Lessons we can learn from a lost world

Can we revisit old models of care to provide better services for people with mental health problems?

Can we revisit old models of care to provide better services for people with mental health problems?

Claybury Hospital, opened in 1893. Picture: Wellcome Collection


Many moons ago, on completing nurse training, I applied for a post at Claybury Hospital, a former psychiatric hospital on the edge of east London.

Deterred by a description of the ‘total institution’ in Erving Goffman’s classic book, Asylums, I did not pursue the application, but in 1992 I visited Claybury with a nurse who worked there.

On arriving, we passed several blocks with boarded-up windows along the main drive. It was if the old Victorian behemoth was retreating to its core, but the wide corridors in its main block were still busy with motorised carts heading to or from the laundry or kitchens.

My colleague showed me the rehabilitation ward where she worked: a high-ceilinged space with an overpowering institutional odour.

Patients with chronic schizophrenia cadged cigarettes while the nurses kept order.

As the years passed by, large psychiatric institutions such as Claybury were replaced by care in the community.

Yet my impression, as a historical narrator of mental health nursing, is that the more things change, the more they stay the same.

Treatment methods

A cherished item among my artefacts is a brochure produced by the Claybury Hospital management committee in 1958.

It offers a remarkably candid account of the work of the hospital, and many of the challenges it describes persist in mental health services today.

Opened in 1893, the hospital had 2,300 patients and hundreds of resident staff. The brochure boasts of modern methods of treatment, such as insulin coma therapy and prefrontal leucotomies, as well as the recent arrival of tranquillising drugs.

Social methods are emphasised too. One of the highlights at the hospital was a weekly dance, although this no doubt would have been a stilted waltz.

According to average attendance figures, fewer male patients were trusted to mix with the opposite sex. They numbered only 78 of the 280 patients present while, of the 218 patients from ‘disturbed wards’ who attended films being shown in the main hall, 160 were female.

The therapeutic community model for which Claybury became famous is not mentioned.

In the 1960s, this radically liberating approach had been introduced throughout the hospital by Denis Martin, after his promotion to physician superintendent, with the indispensable help of matron Vera Darley.

His predecessor in 1958 was evidently a proponent of behaviourist methods, with wards assigned to ‘habit training’. 

Recruitment problems

As today, mental nursing experienced recruitment problems, and NHS hospitals tapped into Britain’s colonial past by bringing recruits from distant shores to fill the many gaps in staff numbers.

Photographs of nurses show this demographic change at Claybury. The experience of foreign nurses, long before the emergence of a multicultural society, is a fascinating aspect of our social history.

The mental hospitals served a purpose – admittedly not always well – as sanctuaries. As the number of beds plummeted, psychiatric wards, typically in general hospitals, became known for their high threshold for admission and rapid turnover.

Most patients are ‘sectioned’ and treated with potent antipsychotic medication. There is little time or space, and the nurses are under stress.

While services have been transformed, the needs of people with severe mental health disorders have not changed. Hopefully, policymakers will begin to rethink the concept of the asylum.  

About the author



Niall McCrae is a lecturer at King’s College London. His book, The Story of Nursing in British Mental Hospitals: Echoes from the Corridors, co-authored with Peter Nolan, is now available in paperback.

This article is for subscribers only