Mental Health History archive of a website first archived by the international archive on 24.6.2003 - page one of two

Links to the Mental Health History website have been added

M ental

I llness

C oncerns

A ll


Care in the Community is not new policy.

From 1949 most mental hospitals were running down their numbers, soon after the new NHS structure came in.
One that did it spectacularly was the Mapperley hospital in Nottingham.

In those days there were three bosses in mental hospitals - the medical superintendent, the chief male nurse, and the Hospital Secretary.

The medical superintendent inherited the power over his medical staff. He called them to a 9'o'clock morning meeting in his ofice and distributed the decisions about any trouble; the rest of the day was their own.

The superintendent got first tranche of the strawberries and potatoes grown in the grounds, and of the available patient servants.

In Nottingham he had also been the public Medical Officer of Health, with a fair grip on the social workers of the time. The chief nurse decided the holiday rostas for his nurses. Nurses were generally ex-miners or Irish; people who were biggish, could played sports, or knew a musical instrument. The new NHS was non-discriminatory. This meant that there was theoretical equal funding for the mentally ill and the physically ill hospitals. The Nottingham Hospital Secretary saw this, believed it where others did not, and pushed ahead with acquiring it.The hospital was completely refabricated; the wards alive with colour and new furnishing. But little personal possession. A shortage of personal toothbrushes was noted when a later comparison was made between this totally open hospital and two others: a traditional one - Severalls' in Colchester where the superintendent wrote a book - Institutional Neurosis; and Netherne Hospital in Surrey where their was a very busy and active occupational and workshop activity programme.

It was at the latter that the influence of 'emotionality' on schizophrenia was noted - supervison which shouted got poorer production than supervision which prompted.

The Medical Superintendent at Mapperley had simple rules.

The patients will be treated with respect.

There will be no locked wards, no seclusion rooms.

When someone leaves the back wards, their beds are removed.

Nobody goes from the admission wards to the back wards.

The outer walls came down. All is open. Visitors came from all over the world - on World Health Organisation travelling grants - to see this wonder, an open mental hospital, within a city boundary, with no locked ward, and no seclusion rooms. Some let themselves in without telling at weekends and spied round the hospital.

Unlike most mental hospitals Mapperley Hospital was within the boundaries of the city.The social workers in mental health visited the hospital regularly, and discussed common matters at bi-monthly meetings. At the Hospital and at the Social service Offices. They were active in building up and supervising a lodgement listing.

The numbers fell from 1500 at the start of the NHS down to 400 in 1962. The ward numbers fell from around sixty in the back wards , down to twenty-five or so. But little use was made to make space for occupational activity and interest.

In 1952, the neuroleptic medications arrived in general use. NHS consultants arrived with some freedom of endeavour.

The revolving door had arrived. Out to lodgings or the family ; in when medication lapsed. Out again, in again.

Maybe the old idea of Bleuler - if static discharge, some may - who unable to predict - 'normalise' under more normal conditions of expectation. Give them the chance.

So what went wrong?






M ental I llness C oncerns A ll