Ten years ago I was contacted by Edmund who worked at Hellingly from 1955. He wrote:
I travelled from Durham on a Monday in September 1955 and took a taxi from Hailsham to the hospital. When we entered the drive I at first thought that the building on the right was the hospital as it looked quite big (this was Park House, the acute admissions hospital) until we reached the top of the drive a half mile later and arrived at the main entrance.
On entry through the big doors I was greeted by the porter who asked to see my letter of appointment. He was a severe looking man,which did not help my feelings at all! He then took me to the office of the Deputy Chief Male Nurse for registration. To reach that sanctum we passed through at least three doors all of which were locked. I was given my own pass key for which I had to sign, together with a homily on care of same. I was then taken to my room whisch was a side room in the voluntary admissions villa (Homestead) and was informed that resident staff living on wards were expected to be on call in case of any problems with the patients. I was then introduced to a male nurse who was to show me where everything was to be found by way of catering, laundry, social club etc. I was then told to be at the Deputy`s office by 8.40 to be seen by the Chief Male Nurse and then to be taken to be interviewed by the Medical Superintendent Dr. Reid – a dour Scot. I was then left to my own devices for the rest of the evening . I can assure you that I did not feel like staying but I later met up with some young staff who were very friendly and helped me settle in.
The interview was quite severe and there were included a list of “thou shalt nots”. After the interview I was taken to be measured for my uniform and told to report to sick bay for my medical examination. The uniform consisted of a three piece navy blue suit, double breasted with the county crest on the buttons – more a warders uniform than a nurse`s. This then was my introduction to mental nursing.
It was quite an intimidating experience even though I had experience in institutions having worked for a year in an “institution for mental defectives” as people with learning difficulties were then labelled. I knew absolutely nothing about Hellingly before my arrival, but I was encouraged to move there by some mental trained staff at the Aycliffe Hospital where I had been employed as mentioned above.
At the time of my arrival it seemed that the long stay staff were as institutionalised as the patients in their attitudes to new staff as well as new patients.
A large proportion of the staff were from the catchment area of the hospital, however it was during the 1950`s that it became more cosmopolitan. This change was due to a fall in recruitment and a mix of French, Irish and to lesser extent West Indian people joined the staff.
In the 40`s after the war there was a special course for ex-sercice men and women to take a shortened course of training. There were a few such members of staff but not excessive. As too the cultural differences the cosmopolitanmembers were generally accepted by the local staff. As for the movement from one institution to another the regimes for the staff were not too dissimilar.
Daily Life
The working day was from 7am to 7.30pm, five days a week there was time out for meals- twenty mins for breakfast ,forty five mins for lunch and twenty mins for tea.Duties on most wards were primarily making sure patients were clean and tidy then the ward was cleaned, by a mix of staff and patients. After this the patients were taken into the exercise gardens if it was not raining, for an hour before lunch and again after lunch for an hour.
Four nights a week there was a coach provided to take resident staff to Eastbourne. It left the hospital at 8pm and Eastbourne at 11pm. This did make up for the lack of amenities within the hospital. The social club was a room off the central corridor and supplied soft drinks biscuits and sandwiches at low prices.
Senior staff did have some contact with the patients however this was minimal. Basically when they did ‘ward rounds’ – checking on the ward management!
Institutionalisation
This applied to both staff and patients. Both groups became agitated if routines were disturbed. In the exercise gardens both staff and patients walked round in the same direction every time they went out. To get to the sportsfield it was necessary for some ward groups to pass through several gardens and they were counted through every one. In the late 50`s the fences were removed when a more liberal regime was introduced but everyone still followed the old path through the still existing gateposts but no gates or fences! It was compulsory practice on all wards that no patient could leave the meal table until all cutlery had been counted, and every process on the ward was governed by the clock from getting up to going to bed. Patients were not allowed to dress before day staff had come on duty and had to be in bed when the night nurse came on duty,even in the summer when it could be light until after 9pm.
To some extent it was true that change was not welcome and forecasts of great disasters were expressed but usually proved wrong. This was particularly true in the 50`s and 60`s when numerous changes were all taking place in a relatively short time.
Historical overview
To understand the situation it would be helpful to know something of the history and structure of Hellingly. It was built as a function of the Lunacy act 1890 and opened in 1907 with the capacity to hold 700 patients, but when I arrived at the hospital there were 1250 patients which meant that the wards were very overcrowded and patients’ beds were placed along the ward corridors. All the patients in the main building were certified and the only treatments available were barbiturates, paraldehyde and Electro Convulsive Therapy, so you can imagine the difficult circumstances under which the staff worked.
Padded rooms were still in use when I first arrived because of the difficulty in controlling disturbed behaviour. This supported the staff in their need for some form of routine. Suicidal patients were kept on special watch and every nurse who worked on a ward where such a patient was nursed was told which patient(s) were so labelled and was then required to sign the parchment relating to that person.
After the Lunacy Act the next important legislation was the Voluntary Treatment Act of 1935 which allowed for the informal admission of patients who were not certifiable within the meaning of the act and could request treatment, however they were not able to take immediate discharge but had to give 72 hours notice of their intention to leave, thus giving the medical staff time to arrange certification if necessary. We had to wait until 1957 for the development of what was to become the Mental Health Act 1959, which was the main engine for change that saw great improvements in the care provided and was the forerunner of today’s quite different approach to the care of people suffering from psychiatric disorders.
Of course all these rapid changes had a disturbing effect on the local villagers who were very afraid of patients seen walking down the drive and out of the grounds while unescorted and a great deal of effort was needed to convince them of their safety.
The main link between the hospital and the local community was through the staff who lived locally, some of whom were third or fourth generation of staff. However with the long hours of duty and the suspicion of the locals that ‘they must be mad to work in the asylum’, they did not mix.
The hospital was very hierarchical when I arrived. As discussed earlier the definite head was the Medical Superintendent with overall control the next tier consisted of Matron, group Secretary, Group Engineer and Chief male Nurse in that order. Matron not only controlled the female nurses she also was head of the school of Nursing, the laundry and staff welfare. Matron and Chief Male Nurse had a deputy and several assistants. Wards had a Charge nurse and a deputy,then staff nurses, students and nursing assistants. Every male staff member was always addressed formally by rank or ‘Mr.’, but male patients were generally addressed by their surname.
Changes.
The 50s and 60s were years of great change in Mental Health Care. There were legal, medical and managerial changes which, in combination, were of great consequence.
Legally the 1959 Mental Health Act further increased the patients’ rights, and they were allowed to challenge the decisions on ‘sectioning’ – the new replacement for certification. Voluntary patients became informal and this was altogether a liberalising act which led to a lot of anxiety among the older staff, as it took away a lot of their control.
Medically there was a great surge in the physical treatment of patients with the introduction of the major tranquillizers such as Chlorpromazine and stelazine which were used primarily for patients with schizophrenia and given in massive doses of up to 1000mg, three times a day! Antidepressants such as the Tricyclics and monoamine oxidase inhibitors which were used for bipolar disorders and severe depression. Deep insulin therapy was also used for some types of schizophrenia with some measure of success. Neuro surgery also had its day. All these methods helped to reduce the length of stay – it also demanded more individual nursing care and this in itself helped a lot of patients to recovery.
Managerial.
Towards the end of the 50’s there began the first mixed nursing at Amberstone where there was also the first shoots of group therapy. There was a mixture of both staff and patients and no doubt you can imagine the reaction of some of the older staff to this! A new physician superintendent was appointed and heads of nursing services and changes in the syllabus for nurses all helped in the changes. By the time I moved on in 1971 the number of patients had fallen by about 50%.- the first signs of movement towards at least the closure of wards and then ultimately the whole hospital.
Nationally the treatment philosophies were divided between ‘nature’ and ‘nurture’ with the former relying on physical methods of treatment and the latter on psychotherapeutics – my personal preference was to lie somewhere between the two. Hellingly was very much in the nature camp. (My move to Claybury put me into the leading hospital in the development of the Therapeutic community under the auspices of Dr. Martin Where I was Head of the School of Nursing for 5yrs).
Occupational Therapy was introduced, with a purpose-built unit and qualified Therapists to teach new skills and reawaken old skills in long stay patients, such as carpentry, toy making, tapestry, furniture making and repair etc.
Open days were held and a friends of the Hospital was formed. The highlight of their year was the annual Fete where some of the items made by the patients were sold. This seemed to please the long-stay patients particularly.
Staff uniforms for men were changed to clerical grey lounge suits which was a great change and was to be the forerunner of the staff wearing mufti.
Ward meetings were instituted and management moved towards democracy – however reluctantly!
Nurse Training/Education
Changes were also taking place in the training of nurses, which helped in the development of care with more positive outcomes.
The early training was under the auspices of the Royal Medico Psychological Association (RMPA). This was generally taught by doctors and the sole textbook was the Red Handbook of that organisation. The teaching usually consisted of the doctor reading a chapter and asking a few questions. On completion of training the candidates were questioned by the Medical Supereintendent and then awarded the RMPA.
Following the formation of the National Health Service when the hospitals were taken out of the control of the local authorities, The General Nursing Council (GNC) produced a syllabus, which was closely aligned to the general nursing syllabus and to a great extent was not overly relevant to mental nursing. Those registered with RMPA were automatically allowed to register as RMN on the payment of a fee, but with no further training. In 1957 they produced a new syllabus which was a great step forward. The emphasis on physical illness was replaced with much more in depth learning of psychiatry and psychology. No longer did RMN students have to take the practical physical nursing exam as taken in the general hospital. Unfortunately the service managers were not willing to fund full preparation of already qualified staff (mainly RMPAs) for their role in properly supervising the students, consequently the changes were only reluctantly accepted by them.
In 1965 Mr. Gutteridge, the principal tutor, began negotiation for a revolutionary experimental educational scheme which rejoiced in the title Regional Collegiate Scheme and I went to Battersea College of Technology (Now the University of Surrey) to train as a tutor from 1965 to 1967. The theory was that with good teaching and properly organised clinical experience students could cover the syllabus in two years instead of the conventional three years. The clinical areas included working in a psychiatric unit in a general hospital and three months with the mental welfare officers in the catchment area of the hospital. There was also a period in a private clinic so you see that this was quite unique (CPNs were not employed at that time except for Warlingham Park Hospital who funded them from their budget).
The third year was spent as a junior staff nurse on not more than two clinical areas which they could choose from where they had been placed for their clinical experience and also included a first line management course. I was officially appointed course tutor and the first group commenced in September 1968. I had been closely involved with the finalising of the content of the course. There were twelve students in the group and I was able to see them to completion, all successfully, before my transfer to Claybury Hospital as Principal Nuring Officer(Teaching).
We liked to think that this was the forerunner of changes leading to Project 2000.These bright young students were part of the engine for change in attitudes, however there was still some opposition from older senior staff who had no control over the allocation of these students to use them as stopgaps for their allocation shortcomings.
Unfortunately the scheme only lasted for three intakes. After I left the Principal also moved on, primarily because of the lack of support of the managers, who closed it down because of ‘lack of applications’ but in reality this was due to lack of publicity.
The Main Hall was in constant use in the 40`s and 50`s as patients were seldom allowed out of the confines of the hospital. Some of the activities were: Sunday & Wednesday 2 – 4 pm were visiting days and patients saw their families in the Hall. Visitors were only allowed on the geriatric wards and infirmary wards Jevington (J1) and Guestling (G1) on the male side and East Dean (E1) and Bodiam (B1) on the female side. In the evenings there were socials that were supervised by staff that were allocated to duty in the hall by the assistant chief and assistant matron. Some evenings there would be a dance or games. On Saturday nights there was TV on a projection screen for two hours for the patients and later for the staff TV was only in its infancy then and there was only one channel. There were no sets on the wards at that time. Thursday evening there was a film, which was also available for off duty staff, and this was usually a fairly recent release. There were occasional concerts and drama groups who gave shows on the fully equipped theatrical stage.
I understand that in the 30s and 40s the hospital had its own orchestra and it was a known fact that when applying for a job applicants had to be either a sportsman or a musician before they could be considered Staff functions were also held there Nurses’ prize giving, annual ball flower show exhibitions etc. There used to be a full-size organ that could be played manually or as an automatic with several rolls of music, which could be used if there wasn’t an organist available.
As the hospital moved from all locked wards to open doors then the open spaces allowed patients the freedom to seek time and space for their own thoughts and activities. As one walks around the perimeter of the buildings one would have to pass from one garden to the next through locked gates e.g. from K block to the playing fields patients would have had to pass through four gardens and five locked gates, and counted through each one but once the fences had gone they were free to roam as they wished. As I mentioned earlier some of the long stay patients still followed the original paths and passed through all the gateways.
Stigma.
You must bear in mid that it was only relatively recently that treatment was possible and that a great number of the inmates, particularly in the acute phase of their illness, would be acutely disturbed, often violent and also difficult to communicate with and in the long term seldom were discharged back to the community. As you say, asylum in the true sense of a place of safety is what they needed and the large institutions were able to provide. Those who were discharged were never said to be cured, the best that could be said was that they had recovered, otherwise reported as condition improved or no change.
Treatment
Fresh air and exercise were thought to be essential for the physical wellbeing of the patients in closed wards and to this end they were compelled to take physical exercise outdoors twice daily, weather permitting. This was phased out as wards were opened and patients could come and go as they pleased – with limited freedom!
The hospital was designed in roughly two squares, male and female, which were linked by the common functions of Stores, Main kitchen, Shop Recreation Hall, Pharmacy and Path lab.
The ward blocks were labelled alphabetically as A1, A2, B1, B2, C1, C2, D1, D2, E1, E2, F1, F2, were the female wards and G1, G2, H1, H2, H3, J1, J2, K1, K2, K3, the male wards. The naming of wards occurred with the change of management and were given the names of Sussex villages. Different wards had different functions.
G1 (Guestling) was the male infirmary ward. Patients were moved there if they had physical diseases and returned to their own wards when recovered. G2 (Glynde) was male refractory ward, which housed those patients who were likely to be dangerous to themselves or others, and was high security status.
H1 (Heathfield) was chronic longstay, H2 and H3 were originally one ward but split as overcrowding diminished with the new methods of treatment. H2 became Halland and was acute disturbed admission and H3 was a chronic low risk ward. J1 (Jevington) was psycho-geriatric – mainly dementias. J2 (Jarvisbrook) was longstay mental defectives – mental handicap, people with learning difficulties with overriding psychotic problems. There were two other hospitals in the group dealing with patients with learning difficulties one at each end of the catchment area, Laughton Lodge near Lewes and Hill House, Rye. These were managed remotely by the Hailsham Group Hospital Management Committee. Park House was a small edition of the main hospital, which consisted of PHEast female, and PH West male.
There were three dormitories and several side-rooms for the patients in the male side. There was a common entrance but the ladies turned left and the men turned right to their separate quarters. Soon after I arrived Park House began to specialise in psychoneuroses and the whole regime changed so that the male and female patients could socialise during the day, however the connecting doors were locked at night! The next major development was the building of Amberstone Hospital and I was one of the first staff to be allocated there for a short period before taking my tutor’s course.
To return to the main building, at every junction of the corridors there was at least one locked screen door and wherever male and female corridors met. Indeed patients from Glynde ward exercised in one stretch in inclement weather. I have mentioned the shop previously and how it was divided. The main kitchen and Stores had separate doors for access to the two sides. The Laundry and needle room were situated on the female side. The Bakery, Tailors` and shoe repairers were on the male side – these areas were used as employment for trusted long stay patients. There was also a villa at the hospital farm (Farmstead) that housed `Burnt out Schizophrenics` who were employed full time on the farm.
Male nurses could collect and deliver linen to the laundry, but porters delivered bread and clothing to the female wards. Resident male staff were allowed to go into the female corridor as far as the dining room at night to get supper after coming off duty at 7.30pm, but during the day they ate in the male canteen.
Male staff were not allowed near the female nurses. Home and dismissal was the punishment for being caught there – but it didn’t deter the more daring men! Otherwise if caught on the female corridors without reasonable excuse led to disciplinary action, which usually took the form of a lecture and warning
In the Works Yard was a metal workshop and furniture repair shop, which was very necessary as disturbed patients regularly, damaged furniture. Beyond the Mortuary was the old engine sheds, which became average and vehicle repair shop for the entire Groups` transport and next to that was the Fire Station, which was manned by male staff and particularly resident staff. If there was a drill we got 2/6 (12.5pence)!
As the 50`s progressed into the 60`s the regime became more liberal as the Chief Male Nurse, Matron and Medical Superintendent all retired and more forward-thinking senior staff were appointed
There were some dissenters among the older staff and they posted staff on the door to stop patients’ going out on their own which in effect was as good as locking the door itself!
I travelled from Durham on a Monday in September 1955 and took a taxi from Hailsham to the hospital. When we entered the drive I at first thought that the building on the right was the hospital as it looked quite big (this was Park House, the acute admissions hospital) until we reached the top of the drive a half mile later and arrived at the main entrance.
On entry through the big doors I was greeted by the porter who asked to see my letter of appointment. He was a severe looking man,which did not help my feelings at all! He then took me to the office of the Deputy Chief Male Nurse for registration. To reach that sanctum we passed through at least three doors all of which were locked. I was given my own pass key for which I had to sign, together with a homily on care of same. I was then taken to my room whisch was a side room in the voluntary admissions villa (Homestead) and was informed that resident staff living on wards were expected to be on call in case of any problems with the patients. I was then introduced to a male nurse who was to show me where everything was to be found by way of catering, laundry, social club etc. I was then told to be at the Deputy`s office by 8.40 to be seen by the Chief Male Nurse and then to be taken to be interviewed by the Medical Superintendent Dr. Reid – a dour Scot. I was then left to my own devices for the rest of the evening . I can assure you that I did not feel like staying but I later met up with some young staff who were very friendly and helped me settle in.
The interview was quite severe and there were included a list of “thou shalt nots”. After the interview I was taken to be measured for my uniform and told to report to sick bay for my medical examination. The uniform consisted of a three piece navy blue suit, double breasted with the county crest on the buttons – more a warders uniform than a nurse`s. This then was my introduction to mental nursing.
It was quite an intimidating experience even though I had experience in institutions having worked for a year in an “institution for mental defectives” as people with learning difficulties were then labelled. I knew absolutely nothing about Hellingly before my arrival, but I was encouraged to move there by some mental trained staff at the Aycliffe Hospital where I had been employed as mentioned above.
At the time of my arrival it seemed that the long stay staff were as institutionalised as the patients in their attitudes to new staff as well as new patients.
A large proportion of the staff were from the catchment area of the hospital, however it was during the 1950`s that it became more cosmopolitan. This change was due to a fall in recruitment and a mix of French, Irish and to lesser extent West Indian people joined the staff.
In the 40`s after the war there was a special course for ex-sercice men and women to take a shortened course of training. There were a few such members of staff but not excessive. As too the cultural differences the cosmopolitanmembers were generally accepted by the local staff. As for the movement from one institution to another the regimes for the staff were not too dissimilar.
Daily Life
The working day was from 7am to 7.30pm, five days a week there was time out for meals- twenty mins for breakfast ,forty five mins for lunch and twenty mins for tea.Duties on most wards were primarily making sure patients were clean and tidy then the ward was cleaned, by a mix of staff and patients. After this the patients were taken into the exercise gardens if it was not raining, for an hour before lunch and again after lunch for an hour.
Four nights a week there was a coach provided to take resident staff to Eastbourne. It left the hospital at 8pm and Eastbourne at 11pm. This did make up for the lack of amenities within the hospital. The social club was a room off the central corridor and supplied soft drinks biscuits and sandwiches at low prices.
Senior staff did have some contact with the patients however this was minimal. Basically when they did ‘ward rounds’ – checking on the ward management!
Institutionalisation
This applied to both staff and patients. Both groups became agitated if routines were disturbed. In the exercise gardens both staff and patients walked round in the same direction every time they went out. To get to the sportsfield it was necessary for some ward groups to pass through several gardens and they were counted through every one. In the late 50`s the fences were removed when a more liberal regime was introduced but everyone still followed the old path through the still existing gateposts but no gates or fences! It was compulsory practice on all wards that no patient could leave the meal table until all cutlery had been counted, and every process on the ward was governed by the clock from getting up to going to bed. Patients were not allowed to dress before day staff had come on duty and had to be in bed when the night nurse came on duty,even in the summer when it could be light until after 9pm.
To some extent it was true that change was not welcome and forecasts of great disasters were expressed but usually proved wrong. This was particularly true in the 50`s and 60`s when numerous changes were all taking place in a relatively short time.
Historical overview
To understand the situation it would be helpful to know something of the history and structure of Hellingly. It was built as a function of the Lunacy act 1890 and opened in 1907 with the capacity to hold 700 patients, but when I arrived at the hospital there were 1250 patients which meant that the wards were very overcrowded and patients’ beds were placed along the ward corridors. All the patients in the main building were certified and the only treatments available were barbiturates, paraldehyde and Electro Convulsive Therapy, so you can imagine the difficult circumstances under which the staff worked.
Padded rooms were still in use when I first arrived because of the difficulty in controlling disturbed behaviour. This supported the staff in their need for some form of routine. Suicidal patients were kept on special watch and every nurse who worked on a ward where such a patient was nursed was told which patient(s) were so labelled and was then required to sign the parchment relating to that person.
After the Lunacy Act the next important legislation was the Voluntary Treatment Act of 1935 which allowed for the informal admission of patients who were not certifiable within the meaning of the act and could request treatment, however they were not able to take immediate discharge but had to give 72 hours notice of their intention to leave, thus giving the medical staff time to arrange certification if necessary. We had to wait until 1957 for the development of what was to become the Mental Health Act 1959, which was the main engine for change that saw great improvements in the care provided and was the forerunner of today’s quite different approach to the care of people suffering from psychiatric disorders.
Of course all these rapid changes had a disturbing effect on the local villagers who were very afraid of patients seen walking down the drive and out of the grounds while unescorted and a great deal of effort was needed to convince them of their safety.
The main link between the hospital and the local community was through the staff who lived locally, some of whom were third or fourth generation of staff. However with the long hours of duty and the suspicion of the locals that ‘they must be mad to work in the asylum’, they did not mix.
The hospital was very hierarchical when I arrived. As discussed earlier the definite head was the Medical Superintendent with overall control the next tier consisted of Matron, group Secretary, Group Engineer and Chief male Nurse in that order. Matron not only controlled the female nurses she also was head of the school of Nursing, the laundry and staff welfare. Matron and Chief Male Nurse had a deputy and several assistants. Wards had a Charge nurse and a deputy,then staff nurses, students and nursing assistants. Every male staff member was always addressed formally by rank or ‘Mr.’, but male patients were generally addressed by their surname.
Changes.
The 50s and 60s were years of great change in Mental Health Care. There were legal, medical and managerial changes which, in combination, were of great consequence.
Legally the 1959 Mental Health Act further increased the patients’ rights, and they were allowed to challenge the decisions on ‘sectioning’ – the new replacement for certification. Voluntary patients became informal and this was altogether a liberalising act which led to a lot of anxiety among the older staff, as it took away a lot of their control.
Medically there was a great surge in the physical treatment of patients with the introduction of the major tranquillizers such as Chlorpromazine and stelazine which were used primarily for patients with schizophrenia and given in massive doses of up to 1000mg, three times a day! Antidepressants such as the Tricyclics and monoamine oxidase inhibitors which were used for bipolar disorders and severe depression. Deep insulin therapy was also used for some types of schizophrenia with some measure of success. Neuro surgery also had its day. All these methods helped to reduce the length of stay – it also demanded more individual nursing care and this in itself helped a lot of patients to recovery.
Managerial.
Towards the end of the 50’s there began the first mixed nursing at Amberstone where there was also the first shoots of group therapy. There was a mixture of both staff and patients and no doubt you can imagine the reaction of some of the older staff to this! A new physician superintendent was appointed and heads of nursing services and changes in the syllabus for nurses all helped in the changes. By the time I moved on in 1971 the number of patients had fallen by about 50%.- the first signs of movement towards at least the closure of wards and then ultimately the whole hospital.
Nationally the treatment philosophies were divided between ‘nature’ and ‘nurture’ with the former relying on physical methods of treatment and the latter on psychotherapeutics – my personal preference was to lie somewhere between the two. Hellingly was very much in the nature camp. (My move to Claybury put me into the leading hospital in the development of the Therapeutic community under the auspices of Dr. Martin Where I was Head of the School of Nursing for 5yrs).
Occupational Therapy was introduced, with a purpose-built unit and qualified Therapists to teach new skills and reawaken old skills in long stay patients, such as carpentry, toy making, tapestry, furniture making and repair etc.
Open days were held and a friends of the Hospital was formed. The highlight of their year was the annual Fete where some of the items made by the patients were sold. This seemed to please the long-stay patients particularly.
Staff uniforms for men were changed to clerical grey lounge suits which was a great change and was to be the forerunner of the staff wearing mufti.
Ward meetings were instituted and management moved towards democracy – however reluctantly!
Nurse Training/Education
Changes were also taking place in the training of nurses, which helped in the development of care with more positive outcomes.
The early training was under the auspices of the Royal Medico Psychological Association (RMPA). This was generally taught by doctors and the sole textbook was the Red Handbook of that organisation. The teaching usually consisted of the doctor reading a chapter and asking a few questions. On completion of training the candidates were questioned by the Medical Supereintendent and then awarded the RMPA.
Following the formation of the National Health Service when the hospitals were taken out of the control of the local authorities, The General Nursing Council (GNC) produced a syllabus, which was closely aligned to the general nursing syllabus and to a great extent was not overly relevant to mental nursing. Those registered with RMPA were automatically allowed to register as RMN on the payment of a fee, but with no further training. In 1957 they produced a new syllabus which was a great step forward. The emphasis on physical illness was replaced with much more in depth learning of psychiatry and psychology. No longer did RMN students have to take the practical physical nursing exam as taken in the general hospital. Unfortunately the service managers were not willing to fund full preparation of already qualified staff (mainly RMPAs) for their role in properly supervising the students, consequently the changes were only reluctantly accepted by them.
In 1965 Mr. Gutteridge, the principal tutor, began negotiation for a revolutionary experimental educational scheme which rejoiced in the title Regional Collegiate Scheme and I went to Battersea College of Technology (Now the University of Surrey) to train as a tutor from 1965 to 1967. The theory was that with good teaching and properly organised clinical experience students could cover the syllabus in two years instead of the conventional three years. The clinical areas included working in a psychiatric unit in a general hospital and three months with the mental welfare officers in the catchment area of the hospital. There was also a period in a private clinic so you see that this was quite unique (CPNs were not employed at that time except for Warlingham Park Hospital who funded them from their budget).
The third year was spent as a junior staff nurse on not more than two clinical areas which they could choose from where they had been placed for their clinical experience and also included a first line management course. I was officially appointed course tutor and the first group commenced in September 1968. I had been closely involved with the finalising of the content of the course. There were twelve students in the group and I was able to see them to completion, all successfully, before my transfer to Claybury Hospital as Principal Nuring Officer(Teaching).
We liked to think that this was the forerunner of changes leading to Project 2000.These bright young students were part of the engine for change in attitudes, however there was still some opposition from older senior staff who had no control over the allocation of these students to use them as stopgaps for their allocation shortcomings.
Unfortunately the scheme only lasted for three intakes. After I left the Principal also moved on, primarily because of the lack of support of the managers, who closed it down because of ‘lack of applications’ but in reality this was due to lack of publicity.
The Main Hall was in constant use in the 40`s and 50`s as patients were seldom allowed out of the confines of the hospital. Some of the activities were: Sunday & Wednesday 2 – 4 pm were visiting days and patients saw their families in the Hall. Visitors were only allowed on the geriatric wards and infirmary wards Jevington (J1) and Guestling (G1) on the male side and East Dean (E1) and Bodiam (B1) on the female side. In the evenings there were socials that were supervised by staff that were allocated to duty in the hall by the assistant chief and assistant matron. Some evenings there would be a dance or games. On Saturday nights there was TV on a projection screen for two hours for the patients and later for the staff TV was only in its infancy then and there was only one channel. There were no sets on the wards at that time. Thursday evening there was a film, which was also available for off duty staff, and this was usually a fairly recent release. There were occasional concerts and drama groups who gave shows on the fully equipped theatrical stage.
I understand that in the 30s and 40s the hospital had its own orchestra and it was a known fact that when applying for a job applicants had to be either a sportsman or a musician before they could be considered Staff functions were also held there Nurses’ prize giving, annual ball flower show exhibitions etc. There used to be a full-size organ that could be played manually or as an automatic with several rolls of music, which could be used if there wasn’t an organist available.
As the hospital moved from all locked wards to open doors then the open spaces allowed patients the freedom to seek time and space for their own thoughts and activities. As one walks around the perimeter of the buildings one would have to pass from one garden to the next through locked gates e.g. from K block to the playing fields patients would have had to pass through four gardens and five locked gates, and counted through each one but once the fences had gone they were free to roam as they wished. As I mentioned earlier some of the long stay patients still followed the original paths and passed through all the gateways.
Stigma.
You must bear in mid that it was only relatively recently that treatment was possible and that a great number of the inmates, particularly in the acute phase of their illness, would be acutely disturbed, often violent and also difficult to communicate with and in the long term seldom were discharged back to the community. As you say, asylum in the true sense of a place of safety is what they needed and the large institutions were able to provide. Those who were discharged were never said to be cured, the best that could be said was that they had recovered, otherwise reported as condition improved or no change.
Treatment
Fresh air and exercise were thought to be essential for the physical wellbeing of the patients in closed wards and to this end they were compelled to take physical exercise outdoors twice daily, weather permitting. This was phased out as wards were opened and patients could come and go as they pleased – with limited freedom!
The hospital was designed in roughly two squares, male and female, which were linked by the common functions of Stores, Main kitchen, Shop Recreation Hall, Pharmacy and Path lab.
The ward blocks were labelled alphabetically as A1, A2, B1, B2, C1, C2, D1, D2, E1, E2, F1, F2, were the female wards and G1, G2, H1, H2, H3, J1, J2, K1, K2, K3, the male wards. The naming of wards occurred with the change of management and were given the names of Sussex villages. Different wards had different functions.
G1 (Guestling) was the male infirmary ward. Patients were moved there if they had physical diseases and returned to their own wards when recovered. G2 (Glynde) was male refractory ward, which housed those patients who were likely to be dangerous to themselves or others, and was high security status.
H1 (Heathfield) was chronic longstay, H2 and H3 were originally one ward but split as overcrowding diminished with the new methods of treatment. H2 became Halland and was acute disturbed admission and H3 was a chronic low risk ward. J1 (Jevington) was psycho-geriatric – mainly dementias. J2 (Jarvisbrook) was longstay mental defectives – mental handicap, people with learning difficulties with overriding psychotic problems. There were two other hospitals in the group dealing with patients with learning difficulties one at each end of the catchment area, Laughton Lodge near Lewes and Hill House, Rye. These were managed remotely by the Hailsham Group Hospital Management Committee. Park House was a small edition of the main hospital, which consisted of PHEast female, and PH West male.
There were three dormitories and several side-rooms for the patients in the male side. There was a common entrance but the ladies turned left and the men turned right to their separate quarters. Soon after I arrived Park House began to specialise in psychoneuroses and the whole regime changed so that the male and female patients could socialise during the day, however the connecting doors were locked at night! The next major development was the building of Amberstone Hospital and I was one of the first staff to be allocated there for a short period before taking my tutor’s course.
To return to the main building, at every junction of the corridors there was at least one locked screen door and wherever male and female corridors met. Indeed patients from Glynde ward exercised in one stretch in inclement weather. I have mentioned the shop previously and how it was divided. The main kitchen and Stores had separate doors for access to the two sides. The Laundry and needle room were situated on the female side. The Bakery, Tailors` and shoe repairers were on the male side – these areas were used as employment for trusted long stay patients. There was also a villa at the hospital farm (Farmstead) that housed `Burnt out Schizophrenics` who were employed full time on the farm.
Male nurses could collect and deliver linen to the laundry, but porters delivered bread and clothing to the female wards. Resident male staff were allowed to go into the female corridor as far as the dining room at night to get supper after coming off duty at 7.30pm, but during the day they ate in the male canteen.
Male staff were not allowed near the female nurses. Home and dismissal was the punishment for being caught there – but it didn’t deter the more daring men! Otherwise if caught on the female corridors without reasonable excuse led to disciplinary action, which usually took the form of a lecture and warning
In the Works Yard was a metal workshop and furniture repair shop, which was very necessary as disturbed patients regularly, damaged furniture. Beyond the Mortuary was the old engine sheds, which became average and vehicle repair shop for the entire Groups` transport and next to that was the Fire Station, which was manned by male staff and particularly resident staff. If there was a drill we got 2/6 (12.5pence)!
As the 50`s progressed into the 60`s the regime became more liberal as the Chief Male Nurse, Matron and Medical Superintendent all retired and more forward-thinking senior staff were appointed
There were some dissenters among the older staff and they posted staff on the door to stop patients’ going out on their own which in effect was as good as locking the door itself!
