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Houston RA. Asylums: the historical perspective before, during, and after. Lancet Psychiatry 2020; 7:354-362. [PMID: 31862356 DOI: 10.1016/s2215-0366(19)30395-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 09/12/2019] [Accepted: 09/18/2019] [Indexed: 11/30/2022]
Abstract
Extensive institutionalisation of people with mental disorders has a brief history lasting just 150 years. Yet asylums feature prominently in modern perceptions of psychiatry's development, on a mental map drawn in sharp contrasts between humanity and barbarity, knowledge and ignorance, and good and bad practice. This Review seeks to nuance the standard narrative of asylums by considering the voices and views of those who were in them at different historical timepoints. The arguments are to caution against dismissing inpatient care outright as simply fundamentally misconceived, and to show the ideological background to many structures and changes, which might superficially seem merely clinical and instrumental. The aim of this Review is to bring out what current mental health systems can learn from an evidence-based analysis of asylums' actual successes and failures in the past.
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Affiliation(s)
- Rab A Houston
- School of History, University of St Andrews, St Andrews, UK.
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Wallis J. In the shadow of the asylum: the Stanley Royd Salmonella outbreak of 1984. MEDICAL HUMANITIES 2016; 42:11-16. [PMID: 26324457 DOI: 10.1136/medhum-2015-010671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 06/04/2023]
Abstract
In August 1984, an outbreak of Salmonella at Stanley Royd Psychiatric Hospital in Yorkshire led to the deaths of 19 elderly residents. It was an incident that attracted a good deal of comment in both the local and national press, and one that had enduring relevance for ideas about psychiatric care, food handling and catering provisions, hospital management and the official inspection of medical institutions. This article examines the impact that the 1984 outbreak had on official and popular perceptions of these issues. As well as bringing to public attention the fact that large numbers of vulnerable elderly patients were long-term residents in psychiatric hospitals, the Salmonella outbreak highlighted the inadequacies of Victorian hospital buildings in modern healthcare. Throughout the press reports and official investigations examined here, the provenance of Stanley Royd was repeatedly emphasised; its Victorian fabric persistently interfered with cleaning regimes, cold storage facilities and the conveyance of food to patients. Within institutions like Stanley Royd, 'new' and 'old' risks came together--the microscopic bacterium and the crumbling nineteenth-century building--to create a strong critique of existing psychiatric care. The episode also highlighted broader problems within the NHS, such as systems of management and the status of psychogeriatrics as a specialism.
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Wilson D. Quantifying the quiet epidemic: Diagnosing dementia in late 20 th-century Britain. HISTORY OF THE HUMAN SCIENCES 2014; 27:126-146. [PMID: 25866448 PMCID: PMC4361470 DOI: 10.1177/0952695114536715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
During the late 20th century numerical rating scales became central to the diagnosis of dementia and helped transform attitudes about its causes and prevalence. Concentrating largely on the development and use of the Blessed Dementia Scale, I argue that rating scales served professional ends during the 1960s and 1970s. They helped old age psychiatrists establish jurisdiction over conditions such as dementia and present their field as a vital component of the welfare state, where they argued that 'reliable modes of diagnosis' were vital to the allocation of resources. I show how these arguments appealed to politicians, funding bodies and patient groups, who agreed that dementia was a distinct disease and claimed research on its causes and prevention should be designated 'top priority'. But I also show that worries about the replacement of clinical acumen with technical and depersonalized methods, which could conceivably be applied by anyone, led psychiatrists to stress that rating scales had their limits and could be used only by trained experts.
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Challis D, Tucker S, Wilberforce M, Brand C, Abendstern M, Stewart K, Jasper R, Harrington V, Verbeek H, Jolley D, Fernandez JL, Dunn G, Knapp M, Bowns I. National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes. PROGRAMME GRANTS FOR APPLIED RESEARCH 2014. [DOI: 10.3310/pgfar02040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BackgroundThe rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models.AimsThe programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups.MethodsThe programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award.ResultsBoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training.LimitationsLimitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored.ConclusionsBoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental health services and the relative cost-effectiveness of different models of mental health outreach for older care home residents.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Sue Tucker
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Mark Wilberforce
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Christian Brand
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Michele Abendstern
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Karen Stewart
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Rowan Jasper
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Val Harrington
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Hilde Verbeek
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands
| | - David Jolley
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Jose-Luis Fernandez
- Personal Social Services Research Unit, London School of Economics, London, UK
| | - Graham Dunn
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics, London, UK
| | - Ian Bowns
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
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Hilton C. 'Sans teeth, sans eyes, sans taste, sans everything:' resourcing mental health services for older people. J R Soc Med 2012; 105:146-50. [PMID: 22532654 DOI: 10.1258/jrsm.2012.120008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Claire Hilton
- Older People and Healthy Ageing Directorate, CNWL NHS Foundation Trust, Bentley House, 15-21 Headstone Drive, Harrow HA3 5QX, UK.
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Abstract
PURPOSE OF REVIEW The present article reviews the English language literature on the history of psychiatry published within the previous year. RECENT FINDINGS Research has been conducted in the history of clinical syndromes, famous people and psychiatrists, psychiatric institutions, treatments and legislations. The importance of the sociocultural contexts has been shown, particularly in research emanating from Europe and North America, which addresses late 18th to late 20th century issues. SUMMARY Much varied and important research on the history of psychiatry is being performed around the world. This scholarship provides insight into the cultural context and ways in which psychiatry was practised in the past and can help shed light on the way in which psychiatry is conducted today.
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