The Asylum vs. Care in the Community.

When I was growing up in Stoke, the reputation of our local psychiatric hospital took on almost mythic qualities. Based in Cheddleton, the St.Edward's hospital was the subject of many, possibly apocryphal, stories, and whenever anyone would act a little "crazy", people would always say "be careful, you'll end up at Cheddleton". The remark was usually delivered in a derisory or humorous fashion, and what it made clear was that those who actually did find themselves "at Cheddleton" were separate from the rest of us. "They" were the insane, while we were, to quote Foucault, shining examples of "a reason sure of itself". So, the element of stigma was clear. The inmates of St.Edward's weren't like us. They were almost a different species, the insane, and I remember thinking very clearly that I would never end up in such a place. Little did I know.

St.Edward's Psychiatric Hospital, Cheddleton.

But what this got me thinking about was the eventual closure of St.Edward's and other places like it, with them eventually being replaced by so-called "care in the community".
The drive for this change began in the '50s and '60s, when there was a rise in patients' rights movements, in turn tied to civil rights campaigns. The stories of many languishing in the long-stay asylums aroused such campaigns, the object of which was to end the isolation of the mentally ill and integrate them back into the community, thereby reducing the stigma attached to such conditions. The 1959 Mental Health Act abolished the distinction between psychiatric and other hospitals and encouraged the development of community care. During the '70s, large-scale psychiatric hospitals were steadily discredited and the setting up of new district general hospitals resulted in a reduction of beds from 150,000 to 80,000 by 1975. The 1983 Mental Health Act set out the rights of those admitted to psychiatric hospitals and allowed them to appeal against committal.
So, so far, so good, one would think. Indeed, attitudes had changed as well. No longer was homosexuality viewed as a matter of mental ill health, and no longer would single women who had fallen pregnant be detained in the old-style Victorian asylums.
However, throughout the '80s and '90s there were a number of high profile cases which led many to question the efficacy of "care in the community". In 1984, social worker Isabel Schwarz was murdered by a former client, which led to a government inquiry into community care. The resulting report, "Community Care: Agenda for Action" was a forerunner to the Community Care Act of 1990, and after a number of similar cases in the '90s, most notably that of Christopher Clunis, who killed Jonathan Zito on the platform of Finsbury Park tube station in 1992, the debate over whether community care was a good idea raged once again. "Forget the patient's rights", the right-wing press seemed to declare, "what about the public's right not to be attacked and killed?" Such was the frenzy of accusation, that the then government proposed controversial changes to mental health law concerning those with severe personality disorder, which would make treatment for them compulsory. Many argued that such changes would infringe patients' civil rights and turn doctors into jailers, and what appeared to have been forgotten was that such cases were really a rarity. The vast majority of murders are committed by "sane" people, but no one ever seems to speak of this violent epidemic spreading amongst the sane.
So, perhaps the question to be asked is did "care in the community" really achieve its aims? Sure, patients' rights have been significantly advanced, but has it had the desired effect of also reducing stigma? Indeed, has it really improved the care of those with experience of mental ill health?
All I can say is that many mental health staff and indeed, also service users, refer to the old long-stay institutions with a certain fondness. St.Edward's itself was set amidst beautiful grounds, and it seemed to be a time when the word "asylum", with its true meaning of sanctuary and protection, was entirely apposite. For many with mental ill health, some time away from everyday life and its problems can be invaluable in their recovery, and I remember one service user stating to me that, contrastingly, "care in the community" really meant "no care in the community".
Speaking for myself, though, I have to say that I wouldn't welcome a return to the old long-stay institutions. The set-backs are simply too many. And if I were around in the '50s, before the impetus for community care came about, who is to say that I wouldn't, with my diagnosis of schizophrenia, be languishing on some grey ward. The problem of stigma, I also have to say, seems to be improving.
In the place of St.Edward's then, we now have the relatively new "Harplands" hospital. But, having made the previous positive comments, I would say that its reputation amongst service users is not that great. One lady, who had experience of depression, even remarked when speaking on our local BBC radio station, that she would rather have committed suicide than go on an acute ward at the Harplands. So it seems that any psychiatric institution will always be feared, and maybe, the old Stoke saying of "be careful, you'll end up at Cheddleton" has merely been replaced by something to the effect of, "be careful, you'll end up at the Harplands".       
 

Comments

klahanie said…
Dear David,
Another very informative posting and one to which I can rather relate.
So, I will allude to a couple of points. I look back on my own stay at St. Edwards with much fondness and also, much sadness. I recall the beautiful settings, some deeply profound times and some remarkable patients who did not fit the convenient stereotypes. I also remember some excellent psychiatric nurses and some who treated us like naughty little children. That caused great resentment.
Care in the community. The jury is still out on the pros and cons. I do agree that long-term stay in an 'institution' is not conducive to improvement of mental health well being. If anything, I felt stagnated during my times there.
Yet, those were the best of times and the worst of times for me. And of all the places I ended up in over the Stoke on Trent, Staffordshire Moorlands area, by far, St. Edwards, has the best full English breakfasts.
Talk to you soon, David.
Very kind wishes, Gary
David said…
Dear Gary,
Very interesting response, my pal.
I never got the privilege of staying at St.Edward's myself, so you have confirmed what I thought most felt about it.
I have, however, been in the newer Harplands hospital, and not surprisingly, I did not enjoy my time there. It would be interesting, then, to know someone who had been in both places, to see how their experiences compare.
Thanks for the comment, Gary, you naughty little child, you.
Very Best Wishes, and a full English, your way,
David.
bazza said…
When I was a small child the expression was "be careful or you'll end up in Barley Lane"! Even to write those words still sends a shiver down my spine.
At the age of about twelve I was shocked/amazed/impressed to discover that it was a referrence to Goodmayes Hospital which you can seeo on “this map” still exists and is in Barley Lane, Goodmayes, Ilford.
From the one or two people I know who have been 'guests' there it matches Gary's description of St. Edwards but I'm not sure about the health benefits of the 'full English'!
I am pleased to say that the expression is no longer in use!
Thanks for an interesting post David. Have a great weekend.
David said…
Thanks bazza. It would seem, then, that every area had their own version of the St.Edward's myth.
One does hope that things have improved, both in terms of stigma and mental health care, but as my post and your comment suggest, mental ill helath and its treatment is still seen as a thing to be feared.
Have a great weekend yourself.
With Very Best Wishes,
David.
dcrelief said…
Hello David!
That's a pretty menacing photo; I think I'd run away from there.

The 'lucky ones' here, are sent to the eighth floor of Memorial Hospital. The 'standard' treatment is shock therapy. Then you go home without any memories of the event that brought you there. Community care? what's that?

When your memories cannot be squashed, you're referred to 'Morganton Institute'...a private little hell you'd rather skip.

Yes, they all do the group therapy sessions, but without memories, why do they bother? Well, to make sure their modes of therapy work, of course.

The 'standard' treatment for 'outpatient' and or, 'returned to society' is a script of medicines; simple as that. And now you're regular MD can prescribe your meds and you don't have to see a social worker, psychologist, or a psychiatrist. "Here, have some Zoloft, Paxil, yum-yums"

Community Care? What's that? Everyone is treated the same or ignored the same. I'm the community when I can help someone. Most of the time we simply need someone to listen.

Great post; wish I had something more positive to say.
In peace,
Dixie
David said…
Dear Dixie,
Things are obviously a little different in the States to over here, and I have to say you make it all sound a bit grim. I say "a bit", what I mean is a lot.
Although our system in the UK does have its failures, it does seem to be improving, and things like "shock" therapy would never be used as a "standard" treatment, but only in very severe cases.
Overall, Dixie, you make me glad I live in the UK, and not the good, old U.S. of A.
Still, sending you very best wishes,
David.
The Manic Chef said…
Dear David your entry brought back memories of the "Mental Health" facility in Buffalo, NY, where I had a friend back in the late 60's who had suffered a 'nervous breakdown' and ended up at this 'monastery of nutsos'(I'm being cynical). I went to visit my friend to take him some personal things, and when I walked in one of the corridors on the ward where he was "stationed", I was mortified at the surroundings, many of the 'inmates' wandering around in a drugged out stupor, certain members of this "private club" were groping one another in the hallways, open sexual activity, screaming and yelling by other patients, with people in white uniforms walking around checking on rooms, etc. I was frightened out of my skin, I can tell you, and when I found my friend in his room, I was stunned at the carrying on by his "roomie". My friend was drugged, but recognized me, and said he would be out soon. His mother put him into this place. I can't tell you the anger I felt, when I realized what he had to endure to get some 'quiet rest'. Please "you've go to be kidding me.....right? Was my initial response, I knew he did not belong there, and I was angry that a family member would do such a thing. After that I never heard from him again. That was my experience with a Mental Health institution. So I'm glad it's changed, but in Toronto years later, I saw so many poor souls, just meandering around in certain neighbourhoods with no purpose, drugged out of their minds, after they closed these institutions, and placed them into "halfway houses" which were not desired in certain communities whith children. This to me, was not solving a problem, but creating a worse dilemma, for those suffering with "emotional and mental" challenges which had no place to call home. It's all very sad at the heartlessnes that is shown to humanity.
Of course you know your articles really do kick start an emotional response in me. Thanks for getting my blood circulated. Later...
David said…
Dear Manic Chef,
I suppose the state of many of the old asylums had something to be desired, and your story about your friend seems to confirm that the worst stereotypes about such places are actually true.
I hope and think that things have improved, although there are stories one hears from time to time about how bad conditions on even the new wards can be, and they are indeed still places that no one would actively want to spend time in, and appear still to be much feared.
Anyway, thank you for your views and illuminating experiences. I hope we can make a collective wish that things only get better, and not worse.
With Very Best Wishes,
David.
Johnnie said…
Hi There. I Had Therapy Sessions With The OT Staff At Saint Edwards.Ive Suffered Mental Ill Health For The Past 20 Or More Years. I Find It Really Difficult To Be In groups Of People. Which Made It Difficult To Attend Groups. I Have A Personality Dissorder & Find The Mental Health Services In Stoke On Trent Pathetic. No One Listens. Im Going Out Of My Mind & Now The D.W.P Are Making Me Go OnThese Stupid Interviews. I Cant Cope. The Meds Theyve Put Me On Dont Help & Well My Doctor Couldnt Care Less.

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