John Conolly – a legacy and a future obligation – reflection

On 27 May 2022, English Heritage unveiled a ‘Blue Plaque’ celebrating the life and work of Dr John Conolly (1794–1866). These plaques have celebrated those who have done the extraordinary in London since the scheme's foundation in 1866.

Here, the building was the old Hanwell Asylum, currently St Bernard's Hospital in West London NHS Trust, and the extraordinary was the work Conolly did after appointment as its resident physician in 1839. In the face of staff opposition, and against the ethos of contemporary methods, within 3 months he had mechanical restraints¹ – chains, strait-jackets and the like – removed and banished from use in hundreds of patients. It heralded a sea-change in practice that rippled out from Hanwell across the public asylums.

Conolly was born in Lincolnshire, of Irish ancestry. Fast forward a period in the army, marriage and studies in medicine at Edinburgh where he achieved his MD with a dissertation on mental health, and stints at the humane Retreat hospitals in Lincoln and York. In an interesting historical twist, he ended up the father-in-law of one Henry Maudsley.

He was a regular author for the journal that would later be the BMJ, appointed a professor at University College London and, with others, formed an association that would eventually become the British Medical Association. Humanitarianism permeated his life, and he spoke out against the death penalty and campaigned for girls’ education. His handwritten notes across his own printed work demonstrate growth in understanding, reflectiveness and a willingness to admit mistakes – one notable insertion stating ‘A great mistake. J.C. 1844’.²

The Plaque helps counter-balance stereotypical myths that only bad occurred in our past, but also challenges us on what our descendants will question about our contemporary mental health practices. Will it be the lack of progress on the persistently higher rates of detention of Black Caribbean patients despite years of highlighted data, or how Black and minority ethnic NHS staff continue to have worse outcomes on every workforce measure? What will they say of diagnoses of personality disorder and substance use disorders routinely leading to the denial of care, or our early talk of co-production not actually giving patients a seat, but just creating another table?

Decades of unambiguous information on inequity, yet glacial progress despite people so impatient for change. Conolly went against the Victorian grain, achieving in months what people could not have envisioned in years. If the pandemic has taught us anything, it is that if there is a need and a will for rapid change, it can happen. Disruption and system disruptors are needed now.

Conolly's legacy may best be summed up in his own words, ‘the great and only real substitute for restraint is invariable kindness’; his obligation to us is to disrupt the systems around us while inequity continues to pervade mental healthcare.