community care side of the new policies. The scandals of the late 1960s and 1970s shone a light on the consequences.

1967 Sans-Everything - A Case to Answer
1968 Report of Government Inquiry into the Sans Everything allegations

Sans-Everything was a collection of articles edited by Mrs Barbara Robb that dealt with the condition of elderly residents in institutions. It included accounts of individual cases of ill-treatment in psychiatric and geriatric care. The official report into its allegations substantiated many of them.

The establishment in 1972 of a Health Service Commissioner ("Ombudsman") to investigate complaints of individual ill-treatment, followed suggestion made by Professor Abel-Smith in Sans-Everything

1969 Ely Hospital Inquiry Report
1970 Farleigh and Coldharbour

The light shone into mental subnormality (handicap) hospitals with the publication of official reports into Ely Hospital, Cardiff, in 1969; Farleigh Hospital, Somerset and Coldharbour Hospital, Sherbourne, Dorset, in 1971.

Richard Crossman, Secretary of State at the time, responded to Ely as a personal challenge. He launched a programme of additional resources to the mental handicap hospitals, established (November 1969) a Hospital Advisory Service to visit hospitals - especially long-stay ones - and advise him on their condition, and stared a re-appraisal of plans that eventually surfaced as the white paper Better Services for the Mentally Handicapped

The National Association for Mental Health (1969/1970 Annual Report) had a "perverse" regret that there had not been a scandal on the same scale as Ely in a hospital for the mentally ill whilst Crossman was Minister, to stimulate an "accelerated re-appraisal of their needs and progress". It was coming, but by the time the Whittingham Inquiry reported the government had already announced its intention to scrap the old asylums and replace them by "comprehensive psychiatric services" in each district.

This way to the next scandal

In the late 1960s Hospital Boards were informed of a change in government thinking. Instead of just acute, short stay, psychiatric units, they were asked to provide a comprehensive service for all patients at District General Hospitals (Ham, C. 1981 p. 129). This changed thinking was incorporated into Hospital Services for the Mentally Ill in December 1971.

November 1969 Establishment of "Hospital Advisory Service".

Fluphenazine (Modecate). The first long-acting anti-psychotic phenothazine was tested at All Saints Hospital, Birmingham. By one injection every few weeks it was now possible to ensure people were medicated even whilst living outside hospital. Patients needed to be readmitted only if they refused their injection. If a patient did not keep an appointment at the "Modecate clinic", a psychiatric community nurse would visit to see what was happening.

1970

June 1970 Conservative Government
From being a Labour Minister, David Ennals became MIND's first Campaign Director.

1971 Science Time Line

1971 Statistics
In 1971 St Lawrences had 1,850 patients from all over London - mostly mentally handicapped - from young children to men and women who had grown old in the institution. (See 1870 and 1981)

1971

Royal College of Psychiatrists the new name for the Medico-Psychological Association In the 1960s the British Consumers Association broke taboos with its Consumers Guide to Contraceptives. In 1971 it broke another taboo by making mental health a consumer issue, publishing Treatment and Care in Mental Illness

In April 1971 Local Education Authorities became responsible for the education of all mentally handicapped children, however severe their handicap, under the 1970 Education (Handicapped Children) Act. As a result of the Act some level of education had to be provided for every child from five to fifteen years old. As well as providing education for the children, this meant that parents of severely handicapped children were relieved of their care during the day. The Jay Report in 1979 thought this had had such an impact on the lives of families with severely handicapped children as to partly explain why far fewer children went into residential care in the 1970s.

Better Services White Papers
There were two Better Services White Papers. The one on Mental Handicap in 1971, and one on mental illness in 1975.

June 1971: Better Services for the Mentally Handicapped
This White Paper proposed a U-turn in public policy - a pronounced shift in the balance of provision away from hospitals towards non-medical services in the community. Better Services for the Mentally Handicapped took the unprecedented step of setting targets for the number of places in hostels, schools and training centres that local councils would need to supply if the new policy was to be successful.

Campaign for Mentally Handicapped People

The White Paper fell short of what members of Crossman's working group desired. One of them, Peter Townsend, published his disagreements in the Sunday Times on 27.6.1971, the week after the paper was published. He believed the hospitals should have been phased out altogether and that the proposed 25 bed hostels for those who left hospital were:

"a system of minor isolated barracks put up by local authorities in pale imitation of the larger Victorian barracks which are at present run by the hospital authorities"

Townsend wanted mentally handicapped people to live in small houses resembling private housing. A similar position was taken by the Campaign for Mentally Handicapped People (CMH), a group started in 1971 in the belief that people with a mental handicap:

had a right to live lives as close as possible to those of other people

should participate as much as possible in the decisions that affect their lives

should use the same services as everyone else

This policy of normalising the lives of disadvantaged and stigmatised groups has since been called normalisation. It is the converse of the Social Darwinist policy of segregation. Social theory, though not social reality, had turned full circle

December 1971: Hospital Services for the Mentally Ill
This stated that the development of psychiatric methods, and increase in psychiatric units, had brought things to a point where it was thought possible:

to accelerate developments...towards the eventual replacement of the large separate mental hospitals by a service based on general hospitals"

1972

January 1972. The film Family Life told a story of Janice who, as a consequence of family conflict, received two types of psychiatric treatment. Group therapy helped her, but drugs and electroconvulsive therapy broke her spirit. The film (and the television play that preceded it) dramatised the theories of Ronald Laing and David Cooper.

Kathleen Jones' A History of the Mental Health Services. See 1955 and 1960

This way to the previous scandal
THE WHITTINGHAM HOSPITAL REPORT.

February 1972: Whittingham Hospital, just outside Preston in Lancashire, had 3,200 beds in 1953 and 2,045 in 1971. It was one of England's largest mental hospitals, though shrinking as active psychiatry was moved to District General Hospitals in Preston. Allegations of ill-treatment and the conviction of a male nurse for the manslaughter of a patient, led to an inquiry, which reported that for many of Whittingham's patients "the therapeutic revolution of the 1950s" never happened. Almost half had no occupation during the day, but sat around "becoming cabbages". On one ward, 126 patients were cared for by just six nurses. Doctors did not visit long stay wards, but concentrated on acute work and their work outside the hospital. The inquiry conclude that the English mental health system was dividing into "well staffed 'acute' units and 'long stay dumps'".

This way to the next scandal

Patients join protest

The establishment of Psychiatric Units in General Hospitals was also squeezing out community therapy. Community therapy aimed to develop patient self-determination. It was perhaps, not surprising, that squeezing led to patients taking part in the protest.

3.3.1972: "800 people crowded into a meeting at Sidney Webb college on 3rd March to discuss the threatened closure of the Paddington Day Clinic, a therapeutic community. The opening of a psychiatric unit in a nearby general hospital has been given by the Regional Hospital Board as the reason for making the hospital redundant. The patients and staff of the P.D.H. have formed a protest group to oppose this proposal because they feel the work done in this hospital is concerned with increasing the individuals awareness of the problem rather than blotting out the symptoms it may produce". First paragraph of an article signed by Nicky Road, Anna Chadwick and Keith Venablesin Politics of Psychology Newsletter 12.3.1972

October 1972: Services for Mental Illness Related to Old Age

Mental patients unite

SUMP (Scottish Union of Mental Patients) formed by Tommy Ritchie and Robin Farqhuarson. This was the first union of psychiatric patients in the United Kingdom that I know of.

In December 1972, a group of people in the London area produced a pamphlet on The Need for a Mental Patients's Union arguing that "psychiatry is one of the most subtle methods of repression in advanced Capitalist society". This was circulated to psychiatric hospitals and various places where ex-patients were likely to congregate, together with notices of a meeting to be held during March 1973 to discuss the formation of a union.

1973

Wednesday 21.3.1973
150 people attended a meeting at Paddington Day Hospital to discuss forming a mental patient's union (MPU). Over 100 were patients or ex-patients, some coming from as far afield as Scotland.

The large attendance was substantially due to an item on the Today programme in which Michael Sheils interviewed Andrew Roberts, one of the ex-patients involved.

This initial meeting resolved that full membership of the union would be restricted to patients and ex patients only.

A working party of some two dozen full members was formed and not long after set up office in a London squat. This nucleus was given the task of producing a statement of the union's intent and drafting a proposed organisational framework for MPU.

Economic crisis and cuts: Community care policies from 1961 to 1972 assumed continuous economic growth, from which they would be financed. The Arab- Israeli war of October 1973, and the Arab oil embargo, signalled a long period of economic problems. The (Conservative) government responded with drastic cuts in health and welfare capital expenditure, and the cuts were continued and later increased by the subsequent Labour government.

1974

February 1974 Labour Government

1974: Mind Report: Co-ordination or Chaos?

Secure accommodation

April 1974: Interim report of the Butler Committee. As a result of this, a network of Regional Psychiatric Secure Units was planned for England and Wales.

By the 1970s, Broadmoor was seriously overcrowded. On a visit, I looked through a window and saw a sea of short haircuts so close that one could have walked across the room from one head to another. Partly to relieve this pressure, a new "Special Hospital", called Park Lane, was built on land next to Moss Side. The first 35 patients moved in in 1974.

1975

February 1975: Barbara Castle's Mencap speech

October 1975:

Butler Committee Report

and

Better Services for the Mentally Ill

Castles in the Air The ninety one page White Paper Better Services for the Mentally Ill was nicknamed Castles in the Air by COPE when it was presented by Barbara Castle, the Secretary of State at the Department of Health and Social Security, in October 1975. It was long term strategic document, pointing out the general direction the Government wanted services to take, prefaced with a statement that little progress could be made until the economic situation improved. Its emphasis was on providing a comprehensive range of local services in place of asylums, before asylums closed: "... our main aim is not the closure or rundown of the mental illness hospitals as such; but rather to replace them with a local and better range of facilities. It will not normally be possible for a mental hospital to be closed until the full range of facilities described has been provided throughout its catchment area and has shown itself capable of providing for newly arising patients a comprehensive service independent of the mental hospital. Moreover, even then, it will not be possible to close the hospital until it is no longer required for the long stay patients admitted to its care before the local services came into operation" (par.11.5)

The elements of community care before the 1980s included hospitals. The local psychiatric unit was considered part of the community. Community care was a package of local provision, distinct from the distant asylum care. During the 1980s, care in the community came to mean care outside hospital, as distinct from care in hospital. In the 1990s, support in the community moved towards meaning care outside hospitals, hostels or day centres. Notice, however, the development of secure units which substituted, in part, for the custodial provision in the old asylums.

This diagram, that I drew just before the change took place, shows the facilities provided by the National Health Services and Local Authorities that should be part of the community care packet. Underneath I drew a Bargain Basement which contained the possibility of alternative provision by the voluntary sector. In the 1980s and 1990s, the bargain basement grew and developed a private sector department.

1976

1976 Peak in mental hospital admissions (falling since)

The actual numbers in hospital had been falling since 1954

Between 1970 and 1975 the population of mental illness hospitals was reduced from 107,977 to 87,321. The population of mental handicap hospitals was reduced from 55,434 to 49,683 (In-Patient Statistics 1975, tables A8 and B10).

The statistics were said to reflect the success of care in the community, but some argued that the fall had been achieved by discharging patients to families ill-equipped to cope with them, to private hotels that exploited them or, in some cases, onto the streets.

Better Services for the Mentally Ill acknowledged that such things happened, and said:-

"the public... cannot be expected to tolerate under the name of community care the discharge of chronic patients without... after-care... who perhaps spend their days wandering the streets or become an unbearable burden on the lives of their relatives... Such situations do not occur very frequently; but where they do, the whole concept of community care is placed at risk" (par.2.27)

This way to the previous scandals
THE BIRMINGHAM SCANDAL.

On January 12th 1976, the Daily Mirror sensationally questioned the claim that discharge from hospital without inadequate care was infrequent. It ran a feature by John Pilger sub-headed:

Dumped on the streets and in the slums -
5000 people who need help

Birmingham was headlined as

The city of lost souls

A West Midlands Health Official said the DHSS had "applied the screws" to mental hospitals to "decant" patients. Pilger commented that "to be decanted is to be dumped", if you have not got families or friends to take you. The Midlands organiser of MENCAP told him:

"In a few years... you'll be able to see them dying in the streets"

A practice of discharging patients to hotels had been reported four years earlier as a positive advance in community care. The Sunday Times of 17.10.1971 carried a glowing report of how Denbigh Hospital, North Wales, had cut its size from 1,6000 beds to a mere 600, over seven years, by placing patients in the care of the landladies of seaside boarding houses. The ex-patients paid for their keep from their social security benefit.

Pilger's report showed a seamier side to this policy. In Birmingham, an array of guest houses, hotels and boarding houses flourished on the trade in ex-patients. One landlady told Pilger:

"We pick them off the streets or the hospital rings us up and says 'can you take a few?'"

She had

"a cupboard filled with... prescribed tablets... to keep them quiet".

Although this was one of the better hotels, residents still sat all day

"looking blankly at each other... or at the television" [or went] "to St Agnes's hall to stuff toys - 'occupational therapy'"

In one of the worst establishments patients had been slept

"nine in the attic some of them less than four feet from the ceiling" [and fed on "two slices of bread and dripping and a third of a sausage roll"

A councillor reported seeing guests

"with scabies and lice. They had dirty clothes and ten men had no vests and underpants"

A Birmingham Social Services' spokesman said it was not uncommon to find "disturbed and frightened people" wandering about the railway station:

"having just arrived with a travel warrant from hospitals as far afield as London and Scotland. The word seems to have got out that Birmingham has places that will take them."

Hundreds were said to be "just wandering". The Salvation Army hostel said "up to 30%" of the people it took in "from the streets" were ex-patients. "The overwhelming majority" of those who queued "in the cold every night" outside a Catholic refuge were "psychiatric patients".

Whose fault was it? According to Pilger, Birmingham Social Services blamed the hospitals and the hospitals blamed Social Services.

This way to the next scandal

A debate in the House of Commons on better services for mentally ill people was moved for by the Conservative opposition in January 1976. Shortly before the debate, the shadow health minister, Norman Fowler, asked Cecil Parkinson MP to form a Conservative Party policy group on the progress that had and could be made towards community based services for mentally ill and mentally handicapped people. It was an issue of special interest to Mr Parkinson because his constituency, Hertfordshire South, contained three large hospitals for mental illness and two for mental handicap, only one of which served the constituency - the others received their patients from North London.

Parkinson's group drew on considerable expertise from outside party politics. It met regularly for three years and completed its investigations in spring 1979, just as the Conservative Party moved from opposition into Government.

February 1976 The film One Flew Over the Cuckoo's Nest dramatised the 1963 novel by Ken Kesey about the way asylums change the personalities of people who become their in-patients. The novel and film popularised the theories of Erving Goffman, in Asylums (1961)

March 1976: Priorities for Health and Personal Social Services A Consultative Circular on Joint Planning and Finance was issued at the end of March. Priorities was, amongst other things, an effort to advance such causes as Better Services for the Mentally Ill by giving them more money at the expense of other areas. The 1975 White Paper had said that investment on the scale needed to achieve its ends would not be possible "over the next three or four years" (par. 11.5), but by giving deprived sectors priority of general and acute hospital provision, Priorities proposed a rate of development which, "if maintained", would enable the Better Services aims to be achieved over most of the country within twenty-five years.

1977

Beech Tree House, Hertfordshire, was established by the Spastics Society in 1977 to demonstrate that even the most severely disturbed children from mental handicap hospitals could be successfully educated given sufficient resources and the right approach.

May 1977 HC(77)17 second circular on Joint Care Planning

SEPTEMBER 1977 THE WAY FORWARD

1978

April 1978: Children Living in Long Stay Hospitals

May 1978: The Warnock Report

On Our Own. Patient-Controlled Alternatives to the Mental Health System by Judi Chamberlin gave Judi's "patient's view of the mental health system", an account of her own treatment, and an account of communities run by their users. The book drew on the work of colleagues in Mental Patients' Liberation groups in North America, but also used some United Kingdom material.

1979 Science Time Line

1979

The Borocourt Hospital League of Friends donated an outdoor play area for severely handicapped patients to use in good weather. It was a wirenetting fence surrounding a spacious area with a large cedar tree and toys for patients to play on.

March 1979 The Jay Report

May 1979 Thatcher Government

Spring 1979; The Parkinson Report (see 1976) was produced for the Conservative Party, but it was kept secret until 1981. The report strongly endorsed community care and called for a determined programme of hospital closures, linked to a statutory duty and financial incentives for councils to make community provision.

It said that, although all governments since 1959 were committed to community care policy, there was little real progress in creating services in the community. Amongst hospital staff, they found considerable resistance to the policy and "a strongly held belief that successive governments had not meant what they said."

Cecil Parkinson suggested that the policy had been discredited "because it is not really being implemented". Patients left the hospitals, but the money and skills stayed in them, so patients went into the community without the support they needed.

JULY 1979: NHS COMMISSION ON THE NATIONAL HEALTH SERVICE REPORT

DECEMBER 1979 PATIENTS FIRST

[December 1979?] National Development Group for Mental Handicap to be axed as a "QUANGO".

1980s
In the 1980s and 1990s there were major changes in what community care means. It no longer meant care outside hospital in an overall system where hospital plays a major role. It no longer meant replacing distant asylums by treatment in local psychiatric hospitals. It came to mean providing services for people who continue to live in their own homes, and continually cutting back on any kind of institutional provision, whether in a hospital, a hostel or a day centre. The keynote of the decades was set by the Parkinson Report, made in 1979, but kept secret until 1981.

JANUARY 1980: THE NODDER REPORT [Published] [Working Group on Organizational and Management Problems of Mental Illness Hospitals]

January 1980 Jenkin promises "priority"

MAY 1980: THE FUTURE PATTERN OF HOSPITAL PROVISION [DHSS Consultation Paper]

DECEMBER 1980: MENTAL HANDICAP: PROGRESS, PROBLEMS AND PRIORITIES

October 1980 MIND CONFERENCE

DECEMBER 1980 PROGRESS, PROBLEMS AND PRIORITIES: (A review of mental handicap services since the 1971 White Paper)

1981 Science Time Line

1981 Statistics
By 1981, deaths and discharges from St Lawrences had reduced the number of patients to 1,300. It was one of seven English hospitals with the least money to spend on patients. (See 1870 and 1971 and Silent Minority (below))

The International Year for Disabled People

1981 Special Education Act

February 1981: Care in Action

This way to the previous scandal

10.6.1981: Silent Minority
This television documentary was shown in peak viewing hours with a warning that some of the scenes might prove disturbing. The scenes were of what happened out of view in two understaffed hospitals for the mentally handicapped, St Lawrences and Borocourt. The hospitals had cooperated with making it "in the hope of conveying...the message that hospitals for the mentally handicapped are seriously understaffed and under-financed", but one of the messages of the documentary was that hospital asylums were the wrong place for mentally handicapped people to live.

Silent Minority concentrated its attention on the most severely disabled patients - those that Government policy still believed would always need "the special facilities of hospital care". It contrasted the understaffed wards at St Lawrences - where children were clean, fed and dressed, but bored and lonely - with Beech Tree House.

It suggested that the intensive education of children in a small unit at Beech Tree House prevented them becoming disturbed, frightened and frightening adults like some who were in a wire compound during daylight hours at Borocourt. Many of the Borocourt patients were sedated with Largactil - but, even so, the hospital seven seclusion rooms. A man described by the hospital as "one of its most aggressive patients" was said on the television programme to have spent almost six months in almost continuous solitary confinement. A member of staff claimed that, as a result of solitary confinement, the patient seemed "on the edge of almost total madness".

Press headlines gave the impression that Government Ministers reactions to Silent Minority were apoplectic - FILM BIASED, SAYS JENKIN (The Guardian 11.6.1981) - FOWLER RAPS 'BIASED SILENT MINORITY FILM (Nursing Mirror 4.11.1981)

Minister's reactions contained more positive elements, the most important of which was that the Under Secretary of State, George Young, insisted his civil servants put some urgency into producing the Green Paper Care in the Community.

The effect of the documentary that seemed most important to me was its effect on the public, but a friend who lobbies governments disagreed with me when I wrote that "Silent Minority probably did more to create a popular demand for community care than a decade of official policy statements". She was more conscious of what goes on in government. I just experienced what was happening in Hackney. Relatives and friends of mentally handicapped people from Hackney living miles from home in St Lawrences, and other asylums around London, had simmered with anger and anxiety about them for several years. Silent Minority helped to bring their concern to the boil, and in January 1982 families, professionals, voluntary groups and articulate local people with a mental handicap formed HAMHP (Hackney Action for Mentally Handicapped People) to press for local services that would give all mentally handicapped people from Hackney a chance to live as part of our own community.

Care in the Community and the Parkinson Report

July 16th 1981: Care in the Community was the title of a Green Paper that suggested ways of moving money and care from the National Health Service to local councils and voluntary associations. It was a way of implementing the (hitherto secret) Parkinson Report, and seven days later the Conservative Political Centre published The Right Approach to Mental Health, an edited summary of the Parkinson Report.

Care in the Community began by saying:

"Most people who need long-term care can and should be looked after in the community. That is what most of them want for themselves and what those responsible for their care believe to be best".

Care in the Community applied especially to mentally handicapped, mentally ill and elderly patients (in that order).

It suggested that 20,000 long-term patients (15,000 in mental handicap hospitals and 5,000 in mental illness hospitals) could be discharged "immediately" if funds could be switched from the Health Service to local authorities (paragraphs 3.1. and 3.2).

Opinions were sought on seven possible ways of moving money and patients. On July 28th 1982 the Government said it had decided to adopt three main proposals:

The maximum period for which the NHS could pay for schemes under joint finance would be extended from seven to thirteen years for projects to move people out of hospital, and the NHS would be able to pay 100% of the money for up to ten years.

District Health Authorities would be allowed to make guaranteed annual payments to councils and voluntary bodies for ex-patients they provided for in the community.

Fifteen million pounds would be set aside from joint fiance money to develop and assess a series of pilot projects.

1982

Peter Sedgwick's Psychopolitics, published in 1982, criticised the anti-psychiatry movement of the 1960s/1970s theoretically and politically. Sedgwick's political criticism of the Myth of Mental Illness idea was that it undermined efforts to secure community care resources for those who suffer from mental distress.

Mental Health and Civil Liberties

We Can Speak for Ourselves. Self-Advocacy by Mentally Handicapped People, by Paul Williams and Bonnie Shoultz. This American book said that mentally handicapped people usually had decisions made for them about every detail of their lives, but that through the Self-Advocacy Movement many were learning to formulate their own needs, to put forward their demands and to campaign to win them.

1983

1983 Mental Health Act. Under the 1959 Mental Health Act it is legally unclear whether a legal order to detain in hospital, against a person's wishes, empowers the hospital to impose medical treatments. If it does (which was generally accepted), there were no controls in the Act of the treatments imposed. The 1983 Act places legal controls on the application of medical treatments, particularly surgery, electro-convulsive therapy and mood- altering drugs.

Section 117 imposes a duty on local Social Services Authorities as well as Health Authorities to provide aftercare services for some mentally disturbed patients who have ceased to be detained and who leave hospital.

1984
Valerie Argent's poem Inner Circle was written in a psychiatric ward at Hackney Hospital.

1986 Disabled Persons Services Consultation and Representation Act. Under this Act, Social Services must assess the needs of disabled people on request for certain welfare services and local authorities must provide to meet those needs if they decide it is necessary. Including provision or help over telephone, television, radio, library facilities, holidays, recreation, access to education, transport to and from services, social rehabilitation and adjustment, occupational, social, cultural and recreational activities. Disabled means "Blind, Deaf or dumb or who suffer from mental disorder of any description or who are substantially and permanently handicapped by their illness, injury or congenital deformity"

Empowerment In 1986 the compilers of the Oxford Dictionary noticed that an old (1690) Quaker word had re-entered the vocabulary with a secular meaning. Individuals and groups were being "empowered" to be stronger and more confident in controlling their life and claiming their rights. The word must have spread quickly: The 1985-1986 Report of City and Hackney Community Health Council, for example, was called Empowering the Users of the Health Service. "Developments in mental health services", it said, will not work well unless they are supported by the people that use them and so the CHC believes they should have a say in planning them and a continuing say in how they are run". A similar theme ran through all issues.

1989
David Ennals was President of MIND from 1989 to 1995

1990: National Health and Community Care Act

1991 Survivors' Poetry founded by Frank Bangay and others. From Dark to Night, an anthology edited by Frank Bangay, Hilary Porter and Joe Bidder, was published by the Survivors Press in 1992. In 1999, an illustrated collection of Frank Bangay's poems Naked Songs and Rhythms of Hope (1974 to 1999) was co-published by Spare Change Books, Box 26, 136-138 Kingsland High Street, Hackney, London, E8 2NS and Survivors Poetry, 34 Osnaburgh Street, London, NW1 3ND. In 2001 A True Voice Singing, a CD of Frank Bangay reading fifteen of his poems to musical backgrounds, was published by CORE Arts. Frank Bangay can often be heard performing at the Krazy Kats n Dogs Klub

1993

Homeless mentally ill people not ex-patients of the asylums. Who are they?

October 1994: In Finding a Place: A Review of Mental Health Services for Adults, the Audit Commission found that the favoured policy, of individual, locally based care within the community, was "struggling".

20.2.1995 Government asked in the House of Lords, how it judged the strength of local and family opposition to the proposed closure of the following long-stay hospitals for mentally handicapped people: Cell Barnes Hospital, St Ebbas Hospital, Turner Village Hospital, Llanfrechfa Grange Hospital, Northgate Hospital, Prudhoe Hospital, Meanwood Park Hospital, Ida Darwin Hospital, Calderstones Hospital, Leybourne Grange Hospital, Tilworth Grange Hospital, Clarefield Hospital.

1997

May 1997 Blair Government

In a written answer on 17.7.1997, updated 16.11.1999, the Secretary of State, Alan Milburn, identified hospitals listed as having recently been, or currently, the subject of consultation which could lead to the full closure. The psychiatric hospitals on this list included: Fulbourn , Goodmayes, Horton, Napsbury, Runwell, Shenley, Warley, Belmont, St. Andrew's, St. Mary's, Winterton Hospitals, All Saints, Ida Darwin, Sundridge Hospital, Highcroft, Monyhull, St. Edward's, Stallington,

May 1998: Audit Commission published Home Alone: The Housing Aspects of Community Care

September 1999: Audit Commission published Children in Mind: Child and Adolescent Mental Health Services

January 2000: Audit Commission published Forget Me Not: Mental Health Services for Older People

Spring 2000: Rossbret workhouse and hospitals (including asylums) mailing list established in Birmingham. Supported by people engaged in family history, the list and its website reflect a major change in social attitudes from the days when a relative in an asylum was a closely guarded secret.

2001

Valuing People: A New Strategy for Learning Disability for the 21st Century Department of Health March 2001. The first white paper for people with learning disability since Better Services for the Mentally Handicapped in June 1971.

It says we should all be citizens with legal and civil rights.

 

It supports independence.

 

It supports having more choice.

 

It supports being included.

2002

Geraldine Bedell, The Observer Sunday 7.4.2002: "Today, fewer than 20 of the original 120 Victorian asylums remain" Anybody know which they are? Please let me know

25.6.2002: House of Commons Mental Health Debate Liam Fox on Conservative reforms since Lord Ashley David Hinchliffe: Community Care has not failed

27.11.2002 Ceremonial blowing up of the water tower of Bexley Hospital. The plunger on the explosives was pressed by Linda Noyes, who trained as a nurse at Bexley Hospital. Click on the picture for news release. Click on this link for a poem that Debbie Mayes wrote (22.12.1998) about being a patient in Bexley.

January 2003 Making Things Happen Better, the first annual report of the Learning Disability Task Force will be available online soon (we hope!). It is available free by phoning 0808 8081111 and you can read a Guardian Review online

On Sunday 4.5.2003 Gordon Tozer took a break from his work on the world of asylums to photograph what is left of Coney Hill Mental Hospital in Gloucestershire Click on the ruin to see Coney Hill as it was Gloucestershire Primary Mental Health is part of the structure of community care that has replaced the asylum.