Since 1974, Cane Hill had been administered by the South East Thames Regional Health Authority, receiving patients from Bromley, Camberwell, Lewisham and North Southwark Health Authorities.
Through the work and ideas of Dr Douglas Bennett and Dr Tony Isaacs in the 1960s and ’70s, Cane Hill had changed from a general mental hospital to what was essentially an acute and psycho-geriatric hospital. Instead of looking to provide a long term hospital bed for those admitted, the emphasis had changed to preparing ‘career’ mental patients for the next step; real life in the community.
The population had decreased to 643 in 1985, mainly through transfers of certain types of patient to St Francis’ and Bethlem and Maudsley, New cases from Camberwell had not been arriving at Cane Hill since the 1970s, only chronic cases transferred from the Camberwell Reception Centre, which was set up in St Francis’ hospital in Dulwich (the former Constance St Workhouse). The patients at Cane Hill were mainly diagnosed as schizophrenic, although there were also bi-polar cases and those suffering from neurotic and organic mental illnesses.
In 1986, access to long-term beds at Cane Hill ceased. Only acute cases where a short term stay was needed were admitted. New long-term admissions would have been sent to Bethlem and the Maudsley.
Cane Hill’s long term population was growing to be increasingly dependant. Unlike younger patients in the earlier stages of mental illness, Cane Hill’s patients had been in the system for the majority of their lives, and were developing age related issues such as dementia, lack of mobility and the loss of motor skills.
“The majority of the survivors required assistance in bathing or dressing (81%), nearly half were incontinent of urine or faeces once or more a week (46%), and almost all required supervision outside the home (88%). Over half (54%) were regularly awake at night, although only a minority (27%) engaged in problematic behaviours at night. Problematic behaviours were commoner during the day (53%) and a proportion were prone to hoard items (27%) Very few of the sample (8%) socialised readily with others and a few (15%) were able to keep themselves occupied in constructive activity ”.
This made the transfer system markedly different to hospitals that had previously been admitting new cases. The resettlement teams were dealing with patients with multiple and very complex needs, and there were just 5 options available for re-accommodation.
Nursing homes, residential homes and supported accommodation were the preferred choices. The other options were a transfer to another large long-stay hospital, or a hospital-hostel, although these were not so common. From the evidence above, very few of the sample would have been capable of living in the community without permanent supervision.
Although the deinstitutionalisation system was designed to provide the most appropriate support in the community, these patients had followed a similar course of action to any other elderly person with age-related health issues.
A study carried out between 1987 and 1992 assessed 49 patients, and from the follow-up in 1992, 22 of them had died (13 at Cane Hill)
“Eight patients moved to the SHS, a network of well staffed small houses within Camberwell run by a voluntary organisation. Thirteen patients moved into residential homes and nine moved into nursing homes. A further five patients moved into beds purchased in a long-stay NHS hospital. In addition, one patient moved into a hospital hostel in Camberwell ”
The alleged main benefits of the transfers for these patients were the quality of their environment and quality of life. They had more of a say in the decisions about their life, including what they ate and whom they spent their time with. Their accomodation was also apparently more personal: each patient had their own room, rather than the large dormitories they had slept in at Cane Hill. It was reported in 1985 that 75% of patients in Cane Hill were unaware of plans to change their accommodation, and 55% did not want to leave.
On 27 April 1990, the following motion was raised in the House of Commons by Harriet Harman, MP for Peckham.
That this House expresses its deep concern over the delays of nearly four years in implementing plans for the development of the Knights Hill Home for the mentally ill in south-east London; notes that the Cane Hill hospital in Surrey is due for imminent closure yet alternative places for all the patients have not been found because of these delays; recognises that plans for the development of the Knights Hill site were first drawn up in October 1986 and are now far advanced; is worried about the anxiety caused to relatives of patients and to staff by these delays; is concerned at the cost of these delays to the Camberwell Health Authority; and calls on the Government to urge the South East Thames Regional Health Authority to grant approval in principle to the plans for the development of the Knights Hill site.
It received 16 signatures and in 1992 the Knights Hill home opened, a modern building for people with dementia, offering day services as well as residential. The emphasis was on making people feel at home and the design of the building was related to these themes. It was built on a cruciform plan, each patient had their own room, and the building was light and spacious. It did however lack the open space that was available at Cane Hill, and was eventually demolished in 2011, having closed 4 years prior.