Cane Hill in the 1960s

Cane Hill in 1960 was running close to capacity. 1953 had seen the absolute peak of psychiatric beds used across Britain, and Cane Hill as well, with 2,400 beds occupied. Cane Hill was running at capacity and 700 staff members were needed to care for the patients.

Capacity slowly decreased through the late fifties, but by 1960 Cane Hill still had 1,600 patients occupying it. The catchment area had reduced soon after the NHS was established, and Cane Hill was primarily used to provide services to South London.

Antipsychotics

In the 1930s, French laboratories began to research chemical compounds they’d developed through other experimentations. In 1947, Antihistaminic compounds and sedatives were combined to produce another compound that created indifference and relaxation in the recipient. This was developed over the next few years and eventually Chlorpromazine was produced, which was tested in 1951 in Paris. Reports were startling. Patients not only responded to the sedative element, but also displayed improvements in thinking and a reduction in negative emotional behaviour. In 1954 Chlorpromazine was marketed in the UK as Largactil, and was used widely.

The side effects of Largactil were severe: Constipation, excess appetite, skin hypersensitivity, and photosensitivity occurred. Patients that were on long courses experienced skin problems, dermatitis discolouring of the skin. The reproductive system suffered, with female patients growing excess hair and falsely passing pregnancy tests, males losing their libido and both genders suffering a reduction in the generation of reproductive cells. Finally, patients taking Largactil were more susceptible to have a seizure. For these reasons, research continued and other drugs were developed. The widespread use of Largactil ended as other stronger drugs were introduced.

Comments were made regarding the benefits of the anti-psychotics. Dr NH Rathod, a psychiatrist at Cane Hill, noted that the ‘tranquillizer’ drugs worked less effectively on wards where particular attention was made to creating a therapeutic environment[1], which suggested that the behaviour of the patients was relative to the environment in which they lived. Patients typically were crammed into dormitory type wards, with some housing as many as 100 people.

Despite Powell’s calls to terminate the usage of the mental hospitals, Cane Hill had run a scheme of improvements throughout the sixties. Lifts had been installed in 4 of the three-storied blocks, the old gas lamps were re-wired as electric, the heated swimming pool was built, and the school of nursing was moved into the old manor house at the bottom of the site, with the previous premises being converted to recreational areas. In addition to this, the block at the back of hospital was taken over by domestic staff, and nurses were accommodated in the new buildings on the drive.

ECT

ECT had been present in psychiatric hospitals since the 1930s, and became widespread throughout the fifties. It consisted of a wave of electricity entering the patient’s brain. The patient would be strapped to a bed whilst wearing a mouthpiece to prevent them biting their tongue. While ECT was being tested, the patients undergoing it would not be anesthetised, and the seizure would result in full-scale convulsions. This would sometimes lead to breaking of limbs.

The lack of understanding and knowledge of the capabilities of these new treatments had allowed widespread misuse of them. Unregulated by anybody outside the county council and the hospital committee, the perceptions of a small group of people allowed the preferred treatments to differ widely across the London area.

With the development of the anti-psychotic drugs some patients could be discharged to live in the community once their conditions stabilised, and the oppressive, containment-based trains of thought evaporated. Fences around the airing courts disappeared, the strong-arm management of difficult patients was no longer required, and the number of patients in the refractory wards started to decrease. Ward blocks started to close, with those at the back of the Male side shutting their doors in 1964. York was shut in 1964 and had previously housed unmanageable or ‘refractory’ patients. These were moved to Zachary/Unwin as numbers decreased.

Admissions

Admissions still continued at Cane Hill, with the Camberwell District Service dealing with admissions for the area. Douglas Bennett of the Camberwell service had been allocated beds to fill in St Francis’ and Cane Hill, and was keen to allocate them appropriately. It was established that the ‘objecting and objectionable’ would be placed in St Francis’ Hospital in Dulwich. The Joint Hospital service (Bethlem and Maudsley Hospitals) would take the ‘accepting and acceptable’, and Cane Hill would take the chronic long stay patients.[2]

This meant that the services at the different South London hospitals could be more specifically tailored for the patients that they accommodated. The Maudsley was well known for it’s innovative attitudes towards treatment and research into mental illness, and in the late 1960s took on many depressives and suicidal cases, which would eventually be transferred to Cane Hill after a few months, depending on their chances of recovery

During this period Cane Hill would be allocated the patients that required more long term care, essentially those with less chance of recovery. The numbers in Cane Hill were also being ground down by new cases being sent to other hospitals in the area. There was no desire at the time to use Cane Hill as an admissions centre for short-term patients, and for this reason, ward blocks continued to close on the male side as elderly patients gradually died and beds emptied.

Douglas Bennett was a consultant psychiatrist at the Maudsley hospital and put a lot of effort into moving the chronic patients to the better care available at the Maudsley.

“John Wing introduced the Camberwell register and subsequently we introduced the idea of a Camberwell service and eventually stopped admitting patients to Cane Hill. In other words Dr Tony Isaacs and I ran down our beds in the mental hospital, not by discharging ex-patients to the community, but by admitting all new patients, to St Francis’ and The Bethlem and Maudsley instead of Cane Hill

I felt it was important to get the chronic patients into the Maudsley. It remained with me, since my experience at Netherne, that psychiatry was upside-down with the least ill and least disabled patients being treated by the most able and qualified staff. I believed that it would make a great difference if we could change this and bring these unfortunate people to the attention of the best therapists… …We did have some success in moving chronic patients from Cane Hill and St Francis hospitals to the joint hospitals[3]”

In 1967 the catchment areas changed so that St Francis’, Maudsley and Bethlem were responsible for the Camberwell district, with Cane Hill taking an agreed number of psycho-geriatric and severe schizophrenic admissions. Cane Hill had previously been the preferred hospital for all admissions.

The 1960s saw a great change in the administration of mental health treatment. It was the introduction of collaboration between the hospitals administered by the Bromley Health Authority that allowed appropriate treatment to be given to patients who needed it the most. This policy, combined with the reluctance to place patients in the ‘distant mental hospital’ to be forgotten about meant that there was a greater crossover in services in the centre of the district. This contributed greatly to the drop in patients at Cane Hill in the 1960s.

Life-skills/Rehabilitation

Ebben Roderic-Evans, Consultant Psychiatrist at the hospital, was quick to act on Powell’s words in 1961. Having been at Cane Hill since the mid 1950s, he had seen several changes take place already. The introduction of the mental health act 1959 had allowed voluntary patients to leave as and when they desired. This was a key contributor to the decrease in patients that had occurred, and of course, the introduction of antipsychotic drugs changed the attitudes of nurses and allowed the introduction of more palliative care.

Roderic-Evans had already been running life-skills programmes for patients with schizophrenia, establishing an early rehabilitation scheme, but with Powell’s speech, this picked up speed. Suitable patients in long-stay wards were placed into group homes first in the grounds of the hospital, and later in the community. He proposed that ward sisters should visit patients in these homes, contributing to the idea of the Community Practice Nurse. (CPN)

John Hutchinson, another consultant psychiatrist at the hospital, had worked closely with Roderic-Evans to establish the secure unit at the former Coulsdon Cottage Hospital slightly south of the main complex. This allowed more dangerous patients to be moved from the main complex, allowing it to house those that could feasibly be re-accommodated into the community over time.

Another early sign of deinstitutionalisation was the introduction of unlocked wards. Certain patients were given the freedom to leave the ward and roam the corridors, including the facilities attached, such as library, social centre and hairdressers. A higher level of privilege was a grounds ticket, which allowed unsupervised access into the hospital’s estate, including airing courts, grassland and farmland. There were still gatehouses at the Brighton Road and Portnalls Road entrances, which would only allow patients out if they had a town ticket.

These privileges were of course retractable. Patients that abused these hard earned rights by behaving disruptively, failing to return to the ward on time, or attempting to escape, would be confined to the ward again until they had proven their merit and gained the trust of staff again.

[1]“Recovery from schizophrenia: psychiatry and political economy” Richard Warner, Psychology Press, 2004

[2] Douglas Bennett, in conversation with Greg Wilkinson. 1994. Psychiatric bulletin.

[3] Op cit