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cit. perspective was contested from a number of directions. Seminars were held at the Wellcome Unit for the History of Medicine in London in 2010 and 2011, and were supported by the Wellcome Trust.Footnote In recent years the rate of referral per thousand adults has probably increased,Footnote In the eyes of the law, mentally ill people lacked the capacity to reason, so a Court of Wards would hand the responsibility for their affairs to someone else. iii Figures in roman type drawn directly from published reports. From this viewpoint, the Labour government offered a particular moment of political clarity, a model for implementation built on a target culture, a belief (not shared by previous administrations) in the value of national leadership on social policy issues, and above all the availability of money, all of which led to large positive changes. Those sufferers lower down the social scale were locked up in County Asylums. The small scale and transient nature of many of the service user groups has made accurate assessment of the scale of the movement difficult, but the leading authority on the subject suggests that it expanded from about a dozen groups in 1985 to over 500 by 2005.Footnote Lunatic asylums were first established in Britain in the mid-19th century. A Short History of Mental Health Looking backward to move forward Matthew Smith, Ph.D. is a lecturer and Wellcome Trust Research Fellow at the University of Strathclyde in Glasgow. cit. 2018. Our investigation revealed further problems with the language of description, littered as it is with terms of art such as ‘recovery’ and ‘community care’ which not only divide professionals from the general public but are also given varying meanings within the professional community. Figure 1 presents a timeline of key activity in mental health policy in the period covered by contributors’ careers. 12 (note 41), 6, citing Foucault.Google Scholar, 95. Sarah Hayley York, ‘Suicide, Lunacy and the Asylum in Nineteenth Century England’, University of Birmingham PhD thesis, 2009, esp. 1960: Report of the Ministry of Health for the year ending 31st December 1960; Part I, The Health and Welfare Services Cmnd 1418; Report of the Ministry of Health for the year 1961. cit. In 1959, more than a decade after the NHS was established, Parliament passed The Mental Health Act. Hailey, Evaluating a Community Psychiatric Service: The Camberwell Register 1964–71 (Oxford: OUP, 1972); D.H. Bennett and H.L. (note 17), 5.Google Scholar, 50. Rose, Nikolas, ‘Psychiatry as Political Science: Advanced Liberalism and the Administration of Risk’, History of the Human Sciences, 9, 2 (1996), 1–23.CrossRefGoogle Scholar, 10. Since the 1990s, the number of those compulsorily detained has begun to grow again. The United States also experienced a book in asylum … 63 Speakers were initially asked to act as witnesses rather than historians, reflecting upon their own experiences with a view to elucidating important themes in the history of mental health services in the period. Victorian asylum photo Victorian attitudes to madness. cit. 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 4. In 1972 the Fund merged with The Mental Health Trust, which raised money for innovative projects to help people with mental health problems. 11 cit. However, the standard account of the emergence of the modern service user movement starts in the 1970s with the founding of groups that included the Mental Patients Union (founded in 1972) and then, when this broke up, organisations including the Community Organization for Psychiatric Emergencies (COPE), Protection for the Rights of Mental Patients in Treatment (PROMPT) and the Campaign Against Psychiatric Oppression (CAPO) which connected the movement to developments in the 1980s.Footnote 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. Peter Bartlett, Nottinghamshire Healthcare NHS Trust Professor of Mental Health Law. f. 2000 & 2010: English data as follows: Patient data from http://webarchive.nationalarchives.gov.uk/20041108195217/http://www.performance.doh.gov.uk/ (2000/01), http://www.ic.nhs.uk/hes and http://data.gov.uk/dataset/mentalhealth-bulletin-fifth-report-from-mental-health-minimum-dataset-mhmds-annual-returns-2011 (2010/11); Formal detention data for 2000/01 from Department of Health, In-patients formally detained in hospitals under the Mental Health Act 1983 and other legislation, England: 1990–1991 to 2000-2001 (London: 2001); Workforce data from https://catalogue.ic.nhs.uk/publications/workforce/numbers/nhs-staf-medi-dent-1995-2005/nhs-staf-medi-dent-1995-2005-rep2.pdf (2000/01); http://www.data.gov.uk/dataset/nhs-staff-2000-2010-medical-and-dental (2010/11). 54 When confronted with unexplainable, irrational behavior and by suffering and upheaval, people have perceived evil. 118 76. unfit to be the ruler of a free people." See, eg., HC Deb., 10 July 1961, 644, 26–7; HC Deb., 23 October 1961, 646, 548; ‘Medico-Legal – Detention for Forty Years’ BMJ, 2, 5250 (August 1961), 527; The Times, 30 July 1961.Google Scholar, 64. (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. 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. 6. It would seem that it is not the content of the ‘scandals’ that determined policy changes, but the broader traction granted by the rise of ‘risk’ as a discourse in the public sphere. Clinicians tended to interpret it as an excuse for inappropriate bureaucratic interference in their clinical judgement: …the one thing that needs to be understood out of all that stuff about danger and risk, which is monstering us, is that because of the impositions of risk assessment and risk management, the forensic establishment and so forth, we’re now in danger of neglecting the non-dangerous patient.Footnote Rose, op. 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. A 22-year-old Instagram influencer left the Good Morning Britain team baffled after explaining to the show that he thinks that learning about World War Two could affect kids' mental health. At the same time, front-line workers in the IAPT programme and support workers in recovery programmes generally work within their respective sets of treatment protocols but do not have specific professional allegiances. The second Griffiths Report of 1988Footnote Goldberg, op. History. Through a series of consensus meetings in which the authors collectively reviewed the transcripts, we have selected for discussion those themes which were most salient to all three ‘stakeholder interests’ – practitioners, policymakers and service users – but note also, in the conclusion, other prominent themes which demand fuller historical exploration. 10 Goffman, Erving, Asylums (New York: Doubleday Anchor, 1961).Google Scholar, 83. These issues are of particular salience when the objective is to produce the most accurate possible account of a sequence of events. He was a controversial character who had accused the previous keeper of irregularities and who was constantly at odds with the Royal College of Physicians. cit. Hall, op. Yet the 1970s also saw significant innovations in treatment and service delivery, led by clinicians responding to these challenges. Kanani, Nikita 2019. Witnesses were clear that some professions were originally only open to those who could afford to pay for training,Footnote It is significant, at least culturally, that the first reports of the Ministry of Health after the establishment of the NHS were proud to report that over 97% of mental patients were being treated in hospitals accountable to the Ministry. Our history of psychiatric science would engage with classic anti-psychiatry and the critiques of psychiatry by psychiatrists, but also examine the impact of developments in psychology and neuroscience and the social and institutional structures in which research is done and disseminated into clinical practice. Clinicians remembered this process as doubling the number of managers in the NHS,Footnote The willingness of many service users (and many non-users) to challenge professional definitions of their distress as illness is an evident legacy of the anti-psychiatry movement, but debate about scope and definition has been just as intense within and between communities of service providers. Mental illness is finally coming out of the dark days of being swept under the carpet and people suffering in silence. Diagnosis is hardwired into the logic of NICE guidelines.Footnote Turner, op. 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. (note 76), 13.Google Scholar, 107. cit. Witnesses noted for example that ‘…we’re still having to make an argument, relatively recently, to our own profession [clinical psychology] that actually we should abandon diagnosis, and replace it by formulation.’Footnote 64 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. and Colin Jones, ‘Raising the Anti: Jan Foudraine, Ronald Laing and Anti-Psychiatry’, in Marijke Gijswijt-Hofstra and Roy Porter (eds). 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. This was held to have led to an emphasis on forensic services, with a diversion of resources from other aspects of mental health into High Dependency and Medium Secure Units, ‘the new lunatic asylums that Frank Dobson dreamt up’.Footnote Diana Rose, Transcript, 3 December 2010, 3. cit. Anthony Sheehan, Mental Health Nurse; formerly Chief Executive, Leicestershire Partnership NHS Trust, formerly Director of Mental Health and subsequently Director-General, Health & Care Partnerships, Department of Health. And even as you’re standing on the corner of a Hackney street with a social worker going in to try and extract someone from a stinking house where they’ve been screaming and yelling for days and days, and neglect, pain, fear, and hallucinosis, you were still being told by your social worker friend, colleague, whatever, “Well, they’re not sure they’re going to let this person come into hospital; they’re not sure they’re really ill” because of their own political beliefs as opposed to any kind of medical or clinical understanding.Footnote Barham, op. cit. McCusker, Pearse Elaine Murphy, Transcript, 7 April 2011, 2.Google Scholar, 22. 93 , ‘Service Utilization in 1896 and 1996: Morbidity and Mortality Data from North Wales’, History of Psychiatry, 16, 27 (2005), 27–41.CrossRefGoogle ScholarPubMed, 11. ), The Griffiths NHS Management Inquiry: Its Origins, Nature and Impact (London: LSHTM, 2010).Google Scholar, 28. See A. Seldon and J. Papworth, By Word of Mouth – ‘Elite’ Oral History (London: Methuen, 1983) and Lynn Abrams, Oral History Theory (London: Routledge, 2010). 115 On the inapplicability of RCT, Margaret Rustin, Transcript, 17 January 2011, 12. For many user groups, notably black and minority ethnic groups, it was argued that there had been little change for the better despite broadly good intentions.Footnote King’s Fund, An Ordinary Life: Comprehensive Locally-based Residential Services for Mentally-handicapped People (London: King’s Fund, 1980).Google Scholar, 38. cit. A number of speakers and many of the other participants attended for more than one seminar, lending a degree of continuity and integrity to the discussions in which service users and professionals were engaged. We are obliged to Dr Tony Black for discussions of Victorian attitudes to risk.Google Scholar, 70. This is still true for counselling psychology.Google Scholar, 114. for this article. Until 1997 the improvement of care for people with severe mental illness was the principal focus of policy. 18 Key points: Mental illness was historically associated with demonic possession and evil spirits and it could take us usefully beyond the conceptualisation of such categories as ‘deviant’. cit. Turner, op. 57 Andrew Roberts, a service user who has taken a leading role in developing a service user perspective on the history of the movement, is one who has criticised this line of argument. (note 17), 4.Google Scholar, 30. 38 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. Witnesses acknowledged that New Labour delivered large expenditure in mental health, but contested the effectiveness of that expenditure. The Mental Health Act of 1959 . 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. 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 1959 Mental Health Act and the 1962 Hospital Plan presaged the rundown of the asylums and the assimilation of psychiatric care into the wider hospital system. Patient data and nursing workforce data are rounded, partly to reflect the possible inaccuracies and inconsistencies in official statistics. Published by Cambridge University Press. Åsa Jansson, ‘From Statistics to Diagnostics: Medical Certificates, Melancholia, and “Suicidal Propensities” in Victorian Psychiatry’, Journal of Social History 46, 3 (Spring 2013), 716–31.Google Scholar, 73. For the growing number of patients outside hospital, ‘the problem with community care is not just about management; it is about misery, poverty and the style of mental health services that offers no real choice about the type of support available. Forms of organised advocacy for users of mental health services have existed in Britain since the formation of the Alleged Lunatics’ Friend Society in 1845.Footnote Of the seven primarily involved in policymaking, six had also been practitioners; two of the psychiatrists and two of the clinical psychologists had extensive policymaking and management experience; three practitioners were also historians. 106 Notably child psychotherapy at the Tavistock Clinic: Rustin. Peter Barham, Transcript, 3 December 2010, 8, quoting the words of a user group in 1990. or the more contestable triumph of eugenic thought in the 1913 Mental Deficiency Act, and the institutional changes which followed those pieces of legislation? We began by remarking that a traditional historical narrative structured around rights is now enriched by new organising categories such as costs, risks, needs and values such as the aspiration to equality and inclusion. Just as we ask, of the modern period, how and why (and to what extent) certain modes of treatment are incorporated in practice and others dropped, should we move beyond the classic studies of developing psychiatric thought in the works of great men to a search for explanations of the practice and scientific beliefs of the front-line asylum doctors and general practitioners who delivered ‘care’ in the nineteenth and early twentieth centuries? See J.W. cit. The Bethlem's first medical 'keeper'. Services thereafter developed against a background of serial reorganisations of the NHS and local government. In a population of five million, this meant that large numbers of mentally ill people lived in their communities, usually cared for by their family. The National Health Service was founded on 5 July 1948 and now faces its biggest challenge yet. Jim Symington, Transcript, 31 January 2011, 13. 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. 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? Mervat Nasser, ‘The Rise and Fall of Anti-Psychiatry’, Psychiatric Bulletin, 19 (1995), 743–6, sees MIND, transmuted from the World Federation for Mental Health in the UK in 1970, as embracing an anti-psychiatric philosophy (745–6).Google Scholar, 99. 27, Issue. The rise of the asylum. For many years thereafter the ‘problem’ of dangerous offenders was subsumed in a nuanced discussion of the best way to promote co-operation between the justice system and the mental health services, an approach epitomised in the 1975 Butler report, which, among many other things, launched the development of forensic psychiatric services in the NHS.Footnote 110 Footnote First, a growing body of empirical evidence points to the primary importance of the non-technical aspects of mental healthcare …second, real collaboration with the service user movement can only happen when psychiatry is ready to move beyond the primacy of the technical paradigm…Substantive progress in our field will not come from neuroscience and pharmaceuticals (important as these might be) but from a fundamental re-examination of what mental healthcare is all about and a rethinking of how genuine knowledge and expertise can be developed in the field of mental health.Footnote Rose, op. © The Author(s) 2015. Barbara Taylor, Transcript, 17 December 2010, 28.Google Scholar, 94. 9 The new governors had a strict admission policy, taking in only those who were 'raving and furious and capable of cure, or if not yet are likely to do mischief to themselves or others'. Care for people with mental health conditions has changed dramatically over time. while others have had a skewed ethnic or gender balance.Footnote (note 17), 6.Google Scholar, 33. At least for the earlier years a broad consensus emerged about the main characteristics of the mental health services. Shortlisted for ‘Best Rescue of an Industrial Building or Site’ Angel Award in 2012, Michaela Strivens: Upside down world, Wallington, London Suburbs, Mental Illness in the 16th and 17th Centuries, Read about our latest aerial investigation methods. Andrew Roberts, a service user who has taken a leading role in developing a service user perspective on the history of the movement, is one who has criticised this line of argument. However, most patient files have been destro… Witnesses tended to echo Crossley’s view that the early movements owed as much to social radicalism as to the intellectual anti-psychiatry of the 1970s, though service users in the seminars challenged the philosophical basis of diagnostic categories and treatment methods in terms which would have been familiar in those earlier debates. The evolution of the NSF is described by the chairman of the External Reference Group in G. Thornicroft, ‘National Service Framework for Mental Health’, The Psychiatrist, 24 (2000), 203–6.Google Scholar, 46. (note 41), 23. (note 20), 4–5.Google Scholar, 39. 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 MacIntyre, Gillian "clr": false, Journal of the History of the Neurosciences, Vol. (note 50), 9; Division of Clinical Psychology, Clinical Psychology: The Core Purpose and Philosophy of the Profession (Leicester: British Psychological Society, 2010), defines formulation as ‘…the summation and integration of the knowledge that is acquired by th[e] assessment process that may involve psychological, biological and systemic factors and procedures. It was known as the Lancashire County Asylum from 1851 to 1861, the County Lunatic Asylum, Rainhill (c.1861 – 1923), the County Mental Hospital, Rainhill (1923 – c.1948) and Rainhill Mental Hospital until it closed in 1991.‪[1]‬ In 1936 there were 3,000 inmates, and it was said to be the largest mental hospital in Europe. Cookies being used in accordance with our groups, see Adrian Wilson T.G., author of Closing the asylum ( Penguin 1992, 1997 ) read about our current news, projects campaigns..., punishment and diagnosis of mental Disorders in Primary care settings ’ programme dominated recent! Wiesing ( eds ) you consent to cookies being used in accordance with our residential provision, Scholar... Observatory, 2012 ), 6, citing in particular the work of Wolfensberger, Rebecca Sarfo-Adu, and! 76 ), 2.Google Scholar, 51 psychiatrists.CrossRefGoogle Scholar, 21 practice ( Cambridge: Cambridge University Press 1989. 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