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A backward step in mental health care
LAST week’s news of a new Mental Health Act, to allow people with mental illness to be locked up even with no history of danger to others or themselves, is not something I welcome.
For more than half a century I worked in mental health, sharing some of the revolutionary changes and learning some of the most important lessons in my life from people dismissed by much of society as ‘mentally ill’.
I was on the Board of Friern Hospital, originally Colney Hatch Pauper Lunatic Asylum, opened in 1851 as Europe’s largest, most modern institution.
When I first joined the hospital I was shocked to find people locked up for life for being naughty children or rebellious teenagers. They might have had illegitimate children; often they had been raped. There were wards full of people with venereal diseases and ‘General Paralysis of the Insane’ (one of the later stages of syphilis).
Others were considered mentally defective because of physical conditions such as deafness, blindness or inability to speak.
Walking round the grounds one day I found, on an overgrown patch of earth, a stone carved with the message ‘Holy Ground In Which Are Buried One Hundred Pauper Lunatics’.
It was almost a self-sufficient community. Patients all worked on the hospital farm, where we had cows, chickens, turkeys and grew all the vegetables. We baked our own bread. There were carpentry and upholstery workshops.
Patients did not wear their own clothes but were dressed in ill-fitting garments. Clothing was all mixed up in the laundry. Men and women were strictly segregated except when they had special parties or dances.
One lesson I learned early was that as soon as I made a nuisance of myself, asking awkward questions or doing anything that might challenge ‘existing wisdom’, they set up a working party to keep me busy and out of the way.
One of my first troublemaking initiatives was to say patients needed “a real cup of tea”. Tea, like food, was served in a bucket, milk and sugar added, carried two thirds of a mile along corridors and up stairs to wards.
I was told patients “couldn’t tell the difference”. It took me ten years just to achieve that simple objective, a “real cup of tea and edible food”, but I learned so much in the process.
We won many changes I was informed were “impossible”, such as electric kettles and teapots in the wards or patient lifts (we simply built the shafts outside the building and provided them).
All this has now changed. Friern, like so many hospitals, has become yet another victim and symbol of Thatcher/ Blair’s Britain, prohibitively expensive, private housing.
Before the 1959 Mental Health Act was passed, under the stewardship of Kenneth Robinson, then Minister of Health and our MP for St Pancras North, a working party was set up and we went through the White Paper line by line.
From being “certified lunatics”, most became “voluntary patients”.
The Act recommended “care in the community” through small homes, hostels and day centres. In 1968, with the help of Millie Miller, then Mayor of Camden, we set up the Camden Association for Mental health, Inner London’s first local branch.
When the Act passed, people said: “We don’t want any mental patients here.”
I went door to door around Highgate New Town and Lissenden Mansions, asking if people had met anyone with a mental breakdown.
Everybody had. When I then asked if they would object to having a hostel or accommodation in their area, they all agreed.
Camden Council helped by making premises available for us to use as a day centre, the Jamestown Centre. New Town was to be demolished and new housing built. We were given four premises there, three houses and a shop.
With voluntary labour and furniture donated or picked up from skips, we furnished, decorated and provided homes for groups of patients.
It was fascinating to see how, with volunteer help, these people adapted to life in the community.
They had to learn to shop, cook and do housekeeping. One woman said: “Do you know, you can buy bacon cut as thin or thick as you like?” Another said: “I could actually buy a bra to fit me!” They were not used to wearing their own clothes or choosing food in hospital. At the centre, patients could learn to socialise and to do many useful things, often leading to a job. We had wonderful volunteers, doing poetry, exercises, and various creative and practical activities.
The dream of community care has never been fully realised. Now it’s dying. Community care homes have been handed to housing associations or developers. Day centres, still acting as lifelines for people who might otherwise break down or commit suicide, are threatened with closure.
Without a home, friend, and occupation, as provided for example by the Psychiatric Rehabilitation Association set up by John Wilder, there are inevitable disasters. Many patients end up in prison, homeless on the streets or return to other hospitals.
At the beginning of the National Health Service, Nye Bevan said: “I don’t know anything about mental health but I want to take the financial anxiety out of illness”.
We are putting it back.
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