From the asylum… Bedlam, by William Hogarth (1697-1764)

County Asylum, Lancaster (1816-2002) All Saints Hospital, Birmingham (1847-2000) Bethlem Hospital (‘Old Bedlam’) Warlingham Park Hospital, Surrey (1903-2000)

…to the community

The era of the asylum Europe’s first asylum was London’s Bethlem hospital, which opened in 1247 The ‘Great Confinement’ in France began in the 17th century Early to mid-19th century: policy of building asylums extended throughout Western Europe and North America In the UK, the 1845 Lunacy Act introduced the era of the asylum system Colney Hatch Hospital, north of London (renamed Friern Hospital in 1937)

Asylum life [1] See: http://www.bbc.co.uk/education/beyond/factsheets/makhist/makhist7_prog3b.shtml The Colney Hatch Lunatic Asylum was one of the most famous and dreaded of the many ‘warehouses of madness’ established in the mid 19th century. Colney Hatch was once a hamlet in the countryside, north of London. Housing estates shot up in the area following the building of a station on the Great Northern Railway line to Peterborough in 1850.

Asylum life [2] A year later a large mental hospital opened there. This was to be the lunatic asylum for the County of London. As a work of architecture Colney Hatch was outstanding, made of brick and decorated with stone. It was of Italianate design by the architect Samuel Whitfield Daulkes (1811-80). Prince Albert laid the foundation stone on 8 May 1849 and the first patients arrived in July 1851.

Asylum life [3] Built at a cost of about £400,000, Colney Hatch was originally designed for less than 1,000 patients. Before long this increased to 2,000. By the First World War Colney Hatch had 3,500 patients. The front of the hospital building was nearly 2,000 feet in length, with towers at each side. The asylum also had the longest corridor in Britain.

Asylum life [4] Occupying 20 acres of the site was a 600-seat chapel, farm buildings, a workshop, yards and lodges. There was also a kitchen garden, cemetery and other land including a 160-acre farm. By the 1870s the whole area was so dominated by the presence of the Colney Hatch Asylum, that the very name, Colney Hatch, would strike dread into people's hearts and even blighted development in the area.

Asylum life [5] In Britain, the County Asylums Act 1845 required boroughs and counties to provide adequate asylums at public expense for pauper lunatics. It was in the 25 years after the Act that most of Britain’s mental hospitals were built. The funding arrangements encouraged local parishes to move the parish poor into asylums, which were funded by the county council and not the parish. By 1900 there were about 100 asylums in the country.

Asylum life [6] A Corridor in the Asylum, painted by Vincent Van Gogh in 1889 Now held by the Metropolitan Museum of Art, New York

Asylum life [7] Saint-Paul Asylum, Saint-Rémy

Asylum life [8] Winwick Hospital, Warrington (north England)

Asylum life [9] Female ward, Whittingham Asylum (north England)

Towards community care Interest in finding alternatives to institutional care grew from the 1940s onwards, for a variety of reasons… …such as??

Why community care [1]? ‘Orthodox’ accounts include: the emergence of new psychiatric treatments; the appearance of ‘social psychiatry’; the growth in influence of ‘anti-psychiatric’ ideas (e.g., see the writings of Laing and Szasz); the growth of civil rights movements;

Why community care [2]? concern over declining standards of care in the mental asylums; observations from scholars such as Goffman regarding the perils of life in closed institutions; an increased willingness on the part of communities to tolerate the presence of people with mental health problems; the desire of people with mental illnesses to be cared for in their own homes.

Why community care [3]? ‘Radical’ explanations include: the cost advantages to hard-pressed industrial capitalist societies of pursuing alternatives to expensive hospital care. See: Goodwin S. (1997) Comparative mental health policy: from institutional to community care. London: Sage

Contemporary mental health care [1] Comprises: Primary health care Secondary community care (e.g., the multidisciplinary community mental health team) The psychiatric hospital Specialist and other services provided in both hospital and community settings

Contemporary mental health care [2] Themes: an evidence-based approach; working across boundaries; working collaboratively with service users; maintaining public safety through effective management of risk.