An early history of mental hospitals

An early history of mental hospitals

This section sets out a brief historical perspective: for a more detailed account of early history of mental illness and LD, readers are referred to the mental health history timeline. From ancient times both mental illness and LD were associated with evil and people suffering them were excluded from normal society. Even Socrates is reported to have stated that they should be ‘put away in some mysterious place’. In England the first records of a specific place for ‘lunatics’ was the religious priory of St Mary of Bethlem in the 14th century. The Elizabethan Poor Law Acts required every parish to appoint overseers for the poor and set up parish houses for poor people who could not support themselves. After this period these remained the places where the mentally ill were housed. In the 18th century facilities for the mentally ill were generally of a very poor standard, although some were designed so that the ‘lunatics’ could be displayed for visitors. Many ‘madhouses’ were run as private facilities and housed between 50 and 400 ‘inmates’.

Following the attempted assassination in 1800 of George III by James Hadfield (who was deemed to be insane), the mental illness of George III himself and the passing of the County Asylums Act in 1808, the 19th century witnessed a large expansion of public asylums and the movement of the mentally ill from poorhouses to specific institutions. Although these institu-tions were originally designed to offer hope and better facilities for the men-tally ill, by the late 19th century the beliefs associated with social darwinism (that insanity is the end-product of an incurable degenerative disease) saw them becoming social backwaters. Throughout this period, the powers enabled by the 1890 Lunacy Act led to huge expansion of the grounds for confinement of any person regarded to be ‘lunatic, idiot or of unsound mind’.

By the 1930s there were 98 mental hospitals housing 110 000 patients in England and Wales. They varied in size, with the average number of patients over 1000. By the 1950s the concepts that had shaped the pre-war policy were no longer acceptable and the 1946 Mental Health Service Act defined a hospital as including institutions that were for ‘the reception and treatment of persons suffering from illness or mental defectiveness’.

Much of the modern development of mental health services results from the 1959 Mental Health Act. It provided for admission to mental hospitals to be on an informal basis wherever possible and made councils responsible for the social care of people who did not need inpatient treatment.

For much of the early history, people with LD suffered a similar fate to those with mental illnesses. However, by the early part of the 20th century separate institutions had been established that accommodated both children and adults with mental disabilities. The institutional model remained until the late 1960s when a series of investigations shone a light on the conditions in many ‘mental handicap’ hospitals. The findings of these scandals led to a policy change, later published in Better Services for the Mentally Handicapped, which expressed the intention to close all such institutions and move towards a community-based model.