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Institutional Care for the Mentally Defective, 1914–1948: Diversity as a Response to Individual Needs and an Indication of Lack of Policy Coherence

Published online by Cambridge University Press:  17 May 2012

Graham Chester  and
Pamela Dale
Pamela Dale
Affiliation:
Centre for Medical History, Amory Building, Rennes Drive, University of Exeter, Exeter, Devon, EX4 4RJ, UK.
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Information
Medical History , Volume 51 , Issue 1 , 01 January 2007 , pp. 59 - 78
Copyright
Copyright © The Author(s) 2007. Published by Cambridge University Press

References

1 Mathew Thomson, The problem of mental deficiency: eugenics, democracy and social policy in Britain c. 1870–1959, Oxford, Clarendon Press, 1998; David Wright and Anne Digby (eds), From idiocy to mental deficiency: historical perspectives on people with learning disabilities, London, Routledge, 1996; Mark Jackson, The borderland of imbecility: medicine, society and the fabrication of the feeble mind in late Victorian and Edwardian England, University of Manchester Press, 2000; Peregrine Horden and Richard Smith (eds), The locus of care: families, communities, institutions and the provision of welfare since Antiquity, London, Routledge, 1998; Peter Bartlett and David Wright (eds), Outside the walls of the asylum: the history of care in the community 1750–2000, London, Athlone Press, 1999; David Wright, Mental disability in Victorian England: the Earlswood Asylum, 1847–1901, Oxford, Clarendon Press, 2001.

2 Thomson, op. cit., note 1 above, pp. 3–4.

3 David Garland, Punishment and welfare: a history of penal strategies, Aldershot, Gower, 1985.

4 Thomson, op. cit., note 1 above, introduction.

5 Pamela Dale, ‘Implementing the 1913 Mental Deficiency Act: competing priorities and resource constraint evident in the South West of England before 1948’, Soc. Hist. Med., 2003, 16: 403–18.

6 Jackson, op. cit., note 1 above.

7 We are indebted to Oliver Russell, the former Honorary Director of the Norah Fry Research Centre: Research on Services for People with Learning Difficulties at the University of Bristol, for facilitating access to his personal collection of papers relating to the life of Norah Fry (1871–1960). These included a copy of the obituary written by Sir Philip Morris that appeared in The Times, 17 June 1960, p. 19.

8 The evolution of statutory and voluntary services in Somerset is summarized by Eric Rose, Services for people with a mental handicap: a brief history of the development of hospital care in the county of Somerset, Taunton, Somerset County Council Social Services Department, 1989.

9 Ibid., pp. 9–10.

10 The role of the County Medical Officer of Health has attracted far less interest and research than his municipal medical colleagues, although it might be anticipated that the greater geographical area served necessitated less personal involvement with particular problems and schemes to alleviate them. Professional and personal interests may have been important, as the Devon Medical Officer of Health took a leading role in mental deficiency work.

11 Mrs Cooke-Hurle was closely associated with both institutional and community services, such as the occupation centres, initiated by the SAMW, and also sat as the Somerset County Council representative on the managing committee of the RWCI. She supported the appointment of a resident medical officer at the RWCI and widely canvassed support for her preferred candidate. Exeter University Library RWCI Collection (hereafter RWCI Collection), Joint Committee of RWCI, special sub-committee, 18 Jan. 1938, minute 28.

12 Jan Walmsley, Dorothy Atkinson, and Sheena Rolph, ‘Community care and mental deficiency 1913 to 1945’, in Bartlett and Wright (eds), op. cit., note 1 above, pp. 181–203, p. 189.

13 Ibid., p. 196.

14 RWCI Collection, Joint Committee of RWCI, special sub-committee, 27 July 1940, discussed and declined proposals to create an army psycho-neurotic unit at the Langdon Colony. Instead it agreed to take up to 200 cases evacuated from Sandhill Park. These were Somerset cases, but they were not the patients the beds had been intended for.

15 The military use of this facility is briefly described in Edgar Jones, ‘War and the practice of psychotherapy: the UK experience 1939–1960’, Med. Hist., 2004, 48: 493–510, pp. 495–6.

16 RWCI Collection, file marked Somerset Mental Deficiency Committee, Jan. 1939 to Dec. 1940, letter from H King (Clerk) and C W Mayer (RWCI superintendent), 21 Apr. 1939.

17 RWCI Collection, file marked Somerset Mental Deficiency Committee, Jan. 1939 to Dec. 1940, correspondence between H King and C W Mayer, 7 Jan. 1939 and 20 Feb. 1939 enclosing letter from Mr C.

18 RWCI Collection, file marked Somerset Mental Deficiency Committee, Jan. 1939 to Dec. 1940, letter from H King to C W Mayer, 17 Apr. 1939.

19 In Devon the RWCI had to make independent arrangements with the Devon equivalent of the SAMW to supervise patients temporarily absent from the institution.

20 RWCI Collection, file marked Somerset Mental Deficiency Committee, Jan. 1939 to Dec. 1940, letter from H King to C W Mayer, 14 Feb. 1939.

21 RWCI Collection, file marked Somerset Mental Deficiency Committee, Jan. 1939 to Dec. 1940, letter from H King to C W Mayer, 13 Apr. 1939.

22 RWCI Collection, file marked Somerset Mental Deficiency Committee, Jan. 1939 to Dec. 1940, letter dated 28 Apr. 1939.

23 It is worth noting that the correspondence between Somerset County Council and the RWCI, referred to earlier in this paper, which endorsed institutional placements for people previously living in the community, was dated 1939, when the local community services were both extensive and long-established.

24 RWCI Collection, file marked Somerset Mental Deficiency Committee, Jan. 1939 to Dec. 1940, copy of 25th annual report of the Somerset Association for Mental Welfare, 1939. Statistical summary produced by authors from figures given in sections 2–5.

25 Ibid.

26 The 25th annual report of the Somerset Association for Mental Welfare, section 4, mentions 15 cases discharged from order by the Board of Control after two years of continuous licence and 15 similar cases discharged by different visiting committees and superintendents. A further 9 cases were transferred to guardianship schemes.

27 The development of the RWCI before 1914 is discussed by David Gladstone, ‘The changing dynamic of institutional care: the Western Counties Idiot Asylum, 1864–1914’, in Wright and Digby (eds), op. cit., note 1 above, pp. 134–60.

28 Somerset had experimented with institutional and community care for the mentally defective at an early date and these services were viewed as suitable for purpose after 1913. In fact many facilities remained in use throughout the inter-war period, and some were maintained until the final closure programme in the 1980s.

29 Devon Record Office (hereafter DRO), 150/5/1/2. Devon Mental Deficiency Committee (hereafter Devon MD Com), minutes of meeting with representatives of the RWCI, 23 Apr. 1936, pp. 1–4. Statistics shared at this meeting confirmed that Devon cases occupied 249 of the 730 beds then available at the RWCI. This was 99 more than the RWCI was contracted to provide and the RWCI expected to lose more than 100 beds as temporary accommodation was phased out. Thus, while a further 200 beds were allocated to Devon as part of the Langdon Colony extension, many of these were replacement beds not new ones. This did nothing to solve the problem of accommodating the Devon cases that needed transferring from Devon Mental Hospital or local Poor Law Institutions, or a number of children who needed admitting from poor homes. Devon Medical Department reported that these cases numbered at least 326.

30 DRO 150/5/1/2, Devon MD Com, 18 May 1933, minute 767. John P Radford and Allison Tipper, Starcross: out of the mainstream, Toronto, G Allen Roeher Institute, 1988, p. 67, summarize the RWCI position. For full details regarding the Report of the departmental committee on sterilisation, (Brock Report), PP Cmnd. 4485, XV, 1934, see Thomson, op. cit., note 1 above, pp. 193–4, 197–8.

31 Many local authorities estimated their likely patient population and negotiated the admission of a number of anonymous patients of different grades to the RWCI but a patient could only be admitted to graded accommodation if he or she, personally, presented no complicating factor. This meant that despite broad agreement on the nature of cases to be admitted, a number of other factors were taken into account when the beds were actually allocated.

32 A number of cases from Devon, Somerset, and Dorset had been admitted to Metropolitan Asylum Board institutions before 1913 and the Board of Control was very keen to secure their removal to local institutions.

33 Devon County Council regularly debated and endorsed sterilization schemes. DRO 153/5/1/1, Devon MD Com, 22 Nov.1917, minute 113d. References become more frequent after 1925. See, for example, DRO 153/5/1/1, minutes 449 (16 Feb. 1926), 514 (19 May 1927), and 522 (8 Sept. 1927); and DRO, 153/5/1/2, minutes 651 (11 Sept. 1930), 724 (8 Sept. 1932), 740 (10 Nov. 1932), 751 (9 Feb. 1933), and 767 (18 May 1933).

34 Previously the council owned only a small residential unit for boys.

35 This was done by placing Devon County Council representatives on the managing committee. DRO 153/5/1/1, Devon MD Com, 11 May 1920, minute 215, agreed to nominate one representative from the education committee and one from the mental deficiency committee. This later increased to a total of five after the joint committee structure was adopted in 1937, RWCI Collection, RWCI Joint Committee 30 Nov. 1937, minutes list those present and the organizations they represented.

36 RWCI Collection, box 31, Report of the superintendent to the president of the Western Counties Institution, Starcross, for the year ending 31st March 1931, p. 1.

37 The RWCI files include no comparable documents from any of the other partner local authorities.

38 Dorset Record Office (hereafter DorRO), A15/1/3, Dorset County Council Mental Deficiency Act Committee (hereafter Dorset MDA Com) minutes, vol. 3, 1925–1928, 29 Jan. 1927, Appendix 1, pp. 8–9. Pinney's report was written in 1926 and presented to the MDA Com in January 1927.

39 Ibid, p. 8.

40 Ibid, p. 8.

41 While eugenic concerns tended to focus on the “feeble-minded group”, the care of the most severely handicapped was often a more immediate, and expensive, problem for local authorities.

42 Elaine Murphy, ‘The Lunacy Commissioners and the East London Guardians, 1845–1867’, Med. Hist., 2002, 46: 495–524, p. 521.

43 There was some discussion about the temporary use of Devon workhouses during the First World War but it appears that neither the County Council nor the local Guardians were keen to develop this policy. The Board of Control had identified Totnes workhouse as having suitable accommodation but the Guardians reported they had room for only their own inmates. DRO 153/5/1/1, 22 Nov. 1917, minute 113b, and 26 Feb. 1918, minute 122. Torrington workhouse had been offered to the mental deficiency committee but it was declined because of the cost of necessary adaptations. DRO 153/5/1/1, 29 Aug. 1917, minute 101. There was then very little discussion about workhouse inmates before 1929, although some parts of South Molton workhouse were used for mental deficiency cases between 1917 and 1939. The significant numbers of cases later reported to be in these institutions were possibly the responsibility of Poor Law Guardians and later the Public Assistance Committee. In one 1935 report, 104 inmates were listed in former workhouses appropriated by the council for mental deficiency work, while a further 92 individuals were recorded in three certified public assistance institutions, but the history and future of this accommodation was not discussed in any detail. Unpublished work on the Devon census for 1881 (undertaken as part of the Exminster Project) by Joseph Melling and others suggests that at least 116 “idiots” were accommodated in fourteen Devon workhouses.

44 DRO 153/5/1/2, A short summary of the administration of the Mental Deficiency Acts 1913–1927 in the county, in relation to institutional accommodation by John R Harper, chairman of the Mental Deficiency Committee, 18 Nov. 1935, pp. 1–3. This report listed 668 individuals under mental deficiency orders and accommodated in various institutions or maintained on licence or under guardianship in Devon and elsewhere. A further 95 workhouse inmates were certified under the 1890 Lunacy Act and needed transferring to the mental deficiency sector, and there were at least 146 individuals who were in a similar situation although currently uncertified. There were also 224 patients inappropriately accommodated in the mental hospital; the medical department knew of a further 1047 individuals at large in the community and were monitoring 361 borderline cases. This was in addition to new referrals of ineducable children expected from the education department.

45 DorRO A15/1/3, Dorset MDA Com, minutes, 29 Jan. 1927, Appendix 1, pp. 8–9.

46 Ibid, p. 9.

47 Ibid, pp. 8–9.

48 Ibid, p. 9.

49 Ibid, p. 9.

50 See RWCI Collection, box 25, correspondence files, letter from Hyde to C W Mayer 13 Apr. 1933, re Kathleen B.

51 RWCI Collection, box 25, correspondence files, letter from J L Torr to C W Mayer, 4 Apr. 1933.

52 Report of the Mental Deficiency Committee being the Joint Committee of the Board of Education and the Board of Control, 1925–29 (Wood Report), London, HMSO, 1929. For discussion of this report and its findings, see Thomson, op. cit., note 1 above, pp. 60, 97, 183, 209–11, 308.

53 Dorset was not the only local authority to experience problems with their workhouse accommodation. In 1939 the Devon County Council clerk informed the RWCI that the Board of Control “were not prepared to continue the approval of South Molton and other Public Assistance Institutions indefinitely”, but suggested that removing cases the Board of Control were particularly concerned about to the RWCI might help. RWCI Collection, box 25, Devon County Council correspondence, letter from clerk to C W Mayer, 23 Mar. 1939.

54 For example, correspondence between C W Mayer and Hyde re Rose T, Jan. 1934. The RWCI refused to treat the admission of Rose as urgent on the grounds that she was already institutionalized, but later more disturbing information emerged and they turned down the application despite noting that a “period of discipline in the Bridport Institution” might have improved her character. RWCI Collection, box 25, correspondence files, letter from Hyde to C W Mayer, 2 Jan. 1934, and reply 6 Jan. 1934. See further correspondence, J L Torr to C W Mayer, 10 Jan. 1934, and reply, 29 Jan. 1934. This referred to particulars sent in Nov. 1933.

55 These points were outlined in a letter from the Board of Control to the clerk of Dorset County Council, later copied to the RWCI, dated 24 Apr. 1939. RWCI Collection, box 25.

56 Dorset's initial involvement was fairly modest, with an outline agreement to secure 50 of the planned 530 new beds. RWCI Collection, box 30, DCC (colony), C W Mayer to J L Torr, draft agreement with revisions, 2 Oct. 1933, pp. 1–4. The county boroughs of Exeter and Plymouth are distinct from the administrative county of Devon. All three (plus Somerset, Dorset and, in a limited way, Cornwall) were partners of the RWCI, although Devon and Plymouth took more beds than the others and consequently were more involved in determining the future of the institution.

57 The RWCI admitted 2503 patients between 1 April 1914 and 31 March 1939. It is noteworthy that 2167 of these patients were classed as “feeble-minded” and only 346 of the admissions involved adults aged 21 or older.

58 RWCI Collection, box 25, correspondence files, extract of report of [Dorset] Mental Deficiency Committee, 20 May 1931, sent to C W Mayer with covering letter from J L Torr, 22 May 1931.

59 Ibid.

60 RWCI Collection, box 25, correspondence files, letter from Hyde to C W Mayer, 31 Jan. 1933.

61 RWCI Collection, box 25, correspondence files, letter from C W Mayer to Hyde, 2 Feb. 1933.

62 See, for example, correspondence between the Board of Control and Dorset County Council re Joyce G, 11 June and 17 July 1934, RWCI Collection, box 25. The Board wanted Joyce presented for admission to the RWCI, or alternatively Hortham, and would consider an application to Rampton only if she proved unmanageable in a certified institution.

63 C W Mayer addressed the benefits of institutional care and its key role in supporting community care in his speech to the annual meeting of the Dorset Voluntary Association, 30 Mar. 1936, although his scripted remarks make no reference to the ongoing negotiations with Dorset County Council. RWCI Collection, box 31.

64 Garland, op. cit., note 3 above.

65 Ibid., pp. 241–2.

66 See references in note 1 above.

67 The closest equivalent is Lt-Col F B Nixon who served as Chairman of the Dorset MDA Committee and acted as the Dorset representative on the Joint Committee of the RWCI, but he was far less prominent in decision making at the RWCI and his role with other voluntary organizations is unclear. Also in Dorset, Miss Castleman-Smith provided a link between the local voluntary association and the statutory committee, while in Devon several members of the statutory committee served for many years on the RWCI management committee.