WEST PARK HOSPITAL EPSOM SURREY

The First Sixty Years

Bryan C.T. Johnson, F.H.A., Secretary/Treasury/Supplies Officer, West Park Hospital Management Committee

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INTRODUCTION

The only excuse the author can offer for writing this book is that he joined the staff of West Park Hospital within four years of its opening, and has been its servant for forty years since. The main sources of information have been the Board of Control Reports until 1959, and the proceedings of the Hospital Management Committee since 1948. Personal recollections of people have influenced what is written to a very great extent. There have been many outstanding men and women associated with West Park and selection has been difficult. If all were mentioned, the book would be too long, but memory can be deceptive and there may be omissions, incomprehensible to some who have known the hospital for a long time. In such cases the author offers his apologies coupled with the assurance that no slight has been intended. A note has been included in Appendix I on the history and development of the Area Laboratory, which, it is hoped, will be of interest. Information about the early years of the laboratory has been derived from "The L.C.C. Hospitals-A Retrospect," published by the London County Council in 1949· As to Appendix II, the author is indebted to an article on the History of Mental Treatment Administration by T. J. BELBIN, D.P.A., F.H.A., published as a winning Essay in the Journal of the Incorporated Association of Clerks and Stewards of Mental Hospitals in March 1938; also to a series of three articles on the Early Development of Mental Health Services by J. F. Milne, M.c., B.SC., published in The Hospital, January to March, 1954.

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CHAPTER I 1907-1924

It is said that the Chinese calculated a man's age by reference to conception rather than birth. Perhaps this reason inspired the title of this volume, for, although West Park Hospital was opened in 1924, its plans bear the date 1907. In this opening chapter some of the effects of this overlong period of gestation will be discussed. An Act of Parliament of 1845 imposed upon counties and boroughs an obligation to provide asylums for the insane. This was at a time when there was the beginning of an overall increase m the population of the country. Towards the end of the nineteenth century London was experiencing what is now fancifully called a population explosion. This is not a very accurate simile because the "explosion" continues to this day. Upon its constitution under the Local Government Act of 1888 the London County Council had taken over, from the administrative counties from which it was formed, a proportionate number of their asylums, e.g. Colney Hatch (now Frien); Cane Hill; Hanwell (St. Bernard's), and the foundations of Claybury. These were insufficient to meet the ever growing needs of the increasing population of the metropolis. More asylums were needed. In 1896 the Council bought the Manor of Horton at Epsom comprising l,040 acres. The cost was reasonable, which satisfied the rate-payers, and the general population was quite happy to have its lunatics out of sight and out of mind, nearly fifteen miles away from the centre of London. The first asylum to be opened on the Horton Estate was. the Manor in 1899, built around the old manor house, later used for subnormal patients. This was followed by Horton in 1902. Ewell Epileptic Colony (now St. Ebba's) in 1903; and Long Grove in 1907. The Manor, Horton and Long Grove provided approximately 5,500 additional beds for mental illness, but the needs of the county remained unsatisfied. Thus, in the year that Long Grove was opened, the plans for West Park advanced to the drawing board. The general layout of all the mental hospitals designed about this time shows little variation and West Park followed quite closely that at Long Grove, although there are differences of detail. The spine of the hospital runs from north to south, from the boiler house to the administration block, and contains between the two main corridors the common services. These include pharmacy and theatre, recreation hall (seating 1,200), and visiting room, main kitchen and ancillary departments, and. the stores. Immediately adjacent are the needleroom and laundry, and the workshops. In rough semi-circles based on the two main corridors are the principal female wards on the west, and the male wards on the east. The reception hospitals are in a separate building to the south and there are, in addition, four villas for men and three for women, as well as two sanatorium wards and a tiny isolation hospital. The chapel is a large building on the main drive and has seats for 850 worshippers. Hidden from the public eye behind the chapel is the mortuary and a laboratory. In all there were forty-five ,wards, with accommodation for 2,096 patients. Accommodation for resident staff was very limited and separate blocks provided only for female staff. This was for two reasons. It was a matter of policy that nurses should occupy rooms off the wards as a measure of security, and in those days there were only two shifts, compared with three now. Indeed it was not until 1959 that a separate block was built for resident male staff, although a new nurses' home was opened for women in 1938. All the principal buildings were constructed of red engineering bricks, in a particularly pleasing bond, and no ward block is on more than two floors, the ceiling of the lower and the floor of the upper being formed of reinforced concrete. Few visitors to the hospital realise that the corridors which they traverse in every case run over one-and a-half miles of sub-ways, which carry all the main services, i.e. hot and cold water, steam, gas, electricity and telephone cables. The tower, one of those which so disturbed Mr. ENOCH POWELL when Minister of Health, serves two very practical purposes-to enclose the boiler house chimney and to accommodate three oversize water tanks, which alone maintain adequate pressure through the mains. This tower is 120 feet high, and stands on a solid base, 18 feet thick, of blue engineering bricks. The whole is so well planned that virtually all wards and departments face southward. The site is, or was, somewhat of a crater with very varying levels, so that, in building, much of the basement and subway work to the north was built over ground and the levels made up by the movement of earth from the south, and by depositing the spoil from the digging of the tube railway when it was extended to Morden. The hospital is set in 83½ acres of grounds, the actual buildings covering nine acres. The Council had run a railway line to convey coal from West Ewell to the Central Station (between Long Grove and West Park) where electricity was generated for all these mental hospitals; this railway line was extended to West Park, and continued in use until 1949.

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The hospital was planned by the staff of the London County Council under the direction of W. C. CLIFFORD SMITH, O.B.E., F.R.I.B.A., Architect to the Council, and Mental Hospitals' Engineer. The contract for building was let to Leslie & Co. Limited, and work commenced in 1913, being interrupted in 1916 because of the Great War and resumed in 1920. It is interesting to note that the original estimated price was £517,970, but inflation took its toll and the final cost on completion in 1925 amounted to £1,030,670. Despite this doubling of the cost, it is a fact that, to some extent, West Park was a casualty of the first world war in that, where earlier hospitals had hardwood floors, those of West Park were of soft wood, which has increased maintenance problems very considerably. Otherwise, the buildings are most substantial and the main fabric is very resistant to alteration. From time to time, there have been subsidences, due to the clay subsoil, but these have been minimal in relation to the whole, and the hospital continues to present a handsome appearance. An early aerial photograph shows a somewhat naked appearance, but the grounds were laid out with great care, an operation in which the medical superintendent took an intense personal interest. The result over the years has been to ensure a sylvan setting, although it must be admitted that some thinning out has been necessary because trees, however beautiful, can cut off light and air from wards and departments. · This last of the London County Council Mental Hospitals was opened with due ceremony by the Right Honourable JOHN WHEATLEY, M.P., Minister of Health, on 20th June, 1924· Those present included the Chairman of the Council (Mr. J. HERBERT HUNTER, J.P.); the Chairman of the General Purposes Sub- Committee (Sir JOHN GILBERT, K.B.E.); the Chairman of the Mental Hospitals' Committee (the Hon. WILLIAM SIDNEY, J.P.); the Chairman of the West Park Mental Hospital Sub-Committee (Mr. ERNEST SANGER); the Vice-Chairman of the Mental Hospitals' Committee (Mrs. R. DUNN GARDNER, J.P.); the Clerk of the Council (SIR JAMES BIRD, J.P.); the Chief Officer of the Mental Hospitals' Department (Mr. H. F. KEENE, O.B.E.); the Mental Hospitals' Engineer (Mr. W. C. CLIFFORD SMITH, O.B.E., F.R.I.B.A.), and the Medical Superintendent of the West Park Mental Hospital (Major NORCLIFFE ROBERTS, O.B.E., M.D., B.S., D.P.M.). Music was provided by the Long Grove Mental Hospital Orchestra, under the direction of Mr. DARNELL. It would have been a happy conclusion to this chapter to record that the hospital was complete at its opening, but post-war restrictions had made this impossible. There remained to be finished the chapel, the infirmary and acute wards for female patients, and one farm villa for male patients. Final completion was not achieved until 1926.

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CHAPTER II 1924 - 1930

Appropriately, the first patient was admitted on the day on which the hospital was opened - 20th June, 1924. Between then and the first visit of the Commissioners of the Board of Control on, 13th November, 1925, 1,72b patients were admitted, of whom 1,117 were transfers from other mental hospitals and 6o3 were direct admissions. In their first Report the Commissioners noted "The latter figure alone signifies a heavy strain upon the medical and nursing staffs; and a perusal of a number of the clinical records-and also of the nurses' notes, which we are glad to see have been instituted-shows that the work has been done in a painstaking manner; moreover, the records relating to transfer have been made upon an equally high standard." Dr. NORCLIFFE ROBERTS, O.B.E., was the first Medical Superintendent and he had to assist him six doctors. Four of these seven medical men held the Diploma in Psychological Medicine. Miss K. A. LONGLAND was Matron and her opposite number was Mr. A. J. OSBORNE, whose title was "Inspector", not nearly so descriptive of the responsibility of the post as the later title of Chief Male Nurse. Mr. L. CLARKE was Clerk of the Hospital, and Mr. J. J. AGAR was House Steward. In those days, and for the succeeding quarter of a century, the Medical Superintendent was Chief Officer of the Hospital, and this was not in name only. All the official post came to departmental heads via the Medical Superintendent, and to him many reported daily and others weekly. It says much for Dr. Roberts' character that, from the first, he received respect and affection from staff and patients alike, laying the foundation of the happy relationships that have always existed at West Park. He was the chief and he was . referred to as "The Chief", but with affectionate respect and not with servility. From the very beginning the medical staff were engaged in an intensive study of Encephalitis Lethargica and its secondary manifestations, and it was at West Park that patients suffering from this disorder were collected from other hospitals or came by direct admission. In 1925 the Isolation Hospital was being prepared for the treatment of patients suffering from General Paralysis of the Insane by induced malaria. This was in association with the Mott Clinic based at Horton Hospital. The Commissioners commented favourably upon the treatment rooms provided in the Reception Hospital for giving "continuous baths", a form of therapy designed to quieten excitable patients. It was noted in 1925 that four of the male wards and villas were administered on the open-door principle, and this was very soon to be extended to female wards, but already 43 men were allowed "parole" beyond the grounds and 219 men were at liberty to walk about unattended within the grounds. Two entries in this laudatory first Board of Control Report raise wry smiles more than forty years later. First, referring to the furnishing and decoration of the wards, it was said that a sense of solid comfort had been attained, but doubtless in due course additional pictures and other objects of interest would be collected in the wards. Secondly, "The dietary scale is that which obtains in the Council's mental hospitals, is known to be satisfactory as to quantities and variety," and we had no complaints as to food, save from two or three patients who have distressing delusions as to what is given them." While there is no doubt that the food was good and well cooked, and that it was very nourishing, the overall standard fell well below anything that could be considered adequate nowadays. Writing from memory, one recalls that breakfast was always tea, bread, margarine and porridge - eggs were a rarity reserved for sick diets and marmalade appeared occasionally. Tea consisted of bread, margarine, preserve Garn, honey, syrup, lemon curd), cake, and fresh fruit instead of preserve once or twice a week. Supper could be relied upon without fail - cocoa and cake. The working patients received in addition a mid-morning break of tea and cake. The cake was make in the bakery, the fat content normally being dripping; it was substantial and varied - lemon, fruit, coconut, carraway seed - but it must be recorded in all honesty that it was very filling! On the other hand, dinner provided a roast twice a week, stew at least once a week, and fish on Fridays, other main courses included sausages, boiled bacon and homemade brawn; potatoes were never served roasted, while pulses and root vegetables were more in evidence than greens. The sweet course consisted in the main of milk puddings, prunes and custard or steamed puddings. The daily issue of lime juice to male patients was a constant subject of speculation by the unknowledgeable. When one re-reads this first Commissioners' Report, with its praise of the careful medical and nursing attention given to the patients (and this runs as a thread through to their last report in 1958), one is not a little resentful of the denigration meted out to mental hospitals over the years. While accepting that this branch of the service was, and is, treated as a Cinderella, those with any knowledge of the situation know

4 that there was no lack of humanity in the treatment of, nor compassion for, the patients, whose illness necessitated admission to a mental hospital. One turns to the Board of Control Report of a visit made on 18th and 19th December, 1928, just six months after the writer joined the staff. Dr. ROBERTS had been instrumental in the provision of a common room linking the Male and Female Reception Hospitals at first floor level, "for the amusement of the patients in those blocks". Of this it is said, "The room is nicely and comfortably furnished and has a piano, and the female and male patients foregather here ·in the evenings and amuse themselves with music and dancing, a most admirable arrangement, and one which must be for the benefit of and add to the pleasure and contentment of the patients." Let it be remembered that these were newly admitted certified patients! For them, and for the others in the hospital there was also a weekly cinema show, a weekly dance and, in the winter, a weekly concert party in the Recreation Hall, in addition to outdoor recreation. The hospital band provided music for the dances and other entertainments; in the summer the band rehearsed in the ward gardens. Four years after the hospital opened 90 male and 35 female patients had parole beyond the estate, while, in addition, 300 men and 149 women had liberty within the grounds - "this large measure of freedom is much appreciated and the privilege is practically never abused." At the same time, the number of open- door wards had increased to ten - seven male and three female. In the year preceding December 1928, 908 patients had been admitted, 344 had been transferred to other care and 289 had been discharged. The number of admissions and transfers was unusually high, but the discharge rate is typical of the period. In round figures the early years at West Park showed 400 admissions, 200 discharges and 200 deaths. This pattern continued for a very long time, but it does suggest that there has been active remedial work going on throughout the years. Until 1931 all patients were admitted under certificate upon the order of a Justice of the Peace. They arrived from the observation wards in the infirmaries maintained by the Guardians of the Poor of parishes or unions of parishes. The counter-part of the present day Mental Welfare Officer was the Relieving Officer, one of whose tasks it was to admit the patient to an observation ward, to arrange for a medical certificate and for a Justice of the Peace to receive the certificate to examine the patient and sign the order under Section 16 of the Lunacy Act 1890 for the patient's reception into a named mental hospital.' The order and medical certificate were complete with a statement of particulars giving personal details of the patient and signed by the Relieving Officer, who transferred the patient to the mental hospital. Section 16 was used in the majority of cases, but occasionally other sections of the Act were invoked. The situation was such that a person was more than a little disordered before action. was, or could be, taken. Thus patients arrived in an acute stage of illness and problems of treatment were far greater than in latter years, when voluntary admission became possible, co-incident with the inception and extension of outpatient facilities in the community. Continuous baths and various drugs, including the ubiquitous paraldehyde, were available to assist in the treatment of the acutely disturbed patients and there were facilities for nursing patients in padded rooms or lockable side rooms. It is significant that the latter, once shunned, are now coveted as privilege rooms by the patients. Because patients were acutely ill on admission and their treatment was more difficult, the illness often being already long-standing, some wards were not so placid as they became later on. Records had to be kept, and returns submitted, of patients subject to seclusion (i.e. locked up in side room or protective room), or to mechanical restraint. The latter referred to strait jackets which have never been used at West Park. Patients were admitted from any part of the County of London. Vacancies were allocated centrally at County Hall. Because of the concentration of mental hospitals in the Epsom area, it was inevitable that a large proportion came from far afield. The number of Jewish patients was very small, because patients of this faith were accommodated at Colney Hatch Hospital (now Friern) where special arrangements were made to meet their special needs. The London County Council was responsible for capital expenditure on its mental hospitals, but the cost of maintenance was charged to the Boards of Guardians; The cost per patient per week in 1925 was 28/7d., in following years it fluctuated to 30/5d., 27/3d., 26/1od., and down to 26/4d. in 1932. There were a few private patients whose payments ranged from the basic maintenance rate over the additional two or three shillings to cover the total cost, including capital expenditure. These were patients whose means were sufficient to pay the charge, but not enough to pay for the somewhat higher cost of a bed in a private ward at hospitals where such existed. The Boards of Guardians, and later the county welfare authorities, obtained as great a contribution as they could from the patient's estate or from relatives. It followed that each Board of Guardians, and indeed the Council's mental hospitals' department, was at pains to see that it paid for no patients for whom the liability could be passed elsewhere. There were technical questions of "settlement'' and "irremovability", referring to the length of residence in the area from which a patient was admitted. If a

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Board had evidence that the patient was settled or irremovable in another parish or union of parishes, a Justice of the Peace would sign an order of adjudication, transferring the charge thereto. If the patient was adjudged to be chargeable to a Board in another county, arrangements were at once put in hand to transfer' the patient to the appropriate county mental hospital. To transfer a patient for ease of visiting, or to refrain from doing so, involved obtaining the agreement of two Boards of Guardians and two mental hospital authorities - this rarely occurred. Although West Park was from the first titled a Mental Hospital, it was legally an Asylum and Reception Orders were addressed to the Medical Superintendent of West Park Asylum. In these documents the patient was designated a "pauper lunatic", a description used in the Lunacy Act 1890, and one which remained until the passing of the Mental Treatment Act, 1930, when the certified patient became "a rate- aided person of unsound mind", and the word asylum was dropped in favour of mental hospital. The word pauper certainly had a nasty Victorian flavour, and cried out for alteration, but was the "rate-aided person" such a vast improvement ? The administration of the London County Mental Hospitals differed from the norm in that they were controlled centrally by the Mental Hospitals' Department of the Council at County Hall and the Mental Hospitals' Committee undertook the administrative functions of the Visiting Committee. Members and co- opted members of the Mental Hospitals' Committee carried out the statutory functions of the Visiting Committee as they related to the admission, discharge and deaths of patients. This Committee attended every four weeks as the "statutory committee", and every four weeks as a business committee, but there were few executive functions and their clerk was a member of the staff of the central office. It was a legal requirement (and remained so until 1960) that all wards and departments where patients were employed should be visited by at least two members together every two months. Usually the committee split into two at each visit, but even so it was quite an undertaking to cover, the ground. Probably all similar hospitals have the story of a member left behind in a ward on such a visit and not released by the staff until retrieved later by the Medical Superintendent and worried colleagues: West Park has such a story - and it is not apocryphal! In referring to the Committee, one cannot refrain from mentioning one notable member, Mrs. M. M. DOLLAR, J.P., who served continuously from 1928 to 1961 which must surely constitute something of a record. In this chapter reference has already been made to the investigation and treatment of Encephalitis Lethargica and of General Paralysis of the Insane, the latter by induced malaria; by 1930 experiments were being tried out in the use of sulphosin instead of malaria therapy. Ultra-violet radiation was used m 1927 and this and other special departments, e.g. neurology and pathology, were each under the control of one of the doctors. As long ago as 1926 the Board of Control was advocating the provision of X-ray facilities, which did not materialise until nearly forty years later! In the same year it was noted that a Masseuse had been appointed, and a department of physiotherapy has been maintained ever since. Although it was part of the life of all hospitals that patients should be occupied as far as possible - in wards, kitchen, workshops, farm, gardens, etc. - an Occupational Therapy Department was established in 1927. This was found a home in the basement of one of the nurses' homes (later Bond House) and by 1929 there was a strong recommendation for more extensive premises - this need was not satisfied until nearly twenty years later. Another step forward was recorded in 1930 when West Park was linked with University College Hospital, whose honorary consultants attended as required to advise upon treatment in all specialties of medicine and surgery, the latter being carried out in the modest operating theatre at the hospital, described as good in the twenties, but very properly condemned for use for major surgery thirty years later. This brief survey of the first seven years of the hospital's work can give only a fleeting in1pression of a period of real progress in a congenial and happy atmosphere. Car parking presented no difficulty, but the storage of bicycles (and the mobility of their pumps, lamps and other accessories) was a continuing problem. Until the latter end of this period the "national" telephone was something of a 1uxury. To begin with there were only four extensions! The Medical Superintendent had two, one in his office and one in his house; the Clerk of the Hospital had one, and the House Steward had the fourth. Only these exalted officers were allowed access to this facility. Later it was accepted that lesser mortals might, in extreme urgency, have to receive, or even to make, a call to the great world outside. Thus it was that another extension was installed by the telephone exchange at the hospital centre. This was indeed welcomed by some of the more adventurous of the assistant clerks, who on occasion screwed up enough courage to telephone their lords and masters at County Hall to put right an error without advertising the fault to their superiors.

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CHAPTER III 1931 - 1938

In the two years 1929 and 1930 the Local Government Act and the Mental Treatment Act brought about changes which made possible significant advances in the treatment of mental illness. Under the former, local authorities had taken over many of the responsibilities of the Boards of Guardians, including their poor law institutions and infirmaries. At the same time, the hospitals of the Metropolitan Asylums Board were transferred to the London County Council, and this added to the Mental Hospitals' Department, Leavesden, Darenth, Tooting Bee and Belmont Hospitals. There was, therefore, from 1930 onwards one health authority with hospitals, both for physically and mentally ill patients, welfare services and residential institutions. This made for greater flexibility and, as the Council improved the old infirmaries so that they became reasonable general hospitals, this paved the way to the opening of psychiatric out-patient clinics which sprang up in this decade. For forty years the treatment of mental illness (as distinct from sub-normality) had been controlled by the Lunacy Act 1890. This was a very good and comprehensive piece of legislation, only very slightly modified by a short act passed in the following year, but the reader will recall that this made provision only for admission to a mental hospital under an order made by a Justice of the Peace. The Mental Treatment Act 1930 changed this and introduced voluntary and temporary treatment. To many purists this Act was lacking m precision, but it really started nothing less than a revolution in the mental health field. Hitherto, a patient would have reached an advanced state of illness before certification was justified, and this too often resulted in admission too late for treatment to be of much value. From 1931 onwards a patient could be encouraged to seek treatment in the early stages of illness with a far better prognosis. For others, for whom the prognosis was reasonably good, but who refused voluntary admission, this could be arranged on a temporary basis on an application by the next of kin, supported by two medical recommendations. Temporary detention was for not more than six months in the first instance, but this could be extended by two further periods of three months to a maximum of one year. If the patient was still in hospital at the end of this year, and if he would not remain voluntarily, certification under the Lunacy Act 1890 was applied. With greater awareness of the problem of psychiatric illness, many patients were admitted voluntarily, but comparatively few were 12 received as temporary patients. It is not without significance that at this time the London County Council altered the titles of its mental hospitals-thus "West Park Hospital, for all stages of nervous and mental disorder". The records show that in the period 1st January to 13th December, 1931 (the first year of the operations of the new act), 21 voluntary patients had been admitted compared with 318 certified, and that at the end of the year 12 voluntary patients were resident out of a total population of 2,122. Eight years later the proportion of voluntary patients admitted had increased significantly; out of 252 patients admitted in only eight months, 67 were voluntary, and of a total of 2,143 in residence in March 1939, 181 were voluntary. During this period, immediately preceding the second world war, it was possible to institute out- patient clinics in some of the London County Council's general hospitals - the erstwhile poor law infirmaries. This community activity has, of course, extended over the years to provide a valuable, and indeed essential, branch of the psychiatric service to the Metropolis. The Commissioners' Reports are consistent in their commendation of the work achieved in the hospital, although, of course, there are suggestions and criticisms. Among the latter there is the annual reiteration of the need for an X-ray apparatus and references to the need to improve male patients' clothing and the library; it was not until twelve years later that the responsibility for the library and the supply of books to the wards was transferred from the Chaplain to a properly organised system provided by the Library Department of the Order of St. John and the British Red Cross. On the other hand, good work was being undertaken by the Masseuse in a physiotherapy room established between the Reception Hospitals, and patients' sports and physical training were well organised and much appreciated. Occupational Therapy was developing as rapidly as possible with limited resources, and a Psychiatric Social Worker joined the staff in 1938. In the clinical field there was intense activity. The medical staff were following new lines of treatment developing at home and abroad, including the application of insulin and cardiazol, while developments were taking place in the use of new drugs for the treatment of various forms of mental illness. In 1938 thirteen wards were open to the grounds and four to their own gardens; the Commissioners noted

7 that this was an unusually high percentage, and this in itself confirms that the total clinical activity was being rewarded. To this may be added the fact that the death rate was consistently greatly below average. On the score of the physical development of the hospital, the decade, of the 1930's was one of some material difficulty, yet a new home (now Cavell House) was brought into use in 1938 to accommodate 66 female nurses, hitherto sleeping in rooms on the wards. West Park had been planned before the three-shift system had been thought of, so the number of rooms for resident nurses and others was inadequate from the beginning. In any case, it had been policy for at least some staff to live in rooms on the wards to provide a degree of security. The new resident home made this no longer necessary for female staff, although it was not until 1959 that similar provision was commenced for male staff, and in 1968 some men are still accommodated in rooms on the wards. The Bakehouse had been built with the old fashioned peel ovens; these were replaced. by draw- ovens, so much more convenient and efficient. A refrigerator was provided for the kitchen, but quite inadequate in size by modem standards. Laundry equipment was improved, including electric irons to replace the old-fashioned variety heated on a stove, about which the Commissioners remark that the time taken to heat them depended upon the direction of the wind. And the "talkies" came to West Park! The Central Station, supplying electricity to the five hospitals on the Horton Estate was dismantled and the hospitals were connected to the national grid supply, involving all sorts of problems associated with the changeover from D.C. to A.C. Each of the five hospitals had its own farm for the employment of patients. During the period covered by this chapter, the five farms were grouped under the management of one Superintendent Farm Bailiff, working under the direction of the Farming Operations Sub Committee at County Hall. The year 1938 was one of disquiet in the hospital, as everywhere else, with the Munich Crisis and preparations for war. For West Park it involved tragedy in that Mr. J. J. AGAR, the House Steward, was killed by a tram on the Thames Embankment. He was returning from a conference dealing with preparations for war, and there is little doubt that he was so disturbed and upset that he neither saw nor heard the traffic. This period - one of transition as well as of consolidation ended in the shadow of war.

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CHAPTER IV 1939- 1945

The death of Mr. AGAR, the House Steward, was noted in the last chapter. This was the first of sad changes in the senior staff coinciding with the outbreak of the second world war. Dr. NORCLIFFE ROBERTS, who had been such a notable Medical Superintendent during the first fifteen years of the hospitals' life, was taken ill and was invalided out of the service. The tributes paid to his distinguished service were high and very sincere. About the same time, Mr. L. CLARKE retired from the appointment of Clerk of the Hospital, having served West Park loyally and conscientiously since 1924, and elsewhere for many years previously. Thus, by 1940 there was a. total change of principal officers and the newcomers were faced with the double problem in their new appointments being coupled with the exigencies of a war-time situation holding unknown but formidable dangers. Dr. W. ALEX CALDWELL, M.R.C.P., D.P.M., succeeded Dr. ROBERTS as Medical Superintendent. He was no stranger to West Park and his brilliant promise in the Council's mental health services was recognised by promotion at a relatively early age. The Commissioners' Annual Report speak highly of the way he continued the good work started by Dr. ROBERTS, who was delighted in this appointment. In accordance with the Council's policy, the offices of Clerk of the Hospital and House Steward were combined into the single office of Clerk and Steward, to which Mr. G. L. Brown was appointed. The usual trappings of war became apparent. Air raid shelters and blast walls were built. Black out curtains were hung and windows treated to minimise the shattering effect of bombardment. Stirrup pumps and buckets proliferated. The Sanatoria were converted, one to a ration store, and one to a casualty section, and the Isolation Hospital became a Decontamination Unit. Ward accommodation was rearranged to allow all patients to sleep downstairs;. this was eminently sensible, but upset the balance between day and night space, thus adding to the problems of overcrowding. An Air Raid Precautions organisation was set up with a member of the clenca1 staff appointed A.R.P. Officer. He took his duties very seriously, and one has vivid recollections of his training in fire-fighting, when the exercise was so well simulated that, unless the trainees kept to the rules, they would have been rather more than singed! One happier side-light of this appointment derived from the fact that the A.R.P. Officer had to live in. Naturally he sought relaxation in the weekly cinema show, and he appeared to be the only one to realise that the loudspeakers of the "talking pictures" emitted a great noise, but nothing intelligent to the listeners! Attempts made to correct this unnatural state of affairs resulted in some improvement, but have never been wholly successful, due, among other things, to the lamentable acoustic properties of the Recreation Hall. Nothing in the previous paragraph was peculiar to West Park, but all these preparations, with the issue of gas masks, and never ending drills, presented complex problems in a community of this size and type. Problems increased yet more with the evacuation of Horton Hospital in September 1939 on its change to an Emergency Medical Services Hospital. In two days over 400 female patients were transferred to West Park, and one remembers very well the orderly chaos of admitting, documenting, classifying and accounting for the property of such a throng of bewildered patients, let alone the problem of finding physical space to accommodate them. It was at this time that two of the male wards for infirm old men, nursed by female nurses, were turned over for the accommodation of female patients. The confusion of women being in wards Male A.l and Male A.2 continued for twenty years, until these wards were given different names - they still accommodate women. Later in the war there was further strain on the accommodation, when West Park received from St. Bernard's and Friern Hospitals patients evacuated because of damage by enemy action. In 1939 the patient population rose to 2,500. However, this was not the end of the problem. Not long after the outbreak of war, West Park became the host of other evacuees. The Central Pathological Laboratory was evacuated from the Maudsley Hospital to Male F ward at West Park, where it remains and about which a short history is added to this volume as an appendix. Almost the whole of the central office staff were evacuated to West Park and set themselves up in the Committee Room, Greenbank and Santhams Villas, and "Loughta" one of the medical officers' houses. Some of this accommodation was for staff who had to live in because of distance from their homes. Similarly, a large section of the Southern Group Laboratory, manufacturing media for pathological tests, was moved to West Park and housed in the Tailors' and Shoemakers' Shops, the evicted occupants being found working space in the Upholsterers' Shop.

9

Little wonder, then, that life at West Park was crowded and hectic. Yet the Commissioners observed that there was "little outward sign of war, apart from overcrowding"! Indeed, there was a lessening of a "private war" that had been going on for years in that happier relationships were established with the central office staff - they learned something of the real problems of administration at hospital level, and hospital officers came to realise, perhaps reluctantly and with some surprise, that "central office" was human after all. Many people expected that the stresses and strains of war would result in a formidable increase of mental illness. Yet, mercifully, this did not occur. In fact, by 1945 the population of West Park had reduced by 275. To discuss the reasons for this is not within the province of the writer, but it seems not unreasonable to assume that, because the total population was united in a common effort, involving commitment day and night, morale was maintained at a high level and even increased by the resentment against those who had so unmercifully disturbed the peace of home and country. West Park was fortunate in receiving less damage than some other psychiatric hospitals, despite its situation in a vulnerable area. Some were dubious as to the reactions against aerial attack. Early on some incendiaries were dropped near Cavell House, but the nurses dealt with them admirably. A large (reputed l,000 lb.) high explosive bomb fell squarely on the main drive by the Chapel, and the Male Reception Hospital. So well was the Hospital built that structural damage was negligible, although there was widespread blast damage to windows on the male side, calling for intensive activity the next day to arrange first aid repairs, and for the Needleroom to run up hundreds of yards of new black-out curtains. The patients' reactions, as reported, were enlightening. The bomb exploded early in the evening, while the men were playing cribbage or listening to the radio. This they continued undisturbed, some allegedly commenting that, "Some silly b .... s are playing about." There was one casualty - a patient who ran away through a door that had been blown open. Towards the end of hostilities, the hospital was straddled by a stick of four bombs. Only one caused damage. This fell between the Female Reception Hospital and the Administrative Block. Having little penetration, there was a fairly considerable degree of damage to windows and roof of the administrative block. There is little point in writing much about supplies and rationing. These did present difficulties but, on the whole, hospitals were more favourably served than the general community. It is possible that, despite restrictions, the general balance of diet improved, but this was true of the nation as a whole, thanks to the expertise of Lord WOOLTON and his advisers at the Ministry of Food. Annual Reports show that standards of treatment were maintained and further areas of knowledge explored, including investigations into the effect of vitamin deficiency and nitrogen in the metabolic processes. Electro-convulsive treatment became established practice as well as operations for pre-frontal leucotomy in appropriate cases. Occupational Therapy developed with greater involvement of the nursing staff. The patients' war effort was directed in various ways - to the manufacture of sheets in the needleroom; the assembly of containers; and to growing vegetables in allotments in gardens and elsewhere. It was noted that a substantial number of patients was employed. For the period of the war, the best that could be done physically was to maintain plant and machinery as well as possible, but maintenance of the fabric and general redecorating fell behind. However, there was one notable innovation in the provision of a Staff Cafeteria to replace the several dining rooms hitherto used by various grades of staff according to hierarchy and sex. Because of the black-out and stand-by duties associated with general difficulties in getting away from the hospital, a number of recreational indoor activities developed, and this included a Staff Library, which was very well used. Some members of the staff were enlisted and many temporaries were employed - some more temporary than others. Through it all, West Park continued its good traditions of service.

10

CHAPTER V 1946- 1947

The war was over to the great relief of everybody, but material relief was disappointingly slow in coming. Rationing continued and supplies of men and materials were non-existent still. The shortage of nursing staff, particularly women, had been getting progressively wo.rse over previous years and reached a very low ebb. Equipment was wearing out but replacement was impossible owing to lack of funds and machinery. However, staff were returning from service with H.M. Forces. Some of them had suffered much, others had been much more fortunate, but many found re-adjustment to the rigours of civilian life, after a well ordered military existence, just a little difficult. In a sense this chapter has little reason for its existence, and might well have been incorporated in the previous one, but for one outstanding fact. The National Health Service Act was passed in 1946. Although the Bill had been piloted through Parliament by the redoubtable ANEURUN BEVAN on behalf of the Labour Government, it was the product of the thinking of the war-time National Government, as was the case with the contemporary National Assistance Act. To those m the hospital service it was clear that the millennium was about to commence - but a millennium was an unknown quantity and preparation for it was fraught with a good deal of perplexity. Thus the Appointed Day was named as 5th July, 1948. What would happen? The Act itself took a good deal of digesting, but this was only the precursor of an avalanche of regulations, circulars and advice generally, more than a little confused by unofficial advice and speculation, offered with the greatest enthusiasm on all sides. The staff, perhaps a little selfishly, applied themselves to a study of new rates of pay (the recommendations of the Rushcliffe Committee were applied to nursing staff at this time), and not least to the new Superannuation regulations, compared with which the Asylum Officers' Superannuation Act was like a Primary Reader in an Infants' School. In the London County Council hospitals it was found that the apron strings linking with County Hall were to be severed. This proved to be quite a traumatic experience, as there would be a new found independence, at once joyful and intimidating. The Regional Boards were set up in 1947. Would they behave like County Hall? According to the Act, they would not, but there was some suspicion. The Boards proceeded to organise the hospitals in their regions into groups, each to be controlled by a Hospital Management Committee. West Park found that it would be a group in its own right with its own Hospital Management Committee within the South West Metropolitan Region. More speculation! What would the Committee be like? It was to have a Chairman and fifteen members all appointed by the Regional Board. Concurrently, preparations had to be made to embark upon the new way of life. From the administrative point of view, finance posed one of the greater problems, bereft of the control of the Comptroller's Department at County Hall, and supplies followed closely although, as with engineering services, the London County Council was to help out on an agency basis in the early stages of the new regime. There was indeed no lack of advice, in fact an embarrassment of riches, from which had to be selected the fundamental bases on which to establish the reformed service to operate from 5th July, 1948.

11

CHAPTER VI 1948- 1959

The West Park Hospital Management Committee met for the first time on 30th June, 1948, under the Chairmanship of Mrs. S. B. SAMUELS, B.Sc. At this meeting only one member had served previously on the hospital's Visiting Committee, but one more with previous service joined at the second meeting in July. Mr. G. L. BROWN, the Clerk and Steward, was appointed to be the first Secretary/Finance/Supplies Officer, a post he held until his retirement on 30th June, 1954, when he was succeeded by Mr. B. C. T. JOHNSON, F.H.A. The task of the new 'Hospital Management Committee was complex in the extreme. With their officers, the Members had to learn new systems of control administratively and financially, including the mysteries of accounting according to Government practice. Regional Boards and Committees, according to the Act, were responsible respectively for the planning and the day-to-day administration of the hospital and specialist services, but the distinction has not always been too clear cut. Moreover, the new Committee assumed control at a particularly difficult time. The war and its aftermath had left the hospital in a bad way; there was much to be done and little to do it with. The mental health services had never been high on the list of priorities for expenditure, but West Park, being a relatively new hospital, was in better shape than most. The fact that few Members of the Committee had previous experience in the field of psychiatric hospital administration added to the problems, but, on the other hand, those who were newcomers saw the situation with fresh eyes, and they were filled with determination to improve. This they set about with vigour. Of course, there were teething troubles, some of them prolonged. There was so much to be done and it is never very easy to agree on priorities in such a situation. Furthermore, on the financial side the Committee and officers had to walk the tight-rope dividing maintenance expenditure from capital expenditure. However, the year 1948 saw the commencement of a programme of improvement, which has continued with increased momentum for twenty years, and, such is the nature of things that, like painting the Forth Bridge, the end will never be in sight. To make a list of all the improvements would be to bore the reader to distraction. Only a few are now mentioned and it is obvious that some will disagree with the selection, but those listed appear to contribute most to the better environment being provided. Re-decoration and re-furnishing of the wards has been of prime importance. Under the leadership of the Chairman, all Members of the Committee have been imbued with the idea that decor is important and that pictures liven up the wards. This work continues to the extent that in many wards the environment can stand comparison with a reasonable hotel as to appearance and furnishings. This is the target for all wards, despite the scant regard paid by some to what is provided. Sanitary accommodation is an ever present problem, the first programme of up-grading is almost complete. Now, the work starts again at the beginning to raise standards of the first wards upgraded to that found best years later - and so, no doubt, will it go on. Originally there were totally inadequate bathing facilities on the wards. Bathing for the majority of patients was a once-weekly exercise carried out in "general bathrooms" of a spartan, unprepossessing sort. Now all bathing is on the wards, as far as humanly possible, on an "as required" basis. The two old general bathrooms have been converted-one for the Hospital Shop and one for a bathroom for sportsmen and a locker room for male staff. Through the generosity of King Edward's Hospital Fund for London many improvements have been made for the benefit of patients and staff, too numerous to detail. Our of Capital Funds a new Male Staff Hostel with 43 beds was built, and six wards completely up-graded, in addition to an expensive reorganisation of the Area Laboratory, and the conversion of the Female Sanatorium to a delightful additional admission unit. Television has been installed in all wards; the railings around the ward gardens have been removed; and only four wards are now locked. This has reduced the demand for entertainment in the Recreation Hall because of the freedom of patients to go out and about or to watch television in their own wards. Of minor matters one can write of improvements to lighting, heating and recreational facilities. The Committee takes a great interest in catering both for patients and staff with the result that the improvements achieved have been really noteworthy. The foregoing paragraphs serve only to indicate that "Under New Management" had a quite startling effect upon the hospital for the betterment of the patients. Under the new scheme of things, each psychiatric hospital was allocated its own catchment area. Thus West Park has served the Metropolitan Borough of Wandsworth, part of the Metropolitan Borough of Lambeth and the Municipal Borough of Mitcham, comprising a total population of approximately 500,000. (This area has remained unchanged.) Obviously to

12 serve such a distant area is wholly unsatisfactory, but the necessity has been dictated by the geographical location of psychiatric hospitals in and around London, further complicated by the concentration of these hospitals in the Epsom Area. Nevertheless, quite good relationships have been established with the community health services, through out-patient clinics, staffed by psychiatrists from West Park, at the Lambeth, St. John's and Wilson Hospitals, and the William Harvey Clinic - the latter in premises controlled by the London County Council (later Greater London Council). Dr. CALDWELL, who had been Physician Superintendent since 1939, retired to take pension on 30th June, 1959, and was succeeded by Dr. THEO SCHLICHT, M.R.C.P., D.P.M., who had been Deputy Physician Superintendent since 1955. All at West Park were saddened to learn of Dr. CALDWELL'S death two years later. Under Dr. SCHLICHT's leadership a new stimulus was given to clinical activity within the hospital, and in this he was ably assisted by a steadily increasing team of medical officers. During these years there was a steady growth in the number of drugs available for the treatment of mental illness, and full advantage has been taken of these, combined with an increased emphasis on occupational and social therapy. In the latter connection a Patients' Social Club was established in the Visiting Room. Its formation was spontaneous and, like Topsy, it just grew. Towards the end of this period there was a noticeable change in the hospital. At the out-patient clinics patients were being treated earlier and there were fewer admissions of the acutely disturbed type of patient. Patients remained in hospital for shorter periods, but were re-admitted more frequently. The authoritarian tradition was being superseded by team work and greater freedom all round. All this paved the way for the implementation of the Mental Health Act, 1959.

13

CHAPTER VII 1960 - 1968

The Mental Health Act, 1959, was passed after the prolonged discussions of a Royal Commission and its provisions became operative in 1960. It has been noted that the Mental Treatment Act, 1930, made it possible for patients to be admitted voluntarily and, upon application, on a temporary basis. The number of temporary patients admitted had always been very small, but m the twenty years from 1939 to 1959 the proportion of voluntary patients coming to West Park had risen from 30% to well over 70%. The new Act was designed to encourage this trend and indeed reversed admission procedures, the emphasis being placed on informal admissions: Apart from the minority of patients received on orders following proceedings in court, compulsory admission for observation was arranged upon the application of the nearest relative or the Mental Welfare Officer. These provisions are discussed in greater detail in Appendix II. The implementation of the Act had been anticipated by regrading to voluntary status as many of the certified patients as possible. This involved a review of all the patients m the hospital, and it was well that the population by this time had fallen to just about two thousand. The number of admissions and discharges rose steadily in the years following the passing of the Mental Health Act 1959. In 1957 admissions numbered 773 and discharges 652; ten years later, in 1967, these figures had risen to 1,543 and 1,388 respectively. There is no doubt that this was due in large measure to the more humane approach of the new legislation, but a great deal of the credit must be given to the medical staff. Under Dr. SCHLICHT's guidance, the clinical work was being undertaken by medical teams, each headed by a Consultant Psychiatrist, and each with full clinical responsibility. By 1967 the total number of doctors on the staff of the hospital had risen to twenty, including five Consultants, organised into four teams directed by the Physician Superintendent. Of these twenty doctors, two are on quasi permanent duty one at the acute psychiatric unit at St. John s Hospital, and one at the Day Hospital. Including these two doctors, the equivalent of about four whole-time doctors are at work in the catchment area in the various clinics. All this time advantage had been taken of every new development in psychiatric treatment, to the benefit of the patients, and there were several notable steps forward. One such was the opening of the West Park and St. George's Day Hospital Centre at Tooting in 1963. The new St. George's is to be built on the adjoining sites of the old Grove Hospital, and the Fountain Hospital at Tooting Grove, which are within the West Park catchment area. West Park had a link already with St. George's in the field of nurse training. The House Governor (at that time Mr. P. H. CONSTABLE) and Professor DESMOND CURRAN of the Department of Psychiatry, conceived the idea of this Day Hospital Centre, with which West Park was delighted to be associated. The divisional Medical Officer of Health for the area, Dr. TUDOR LEWIS, was joined to the discussions. The outcome was the allocation of two adjoining buildings of the old Fountain Hospital for the Day Hospital Centre, and an adjacent building for the local authority Mental Welfare Department, all only across the road from St. George's Hospital at Tooting. The Day Hospital Centre has been treating an average of 40 patients daily, besides the out-patient clinics held every day, conducted by medical staff from West Park, all under the direction of Dr. SCHLICHT. With the Mental Welfare Department next door, co-operation in this field has been complete and contacts with General Practitioners in the neighbourhood have become very well established. The administrative arrangements involving a Board of Governors, a Hospital Management Committee and a Local Health Authority could not be smoother or more happily conducted. A change of user at St. Ebba's Hospital, Epsom, found a unit of the Medical Research Council dispossessed of accommodation. The Hospital Management Committee at West Park was very happy to accede to requests that this unit should be found a new home at the hospital, and Greenbank Villa was allocated for the purpose. Greenbank had been built as a convalescent villa for female patients, and in 1955 had been improved to serve as an additional admission unit for female patients. Further work was undertaken, including the addition of a laboratory to the villa to enable the Medical Research Council Unit to enter into occupation in 1963. The villa provides 11 male and 7 female beds, and was the first mixed ward in the hospital. The administration of the ward is undertaken by the hospital, while medical services and research are provided by the Medical Research Council, who have been particularly active in the study of depressive states and schizophrenia. During this period, treatment of various forms of addiction came to the fore. For some time there was intensive study and treatment of drug addiction in the hospital, and this presented many problems,

14 considerably relieved when the treatment of addicts to heroin and cocaine was taken over as a national problem, subject to special legislation. However, throughout this period (and continuing) there was building up research and treatment for patients suffering from alcoholism. This culminated in the conversion of the old male sanatorium, now Scott Ward, to form a regional alcoholic unit for the treatment, in first class conditions, of 12 male and 8 female patients. This was the second mixed ward in the hospital. In 1968, Santhams Villa, originally a male convalescent ward, was converted to become yet another mixed admission ward (7 male and II female beds). It has already been noted that the clinical activity in the hospital had gained increasing momentum, and a further step forward was taken when Industrial Therapy was introduced. There had been two .occupational therapy centres, each with a Head Occupational Therapist. When the male Head Occupational Therapist resigned on promotion, the two departments were fused under one Head and concentrated in one department, the original E.2. ward on the male side. The evacuated E.2. ward on the female side was then given over to Industrial Therapy. This involved a good deal of trial and error, but West Park was fortunate in having on the staff an Assistant Chief Male Nurse, who had a flair for this work. He was seconded to put Industrial Therapy into action, with the title of Employment Officer, because he and his supporting staff became responsible for the employment of all patients inside and outside the hospital. The success of the venture has been due to the enthusiasm of this officer and one of the Consultants, who has carried this enthusiasm into the community with the result that there was established Industrial Therapy Organisation (Epsom) Ltd. in co-operation with the Ministry of Employment and Productivity, and witl1 many keen helpers from industry. The Patients' Social Club prospered and, after a great deal of discussion, King Edward's Hospital Fund for London made a grant of £24,000 to defray the cost of the creation of a building for this and allied purposes. Thus the new Patients' Social Centre was opened by Lord McCORQUODALE in 1964. It comprises a large hall, divisible into two by a screen; library and reading room; ladies' and gentlemen's hairdressing salons; and offices for the Chaplains and the Warden. In addition, there were provided demonstration kitchens, in which Occupational Therapists train or retrain women patients in the domestic arts, involving cooking for lunches and the bits and pieces required for socials. The Patients' Social Centre is controlled by a committee of patients, on which sit representatives of medical, nursing and administrative staff in an advisory capacity. The patients organise a comprehensive social programme, and, so popular is the Centre, that it is already far too small. The League of Friends of West Park has contributed nobly to benefit the patients. Though small in number, members are very keen and excel in personal service by visiting and writing to friendless patients. They organise numerous outings, and at Christmas they ensure that no friendless patient, lacks a Christmas card and a present. In addition, as their funds permit, they make grants for specific purposes, among which the hospital has been most grateful to receive garden seats, the furniture for the patients' library, and the promise of a new Altar for the hospital chapel in connection with alterations to be made therein. The Hospital Management Committee cannot speak too highly of the valuable contribution to the hospital's work given so unobtrusively by the League of Friends. The removal of the Patients' Social Club from the original Visiting Room (adjacent to the Recreation Hall) to its new Centre, made possible the conversion of the Visiting Room into a Staff Cafeteria. This superseded the original war-time cafeteria, which was barely adequate, and provided a really good environment in which staff could take their meals. Caldwell House had been opened in 1959 by H.R.H. Princess Marina, Duchess of Kent; the 43 rooms provided for male staff were supplemented by the erection of a further hostel with 20 rooms, which was opened in 1966. West Park House, just outside the gate, had been the residence of the Physician Superintendent, but was no longer required for this purpose following Dr. Caldwell's retirement. It was, therefore, converted to provide new premises for the School of Nursing, with a flat available for one of the Nurse Tutors. These converted premises provided excellent facilities for nurse training. Concurrently the tutorial staff increased in number and the School adventured into new fields. Arrangements were made by St. George's Hospital for their students to receive experience in psychiatric nursing at West Park during their training and this was further extended to provide similar training for specially selected student nurses from St. George's undergoing experimental courses of training based on a university type of curriculum. Student Nurses from Epsom District Hospital also have the opportunity of experience at West Park, and a number of post- certificate courses have been established.

15

Until it moved into West Park House, the school had been accommodated in the original Female Sanatorium. This was converted into a further female admission unit, renamed Parklands, providing a very high standard of accommodation. In 1960 one of the Regional Board's important plans for improving services on the Horton Estate came into being with the opening of the Central Boiler House. This was built on the site of the old central electricity generating station between West Park and Long Grove. Its huge oil-fired boilers provide steam to all five psychiatric hospitals at Epsom. The cost was approximately £500,000, but the savings in fuel are amply justifying the capital outlay, apart from providing a better service. West Park was the last of the five hospitals to be linked, and there is no doubt that there have been many troubles arising from faults that have developed in the steam pipes within the hospital, yet the steam supplied centrally has brought heat to radiators that had been only tepid for years. Indeed, the administration had never imagined the day coming as it did, when staff complained quite emphatically, that they were too hot! The Hospital Management Committee had made available to the West Park Sports and Social Club a large room for a licensed club room. This was originally one of the mess rooms for female staff. While the members of the Club were very grateful indeed, the situation was not ideal, because convivial evenings have been known to result in a little noise and facilities were limited. The Matron set the Club a good example by raising funds, and members joined in. The Hospital Management Committee encouraged this venture to build a club house by making a grant, and King Edward s Hospital Fund for London with a grant of £4,000. The outcome was the opening of a delightful new Club House, in the grounds of West Park. House, in 1967. The premises provide an attractive lounge bar, a sizeable hall and a games room, together' with a kitchen. Needless to say, it is very well used and greatly appreciated. This, and the previous, chapter, covering twenty years can present only a very curtailed account of all that has been taking place since 1948. There will be readers who will be surprised by omissions, but this is inevitable. The purpose has been to endeavour to present a picture of advance and improvement. There is no sense of complacency, indeed, for as long as West Park continues, there can be none, for always there will be needed more and more improvements, and yet higher standards. What is being accomplished results from team-work involving the Regional Board and the Hospital Management Committee - and all the officers of both authorities. For the year ended 31st March, 1968, the cost of maintaining a patient at West Park for a week was £12. 9. 4d., against an average for psychiatric hospitals in the region of £14. 3. 10d. This is a very far cry from the £1. 8. 7d. recorded in 1926 - even allowing for the change in the value of money - but even yet the psychiatric hospitals do not receive their fair share of what is available. How much more could be done with another £10,000 per annum - and that represents only 2s. 0d. per patient per week!

16

CHAPTER VIII PERSONALIA

This is a chapter of random jottings, for which the writer has drawn upon his recollections over forty years. He finds it difficult to know where to start, but the beginning appears to be as good as anywhere else. The Visiting Committee, like the officers at County Hall, were in the early days almost as distant as visitors from outer space. Some members stood out more than others, for example Mrs. M. M. DOLLAR, J.P., who joined the Committee in April, 1928, and served without a break until 1961; she was warm hearted and practical, if just a trifle political as well; she rejoiced in telling the story of being left behind in a ward during a statutory visit - and there she was locked in, until rescued by Dr. ROBERTS and her fellow members some little while afterwards. She had told the Sister, "But I am a member of the Committee'', only to receive the dismaying rejoinder, "Yes, dear, they all say that, but you'll be alright here!" Then there was Mr. SETH COWARD, who always objected vehemently to the deduction of 1s 0d., from his travelling expenses to pay for his luncheon. The Hon. ELEANOR RITCHIE, the Earl of CRANBROOK and Mr. E. J. SAINSBURY served for long periods, and Mrs. MlNNIE U. PARSONS, with Mrs. Doll.AR, was a great champion of the patients. It was Mrs. PARSONS who persuaded the powers-that-were to install dividing curtains to give the women patients a modicum of privacy in the general bathroom. Mrs. S. B. SAMUELS, B.Sc., has been Chairman of the Hospital Management Committee since its inception in 1948. To say that she has kept her fellow members and the staff of the hospital "on their toes" is not an impertinence, but a statement of fact. Throughout her twenty years of service, Mrs. SAMUELS has devoted herself without stint to improving the hospital, and earlier chapters will have shown that, as the leader of a team, the efforts of the Committee and its officers, backed by her own energy, have met with more than a little success. It is invidious to select for special mention other members, but record must be made of the valuable support given by Vice Chairmen - Dr. P. J. WATKIN, O.B.E., Mr. A. E. DA.LE, C.B.E., and Mr. J. F. LYNE, O.B.E. Each of these gentlemen, out of a wealth of experience in his own field, has contributed magnificently to the work of the Committee and its officers. If these reminiscences had a dedication, it would be to pay a sincere tribute to the zeal of the very many devoted men and women who have served on the Visiting Committee and Hospital Management Committee before and since the hospital was opened. Of the medical staff, one thinks of the three Physician Superintendents, each of them so different, yet each bringing his own special gifts to the benefit of the patients. The writer owes more than he can say to the late Dr. ROBERTS, whom he served intermittently as relief personal secretary over a period of seven years. Here was a happy family man, an able psychiatrist and administrator, who brought all the warmth of a distinctive personality to the building up of a new hospital. Dr. CALDWELL, who succeeded Dr. ROBERTS at the outbreak of the second world war, faced a particularly difficult and frustrating period, but he was a worthy successor and had a quite uncanny knowledge of all the patients in tile hospital, and of all the staff; this he had learned from Dr. ROBERTS, and, if to say he knew everybody almost intimately appears to be an overstatement, the writer can vouch for the fact that it is absolutely true. Dr. SCHLICHT brought the "new look" to West Park. Although Physician Superintendent, he did not assume the benevolent authoritarian role of his predecessors, but shed all non-clinical administration upon those best qualified to assume it, and has continued to devote himself to co-ordinating and encouraging the clinical work of his colleagues, while maintaining his own active clinical interests in the Day Hospital and out-patient clinics. Of other medical officers of the hospital, it can be said that many appeared to benefit from association with West Park, when it is remembered that at least nine went directly from West Park to become Physician Superintendents elsewhere, and another became Professor of Psychiatry. Others too became Physician Superintendents or achieved further distinction in the field. Of the administrators one recalls Mr. CLARKE, the first Clerk of the Hospital, and Mr. AGAR the first House Steward. The one rather short, and the other rather tall: one has a mental picture of them speaking to each other over the wall-mounted telephones - Mr. CLARKE standing on tip-toe, with his waxed moustache scarcely reaching the pulled down mouthpiece, and Mr. AGAR leaning down and yet not reaching the upturned mouthpiece. Mr. CLARKE was extraordinarily meticulous in everything, with an encyclopaedic knowledge of Council regulations, and these exchanges sometimes gave the appearance of acrimony! Every morning, Mr. Clarke would await the arrival of the Chief (Dr. ROBERTS) often to chide him gently for sins of omission or commission. Mr. BROWN was appointed to the combined office of Clerk and Steward at the beginning of the 1939-1945 war, and, like Dr. CALDWELL, assumed office under

17 difficulties. The distinction of his career previously was maintained at West Park, and it was a cause of great sorrow that his latter years were marred by ill health. Miss LONGLAND, the first Matron, was, apart from being an excellent Matron, distinguished in the writer's memory by her large flowing white veil and a disposition, unusual in those days, to wear short skirts. Mrs. CHILDS, Mrs. DARKE and Miss MILLER succeeded her during and following the war years, when the hospital was overcrowded and everything was short from supplies to staff. Miss N:W. DILLON served for twelve years from 1955-1967, during a period of rapid transition and advance, to which she contributed most valuably in consolidating and improving upon the foundation so well laid by her predecessors. Mrs. W. SAVORY joined in 1967. Of Chief Male Nurses there have been four, Messrs. OSBORNE, SAUNDERS, PORTER and FORDER, the latter joined in 1959. The first two were "Inspectors" and belonged to the era of double- breasted blue serge Uniforms with braided sleeves. That is not to say that they were indifferent nurses or glorified attendants - quite the reverse - they would have borne worthily the later title of Chief Male Nurse. Writing of nurses, one is often aggrieved by the slighting references to the "old days." Through the writer's forty years of service, the nursing staff have been qualified under the examinations of the Royal Medico Psychological Association, and nurses so qualified were able to register automatically when the examinations were taken over by the General Nursing Council. The number of nurses displaying R.M.P.A. is dwindling, but this qualification is not to be disregarded-these were and are good nurses - not attendants. It is true that, for the men, ability in sport or music was an advantage when applying, but this was not necessarily a bad thing. A man accustomed to playing in a team, or playing in a band, is trained to mix with his fellows under discipline and this is a useful introduction to nursing those sick in mind, for one of the bases of good nursing is to be able to mix freely, and to commiserate in a disciplined environment, with other people. This naturally leads to the inter-war years, when sport Was a very important feature of hospital life. In this, West Park led the field for many years and great was the collection of trophies won by both men and women in all areas of sport. Officially, this was principally for the entertainment of the patients, who very thoroughly enjoyed the events. However, in those days when entertainment was relatively expensive and distant, and before the advent of television, participation in sport was a welcome relaxation, besides doing a great deal to engender and maintain an esprit-de-corps. How sad it is that, not only has this spirit declined, but that, in some quarters, it is no longer held to be of value! Writing a chapter such as this releases a flood of recollection of many personalities associated with the hospital and of groups of people who have joined in various activities. There was at one time a very good concert party, of which the chorus would have done credit to any stage, and won unstinted and noisy approbation from staff and patients alike. The large contingent of Welsh staff provided a choir of no mean ability, among whom were soloists who sang ballads of an earlier era with great verve. There was the Charge Nurse, a conjuror of repute, whose feats of legerdemain astonished all, including the writer, who always took extra care when paying out the wages. The Foreman Engineer and the Foreman Builder each worked extremely well in their respective spheres, but woe betide the unwary who came between them in demarcation disputes when their spheres overlapped! The ample Kitchen Superintendent held undisputed sway in her own province ·and saw that her kitchen maids kept the Main Kitchen absolutely spotless by exercising themselves with scrubbing brushes on their hands and knees - but she had a soft spot in her heart for the clerks, when those exalted personages had their own mess room. Her successors have maintained and improved standards, but with more up-to-date equipment. There were characters to be found through out the hospital and throughout Its existence, not least among the chaplains of the various denominations, who have served from time to time. Of these, there must be a special tribute of affectionate regard to the Reverend W. E. EVANS, the Free Church Chaplain, who has served so faithfully ever since the hospital was opened in 1924, and is the well beloved friend of all. One has had the privilege of meeting and working with many delightful men and women among the patients. About these one would be wrong to write in any detail, but it must be recorded that West Park owes a very great deal to the contribution made to the running of the hospital by so many working in all wards and departments. Some have grown old in one place of work, some have retired to take their ease, some have died. Whenever such breaks occur, the staff are conscious of the same sense of loss as is the case when fellow members depart or pass away. One of the greatest joys in working at West Park is to be greeted by so many old friends as a friend. This chapter must be concluded before the reader becomes bored to tears. However, there remains one important matter about which to write in all sincerity. The writer was appointed Group Secretary to the

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West Park Hospital Management Committee in 1954, having been Deputy Secretary for two years previously. During this time some nice things have been said about improvements achieved. Such improvements have been possible only because of the happy relationships that exist between all concerned with the welfare of West Park, whether medical, nursing, technical or administrative, using each term in its widest sense. In all this, the writer pays particularly grateful tribute to his own colleagues on the administrative staff, whose unfailing loyalty and support have been a constant source of inspiration.

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CHAPTER IX WHAT OF THE FUTURE?

It is to be hoped that this history of West Park will have presented a picture of an active psychiatric hospital, which has, throughout the forty-four years of its existence, been reaching out to improve the lot of those suffering from mental illness. Over recent years there has been much use of the term "therapeutic community" set over against "custodial care". One rebels against this. Certainly in past ages the custody of the mentally afflicted has been an important part of the work of psychiatric hospitals, but only a part. The history of the treatment of mental illness shows that over a hundred years ago many things were being done for the patients, similaF to those arranged today, although there may have been a recession at the turn of the century. Outings were arranged. Patients worked, according to their ability, in wards, workshops or on farms. This was most assuredly occupational therapy, before "therapy" became the fashionable word to replace straightforward "treatment." As far as West Park is concerned, the hospital has always been a "therapeutic community," in other words, a community in which patients were, and are, being treated, as distinct from being allowed to rot. Admittedly, new drugs and physical treatments have been introduced, and patients come to receive treatment before they reach the point of no return. Thank God that, because of this, patients spend longer in the community and less time in hospital, despite frequent re-admission; but at West Park, and all other psychiatric hospitals, there are available for their treatment all the resources of professional expertise in an appropriate environment. One of the problems has been the distance of the hospital from its catchment area, but there is reason to be optimistic that there may soon be changes, as the result of which the problem of distance will not have to be faced. When this happy day arrives, West Park will take on a new lease of life and be able to perform even more efficiently its function of treating the mentally ill. At the time of writing, the policy is to include acute psychiatric units in the new district general hospitals. There can be no doubt that this is right, but only when the circumstances are right; that is, when the specialist psychiatric hospital is distant from the patients' homes. Indeed, West Park has been associated with such a unit for many years. Yet it is impossible to conceive how anybody can think that the treatment and environmental facilities that can be made available in a 40-, 6o- or even 100- bedded unit in a district general hospital can ever approach those available in a specialist psychiatric hospital. This being the case, it must surely be obvious that when a psychiatric hospital is situated within a reasonably compact catchment area, the patients are better served there than in the confines of a unit in a general hospital. In such a situation, the total resources are available in one place and the treatment of the acutely ill, in the same hospital with medium and long stay patients, there is a wasteful deployment of resources, and human nature being what it is, interest in the chronically, ill tends to fade and the tempo to fall off, inevitably so when qualified staff, already few, and are spread too thinly. As has been said, there is a good case for acute psychiatric units in district general hospitals, but this can only be true when a specialist hospital is not conveniently available. West Park has provided for, can provide for, and should continue to provide for all stages of mental illness arising in patients whose homes are easily accessible. Here one has a concentration of specialist knowledge and skill, and wards and grounds where freedom of movement in pleasant surroundings can be enjoyed by those well enough, in addition to the availability of supporting therapeutic services. There need be so far as the provision of specialist treatment for somatic illness. West Park has never yet lacked appropriate consultant services, nor should there be any problems in the future. There is much discussion on the Green Paper on the Administrative Structure of the Medical and Related Services in England and Wales. On one aspect of this, among many others, there may be profound disquiet. This concerns the proposal to dispense with local committees. However attractive may ne the proposition to control hospitals by officers, taking direction from officers of Area Health Boards, it is surely not in the best interests of the patients to leave them entirely in the hands of a bureaucratic machine. This is probably more especially the case in psychiatric hospitals. It is to be hoped that wiser counsel will prevail and local interest maintained by lay committees, not only since 1918, but for centuries before. The future for West Park lies squarely with the planners. If they plan wisely, West Park will retain its own personality, with its own committee to look after the best interests of the patients. These interests can best be assured if West Park remains a hospital for the treatment of all stages of nervous and mental disorder. Given this situation, a good hospital can become a better hospital and West Park can look forward with confidence to the future in providing the best possible treatment for all in need of it. January 1969

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APPENDIX I THE AREA LABORATORY

In Chapter IV reference has been made to the evacuation of the Central Pathological Laboratory from the Maudsley Hospital to West Park at the outbreak of war. Here the Laboratory has remained and continued to flourish. An outline of its history may not be out of place. The London County Council considered the provision of a central laboratory to serve its mental hospitals as long ago as 1895, when it was decided to proceed with the establishment of a laboratory at Claybury Hospital. This arose from the rule that post-mortem examinations were made on all patients who died in the mental hospitals, but without an experienced pathologist. Lacking this expertise in diagnosis and microscopical examinations, the value of the post-mortems was not great, and the Council discussed "whether pathologists should be appointed to each asylum, or whether one or more pathologists should be appointed and their services be rendered to all the asylums." In the event, Dr. (later Sir) FREDERICK MOTT was appointed to the new laboratory at Claybury. Here, then, was the beginning of a new and unique ser\rice, over seventy years ago. From examination of the dead to the treatment of the living was a logical and important step, as it soon appeared that the "pathology of the living'' demanded urgent attention. Thus, alongside the morbid anatomy researches, investigations into "asylum dysentry" and into the incidence and management of typhoid fever, tuberculosis and other diseases grew up. Such diseases were, unfortunately, rife in mental hospitals for another half century or more. Under Sir FREDERICK MOTT, the work of the Laboratory attracted world wide interest, and many eminent workers in the field of brain pathology visited the Laboratory, not a few to work there. Pioneer work in the relationship of syphilis to general paralysis of the insane, and into the problems of schizophrenia distinguished the early years. In 19cn biochemical investigations were started, when Dr. S. A. MANN was appointed assistant in this field. (Dr. MANN was still serving when the Laboratory moved to West Park). In this department there are records of the use of the Wasserman test as far back as 1910. A standardised technique, later worked out in ·the Laboratory, was eventually adopted by the Royal Medico Psychological Association as the standard method for mental hospitals. The Laboratory at Claybury became too small and the proposed establishment of the Maudsley Hospital prompted the building of larger premises in Denmark Hill, Camberwell, to which the laboratory was transferred as the Central Pathological Laboratory in 1916. The next logical step was to establish branch laboratories in all the Council's mental hospitals, and this was done in 1920. Originally the technicians were recruited from nursing staff and trained at the Central Pathological Laboratory. In due time this was superseded by the direct recruitment and training of laboratory technicians, who must now be registered following the acquisition of qualifications prescribed. Sir FREDERICK MOTT was succeeded by Dr. F. L. GOLLA, under whose guidance London University instituted its Diploma in Psychological Medicine. The Laboratory, with the Maudsley Hospital, was recognised in. 1924 for post-graduate teaching in psychiatry as the Maudsley Hospital Medical School of the University of London. In 1936, its Director, Dr. GOLLA, was appointed Professor of the Pathology of Mental Disease. Under Professor GOLLA's direction, research work continued to be fostered, and was financially supported by grants from funds of the Rockefeller Foundation and other sources. One major contribution to mental science was pioneer work in electroencephalography. In 1939, the Maudsley Hospital and Laboratory were evacuated to Mill Hill and Sutton Emergency Hospitals, where research continued. The headquarters of the Laboratory were transferred to West Park. This effected a separation of functions, which had been gradually appearing desirable. At the end of the war, the London County Council decided to re-open the research and teaching section with an increased staff in premises at Denmark Hill under the direction of Professor S. NEVIN. This is now part of the Institute of Psychiatry in the British Post-graduate Medical Federation. In December 1945, the Council decided to continue the Laboratory at West Park as the Mental Health Services' Group Laboratory, with responsibility for the general and clinical pathology and serology of the hospitals and institutions of the Mental Health Services, and oversight of all the hospital laboratories. Dr. W.W. KAY was appointed Pathologist. Thus was completed the first half-century of the Laboratory's life, and a new era opened.

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Dr. KAY was Director of the Laboratory until his retirement at the end of 1961, when he was appointed honorary Consultant Emeritus in recognition of his distinguished services. Under his guidance the work of the Laboratory prospered and the work done, and the papers published, attracted widespread notice. Throughout these sixteen years, work was hampered by lack of staff and shortage of space, but this did not dampen the enthusiasm of Dr. KAY and his colleagues. Although research had been retained at the Institute of Psychiatry, it is quite impossible to divorce research from routine work, especially during the present period of rapid advance in psychiatric treatment. So it is that research continues to this day. Dr. VINCENT MARKS succeeded Dr. KAY on 1st January, 1962, and has maintained the high standards of his predecessor. It would indeed appear that pathology and dynamism are linked in some mysterious way. Each of the Directors has been even more dynamic than his predecessor, in his own way, and the first was not lacking energy and ability in any way whatever. The change of Director was concurrent with further advance. In 1961 agreement had been reached between the Public Health Laboratory Service and the South West Metropolitan Regional Hospital Board to amalgamate the Epsom Public Health Laboratory and the Mental Hospitals' Group Laboratory, thenceforth the combined laboratory bearing the title "Area Laboratory." Dr. D. R. GAMBLE of the Epsom Public · Health Laboratory was appointed honorary Consultant and joined Dr. MARKs, who specialised in Bio- chemistry, and Dr. M. K. BEATTIE, Consultant in Morbid Anatomy and Haematology. At this stage the Laboratory could provide a comprehensive service in all departments. Hitherto, the laboratory had occupied the major part of an erstwhile male ward. Following the amalgamation of the two laboratories, the whole block was given over to the Area Laboratory. It was redesigned and modernised, to be opened formally by Lord TAYLOR of HARLOW in 1964. Thus the two laboratories, working side by side, were brought together physically, but already the increased space was barely adequate. Dr. BEATIIE retired in 1965, and this set off a further train of problems, which are yet to be fully resolved. Dr. J. M. PREECE .was appointed Consultant Haematologist, and this has necessitated the provision of more space, found by bringing back into commission the original small laboratory of the hospital located in the mortuary block. Dr. J. M. BRIERLEY has been honorary part-time Consultant Neuropathologist since, and has been striving manfully to maintain a service in a situation that has worsened. As current discussions are in progress it would be inappropriate to enlarge upon these difficulties in this volume. Over the past seven years, a policy of integrating the work of the Area Laboratory with that of the Epsom Group Laboratory has been developed and is being implemented with modified success. The Consultants in both laboratories hold joint appointments, and, where ever possible, the use of staff and equipment is being rationalised. However, inadequate space in the two laboratories hampers complete success. Automation and computerisation promise Utopia in laboratory work, but he would be a brave man, who planned a laboratory in 1968, and said that it would be adequate for the needs of 1978. Such is the speed of advance of medical science. From this note, it is to be hoped that the reader Will have gained some appreciation of the value of the contribution made by the Area Laboratory to the advancement of the science of psychiatric treatment since 1895. It would be tragic if anything should occur to lessen the contribution that can yet be made in the years to come.

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APPENDIX II AN OUTLINE OF THE DEVELOPMENT OF THE TREATMENT OF MENTAL ILLNESS

Mental illness has always been the subject of alarm and suspicion. Even today, when many efforts have been made to help the general public to understand something of the problem, there are those who try to ignore it. In the pre-Christian era opinions were divided. For the ancient Greeks, epilepsy was a "sacred" disease, and the sufferer was supposed to be divinely favoured. On the other hand, mania was regarded as demonic, and no trouble was spared to drive the demon out by any means, including chastisement and torture. However, Hippocrates disagreed and sought to study mental illness on an objective basis. Later Asclepiades, in the first century B.C., was a pioneer in humane treatment; he denounced incarceration in cells, and called for comfort and occupation for patients. Similar views were expressed by Soronous two centuries later, and were reiterated by Caelus Aurelianus in the fourth century. In the seventh century, Paul of Aegina demanded compassionate and kindly treatment. The rise of Christianity unfortunately shows regression. The faith that nurtured care for the physically sick, seems to have gone into reverse with the insane. There was a parallel growth of intolerance and superstition. Any compassion or rationality of approach disappeared- submerged in a growing sea of belief in the idea of demonic possession. It was regarded as a religious duty to seek out, punish, and, if needs be, destroy these unhappy people believed to be in consort with the devil. Indeed, trials for witchcraft were not abolished in the United Kingdom until 1736. In the reign of Francis I of France, over 100,000 "witches" were killed. From ·time to time isolated voices were raised in protest - yet James I published a work "Daemonologies'', supporting the superstitious view. Against such a background, progress was bound to be slow and the plight of the unhappy lunatic was miserable indeed. The earliest legislation on the subject is in the reign of Edward I, which dealt with the estates and property of "idiots (i.e. natural fools)'', and "lunatics (i.e. persons of unsound mind)". During lifetime, their income went to the Crown; at their death, the .estate reverted to their heirs. The first hospital for the insane was the Hospital of St. Mary of Bethlehem in London, founded as a priory in 1246. By 1403 it housed 1,000 lunatics. It was refounded, after the Dissolution, by Henry VIII in 1547 and was given to the City of London. The Bethlem Royal Hospital still exists and is at Edenbridge, having moved there from Lambeth, where it was situated following removal from the City. The old building in Lambeth now houses the Imperial War Museum. At Bedlam (which is an easily recognisable corruption of Bethlem) it was the custom for people to pay a penny to watch the antics of the poor unfortunates kept there. This showing-off of the insane was not unusual at other asylums, too, and went on in some places into the nineteenth century. The conditions in which these people were kept beggars description. All sorts of mechanical forms of restraint were used, of which the ball and chain were among the least horrible. Sexes were mixed together, and bedding consisted of a litter of straw, infrequently changed and consequently indescribably filthy. In one case at least, a patient was kept for years, firmly fixed to a wall by a chain. passed through it and around his person. No attempts whatever were made to treat the insane, and corruption was rife among the managers and keepers in these asylums. As an offshoot of the voluntary hospital movement of the eighteenth century, the following hospitals or asylums were established:-

1703. Bethel Hospital, Norwich. 1751. St. Luke's, London. 1766. Manchester Royal Lunatic Asylum. 1777. York Asylum. 1782. Montrose Asylum. 1792. Liverpool Royal Lunatic Asylum. 1792. The Retreat, York.

Guy's Hospital in Southwark had a lunatic ward in 1728. This hospital's interest in the treatment of mental illness continues in its York Clinic.

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Until the last century, control of these asylums was minimal. People could be committed to private madhouses and kept there with little formality - just an order from a relative and two certificates from doctor or apothecary; but it must be remembered that there was no legally recognised qualification or registration of doctors in those days. In 1744 an Act was passed empowering Justices of the Peace to apprehend and ensure the safe custody of dangerous lunatics-with no medical examination. In 1774, following a Committee appointed by Parliament in 1763, there was an Act for the regulation - of private madhouses, but this was quite ineffective. The establishment of The Retreat at York in 1792 was a turning point in the treatment of the insane. The Retreat was founded by William Tuke, a Quaker, who was impelled to do this because he was so outraged by the conditions at the York Asylum. From the beginning, treatment at The Retreat has been humane, directed at curing the patient, or at least relieving his condition, so that he may live as decently as possible. The real struggle for improvement ·started in the nineteenth century-only a little more than a hundred years ago.. The leader in this field was Lord Ashley, later Earl of Shaftesbury. He was a Christian gentleman. unfortunately fighting alone against opposition from those who should have known better. A short summary of progress is as follows:-

1815. A Select Committee of Parliament heard evidence about the dreadful conditions in the York Asylum and at Bethlem Hospital. 1827. Another Select Committee sat. 1828. 1828. An Act facilitating the erection of Asylums, but this wils not mandatory and nothing much happened. 1828. An Act to improve the control of licensed houses. Private madhouses were now subject to licence by the Justices of the Peace. 1844. Another Report: this shows some improvement, but underlines the inadequacy of the accommodation available. 1845. An Act making the provision of asylums for the insane obligatory upon Counties and Boroughs. This Act gives the date to many of the old mental hospitals still in use, e.g. St. Bernard's (erstwhile Hanwell), and Friern (Colney Hatch), and very many more up and down the country. 1890. The Lunacy Act was passed. This piece of legislation was very comprehensive and controlled the admission and treatment of the mentally ill, safeguarded their liberty and set up the Court of Protection to manage their affairs. So good was this Act that the Act of 1891 was only a short one, tidying up a few loose ends. This legislation was in force until 1959, when it was finally repealed. 1930. The Mental Treatment Act was passed, permitting the admission of voluntary patients, or the detention as temporary patients of those expected to recover within six months-thus avoiding the stigma of certification. 1959. The Mental Health Act was passed, coming into force in November 1960.

This last Act followed the Royal Commission on the Law Relating to Mental Illness and Mental Deficiency which sat from 1954-1957, under the Chairmanship of Lord Richard Percy of Newcastle. The Act superseded all previous legislation affecting mental illness and mental deficiency, the latter term being replaced by mental sub normality. At this point it is fair to remark that this article is concerned only with mental illness. The Mental Treatment Act 1930 had marked a dramatic change in outlook, providing, as it did, for voluntary and temporary treatment. It was the more effective because only a year earlier, the Local Government Act 1929 had disbanded the Guardians of the Poor and transferred their duties to the County, County Borough and City Authorities, who also became responsible for the workhouses and infirmaries of the old Boards of Guardians. This simplified the provision of community services for the mentally ill because local authorities now controlled the old observation wards as well as the mental hospitals, and the more progressive lost little time in setting up out-patient psychiatric clinics. As a result, the proportion of patients admitted voluntarily to mental hospitals showed a gratifying rise from 1931 onwards. As might be

24 expected, the second world war slowed progress very materially, and the improvements which were embodied in the Mental Treatment Act 1930, could not develop as well as they should have done. The 1959 Act made revolutionary changes. The whole emphasis now is on voluntary treatment. Presumably because of its connotation under earlier legislation, the word "voluntary" was dropped and replaced by "informal", the concept being that there should be no more formality associated with admission to a psychiatric unit or hospital than to a general hospital. Experience has indeed suggested to the writer that there is even less formality attaching to a psychiatric hospital admission than to a general hospital admission. The Mental Health Act 1959 is comprehensive in its provisions to safeguard the liberty of the subject and his possessions. It includes the setting up of Mental Health Review Tribunals and re-enacts the duties of the Court of Protection. Obviously there is, and will be, the need to admit patients under compulsion for their own safety or for the safety of others. The next of kin, or the Mental Welfare Officer can make application, supported by one medical recommendation, for a patient's emergency admission under Section 29 or the Act. By this a patient may be detained for seventy-two hours, during which time the patient may become "informal" as sometimes happens, or a second medical recommendation may be obtained, permitting the patient to be detained for not longer than twenty-eight days, equivalent to Section 25. Under this latter section, the next of kin or the Mental Welfare Officer may make application, supported by two medical recommendations, for a patient to be admitted for observation for a period not exceeding twenty eight days. This provides a more reasonable time for assessment, during which many become informal. In other cases action is necessary under Section 26, which provides for the next of kin, or the Mental Welfare Officer acting with his consent, to apply for admission for treatment. This is to be supported by two medical recommendations, specifying the nature of the illness, describing the symptoms, and stating the reasons for informal admission being inappropriate or impossible. Section 26 applies equally to patients at home or already in hospital. In all cases the first medical recommendation should be made by the family doctor, if at all possible, and the second by a psychiatrist whose name is included in a panel approved by a local health authority. Any patient may be discharged by the Responsible Medical Officer (a psychiatrist) in charge of his case, and those detained under Section 26 may be discharged by the next of kin, subject to certain restrictions, which have to be invoked only rarely. Patients may appeal to the Managers of Hospitals (Hospital Management Committee) or to the Mental Health Review Tribunal, who also have powers to discharge. The continued detention of a patient beyond twelve months is governed by well defined procedures. Although the vast majority of patients are treated on an informal basis, the foregoing paragraph is included to give an indication of some of the Act's main provisions. This outline is necessarily very slight and contains no reference to the admission of patients by direction of courts of law, with or without restriction as to movement. ------This brief appendix cannot do justice to a very complex subject, but it is intended to show that during the past hundred years great strides have been made in caring for those suffering from mental illness. It is a fact that records of the mid-nineteenth century show that, in some outstanding mental hospitals, physicians were using many of the forward-looking methods in use today, e.g. occupational therapy, holidays and outings. However, there appears to have been some regression towards the turn of the century, which was not corrected until after the Great War. In the past thirty years improvement has been rapid and dramatic. Out-patient clinics are available to all; day hospitals have been set up; and psychiatric units are being formed in general hospitals. At the same time, against difficult odds, the mental hospitals are being improved out of all recognition. The physical conditions are better; the railings have gone; protective rooms have disappeared, or reduced to the barest minimum number required; shops, hair-dressing salons, libraries and social centres flourish; and occupation is more meaningful now that industrial therapy supplements occupational therapy. It is true that there .is still over-crowding to a marked degree in many mental hospitals, but there is hope that this will disappear in time. Great strides have been made in medical and nursing techniques, encouraged by an ever-increasing flow of new drugs, which bring relief and render easier the treatment of patients in hospital and community. However, when it is remembered that mental illness in its many and varied forms accounts for 40% of all hospital beds, it is to be regretted that money available for research is far less than should be the case. Yet research continues and there is much hope for the future.

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