Mental Health in Historical Perspective Series Editors Catharine Coleborne School of Humanities and Social Science University of Newcastle Callaghan, Australia Matthew Smith History of Psychiatry University of Strathclyde Glasgow, United Kingdom Covering all historical periods and geographical contexts, the series explores how mental illness has been understood, experienced, diagnosed, treated and contested. It will publish works that engage actively with contemporary debates related to mental health and, as such, will be of interest not only to historians, but also mental health professionals, patients and policy makers. With its focus on mental health, rather than just psychiatry, the series will endeavour to provide more patient-centred histories. Although this has long been an aim of health historians, it has not been realised, and this series aims to change that. The scope of the series is kept as broad as possible to attract good quality proposals about all aspects of the history of mental health from all periods. The series emphasises interdisciplinary approaches to the fi eld of study, and encourages short titles, longer works, collections, and titles which stretch the boundaries of academic publishing in new ways. More information about this series at http://www.springer.com/series/14806 Claire Hilton Improving Psychiatric Care for Older People Barbara Robb ’ s Campaign 1965 – 1975 Claire Hilton Institute of Contemporary British History and Institute of Psychiatry, Psychology and Neuroscience King ’ s College London London, United Kingdom Mental Health in Historical Perspective ISBN 978-3-319-54812-8 ISBN 978-3-319-54813-5 (eBook) DOI 10.1007/978-3-319-54813-5 Library of Congress Control Number: 2017940474 © The Editor(s) (if applicable) and The Author(s) 2017. This book is an open access publication. 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Printed on acid-free paper This Palgrave Macmillan imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland To Samuel, Jacob and Benjamin and their friends who are trying to make the world a better place. F OREWORD My beloved grandmother died frail and confused in an overcrowded long- stay ward in a decrepit Victorian National Health Service hospital. There were so many beds in the ward there was barely room to stand between them. Nurses were seemingly indifferent towards their impossible task. In 1968 I was a bewildered and angry medical student with no idea how to voice my concerns at her evident distress and the lack of personal care. My parents too were troubled by the poor conditions, my grandmother ’ s unkempt appearance, the meals left untouched and out of her reach, the terrible ward stench. They never made a formal complaint, hardly knew where to begin, and in any case my grandmother died soon after admis- sion. I have no doubt that this experience was one of the triggers for my choice of career in the psychiatry of old age. I did not know then that there was a battle in progress in the late 1960s and early 1970s between those who grasped how widespread was the poor care of older people in the National Health Service and were determined to improve it and those lined up against them, the forces of denial inside the service, who really believed there was not much wrong and in any case thought there was nothing to be done about any shortcomings given the resourcing and public ignorance. At the vanguard of the battlefront was one remarkable woman, Barbara Robb, who published Sans Everything: A Case to Answer in 1967, a searing indictment of the conditions for older people in long- stay hospital wards, initiated by her own observations of the care of one of her psychotherapy patients. In this book, Claire Hilton has set out the campaign waged by this one inimitable woman, her organisation Aid for the Elderly in Government vii Institutions (AEGIS) and the long struggles to convince the Ministry and its constituent Regional Hospital Boards that the truth was as she described it and to get them to accept that change was necessary. There could be no better quali fi ed person to document this enlightening story than Claire Hilton. Claire is a dedicated, talented clinician, a psychiatrist working with older people, who has for some years immersed herself in the history of the development of the specialty of old age psychiatry in the twentieth century. She has illuminated the period by bringing together the characters and politics of the in fl uential clinical professionals, policy makers, public health observers, press and government funders. In this new work, Claire has drawn on her profound understanding of the period and, through further scrupulously detailed research, has exposed a story that has wider implications, showing how policy makers can be easily misled by misinformation when the truth is unpalatable. But what she has also given us here is a cracking good read, a compelling story of one woman ’ s battle tragically cut short by Robb ’ s too early death in 1976. The fact is that the scandals have continued in National Health Service hospitals, but more often today in the myriad of independent-sector nursing and care homes that now provide the majority of long-term care for those institutionalised at the end of their lives. Scandals are no longer swept under the carpet, rather under many small rugs, as psychiatrist Klaus Bergmann so memorably put it and quoted by Claire in her disturbing fi nal analysis of what has changed for the better and how much still needs to be done. In spite of the cautionary fi nale, this is an uplifting story, and anyone who is interested in how to campaign on a social issue will learn some invaluable lessons from this splendid book. Elaine Murphy, Baroness Murphy of Aldgate viii FOREWORD P REFACE In 1967, Sans Everything: A Case to Answer , was a best seller, a remarkable achievement for a non fi ction book about the unappealing subject of the poor care of older people in English psychiatric hospitals. The title and scandalous content remained familiar over the years, particularly to old age psychiatrists and others who aimed to provide high-quality mental health services for older people. None of them, however, could tell me anything about its author, Barbara Robb, although at the time she wrote, she was quite a celebrity, achieving both fame and notoriety. Cabinet Minister Richard Crossman wrote in his diary that she was a ‘ terrible danger ’ to the government, and a ‘ bomb ’ who had to be defused. With such an accolade, somewhere there had to be a story. I fi rst read Sans Everything in about 2006 after my husband bought it for me as a birthday present. The contents were gruesome, and like other readers, I focused on them, paying little attention to the chapters providing direction about how to improve care. Breathing a sigh of relief, I reassured myself that things aren ’ t nearly so bad today. While undertaking related historical research, the names of several Sans Everything contributors came to light. Who were they? How did Barbara get them to write for her? Who were the people and places behind the pseudonyms? Who was ‘ Miss Wills ’ who Barbara rescued from ‘ Cossett Hospital ’ ? Who was Barbara? How did she get involved with the psychia- tric hospitals, and what else did she do? These and other questions aroused my curiosity. There are many reasons Barbara Robb was forgotten. She fought to improve provision for institutionalised older people and not for personal ix acclaim. She was a thorn in the side of the National Health Service leader- ship who did not want to remember her, and both she and her husband, Brian, died prematurely. Half a century since publication of Sans Everything, it is time to reconsider the story behind it and its messages, much of which remains relevant to the care of unwell and frail older people today. Perhaps my sigh of relief was only partly justi fi ed. x PREFACE A CKNOWLEDGEMENTS Investigating Barbara Robb and Sans Everything was exhilarating, delving into archives and meeting many people who helped and offered much encouragement. Barbara ’ s family were enthusiastic. Her cousin William Charlton and his wife, Anne, welcomed me to their home in Northumberland, and her great-niece Anna Charlton showed me round Hesleyside Hall. Barbara ’ s niece Elizabeth Ellison-Anne lent me Barbara ’ s photograph album depicting the years 1937 – 1941, and she, with friends Cynthia Bressani, John Gilliver and Colin Bowes, showed me round the family home, Burghwallis Hall, and the adjoining church. Sister Deirdre McCormack showed me round St Peter ’ s Residence, and Constanza Isaza Martínez and Andrés Pantoja allowed me to wander round their home, the cottage where Barbara and Brian lived for many years. Charles and Robin Daniel, whose mother, Joyce, spoke out for more humane hospital provision in Cornwall, told me about her in the cottage where she lived. David Cochrane gave valuable advice at the beginning of the project, and Margaret Shepherd NDS, explained aspects of Roman Catholic practice. Other people told me about Barbara ’ s life and times and provided archives and photographs: they are acknowledged in the endnotes. Anna Towlson, archivist at London School of Economics, was always helpful with my visits to, and queries about, Barbara ’ s extensive archive. Many other archivists and librarians answered questions, retrieved documents and assisted with the project. Numerous historians offered constructive advice, including Tim Hurley, Michael Kandiah, Chris Knowles, Michael Passmore, Mary Salinsky, Sally Sheard, Kathleen Sherit, Mari Takayanagi and Pat Thane. xi Tom Arie and David Jolley, my esteemed colleagues in old age psy- chiatry, read and commented on every chapter with great tact and patience. My husband, Michael, and sons, Samuel, Jacob and Benjamin, all guided me through computer hitches and accompanied me on visits to former psychiatric hospitals. Benjamin also gave advice on logical fallacies in the Sans Everything inquiries. Michael has been endlessly patient with the time spent on this project and has enjoyed our visits to people, places and archives from Cornwall to Northumberland. I am indebted to the Wellcome Trust for funding this study during an eight-month sabbatical from clinical work as an old age psychiatrist. I am also grateful to Central and North West London NHS Foundation Trust for allowing me to take time off and to Lynis Lewis and North Central London Research Network for help with administrative matters. My link to Palgrave Macmillan began with a chance meeting with historian John Stewart at a conference at the Wellcome Trust. He intro- duced me to Matthew Smith and Catharine Coleborne, academic editors of the series Mental Health in Historical Perspective . They were endlessly enthusiastic and guided me through many stages towards publication. I ’ m also grateful to Vicky Long who reviewed the manuscript and whose comments helped shape the book, and to Palgrave ’ s editors, Molly Beck, Oliver Dyer and Sundar Ananthapadmanabhan, who were a pleasure to work with. This list of helpers, encouragers and friends is not exhaustive, and I apologise to anyone missed out who thinks they should have been included. To them too I am most grateful. xii ACKNOWLEDGEMENTS C ONTENTS 1 Introduction: A Strange Eventful History 1 2 Psychiatric Hospitals and Older People: Status Quo or Making Changes? 19 3 Barbara Robb, Amy Gibbs and the ‘ Diary of a Nobody ’ 57 4 Establishing AEGIS and Writing Sans Everything : ‘ The Case ’ and ‘ Some Answers ’ 97 5 Reprinted Before Publication: Plotting a Route for Sans Everything 143 6 The Inquiries: A Lion ’ s Den 173 7 Whitewash and After: ‘ Most Good Is Done by Stealth ’ 201 8 Then and Now: Concluding Remarks 251 Index 271 xiii A BBREVIATIONS AEGIS Aid for the Elderly in Government Institutions BBC British Broadcasting Corporation BGS British Geriatrics Society BLSA British Library Sound Archives BMA British Medical Association BMJ British Medical Journal COHSE Confederation of Health Service Employees CoT Council on Tribunals CPAG Child Poverty Action Group DGH District General Hospital DHSS Department of Health and Social Security ECT Electroconvulsive therapy GNC General Nursing Council GP General Practitioner HAC Hampstead Artists Council HAS Hospital [later Health] Advisory Service HC House of Commons HL House of Lords HMC Hospital Management Committee HMSO Her Majesty ’ s Stationery Of fi ce IPSO Independent Press Standards Organisation JCC Joint Consultants ’ Committee [of the BMA] LMA London Metropolitan Archives LSE London School of Economics MHA Mental Health Act MoH Ministry of Health MP Member of Parliament NAMH National Association for Mental Health [later MIND] xv NHS National Health Service NSGHMC New Southgate Group Hospital Management Committee NWMRHB North West Metropolitan Regional Hospital Board OED Oxford English Dictionary OUP Oxford University Press PA Patients Association PEP Post-Ely Working Party PhD Doctor of Philosophy PHSO Parliamentary and Health Service Ombudsman QC Queen ’ s Counsel RAF Royal Air Force RCN Royal College of Nursing RCPsych Royal College of Psychiatrists RHB Regional Hospital Board SWMRHB South West Metropolitan Regional Hospital Board SWRHB South Western Regional Hospital Board TNA The National Archives TSO The Stationery Of fi ce UWMRC University of Warwick Modern Records Centre WHB Welsh Hospital Board WHO World Health Organisation WYAS West Yorkshire Archives Service xvi ABBREVIATIONS L IST OF F IGURES Fig. 2.1 Friern Hospital, 1957 40 Fig. 3.1 Burghwallis Hall, c.1941 59 Fig. 3.2 Barbara and her grandfather, Ernest Charlton Anne, c.1922 60 Fig. 3.3 Barbara and her brother Robert, winter 1940 – 1941 62 Fig. 3.4 Amy Gibbs creating a foil collage, 1961 67 Fig. 3.5 Foil collage by Amy Gibbs 68 Fig. 3.6 Service in the chapel, St Peter ’ s, 1960s 73 Fig. 3.7 Nun feeding turkeys in the grounds, St Peter ’ s, 1966 74 Fig. 3.8 Party on the women ’ s ward, St Peter ’ s, late 1960s 75 Fig. 4.1 Memorial to victims of Colney Hatch Asylum fi re, New Southgate Cemetery, 1903 105 Fig. 4.2 Joyce Daniel, c.1964 117 Fig. 4.3 Russell Barton ’ s invitation to Barbara, for dinner at Claridge ’ s, September 1967 125 Fig. 7.1 Of fi cials inspect a men ’ s ward at Ely Hospital, 1969 216 Fig. 8.1 Barbara and Brian Robb, c.1972 255 Fig. 8.2 ‘ Older women, djinns and beds ’ by Laura Lehman, 2016 260 Fig. 8.3 Barbara in the driving seat, 1928 261 Fig. 8.4 ‘ Ursula ’ by Brian Robb, 1976 262 xvii L IST OF T ABLES Table 4.1 The Sans Everything witnesses 116 xix D RAMATIS P ERSONAE People most closely concerned with the narrative of Barbara Robb and the AEGIS campaign and those who played a part at several stages in the story: Academics and government advisors Brian Abel-Smith Peter Townsend Barbara Robb ’ s family Ernest Charlton Anne, grandfather Ernestine ‘ Missie ’ Anne, aunt William Charlton, cousin Brian Robb, husband; an artist Campaigners and supporters Mary Applebey, general secretary of NAMH Mabel Franks, an admirer from Leeds Audrey Harvey, Barbara ’ s neighbour and social rights campaigner Helen Hodgson, founder of the Patients Association Lord Strabolgi Chairmen of committees of inquiry First Friern Inquiry 1965 Ann Blofeld Sans Everything inquiries Douglas Lowe, Friern George Polson, St Lawrence ’ s Ely Inquiry Geoffrey Howe xxi Doctors Psychiatrists and psychogeriatricians Tom Arie Alex Baker, director of the Hospital Advisory Service, 1969 – 1974 Russell Barton Klaus Bergmann Garry Blessed M David Enoch Bertram Mandelbrote Brice Pitt Ronald ‘ Sam ’ Robinson J Anthony ‘ Tony ’ Whitehead Other doctors Malcolm Campbell, Friern Hospital, 1964 – 1965 Lionel Cosin, geriatrician Geoffrey Tooth, Principal Medical Of fi cer, Ministry of Health Friern ‘ Cossett ’ Hospital staff, pseudonyms Dr Aix, consultant psychiatrist Miss Cloake, social worker Dr Giddie, ward doctor Journalists and editors Anne Allen, Sunday Mirror Yvonne Cross, Nursing Mirror Anne Robinson, Sunday Times CH Rolph (Bill Hewitt), New Statesman David Roxan, News of the World Ann Shearer, Guardian Hugo Young, Sunday Times RHB chairman Maurice Hackett, North West Metropolitan Isabel Graham Bryce, Oxford Nurses in senior roles who supported AEGIS Keith Newstead WJA ‘ Bill ’ Kirkpatrick Doreen Norton Phyllis Rowe, deputy president of the RCN xxii DRAMATIS PERSONAE Psychotherapists Carl Jung Victor White Politicians and civil servants Minister of Health Kenneth Robinson, 1964 – 1968 Secretaries of State for Social Services Richard Crossman, 1968 – 1970 Keith Joseph, 1970 – 1974 Barbara Castle, 1974 – 1976 Others Beatrice Serota, Minister of State for Health, 1968 – 1970 Arnold France, Permanent Secretary, Ministry of Health, 1964 – 1968 Patients, their relatives and friends Eric Buss, friend of Amy Gibbs Mrs Dickens, sister of Bob, a patient at Friern Hospital Amy Gibbs, ‘ Miss Wills ’ , a patient at Friern Hospital Whistle-blowers Sans Everything author-witnesses and their pseudonyms Jean Biss, Laura Heneage Dorothy Crofts, Elizabeth Tasburg Joyce Daniel, Adeline Craythorne James Davie, Frederick Isham Dennis Moodie, Michael Osbaldeston Roger Moody Eileen Porter, Emily Swinburne Susan Skrine, Louisa Fenton Ely Hospital Michael Pantelides DRAMATIS PERSONAE xxiii