Friday, 28 October 2011

Personal Memories of a Special Place - one

For nearly 20 years, up until January 2010 I had the privilege of being the Chief Executive of a local homelessness charity in the town of Hastings and St Leonards on Sea in East Sussex. Not long ago the organisation celebrated its 25th anniversary, and I thought that it would be appropriate to do a series of blogs about its beginnings, its activities and its clients. Who knows, there might be a book in this.

I'll write about how it came into being next time, but as its origin is steeped in the subject of mental health, and closely linked with the closure of the local psychiatric hospital, I think its important to place it in its historical context. To understand the shift in the treatment of mental health, is to understand why the organisation was born. This shift is about moving from psychiatric hospital care to care in the community, and the problems associated with that.

I'm grateful to the mental health charity MIND for the historical time line, which can be read in full here. In addition I strongly recommend the book by Catharine Arnold, called, "Bedlam: London and its Mad". This is the story of the Bethlehem Hospital, which was founded in Bishopsgate, London in 1247. The book is "a history of London's treatment of its insane". We do well to remember Catharine's opening words in the Introduction, that "the mad, like the poor, have always been with us". She then goes on to briefly outline how the mentally ill have been treated since Roman times. As statistics show that even today, one in four people will suffer some form of mental illness in their life, it is a subject of some relevance.

In 1601, The Poor Law was introduced and clearly defined the responsibility of every parish to support those who were incapable of looking after themselves. Over 200 years later, The County Asylum Act 1808 gave permissive powers to the Justices of each county to build asylums, paid for by local rates, to replace the few psychiatric annexes to voluntary general hospitals. In 1834, The Poor Law Amendment Act was introduced which required relief to be provided within institutions only. This led to the construction of a huge network of workhouses. The Lunacy Act of 1845 required counties to provide asylums, and the majority of Britain's psychiatric hospitals were built during the following 25 years. There's nothing new about taking advantage of funding arrangements, and shifting the responsibility elsewhere, as local parishes were encouraged to move the parish poor into asylums, as these were funded by the county councils, rather than the parishes. Little wonder that so many people who did not suffer from mental illness, ended up in asylums. I think that this must have been recognised, because The Lunacy Act was revised in 1891, and imposed rigid procedures and criteria, so that only people with the most severe mental illnesses were likely to be admitted to hospitals.

The Beveridge Report brought into being The National Assistance Act 1948, which stated, "It shall be the duty of every local authority to provide residential accommodation for persons who, by reason of age, illness, disability or any other circumstances, are in need of care and attention which is not otherwise available to them". Together with the introduction of welfare benefits, this encouraged the beginning of the move from institutional to community-based care. By 1954, the resident population of psychiatric hospital beds reached a peak of 152,000, with many of the hospitals becoming extremely overcrowded. An example is given of Friern Barnet hospital which was built in 1851 to accommodate 1,000 people, and by 1950, was accommodating over 2,000.

A report published in 1957 marked the turning point in official policy from hospital-based to community-based systems of care. Called, "The report of the 1954-57 Royal Commission on the law relating to mental illness and mental deficiency", (thankfully known by the shorter name: the Percy Report). One of its many recommendations was that "the majority of mentally ill patients do not need to be admitted to hospital as inpatients. Patients may receive medical treatment from general practitioners or as hospital outpatients, and other care from community health and welfare services". This was taken a step further in 1961, when Enoch Powell, as Health Minister, made his famous 'Water Tower' speech to the annual conference of what became MIND. He envisaged that psychiatric hospitals would be phased out and replaced by care provided in the community. Powell's plan was for "nothing less than the elimination of by far the greater part of this country's mental hospitals as they stand today".

During the next 20 years, a number of White Papers and new or revised Acts came into being, that tried to settle who would be paying for what. The key change was that funding would move from NHS hospital funding to particularly the Department of Social Services for work in the community. However, problems arose, because although the psychiatric hospital population halved between the mid-1950's and the mid-1980's, insufficient money followed those ex-patients into the community. In a scathing report in 1985, The Social Services Select Committee stated that hospital closures had outrun community-care provisions, particularly in relation to people with mental health problems. There were calls for government action and increased spending. In the committee's own words, "A decent community-based service for the mentally ill or mentally handicapped people cannot be provided at the same overall cost as present services. The proposition that community care should be cost neutral is untenable ... Any fool can close a long-stay hospital: it takes more time and trouble to do it properly and compassionately". The following year, the Audit Commission for England and Wales was pointing out that despite the reduction in the number of hospital beds, local authorities had not been allocated the resources necessary to provide alternative forms of care. It was in 1986 that the first psychiatric hospital was fully closed down.

Many of us working in the social care field in the late 1980's and early 1990's were also critical of this lack of money to support those who had been 'turfed out' of hospital into the community. This criticism remained with me until I retired.

Hellingly Hospital Site
East Sussex was one of those areas required to provide asylum accommodation. Originally there was such a place in Haywards Heath, but the county decided that a new asylum was needed because of overcrowding, and this was built at Hellingly, near Hailsham. It was known as the East Sussex County Asylum, but would be referred to as Hellingly Hospital.

Opened in 1903, the hospital was designed by C.T. Hine, described as the foremost asylum architect in England. Those who know Nottingham will be interested to note that this is the same architect who designed and built most of The Park Estate near Nottingham Castle.

Covering over 400 acres, Hellingly was to be one of the most advanced Asylum designs of its time. It had its own railway, principally used to transport coal from the main line to the hospital's boilerhouse. It had a vast laundry, ball room, patients' shop, sewing rooms, nurses home and extensive grounds. In addition to the main hospital there was also an Acute Hospital known as Park House that was designed to hold about 15% of the total patient population. At its peak, Hellingly accommodated just under 2,000 patients. There was also on site a separate isolation hospital, and in the 1980's, the hospital was one of five hospitals to be selected to have a medium secure unit on site, which was called Ashen Hill, and although the main hospital finally closed its doors in 1994, Ashen Hill is still operating today. I spent quite a bit of time over the years at Ashen Hill (not as a patient you understand, but as a visitor), particularly relating to the needs of mentally disordered offenders.

Hellingly Hospital had been discharging patients into the community for a number of years before it finally closed, and many of those found their way to Hastings, without sufficient resources being available through the local authorities to provide the level of support that most of them needed. It was the needs of these, and the plight of others living in the community who found themselves "socially stranded", that drove a small group of people to set up the Seaview Project. That story will begin next time.

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