Table Of ContentPsychiatric Hospital
Closure
'When someone died here, the bell used always to ring ....
When it rung, everyone said: 0, God, please let me die, as I
am tired of continuing this life inside this place .... There
was nothing to do, because they found themselves closed
here inside and had no hope of getting out. It is like a plant
fading because it did not rain and the leaves wither, this is
what people here were like'.
Andrea, in the Psychiatric Hospital of Gorizia,
L'istituzione Negata, Einaudi, Tarin, 1, 1968.
Psychiatric Hospital
Closure
Myths and realities
Edited by
Shulamit Ramon
Senior Lecturer
Social Work
and
Course Director
Mental Health Work with the Continued Care Client
London School of Economics
UK
Springer-Science+Business Media, B.V.
First edition 1992
©Springer Science+ Business Media Dordrecht 1992
Originally published by Chapman & Hall in 1992
ISBN 978-0-412-42980-4 ISBN 978-1-4899-7142-5 (eBook)
DOI 10.1007/978-1-4899-7142-5
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Contents
Contributors vii
Acknowledgements viii
Preface ix
Introduction xii
The context of hospital closure in the Western World, or why now? xii
PART ONE The experience of planning 1
1. The changing perspective of a resettlement team 3
Tony Wainwright
Introduction 3
Historical context 4
Establishing a team and a strategy 11
Hospital to houses and private placements 27
Resettlement team involvement in other service
developments in Camberwell 41
Progress review 42
2. Planning after a closure decision: the case for
North East Thames Regional Health Authority 49
Dylan Tomlinson
The context 49
The beginnings of closure 51
The conceptual and moral underpinning of the planned closure 59
Interprofessional and inter-agency conflicts 64
PART TWO Being at the receiving end of the closure process 83
3. The workers' perspective: living with ambiguity,
ambivalence and challenge 85
Shulamit Ramon
A note on available evidence 85
What is professionalism? 86
Health-related professions 88
vi Contents
Mental health workers and professions: sources of ambiguity
and ambivalence 91
Hospital closure: issues for professional workers in the hospital 96
Making sense of the experience of closure: a case study of
social work teams 109
Summary 118
4. The experience and perspectives of patients and care staff
on the transition from hospital to community-based care 122
Christine Perring
Introduction 122
The psychiatric hospital: from sociological critiques to the
patients' viewpoints 132
Selection and preparation of the patients to leave hospital 137
Transition 145
Living in a group home 152
Re-evaluating the past 163
Summary and concluding points 164
Conclusions 169
Emerging issues of concern 169
The bid for new control mechanisms 175
The reconsideration of main intervention strategies 177
Training for the future 179
Appendix A 184
The policy context 185
The legislative context 187
The emerging partners in the British scene 190
Contributors
Dr Christine McCourt-Perring is a Research Fellow at the Department of
Government, Brunei University. An anthropologist by training, she is
active in the Islington Forum.
Dr Shulamit Ramon is a Senior Lecturer in the Department of Social
Administration, the London School of Economics - a social worker and
clinical psychologist by training and author of: Psychiatry in Britain:
Meaning and Policy (Croom Helm); editor and contributor to: Psychiatry in
Transition: British and Italian Experiences (Pluto Press) and Beyond
Community Care: Normalization and Integration Work (Macmillan).
Dr Dylan Tomlinson is Research Sociologist, Team for the Assessment of
Psychiatric Services, North East Thames Health Region. He is a political
scientist and sociologist by training and author of Utopia, Community
Care and the Retreat from the Asylums (Open University Press).
Dr Tony Wainwright, Principal Psychologist, Camberwell and Maudsley
Health Authority and Co-ordinator of the resettlement team of Cane Hill
hospital. He is a clinical psychologist by training.
Acknowledgements
I would like to thank past and current residents and workers in psychiatric
hospitals who have struggled with those institutions and thus have greatly
contributed to our understanding of what needs to be improved in our
mental health services and in our society.
The other contributors to this book have been generous in sharing their
ideas, tolerant of my intrusion into their hectic schedules, and enthusiastic
about the project to which they have brought considerable experience and
knowledge, turning working together into an enjoyable experience for me.
Jo Campling continued to offer advice and support whenever required,
despite all of her other commitments.
Aelita suffered long weekends of maternal neglect with the genuine
relish of a teenager and yet has developed an interest in mental health
issues: I therefore dedicate this book to her.
Preface
A major British parliamentary committee on mental health services for
adults commented in its report that 'any fool can close a hospital' (Social
Services Committee, 1985). This book illustrates that even the wisest person
would have found the task of closing a psychiatric hospital most complex
and demanding, yet challenging and exhilarating at the same time. That
this committee of eminent parliamentarians, which has listened carefully to
the evidence of many witnesses and read a lot more on the subject matter,
would thus conclude its deliberations, highlights the emphasis on services
in the community to the point of being unable to focus on hospital closure
in its own right, instead of being treated as an insignificant step towards a
community mental health system.
A different message is proposed in this book. The text demonstrates how
crucial is the process of hospital closure for both the outcomes of such
closure, as well as for the future services in the community. In a number of
ways future services are defined and planned as part of the resettlement
component of hospital closure, a point illustrated time and again in each
chapter of this book.
A British psychiatrist whose intelligence and knowledge I greatly value
has recently reacted to a suggestion to focus on hospital closure in a
professional journal by stating that this would have been relevant in the
1980s, but not in the 1990s. The lack of any research or current discussion as
to what has happened in the massive closures of North American hospitals
in the 1960s and the 1970s would indicate that, there too, professionals do
not see such closures as related to their present services and their dilemmas.
This book highlights that, unless we are able to understand the full impact
of hospital closure on the direct and indirect participants in this endeavour,
we as societies, countries, and people will be unable to connect our
psychiatric past to our psychiatric present and future, and consequently
unable to learn some most valuable lessons. Moreover, in many western
countries the process of hospital closure has only started, with Second and
Third World countries still aspiring to build large psychiatric hospitals. It
would therefore seem that, far from being a matter of a long forgotten past,
this is very much an issue of the present and of the future.
