“There they stand, isolated, majestic, imperious, brooded over by the gigantic water-tower and chimney combined, rising unmistakable and daunting out of the countryside – the asylums which our forefathers built with such immense solidity to express the notions of their day. Do not for a moment underestimate their powers of resistance to our assault”
1961 was a turning point for institutionalised mental healthcare. Enoch Powell had stood as Health Minister for Harold McMillan’s conservative government since July 1960, and was set with the immense task of reforming the nations antiquating hospital services, most pertinently, the Mental Hospitals.
In his address at the Annual Conference of the National Association for Mental Health in March 1961, Powell slammed the institutions. He spoke of the requirement to transition to community based care, the horrors of the asylums, the implications of the changes due, the services he envisaged and the finances needed to deliver his proposed changes. The speech set the wheels turning for community care.
Summary of Powell’s ‘Water Tower’ Speech
Powell introduced himself and briefly summarised the previous Health Minister’s speech from the previous year’s conference. He followed this by introducing the theme of his speech, and his aspirations for a ten-year plan of change for Mental Health provision.
Powell continued to explain why a programme of change was needed, with a view to assessing the needs of the mid and long-term future, and the changes that must take place to accommodate those needs
Powell then expressed the need for ruthlessness in preparing these provisions, and to reduce the number of mental health beds by 50%. This was related to the advances made in recent years, not just in terms of treatment but also in the legislation recently passed.
The next part of Powell’s speech was a question. Where would these beds be, and what environment would be suitable for mental health treatment in the future? He suggested that provisions be made in wings of general hospitals, which would assist in the deinstitutionalisation of mental healthcare.
Powell then described the enormity of the task ahead, the change of attitude needed and the identity of the asylums that needed to be dissolved. This was followed by questions of instinctive resistance, and the need to overcome notions of nostalgia and sentiment.
The next point of the speech was to enforce ideas of changes in attitude. The services themselves were to form the identity of mental healthcare, rather than the buildings, and as such, the buildings and operational framework must be dismantled.
Powell then expressed the need to forget the money spent to improve institutionalised services, and to rather consider the benefits of the changes to be made in order to provide something ‘different and better’
The next point was regarding emotions; to not overlook the merits of the work of thousands of members of staff in the mental hospitals. It was essential to understand and respect their work. It was also important for staff to not be complacent and content with the current services available.
Powell then declared his and the governing bodies’ own responsibilities in this matter, which were to favour change and to be efficient to act where they can.
Powell’s next point was regarding those he described as the ‘sub-normal’, (presumably those with learning disabilities), and the requirement to assess their needs and develop a more concise understanding of the issues faced in managing and caring for them.
Powell stated that the Local Authorities needed to work with medical staff in hospitals in order to develop community services, and that they must take responsibility for those in their care. In essence, it was no longer acceptable to place somebody in a hospital and have no further involvement in his or her care. Teamwork would be required.
The next point related to the benefits of community care. There would be more flexibility in the services provided, both in a sense of the forms of accommodation provided and the degree of care to be provided to individuals. The services would be more individual-centric.
Powell then stated that the forthcoming provision was not to cut down on the costs of healthcare, and that he expected the costs of community care to equal that of the hospitals. He then stated that 1961 would be the start of this great process of change, with the consciousness of those involved being a key factor in the degree of success this project would have in it’s early stages.
Powell finally called for support in this cause, from the hospitals, the ministers and the general public, expressing the need for widespread support in order to fulfil the aims of this early design for community care.