Intermediate care is an integral part of healthcare for older people with physical illness. It ca... more Intermediate care is an integral part of healthcare for older people with physical illness. It can provide rehabilitation and enable early hospital discharge, but people with both mental and physical illnesses have frequently been excluded from intermediate care services. This article describes a 12 bed, nurse led rehabilitation unit for older people with mental and physical health needs. The ethos is to promote independence and allow patients to achieve their objectives no matter what their age and ongoing limitations.
The most relevant chapters for psychiatrists in this fascinating book are those by Michela Summa,... more The most relevant chapters for psychiatrists in this fascinating book are those by Michela Summa, Thomas Fuchs and Till Grohmann. Summa argues that even though it is true that there is a distinction and a discontinuity between reality and fiction, reality shapes fiction and the experience of fiction too acts to reconfigure our sense of reality. This chapter does not deal directly with the discontinuities between 'psychotic' reality and everyday reality, but it is clear that much of what is explored is relevant to an understanding of how patients traverse the differing worlds and may also help to illustrate the interpenetration of psychotic reality and everyday experiences. Fuchs focuses on what he terms the 'as-if ' function; this is the human cognitive function that allows us 'to suspend the force and validity of the immediate experience and to enter a parallel world of imagination, daydreaming, hypothetical thought, fiction, pretence, role play or theatre'. Fuchs' case is that impairment of this cognitive function underlies the concrete attitude, delusions and what he terms 'transitivism' (the threat of loss-of-self that is posed by the presence of others) in schizophrenia. I am not persuaded by his arguments but nonetheless his is a novel approach. Finally, Grohmann disputes the role of the disturbance of Theory of Mind in schizophrenia and autism and argues for an account based on the phenomenology of intersubjectivity. There's no doubting the fact that the case being put forward is not persuasive but it illustrates that, even in a condition such as autism where certain empirical facts are settled and established, alternative accounts are still possible. This is a densely written book that has a lot to offer, but it is not for a general audience. Matters that have a central place in psychiatric thought are treated with seriousness and rigour alongside approaches that will surprise many psychiatrists whilst at the same making the subject seem fresh and vital.
The concluding remarks draw together aspects of AEGIS’s campaign and Barbara’s work, the role of ... more The concluding remarks draw together aspects of AEGIS’s campaign and Barbara’s work, the role of women in the campaign, the last years of Barbara’s life, and AEGIS’s legacy for twenty-first century health and social care policy and practice. Inadequate care still occurs in the twenty-first century, but recurrence of scandal does not invalidate Barbara’s achievements, or those of other pioneer social reformers: William Wilberforce, for example, would be busy today, dealing with modern slavery and people trafficking. Some risky patterns of NHS practice continue: understaffing and regimented monitoring of task-driven rather than person-centred practice is common, and staff new to a hospital are rarely asked for feedback about their experiences and insights, which, seen through a ‘new pair of eyes’, may be valuable.
Within days of war breaking out, the country faced extraordinary chaos in the food market. Many f... more Within days of war breaking out, the country faced extraordinary chaos in the food market. Many foods considered nutritious, such as meat, were prioritised for the soldiers. The large contracts for food required by the asylums became particularly vulnerable, with food diverted into military supplies. Within the asylums, food and fuel distribution was also inequitable, depending more on status than on health need. Alongside asylum managers’ goals of lowest possible expenditure, they often had little grasp of emerging nutritional science, a potentially disastrous combination. In 1919, the Times concluded: “Have we been sending some of our lunatics into the Army and starving the others?” It called for the Board of Control to account.
In October 1965 Barbara established AEGIS (Aid for the Elderly in Government Institutions). AEGIS... more In October 1965 Barbara established AEGIS (Aid for the Elderly in Government Institutions). AEGIS, became a high-profile pressure group. It aimed to call public attention to serious defects in the care of older patients in psychiatric hospitals. AEGIS won the support of policy experts, such as Brian Abel-Smith. Barbara compiled the book Sans Everything, incorporating accounts of poor practice from whistle-blowers who were mainly hands-on staff and new to a hospital. Sans Everything also suggested remedies, including dedicated and proactive psychiatric services for older people, a hospitals' inspectorate, an ombudsman and improved complaints procedures. AEGIS planned tactically, aiming to kick-start the Ministry out of its complacency. This chapter also explores comparisons made by Sans Everything contributors between psychiatric hospital long-stay wards and Nazi concentration camps.
The pre-war annual asylum death rate of under ten per cent rose to 12 per cent in 1915–1916, and ... more The pre-war annual asylum death rate of under ten per cent rose to 12 per cent in 1915–1916, and 20 per cent in 1918. There was little alarm, because causes of death were the same as pre-war, often infectious diseases, so it did not indicate staff failing in their duty of care, such as if the rise been attributed to “accidents” or suicide. Little was done to stem the rising death rate. A parallel rise did not occur in community dwelling civilians. Numerous practices, known to be unhygienic, risked spreading infection. They included: treating healthy and infectious patients together in open wards; lack of hand washing by laundry and kitchen workers and by patients after using the lavatory; lack of measures to prevent inhalation of mycobacterium tuberculosis; and drying soiled underclothing in the ward to be worn again without washing. Overcrowding, understaffing and war time austerity aggravated the situation.
Barbara Robb, Amy Gibbs and the 'Diary of a Nobody' 'Mrs Robb has always been a terrible danger t... more Barbara Robb, Amy Gibbs and the 'Diary of a Nobody' 'Mrs Robb has always been a terrible danger to [the government].. .. I knew we had to defuse this bomb', wrote Richard Crossman in November 1969 (1977, p. 727), a fine compliment from a Cabinet Minister to a woman who emerged from the shadows to fight for improvements in the care of older people. How did she build such a fearsome reputation? What was her background? How did she acquire her skills? What made her take on the cause? What gave her the 'uncrushable belief in the need to expose what was going on'? 1 How did she cope with Hospital Management Committees (HMCs), Regional Hospital Boards (RHBs) and officialdom's tendency to reject critics and criticism and to maintain the status quo? The biographical element of this book seeks to illuminate the aspects of Barbara's background and personality that motivated her and sustained her in her campaign, and to introduce Amy Gibbs. Their life stories lead into the 'Diary of a Nobody', the visit-by-visit record that Barbara felt compelled to start writing on the first day she visited Amy in Friern Hospital, the events of which inspired the founding of AEGIS (Aid for the Elderly in Government Institutions). The Diary ensured that Barbara had an accurate description of happenings that she observed directly or was told about by patients and visitors on the ward in order to achieve her objective of making improvements. 2 It was not written for publication. She used Amy's real name, only later giving her the pseudonym 'Miss Wills'. Barbara did not explain the title. 3 Amy, an ordinary
Britain declared war against Germany on 4 August 1914. For the next four years military prioritie... more Britain declared war against Germany on 4 August 1914. For the next four years military priorities over-rode those of civilians. The entire population faced hardships, but for people designated “pauper lunatics” in public asylums, life became very harsh. At the beginning of the war, the asylums were a story of good intentions gone awry, “vast warehouses for the chronically insane and demented,” the failed dreams of social reformers and psychiatrists. A substantial historiography exists on “shell shock”, the syndrome of mental disorder suffered by war-traumatised soldiers. By contrast, the historiography of First World War civilian asylums and their patients is meagre. This book tells the story of four asylums to the north of London at a time of national turmoil, when intense austerity, deprivation and competing priorities affected those within them.
The Royal College of Psychiatrists' antiquarian book collection originated from the library o... more The Royal College of Psychiatrists' antiquarian book collection originated from the library of psychiatrist Daniel Hack Tuke (1827-1895). A proposal to name the collection after him led us to investigate aspects of his life and work, particularly related to his attitudes concerning race, gender and homosexuality. We juxtaposed his ideas with those of some of his contemporaries. We cannot separate psychiatrists, past or present, from the societal and scientific context that shapes their professional understanding and standards. However, changes in language, knowledge, values and other sociocultural factors over time can affect how we perceive our forebears and how future generations of psychiatrists may perceive us.
Doctor Montagu Lomax was a retired General Practioner, whose service in English lunatic asylums d... more Doctor Montagu Lomax was a retired General Practioner, whose service in English lunatic asylums during the First World War inspired him to write The experiences of an asylum doctor: with suggestions for asylum and lunacy law reform. Published in 1921, the book acted as a catalyst for lunacy reform and stimulated improvements in the mental health services in the United Kingdom. Lomax spent the remainder of his retirement campaigning for lunacy reform. He suffered financial and personal hardship following the publication of the book and was castigated by his own profession. On the centenary of the publication of Experiences, this article explores the background and motivation of a remarkable man.
Covering all historical periods and geographical contexts, the series explores how mental illness... more Covering all historical periods and geographical contexts, the series explores how mental illness has been understood, experienced, diagnosed, treated and contested. It will publish works that engage actively with contemporary debates related to mental health and, as such, will be of interest not only to historians, but also mental health professionals, patients and policy makers. With its focus on mental health, rather than just psychiatry, the series will endeavour to provide more patient-centred histories. Although this has long been an aim of health historians, it has not been realised, and this series aims to change that. The scope of the series is kept as broad as possible to attract good quality proposals about all aspects of the history of mental health from all periods. The series emphasises interdisciplinary approaches to the field of study, and encourages short titles, longer works, collections, and titles which stretch the boundaries of academic publishing in new ways.
PurposeThe purpose of this study is to draw on multiple streams analysis (MSA) and to investigate... more PurposeThe purpose of this study is to draw on multiple streams analysis (MSA) and to investigate how policy change emerged from two inquiries into allegations of abusive hospital care in National Health Service (NHS) hospitals in the United Kingdom (UK) in the 1960s.Design/methodology/approachThe methodology of this study is regarding a historical case study of two inquiries.FindingsThe Sans Everything and Ely inquiries had the same legal standing and terms of reference, but the second put psychiatric hospital reform on the agenda, while the first did not. The main factor making Ely rather than Sans Everything the turning point seems to have been concerned with “agency”, linked with a few key individuals.Research limitations/implicationsA study of 1960s event necessarily relies heavily on documentary and archival sources, and cannot draw on interviews which are an important ingredient of many case studies.Originality/valueThe originality of the study is to examines inquiries, which...
Civilian Lunatic Asylums During the First World War
This chapter aims to bring together components of asylum life—the law, the leadership, staff, pat... more This chapter aims to bring together components of asylum life—the law, the leadership, staff, patients and public—to create a broad picture about what happened when things went wrong: accidents, injuries, escapes and suicides. There are drawbacks, in that much of the material is necessarily anecdotal with inconsistencies and contradictions. However, cases provide enough evidence to identify repeated patterns of attitudes, behaviours and decision making, from which conclusions can be drawn. The Board of Control indicated that it knew about asylum rough handling, but it did little to try to remedy the situation. Despite their rhetoric of good intentions, the asylum leadership frequently rationalised or denied maltreatment, thus failing to secure the most humane conditions for patients.
104 www.thelancet.com/psychiatry Vol 4 February 2017 50 years ago, Barbara Robb compiled Sans Eve... more 104 www.thelancet.com/psychiatry Vol 4 February 2017 50 years ago, Barbara Robb compiled Sans Everything: A case to answer. The book described ill-treatment of older people (most over 60 years of age) in long-stay wards, mainly in psychiatric hospitals. Sans Everything was a bestseller, caused a public uproar, and a national Sunday newspaper described it as “the year’s most challenging book”. This essay explores the context and story of Sans Everything, drawing substantially on research and editorials published in The Lancet, and considers whether any of the issues raised in the book are relevant to psychiatric services today (see appendix for full bibliography). Before the advent of the National Health Service (NHS) in 1948, most hospitals in England were philanthropic “voluntary” hospitals or former Poor Law infi rmaries. Patients had few rights within these institutions and passively accepted whatever treatment and care was available. After 1948, general taxation funded the NHS, giving the public a sense of ownership. The concept of patients as consumers of health care emerged in the 1960s, with the public expecting to exert some control over the services they used. The Patients Association, a pressure group founded in 1963, aimed to do this by infl uencing NHS policy. In 1965, Robb established Aid for the Elderly in Government Institutions (AEGIS), another pressure group that aimed to improve long-stay care for older people. Older people, their families, and health and social care professionals usually accepted declining health in old age as inevitable. Psychiatric symptoms were generally attributed to irreversible “senile dementia”, despite research showing that older people could develop the range of mental illnesses suff ered by younger people. Defeatist attitudes prevailed: older people underpresented symptoms to their general practitioners who underdiagnosed and undertreated, creating a spiral of neglect that was associated with crises and demands for hospital admission. Social interventions to support older people and the families caring for them were rarely available, despite reports indicating the potential for benefi cial outcomes. Families were often willing to care for their older, dependent relatives, but, without support, care frequently broke down. Provision of dynamic psychiatric services for older people lagged behind the expanding and increasingly successful fi elds of geriatric medicine and psychiatric services for younger adults. Older people were often admitted to long-stay wards in the psychiatric hospitals, without previous medical assessment. In 1952, research by psychiatrists published in The Lancet concluded: “we must be practical and temper our remedies to the gravity of the situation. It is more economical...to treat—say—60 patients in two wards, than the same number in three wards”. Geriatrician Wilfred Fine noted the lack of interest from psychiatrists towards older patients, and wrote that the psychiatric hospitals were “silted up” with elderly patients because psychiatrists “do not wish to treat” them. With an expected “looming geriatric impasse”, creativity succumbed to nihilism about remedying the situation, and custodial wards in many psychiatric hospitals became atrociously overcrowded and understaff ed. Despite widespread pessimism, some psychiatrists demonstrated that innovative services that integrated hospital and community approaches could enable mentally unwell older people to keep well, remain longer in their own homes, and avoid long-stay admissions. At Severalls Hospital, Colchester, in 1961, Tony Whitehead created a treatment-focused out patient, domiciliary, and inpatient psychogeriatric service. Bed occupancy in the older people’s wards fell from 374 to 296 over 16 months, despite more short admissions for treatment. The Lancet published Whitehead’s fi ndings in 1965. In the 1960s, stripping—removing patients’ personal possessions, including spectacles, hearing aids, and dentures—was common in traditional custodial long-stay wards. This impaired independence, social interaction, and nutrition: it was easier to nurse passive patients than active ones. AEGIS pressurised the Ministry of Health to ensure that regional hospital boards (RHBs) reviewed stripping in their hospitals, and asked Eric Lubbock MP to raise the issue in the House of Commons. Lubbock’s concern For the 1952 study see Articles Lancet 1952; 259: 377–82
The government acknowledged scandalously poor care of long-stay patients in National Health Servi... more The government acknowledged scandalously poor care of long-stay patients in National Health Service (NHS) hospitals in 1969. This followed the Ely Hospital inquiry, which emerged in the aftermath of revelations of abuse at seven hospitals described in Barbara Robb's book Sans Everything: A Case to Answer (1967). Allegations in Sans Everything and at Ely were similar. However, the inquiry committees which investigated, 'disproved' those in Sans Everything and upheld those at Ely. The Ely inquiry became pivotal to NHS policy reform for long-stay mental illness and mental handicap hospitals, and for giving patients and their families a greater voice if they had concerns about inadequacies. This paper explains the relationship between Sans Everything and 'Ely' and analyses the impact of Robb's work-her high-profile press campaign, networking, and determination to achieve improvement-which triggered revelations at Ely and elsewhere, and helped shape the course and constructive outcome of the Ely inquiry.
Intermediate care is an integral part of healthcare for older people with physical illness. It ca... more Intermediate care is an integral part of healthcare for older people with physical illness. It can provide rehabilitation and enable early hospital discharge, but people with both mental and physical illnesses have frequently been excluded from intermediate care services. This article describes a 12 bed, nurse led rehabilitation unit for older people with mental and physical health needs. The ethos is to promote independence and allow patients to achieve their objectives no matter what their age and ongoing limitations.
The most relevant chapters for psychiatrists in this fascinating book are those by Michela Summa,... more The most relevant chapters for psychiatrists in this fascinating book are those by Michela Summa, Thomas Fuchs and Till Grohmann. Summa argues that even though it is true that there is a distinction and a discontinuity between reality and fiction, reality shapes fiction and the experience of fiction too acts to reconfigure our sense of reality. This chapter does not deal directly with the discontinuities between 'psychotic' reality and everyday reality, but it is clear that much of what is explored is relevant to an understanding of how patients traverse the differing worlds and may also help to illustrate the interpenetration of psychotic reality and everyday experiences. Fuchs focuses on what he terms the 'as-if ' function; this is the human cognitive function that allows us 'to suspend the force and validity of the immediate experience and to enter a parallel world of imagination, daydreaming, hypothetical thought, fiction, pretence, role play or theatre'. Fuchs' case is that impairment of this cognitive function underlies the concrete attitude, delusions and what he terms 'transitivism' (the threat of loss-of-self that is posed by the presence of others) in schizophrenia. I am not persuaded by his arguments but nonetheless his is a novel approach. Finally, Grohmann disputes the role of the disturbance of Theory of Mind in schizophrenia and autism and argues for an account based on the phenomenology of intersubjectivity. There's no doubting the fact that the case being put forward is not persuasive but it illustrates that, even in a condition such as autism where certain empirical facts are settled and established, alternative accounts are still possible. This is a densely written book that has a lot to offer, but it is not for a general audience. Matters that have a central place in psychiatric thought are treated with seriousness and rigour alongside approaches that will surprise many psychiatrists whilst at the same making the subject seem fresh and vital.
The concluding remarks draw together aspects of AEGIS’s campaign and Barbara’s work, the role of ... more The concluding remarks draw together aspects of AEGIS’s campaign and Barbara’s work, the role of women in the campaign, the last years of Barbara’s life, and AEGIS’s legacy for twenty-first century health and social care policy and practice. Inadequate care still occurs in the twenty-first century, but recurrence of scandal does not invalidate Barbara’s achievements, or those of other pioneer social reformers: William Wilberforce, for example, would be busy today, dealing with modern slavery and people trafficking. Some risky patterns of NHS practice continue: understaffing and regimented monitoring of task-driven rather than person-centred practice is common, and staff new to a hospital are rarely asked for feedback about their experiences and insights, which, seen through a ‘new pair of eyes’, may be valuable.
Within days of war breaking out, the country faced extraordinary chaos in the food market. Many f... more Within days of war breaking out, the country faced extraordinary chaos in the food market. Many foods considered nutritious, such as meat, were prioritised for the soldiers. The large contracts for food required by the asylums became particularly vulnerable, with food diverted into military supplies. Within the asylums, food and fuel distribution was also inequitable, depending more on status than on health need. Alongside asylum managers’ goals of lowest possible expenditure, they often had little grasp of emerging nutritional science, a potentially disastrous combination. In 1919, the Times concluded: “Have we been sending some of our lunatics into the Army and starving the others?” It called for the Board of Control to account.
In October 1965 Barbara established AEGIS (Aid for the Elderly in Government Institutions). AEGIS... more In October 1965 Barbara established AEGIS (Aid for the Elderly in Government Institutions). AEGIS, became a high-profile pressure group. It aimed to call public attention to serious defects in the care of older patients in psychiatric hospitals. AEGIS won the support of policy experts, such as Brian Abel-Smith. Barbara compiled the book Sans Everything, incorporating accounts of poor practice from whistle-blowers who were mainly hands-on staff and new to a hospital. Sans Everything also suggested remedies, including dedicated and proactive psychiatric services for older people, a hospitals' inspectorate, an ombudsman and improved complaints procedures. AEGIS planned tactically, aiming to kick-start the Ministry out of its complacency. This chapter also explores comparisons made by Sans Everything contributors between psychiatric hospital long-stay wards and Nazi concentration camps.
The pre-war annual asylum death rate of under ten per cent rose to 12 per cent in 1915–1916, and ... more The pre-war annual asylum death rate of under ten per cent rose to 12 per cent in 1915–1916, and 20 per cent in 1918. There was little alarm, because causes of death were the same as pre-war, often infectious diseases, so it did not indicate staff failing in their duty of care, such as if the rise been attributed to “accidents” or suicide. Little was done to stem the rising death rate. A parallel rise did not occur in community dwelling civilians. Numerous practices, known to be unhygienic, risked spreading infection. They included: treating healthy and infectious patients together in open wards; lack of hand washing by laundry and kitchen workers and by patients after using the lavatory; lack of measures to prevent inhalation of mycobacterium tuberculosis; and drying soiled underclothing in the ward to be worn again without washing. Overcrowding, understaffing and war time austerity aggravated the situation.
Barbara Robb, Amy Gibbs and the 'Diary of a Nobody' 'Mrs Robb has always been a terrible danger t... more Barbara Robb, Amy Gibbs and the 'Diary of a Nobody' 'Mrs Robb has always been a terrible danger to [the government].. .. I knew we had to defuse this bomb', wrote Richard Crossman in November 1969 (1977, p. 727), a fine compliment from a Cabinet Minister to a woman who emerged from the shadows to fight for improvements in the care of older people. How did she build such a fearsome reputation? What was her background? How did she acquire her skills? What made her take on the cause? What gave her the 'uncrushable belief in the need to expose what was going on'? 1 How did she cope with Hospital Management Committees (HMCs), Regional Hospital Boards (RHBs) and officialdom's tendency to reject critics and criticism and to maintain the status quo? The biographical element of this book seeks to illuminate the aspects of Barbara's background and personality that motivated her and sustained her in her campaign, and to introduce Amy Gibbs. Their life stories lead into the 'Diary of a Nobody', the visit-by-visit record that Barbara felt compelled to start writing on the first day she visited Amy in Friern Hospital, the events of which inspired the founding of AEGIS (Aid for the Elderly in Government Institutions). The Diary ensured that Barbara had an accurate description of happenings that she observed directly or was told about by patients and visitors on the ward in order to achieve her objective of making improvements. 2 It was not written for publication. She used Amy's real name, only later giving her the pseudonym 'Miss Wills'. Barbara did not explain the title. 3 Amy, an ordinary
Britain declared war against Germany on 4 August 1914. For the next four years military prioritie... more Britain declared war against Germany on 4 August 1914. For the next four years military priorities over-rode those of civilians. The entire population faced hardships, but for people designated “pauper lunatics” in public asylums, life became very harsh. At the beginning of the war, the asylums were a story of good intentions gone awry, “vast warehouses for the chronically insane and demented,” the failed dreams of social reformers and psychiatrists. A substantial historiography exists on “shell shock”, the syndrome of mental disorder suffered by war-traumatised soldiers. By contrast, the historiography of First World War civilian asylums and their patients is meagre. This book tells the story of four asylums to the north of London at a time of national turmoil, when intense austerity, deprivation and competing priorities affected those within them.
The Royal College of Psychiatrists' antiquarian book collection originated from the library o... more The Royal College of Psychiatrists' antiquarian book collection originated from the library of psychiatrist Daniel Hack Tuke (1827-1895). A proposal to name the collection after him led us to investigate aspects of his life and work, particularly related to his attitudes concerning race, gender and homosexuality. We juxtaposed his ideas with those of some of his contemporaries. We cannot separate psychiatrists, past or present, from the societal and scientific context that shapes their professional understanding and standards. However, changes in language, knowledge, values and other sociocultural factors over time can affect how we perceive our forebears and how future generations of psychiatrists may perceive us.
Doctor Montagu Lomax was a retired General Practioner, whose service in English lunatic asylums d... more Doctor Montagu Lomax was a retired General Practioner, whose service in English lunatic asylums during the First World War inspired him to write The experiences of an asylum doctor: with suggestions for asylum and lunacy law reform. Published in 1921, the book acted as a catalyst for lunacy reform and stimulated improvements in the mental health services in the United Kingdom. Lomax spent the remainder of his retirement campaigning for lunacy reform. He suffered financial and personal hardship following the publication of the book and was castigated by his own profession. On the centenary of the publication of Experiences, this article explores the background and motivation of a remarkable man.
Covering all historical periods and geographical contexts, the series explores how mental illness... more Covering all historical periods and geographical contexts, the series explores how mental illness has been understood, experienced, diagnosed, treated and contested. It will publish works that engage actively with contemporary debates related to mental health and, as such, will be of interest not only to historians, but also mental health professionals, patients and policy makers. With its focus on mental health, rather than just psychiatry, the series will endeavour to provide more patient-centred histories. Although this has long been an aim of health historians, it has not been realised, and this series aims to change that. The scope of the series is kept as broad as possible to attract good quality proposals about all aspects of the history of mental health from all periods. The series emphasises interdisciplinary approaches to the field of study, and encourages short titles, longer works, collections, and titles which stretch the boundaries of academic publishing in new ways.
PurposeThe purpose of this study is to draw on multiple streams analysis (MSA) and to investigate... more PurposeThe purpose of this study is to draw on multiple streams analysis (MSA) and to investigate how policy change emerged from two inquiries into allegations of abusive hospital care in National Health Service (NHS) hospitals in the United Kingdom (UK) in the 1960s.Design/methodology/approachThe methodology of this study is regarding a historical case study of two inquiries.FindingsThe Sans Everything and Ely inquiries had the same legal standing and terms of reference, but the second put psychiatric hospital reform on the agenda, while the first did not. The main factor making Ely rather than Sans Everything the turning point seems to have been concerned with “agency”, linked with a few key individuals.Research limitations/implicationsA study of 1960s event necessarily relies heavily on documentary and archival sources, and cannot draw on interviews which are an important ingredient of many case studies.Originality/valueThe originality of the study is to examines inquiries, which...
Civilian Lunatic Asylums During the First World War
This chapter aims to bring together components of asylum life—the law, the leadership, staff, pat... more This chapter aims to bring together components of asylum life—the law, the leadership, staff, patients and public—to create a broad picture about what happened when things went wrong: accidents, injuries, escapes and suicides. There are drawbacks, in that much of the material is necessarily anecdotal with inconsistencies and contradictions. However, cases provide enough evidence to identify repeated patterns of attitudes, behaviours and decision making, from which conclusions can be drawn. The Board of Control indicated that it knew about asylum rough handling, but it did little to try to remedy the situation. Despite their rhetoric of good intentions, the asylum leadership frequently rationalised or denied maltreatment, thus failing to secure the most humane conditions for patients.
104 www.thelancet.com/psychiatry Vol 4 February 2017 50 years ago, Barbara Robb compiled Sans Eve... more 104 www.thelancet.com/psychiatry Vol 4 February 2017 50 years ago, Barbara Robb compiled Sans Everything: A case to answer. The book described ill-treatment of older people (most over 60 years of age) in long-stay wards, mainly in psychiatric hospitals. Sans Everything was a bestseller, caused a public uproar, and a national Sunday newspaper described it as “the year’s most challenging book”. This essay explores the context and story of Sans Everything, drawing substantially on research and editorials published in The Lancet, and considers whether any of the issues raised in the book are relevant to psychiatric services today (see appendix for full bibliography). Before the advent of the National Health Service (NHS) in 1948, most hospitals in England were philanthropic “voluntary” hospitals or former Poor Law infi rmaries. Patients had few rights within these institutions and passively accepted whatever treatment and care was available. After 1948, general taxation funded the NHS, giving the public a sense of ownership. The concept of patients as consumers of health care emerged in the 1960s, with the public expecting to exert some control over the services they used. The Patients Association, a pressure group founded in 1963, aimed to do this by infl uencing NHS policy. In 1965, Robb established Aid for the Elderly in Government Institutions (AEGIS), another pressure group that aimed to improve long-stay care for older people. Older people, their families, and health and social care professionals usually accepted declining health in old age as inevitable. Psychiatric symptoms were generally attributed to irreversible “senile dementia”, despite research showing that older people could develop the range of mental illnesses suff ered by younger people. Defeatist attitudes prevailed: older people underpresented symptoms to their general practitioners who underdiagnosed and undertreated, creating a spiral of neglect that was associated with crises and demands for hospital admission. Social interventions to support older people and the families caring for them were rarely available, despite reports indicating the potential for benefi cial outcomes. Families were often willing to care for their older, dependent relatives, but, without support, care frequently broke down. Provision of dynamic psychiatric services for older people lagged behind the expanding and increasingly successful fi elds of geriatric medicine and psychiatric services for younger adults. Older people were often admitted to long-stay wards in the psychiatric hospitals, without previous medical assessment. In 1952, research by psychiatrists published in The Lancet concluded: “we must be practical and temper our remedies to the gravity of the situation. It is more economical...to treat—say—60 patients in two wards, than the same number in three wards”. Geriatrician Wilfred Fine noted the lack of interest from psychiatrists towards older patients, and wrote that the psychiatric hospitals were “silted up” with elderly patients because psychiatrists “do not wish to treat” them. With an expected “looming geriatric impasse”, creativity succumbed to nihilism about remedying the situation, and custodial wards in many psychiatric hospitals became atrociously overcrowded and understaff ed. Despite widespread pessimism, some psychiatrists demonstrated that innovative services that integrated hospital and community approaches could enable mentally unwell older people to keep well, remain longer in their own homes, and avoid long-stay admissions. At Severalls Hospital, Colchester, in 1961, Tony Whitehead created a treatment-focused out patient, domiciliary, and inpatient psychogeriatric service. Bed occupancy in the older people’s wards fell from 374 to 296 over 16 months, despite more short admissions for treatment. The Lancet published Whitehead’s fi ndings in 1965. In the 1960s, stripping—removing patients’ personal possessions, including spectacles, hearing aids, and dentures—was common in traditional custodial long-stay wards. This impaired independence, social interaction, and nutrition: it was easier to nurse passive patients than active ones. AEGIS pressurised the Ministry of Health to ensure that regional hospital boards (RHBs) reviewed stripping in their hospitals, and asked Eric Lubbock MP to raise the issue in the House of Commons. Lubbock’s concern For the 1952 study see Articles Lancet 1952; 259: 377–82
The government acknowledged scandalously poor care of long-stay patients in National Health Servi... more The government acknowledged scandalously poor care of long-stay patients in National Health Service (NHS) hospitals in 1969. This followed the Ely Hospital inquiry, which emerged in the aftermath of revelations of abuse at seven hospitals described in Barbara Robb's book Sans Everything: A Case to Answer (1967). Allegations in Sans Everything and at Ely were similar. However, the inquiry committees which investigated, 'disproved' those in Sans Everything and upheld those at Ely. The Ely inquiry became pivotal to NHS policy reform for long-stay mental illness and mental handicap hospitals, and for giving patients and their families a greater voice if they had concerns about inadequacies. This paper explains the relationship between Sans Everything and 'Ely' and analyses the impact of Robb's work-her high-profile press campaign, networking, and determination to achieve improvement-which triggered revelations at Ely and elsewhere, and helped shape the course and constructive outcome of the Ely inquiry.
Uploads
Papers by Claire Hilton