Castles in the air

On 20 October 1975, in the middle of an economic crisis, a white paper, Better Services for the Mentally Ill, was published by Barbara Castle.

Enoch Powell had already, in his water tower speech of 1961, signalled the end of the immense Victorian asylums and a move towards reducing the long stay population through new forms of treatment.

Subsequently, there had been a series of scandals in long stay hospitals, inspection teams had visited many, and change was obviously necessary. But the money was not available.

A radical group, Community Organisation for Psychiatric Emergencies (COPE), provided a nickname for a white paper which said that little progress could be made until the economic situation improved.

It emphasised the provision of a comprehensive range of local services rather than the closure of asylums, not practicable until their services were no longer required by patients admitted many years previously, for whom local services were unsuitable.

There were still 30,000 such patients in 1971 and despite clinical advances “new long stay” patients continued to require institutional care. Money was tight and it was hard to see how community services could be developed when the asylums still had to be maintained. Perhaps money could be squeezed out of the acute sector?

Under the new policy, where long-term inpatient treatment was unavoidable, there would now be a distinction between where the patient resided and where he or she spent the day. The psychiatric unit, for example, was to have “two main functional components”, wards or residential units, often part of a district general hospital, and a day activity area. Progress was only slowly made and soon the policy itself changed and the district general hospital unit was largely dropped in favour of outreach teams and locally based small units.

For a fuller account of health history see www.nhshistory.net