2 The deployment of an economic case for treating mild mental illness can be traced back at least as far as 1957, in Sir Frederick Armer [Chairman of the Board of Control], ‘The Magnitude and Cost of Mental Illness’, The Lancet, 269, 1977 (1957), 1031.Google Scholar, 48. (note 17), 4.Google Scholar, 30. Each seminar was conceived to explore where possible the perspective of a particular group or profession. (note 17), 6.Google Scholar, 33. Article Overview: The question of how to address mental health issues has existed since antiquity; the answers have evolved across cultures and millennia, adapting as the understanding of the human condition has changed in the face of advances in science, chemistry, medicine, and psychology. We are obliged to Dr Tony Black for discussions of Victorian attitudes to risk. 1 "comments": true, cit. The professional and the expanded role of Community Psychiatric Nurses has depended on the acquisition of skills formerly confined to psychiatrists and psychologists.Footnote Louis Appleby, Consultant Psychiatrist; National Clinical Director for Health and Criminal Justice, Department of Health, and Professor of Psychiatry at the University of Manchester. Charles Mercier, reporting on recent medico-legal cases in Journal of Mental Science, 42 (1896), 230. 180–294. 20 In addition, 4.5 thousand patients outside hospital were subject to compulsory treatment orders. 8 In the regime of segregation and compulsory confinement that subsisted until the mid-twentieth century and beyond, it was taken as read that the risk of self-harm or violence was a reason for confinement, which could often induce families or communities to prefer the asylum in individual cases to other forms of care.Footnote (S3282_V_0651), Women outside the 3000th Easiform dwelling to be completed in Bristol, watching the opening ceremony through a ground floor window as a policeman guards the entrance nearby, © Historic England Archive. Matsuda, Taro "clr": false, cit. Murphy, op. The history of mental illness goes back as far as written records and perhaps took its first major leap forward in 400 B.C. 1946: President Harry Truman signs a law that aims to reduce mental illness in the United States, the National Mental Health Act. On the links to the 1980s see Peter Campbell, ‘From little acorns: the mental health service user movement’, in Sainsbury Centre for Mental Health, Beyond the Water Towers: The Unfinished Revolution in Mental Health (London: Sainsbury Centre for Mental Health, 2005), 73–82. The demographics of mental health in Great Britain by Martin Armstrong, Oct 10, 2019 Mental Health The tenth of October marks World Mental Health Day. Yorkshire’s influence on the understanding and treatment of mental diseases in Victorian Britain: The golden triad of York, Wakefield, and Leeds. A WHO study in the early 1990s estimated that for every thousand adults, between 250 and 315 were suffering from some sort of mental disorder, of whom only 101 were detected by GPs, only 20.8 were referred to specialist mental health services (including community-based services) and only 3.4 became in-patients.Footnote Using an old browser means that some parts of our website might not work correctly. Mental illness, according to the Chinese perspective is thus considered as an imbalance of the yin and yang because optimum health arises from balance with nature. Even after 1974 ‘changes in accounting procedures mean that no meaningful comparison of spending over the period can be made’.Footnote For insight on the service user perspective on their own history and for a timeline of developments and a wealth of material on this history: http://studymore.org.uk/mpu.htm.Google Scholar, 98. 73 (note 20), 4–5.Google Scholar, 39. Service users in the seminars also challenged the ethical basis of the ‘screen and intervene’ approach which might prompt services to subject too many people, too early, to active treatment for mental illness and argued that the emphasis on work and social inclusion in the recovery movement (a concept developed within the service user community) could constitute a threat of social control as much as a response to individual needs, echoing Joel Braslow’s critique of ‘recovery’ as nesting ‘neatly within the broader context of neo-liberalism’.Footnote Ulrich Beck, World Risk Society (Cambridge: Polity Press, 1990); Robert Castel ‘From dangerousness to risk’ in G. Burchell, C. Gordon and P. Miller (eds), The Foucault Effect: Studies in Governmentality (Hemel Hempstead: Harvester Wheatsheaf, 1991); Niklas Luhmann, Risk: a Sociological Theory (New York: De Gruyter, 1993); Nikolas Rose, ‘Governing Risky Individuals: The Role of Psychiatry in New Regimes of Control’, Psychiatry, Psychology and Law 5, 1 (1998), 177–95.Google Scholar, 60. History. After 1979, the new Conservative government first reorganised the administration of the NHS in 1984, imposing general management embodied in a new structure of health authorities. White, Rebecca Paul Hoff, ‘Die psychopathologische Perspektive’, in M. Bormuth and U. Wiesing (eds). Clark, op. Healy, David Paul Hoff, ‘Die psychopathologische Perspektive’, in M. Bormuth and U. Wiesing (eds), Ethische Aspekte der Forschung in Psychiatrie und Psychotherapie (Cologne: Deutscher Ärzte-Verlag, 2005), 71–9.Google Scholar, 3. If somebody had a bright idea for a new service, they could do it, provided it didn’t cost very much.’Footnote And the big risk that all the psychiatrists worry about is violence.’Footnote Hugh Freeman, Transcript, 31 January 2011, 17. The phrase was used by Kathleen Jones as a chapter heading in Asylums and After, and has provoked legal and medical historians ever since.Google Scholar. Elaine Murphy, Baroness Murphy, Consultant Psychiatrist; formerly professor of Psychiatry at Guy’s Hospital Medical School, formerly Chair of NE London Strategic Health Authority. xiii Numbers for clinical psychologists were only reported as whole-time equivalents until 1980. Increasing use of data for performance management has increased the probability of manipulation both at the point of collection (at the patient interface) and at the point of reporting (Strategic Health Authorities or Trusts), and thus reduced the reliability of aggregates; this uncertainty applies particularly to admissions, length of stay and outpatient activity in 2000 and 2010. Money wasn’t flowing freely but there was more than there had been; numbers (of patients) were falling, while the staff numbers were being preserved. Acknowledging, as our witnesses would lead us to believe, that the NHS in England and Wales had not by 1959 created a coherent system out of the people and institutions which it inherited on its establishment, should we not also regard the great asylums of the ‘water tower’ period, and the psychiatry practised within them, as rather less a monolithic and inclusive system for the care or control of deviants than a part of a much larger range of mixed institutions and contexts in which the ‘service users’ of the time had to live out their lives? The later records, however, include copies of inquisitions taken in Ireland, and in some British colonies. cit. The range of problems addressed by the services was much larger, and the expectation of cure or relief of symptoms was much higher. In this series Guardian writers examine the state of mental health in Britain. Private ‘madhouses’ were often profitable institutions. Diana Rose, Transcript, 3 December 2010, 3.Google Scholar, 23. However, evidence from a large study in Victoria, Australia showed that in the 25 years since deinstitutionalization, the proportion of people with a mental health problem charged with an offence rose at the same rate as a control group drawn from the general population. Witnesses were clear that some professions were originally only open to those who could afford to pay for training,Footnote Reports of the Department of Health’s New Ways of Working project from 2004 describe, perhaps optimistically, how a different style of leadership and clinical responsibility shared between different professions has come to exist in NHS mental health services.Footnote Conserving the Fog Battery Station on Lundy Island. It was noted that ministers had demanded, and got, evidence of efficacy in minute detail before agreeing to fund, and then continue funding, the IAPT programme.Footnote The first attempt to synthesise data on the totality of NHS expenditure on mental health was only made in 2001/2, and at first covered only adults of working age.Footnote cit. Services were dominated institutionally and intellectually by psychiatrists, who began to establish a more distinct professional identity and formal training under the Royal College of Psychiatry (chartered in 1971). In 1619, Helkiah Crooke became the Bethlem's first medically … Wing, J.K., ‘Laing and Goffman: Self and Others’, British Journal of Psychiatry, 118 (1971), 360–361.CrossRefGoogle Scholar, 86. As a first step in tracing out the new language and landscape of mental health care, this paper sets out a research prospectus in the form of a report on a series of witness seminars and interviews concerning the history of mental health services since the Mental Health Act of 1959, which replaced the legislation under which services had been provided since the 1890 Lunacy Act. (note 22), 5.Google Scholar, 58. A more rigorous account of the total costs of mental health provision would require an assessment of all the agencies and institutions which have provided care and treatment; and in the differentiated environment which has emerged since the 1980s this would include local authorities, third sector and private providers, and increasingly the private funding of new forms of therapy such as counselling and of long-term residential care for dementia sufferers. cit. cit. Jim Symington, Transcript, 31 January 2011, 13. Notwithstanding these caveats, we would contend that the seminar discussions provide the basis for a new programme of enquiry which would reflect the lived experience of participants and, inter alia, respond more fully to the service user perspective than more traditional accounts. 80 Until 1959, patients would have been referred by GPs to psychiatrists working in hospitals and certified, if needed, under the 1930 Mental Treatment Act. One in four adults and one in 10 children experience mental illness, and many more of us know and care for people who do. The same years furnished wholly different insights from and about the users of services. The history of psychiatric services. Contributors were drawn exclusively from England, and the cultural and institutional differences of Scotland, Wales and Northern Ireland are consequently not addressed in this paper.Google Scholar, 4. The phrase ‘ordinary life’ resonates with the title of a seminal King’s Fund paper, and its use, like the reference to Wolfensberger’s work above, illustrates the extent to which approaches originating in the care of people with learning disabilities generalised to other mental health services. Official asylum records in the Medical History of British India Mental Health collection highlight the colonial context of psychiatry in British India and colonial ideas about the native body.. M. Shepherd et al., ‘Minor Mental Illness in London: Some Aspects of a General Practice Survey’, BMJ (1964), 2, 1359–63, amplified in Michael Shepherd et al., Psychiatric Illness in General Practice (London: Oxford University Press, 1966).Google Scholar, 15. cit. This was signed by 35 senior psychiatrists.Google Scholar, 104. The four voices in these discussions – professionals (both approving and disenchanted), service users and policymakers – shared a number of common preoccupations which we argue should be central to future study of recent mental health services in England and probably elsewhere in the United Kingdom. ix Outpatient activity for learning disabilities was a tiny minority of all outpatient activity. In other cases, such as the exploration of the influence of anti-psychiatry, it was evident that speakers were joining an ongoing conversation rather than conveying a coherent account of a situation in the past, and in such cases we have had to refer to existing literature to clarify their argument (and ours). Rose, op. 110 , ‘Improving Access to Psychological Therapy: Initial Evaluation of Two UK Demonstration Sites’, Behaviour Research and Therapy, 47, 8 (2009), 637–728.CrossRefGoogle ScholarPubMed, 14. Anti-psychiatry of the 1970s included three very distinct strands, represented totemically by R.D. While this has prompted passionate controversy over many years about the principles of public funding for care, no consistent distinction has been made in that debate between mental and physical reasons for dependency and ‘meaningful comparisons’ are consequently difficult. 35 180–294.Google Scholar, 72. In 1954 the Percy Commission estimated that 46% of patients in mental hospitals had been resident for more than ten years, and 10% for more than 30 years. Thomas Szasz, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct (New York: Harper & Row, 1974) and 34 other books on similar themes.Google Scholar, 82. The Bethlem's first medical 'keeper'. Discussion of the later period was much less definite. As a result, although the service user voice emerges pervasively in the discussion, it does so rather more diffusely than the professional voices. As one of the earliest forms of mental health treatment, trephination removed a small … Promoting Mental Health Through the Lessons of History started off as three podcast series. Panorama goes inside one of the UK's largest frontline mental health trusts. Murphy, op. Prady, Stephanie L. M. Roth, ‘Schizophrenia and the Theories of Thomas Szasz’, The Concept of Disease and Its Implications for Psychiatry. 113 Feature Flags last update: Mon Dec 07 2020 16:02:19 GMT+0000 (Coordinated Universal Time) 25 Dated from around 7,000 years ago, this practice was likely used to relieve headaches, mental illness or even the belief of demonic possession. Necessarily, because service users as a category are even more heterogeneous than professionals or policymakers, no claim to typicality should be made for the service user contributors; some spoke as individuals, some spoke in a role defined wholly or partly as a service user role which would be construed as representative. But the political salience of risk was recognised as being neither new nor confined to mental health. There was growing awareness that service users’ experience was skewed by ethnicity and gender: young black men were disproportionately subject to compulsory treatment for severe mental illness, women were over-represented among users presenting with mild to moderate illness. Rose, op. Crook was dismissed in 1633, but his influence was long-lasting. 68. 2018. The Mental Health Act of 1959 . In 1619, Helkiah Crooke became the Bethlem's first medically qualified 'keeper'. Kalidindi, Sridevi New emphases in service provision, such as person-centred care, well-being, recovery, the involvement of service users and increased access to psychological therapies, lack a historical context. vi England only. Occasional newspaper excitements were deflected by leading psychiatrists who on one occasion in 1896 observed that ‘no alterations in the Lunacy Law will prevent …the occasional discharge of a patient who may subsequently become homicidal’ and called sarcastically for ‘another Act of Parliament providing that all persons who are likely to become homicidal shall present themselves periodically at the nearest lunatic asylum’.Footnote See, eg., Joseph Melling, Bill Forsythe and Richard Adair, ‘Families, communities and the legal regulation of lunacy in Victorian England: assessments of crime, violence and welfare in admissions to the Devon Asylum, 1845–1914’, in Peter Bartlett and David Wright. cit. James, Adrian Thornicroft, Graham and Tansella, Michele, ‘Components of a modern mental health service: a pragmatic balance of community and hospital care’, British Journal of Psychiatry, 185 (2004), 283–290.CrossRefGoogle ScholarPubMed, 110. As Hess and Majerus noted in 2011,Footnote On the other hand, the report by the National Confidential Inquiry into Suicide by People with Mental Illness (NCISH), Patient Suicide: the Impact of Service Changes (Manchester: University of Manchester, 2013) notes on page 10 that by 2011 ‘Trusts that had retained their specialist teams saw a larger fall in patient suicide than trusts that merged them [into generalist Community Mental Health teams]’.Google Scholar, 35. Turner, op. Historians should recognise the fragmentation of the concepts of mental illness and mental health need, acknowledge the relationship between critiques of psychiatry and developments in other intellectual spheres, place the experience of the service user in the context of wider socio-economic and political change, understand the impacts of the social perception of ‘risk’ and of moral panic on mental health policy, relate the politics of mental health policy and resources to the general determinants of institutional change in British central and local government, and explore the sociological and institutional complexity of the evolving mental health professions and their relationships with each other and with their clients. Nishinaka, Hirofumi The genetic influences that stand behind some types of mental illnesses, along with the physical and chemical assaults that can spark illnesses in some people, have always been part of human life. Notwithstanding innovation, goodwill and improvement on the part of providers, mental disorder for the service user continued to be associated with social exclusion and the denial of civil rights. And there was, in most cases, enough to make the old accommodation certainly tolerable, if not quite satisfactory.’Footnote Responsibility for providing these services, which had previously rested with the NHS and local authorities, had been extended to include the third sector and, increasingly, profit-making contractors. However, shortly before he died in 1547 he transferred its control to the Corporation of London. The treatment, punishment and diagnosis of mental illness has an extraordinary history. Such a scope, valuable and innovative though it has often been, cannot serve the history of a period as complex as the one covered in these seminars. But Kathleen Jones, a non-psychiatrist delivering the Maudsley Lecture in 1978, remarked that ‘behind the rhetorical excesses and the studied irrationality there are some serious points for psychiatry to consider’, in particular that ‘the patient’s view of what is happening to him is as valid as that of the therapist, and therapists ought to listen as well as to prescribe’.Footnote Their symptoms included suicidal thoughts and self-harm, refusal to pray, inability to feel pious, sexual urges, visions, weeping, 'too much talk' and 'hatred of spouse'. Our inception in 1949 as the Mental Health Research Fund (MHRF), after the Second World War and the foundation of the NHS, was born out of the urgent need to get research funding for mental health. For the purposes of this project, this common pitfall was less of a problem than it would have been if we had been trying to use the material to create or validate an historical narrative.Footnote cit. 70 Under the Increasing Access to Psychological Therapies (IAPT) programme after 2006, people experiencing mental distress could also refer themselves to some services without GP intervention.Footnote And "The Madness of King George," which opens tomorrow, ties into the messy state of today's royal family. The seminars allowed an effective exploration of these issues, if only within the very real epistemological constraints of elite oral history. Table 1 illustrates some key aspects of change. The disenchanted professional view held that, as above, the movement of patients out of psychiatric hospitals into the community – ‘decarceration’ – was a good idea spoiled by inadequate resources. 85 As the editors of this series, we see how the development of the intellectual traditions of mental health history has a long history of its own. 1. cit. Diana Rose, Transcript, 3 December 2010, 3. 1961 Enoch Powell, Minister of Health, says mental hospitals to close in 15 years. 116 cit. 14 This has been the subject of intense debate within psychiatry, beginning with Craddock’s 2008 ‘Wake-up call’ in the British Journal of Psychiatry, which argued that although ‘evidence-based psychological and social interventions are extremely important in managing psychiatric illness’ they had resulted in a turning away from neuroscience which threatened the ‘downgrading of medical aspects of care’ and a ‘creeping devaluation of medicine’ in psychiatry.Footnote The link between the movement and classical anti-psychiatry has been challenged by others, and it has been argued that in the anti-psychiatric rhetoric of cutting loose from the system and challenging its legitimacy there had in fact been little engagement with the real problems of modern mental health care.Footnote Department of Health, The Mental Health Policy Implementation Guide (London: HMSO, 2001).Google Scholar, 44. John Laing Collection JLP01/08/007475, New Heritage Partnership Agreement Signed at King's Cross Station, Brixton Windmill - Friends of Brixton Windmill. Response to crisis was held to explain new organisational and procedural demands on mental health services such as the Care Programme Approach (‘a central imposition [in the] 1994 guidance arising out of the Clunis affair’Footnote These three narratives, from disenchanted professionals, from optimistic professionals and from service users, formed the background to discussion of the development of policy and services under the Labour government, which (as previously noted) dominated contributors’ recollections and concerns. Changing reporting conventions make it impossible to present whole-time equivalents on a consistent basis across the period. 32 As the number of patients in long-term residential care, or requiring care in the community, has increased, the share of the cost borne by public expenditure has dropped.Footnote 1, p. 72. Kanani, Nikita developed in these works and the sheer diversity of approaches to understanding and managing mental distress and disorder that characterises the British mental health services at the beginning of the twenty-first century. Diana Rose, Senior Lecturer in User-Led Research, Co-director Service User Research Enterprise (SURE), King’s College, London. Some were on the streets - mentally ill beggars were nicknamed 'Tom o'Bedlams'. cit. The evolution of the NSF is described by the chairman of the External Reference Group in G. Thornicroft, ‘National Service Framework for Mental Health’. ), and care was perceived by service users as ‘awful’.Footnote This article provides a brief historical overview of the development of mental health services in Australia. Over the same period, evidence-based developments in psychological treatment expanded the range of interventions available, and, more generally, the development of a scientific literature led to a greater homogenisation of methods,Footnote By the time of Laing’s death in 1989 this position was uncontroversial and commentators were observing that many psychiatrists had since entered the profession aspiring to an empathetic bond with their patients and that Laing’s contributions were ‘in the main welcome’.Footnote 47. These issues are of particular salience when the objective is to produce the most accurate possible account of a sequence of events. Witnesses acknowledged that New Labour delivered large expenditure in mental health, but contested the effectiveness of that expenditure. On the other hand, the idea that mental illness is definable and treatable as a disease process like any other has been fundamental to many developments in service delivery in the period covered by these seminars. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (. For a partial exception, see Cathy Smith, ‘Family, Community and the Victorian Asylum: A Case Study of Northampton General Lunatic Asylum and its Pauper Lunatics’, Social Inclusion, Social Quality and Mental Illness. Documentary which tells the fascinating and poignant story of the closure of Britain's mental asylums. Instead, Sir Arthur told the Royal Society of Medicine that Britain’s “major duty” was to “carry on” largely as normal, “even when risk to health and life is involved”. For example, J.K. Walton, ‘Casting out and bringing back in Victorian England: pauper lunatics, 1840–70’, in William F. Bynum, Roy Porter and Michael Shepherd (eds), The Anatomy of Madness: Essays in the History of Psychiatry 3 vols (London: Routledge, 1985–88), VII (1985), pp. At least for the earlier years a broad consensus emerged about the main characteristics of the mental health services. Educating people about mental health and raising awareness can help to better understand and support patients suffering from depression or anxiety. 28 Moncrieff’s critique of the scientific basis of drug treatment,Footnote Hugh Freeman, Transcript, 31 January 2011, 17. On present-centredness in historical interpretation, see Adrian Wilson and T.G. Their treatment would have been determined by the Physician Superintendent of the hospital. Bethlem at its Moorfields site © Wellcome Library London. 1960-1970: National Developments and Policies. Many records of asylums, prisons and houses of correction are kept in local archives and especially those of the patients and inmates. 'Microkosmographia: A Description of the Body of Man', second edition by Helkiah Crooke (London, T. and R. Cotes, sold by M. Sparke, 1631) © British Museum. Lunatics, Imbeciles and Idiots: A History of Insanity in Nineteenth-Century Britain & Ireland, reveals the heinous conditions in which the mentally ill were kept. Query parameters: { Following this, mental health was one of three declared clinical priorities alongside cancer and heart disease, in the 2000 NHS Plan. Until 1997 the improvement of care for people with severe mental illness was the principal focus of policy. Emily Pringle looks back through the history of our nation’s treasured NHS Our historical tour of the National Health Service begins in 1948… The National Health Service (NHS) was founded by Health Secretary Aneurin Bevan in 1948. (note 30), 18.Google Scholar, 76. 55. 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