Transformation or stultification? The first fifteen years of voluntary mental treatment in London (1930-1945) and Dublin (1945-1960)
This paper will explore the extent of the adaptations made to mental hospital service provision following the Mental Treatment Acts in the UK (1930) and Ireland (1945). It focuses particularly on the case of the London County Council. On the basis of this analysis, the paper will then offer some parallels with (and divergences from) the implementation of the 1945 Mental Treatment Act in Dublin. The papers argues that mental hospital providers in these capital cities framed the potentialities of these Acts in similar ways, even as they responded to the local contexts that helped determine decisions over their implementation. In each case, these Acts legislated for the admission of voluntary and temporary patients. Prior to these enactments, mental hospital admission had rested principally on a judicial process of certification; subsequently, patients and their families at least nominally obtained greater control over the timing and duration of institutionalisation. How far these new groups of patients warranted distinctive institutional provision became a topic for debate at a local level between psychiatrists, mental hospital committees and local authorities. It is this set of discussions that the present paper examines, through an analysis of mental hospital committee records and correspondence that offers to suggest how far special provision was deliberately made for these voluntary and temporary cases.
The paper concentrates principally upon the London County Council, which in 1930 set up a Mental Treatment Act Sub-Committee to consider changes to existing services in order to accommodate voluntary and temporary patients. This evidence is compared with the experience of Dublin’s mental hospitals after 1945, to suggest how far international precedent, existing institutional provision and prevailing economic and social imperatives influenced services in both countries. Amongst those changes discussed are the developments in outpatient treatment, modernisation of mental hospital buildings and development of ancillary aftercare services.
Previous assessments on the radicalism of these enactments have diverged. For Helen Boyle (President, Royal Medico-Psychological Association), writing in 1939, the UK’s Mental Treatment Act had represented ‘the greatest practical advance’ hitherto made in psychiatry. In contrast, the historian Niall MacRae (2008) has concluded that despite the promise of the Act, a ‘stultifying regime prevailed in the decades that followed its 16 implementation. Brendan Kelly (2008) has further emphasised the failure of the comparable Irish Act of 1945 to reduce in-patient numbers or establish new institutions that might lead to further change. Nevertheless, Kelly has also argued that the Act may have had a ‘decisive influence’ on Ireland’s mental hospital system; particularly in the diminution of the stigma it brought to in-patient treatment. Through an analysis of these debates, this paper offers to suggest what determined the shape of services for patients following the Mental Treatment Acts. Whereas previous studies have tended to focus on the national implications of these laws, this paper will suggest that local circumstances proved vital in shaping the provision mental hospitals made in the fifteen years after their introduction.
Stephen’s research explores the changing place of convalescence and psychiatric recovery in the public mental hospital system and wider community. In particular, his thesis has analysed the contestation of convalescence as a category that defined not only the personal health of the individual patient but also their identity and belonging as patients and citizens.