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Shenley Hospital, a scrapbook Compiled for the Hidden Minds Project 2012


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from the brochure for the opening of Shenley by their Majesties the King George V and Queen Mary

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Patients’ day room

Recreation Hall

Group of patient villas

Central kitchen

The water tower

Patients’ dormitory in a Villa

One of the larger dormitories

Bakery

The dental clinic

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DESCRIPTION OF THE MIDDLESEX COLONY This was the second phase of Shenley and incorporated the Villa System.This description has been taken from the booklet from the opening ceremony

T

HE MIDDLESEX COLONY has been established for the care of mental defectives of all grades and ages. The Colony is intended for mental defectives who are socially inadaptable in the community, or who are neglected or without visible means of support. When accommodated in an Institution of the Colony type, with sufficient land a reasonable amount of liberty is possible. Male defectives who are capable of being employed are provided with suitable agricultural occupations on the land: or at various industrial occupations in the workshops of the Colony. Female defectives have various occupations provided for them in the Laundry, the General Kitchen, and at suitable female industries in the Workrooms. Children who are capable of it are engaged at a variety of simple occupations. Defectives who are helpless only require care and nursing. The, patients are accommodated in separate “Homes” of the Villa or Pavilion type, each accommodating from thirty to’ sixty patients. The idea of a “ Home” is in fact the basis of the Colony system. By more complete subdivision and classification, those whose tastes, habits and interests, and occupations are similar are enabled to associate together and live apart from the others,

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The decision of the Mental Deficiency Committee to recommend the County Council to build a Colony for mental defectives arose out of a number of reports on the provision of Institutional accommodation for Mental Detectives submitted to them by the Mental Deficiency Medical Officer. In these reports all the details of Colony acommodation were fully set out with its advantages over the usual aggregated type of Institution. The County Council, in 1920, passed, a resolution to build a Colony for Mental Defectives, The estate of Porters Park, Shenley, was purchased in September, 1924, and the Mental Deficiency Medical Officer was directed to draw up a Scheme for the establishment there of a Colony for Mental Defectives, The Scheme was approved by the County Council, the Board of Control and the Ministry of Health. The Colony is situated in grounds of about 420 acres and stands about 250 feet above sea, level, and is situated on the land allocated to it on the North side of the Estate. The Institution buildings are surrounded by farm lands and there are considerable areas of wood land. The gardens around the buildings are being laid out and planted by the patients. The building of the Colony has proceeded regularly by stages since 1929 until the present time and the Scheme, including the major part of the Administrative buildings, is mainly completed with the exception of the children’s section providing accommodation for 200 children, which will bring the Institution up to a full complement of 1,154 beds. The Administrative Centre has been built on an axial line running North and South, the Colony buildings for male and female patients being placed East and West of it respectively, an isolated site on the South side being allocated to the proposed children’s section . The patients’ buildings have been arranged around and overlooking Playing Fields for the recreation of the patients. All patients’ buildings have a main Southerly aspect.

The plan arrangement of the patients’ “Homes” with their Day Rooms, Dormitories, Dining Rooms, Ward Servery Kitchens, Lavatories and Bathrooms, is representative of the policy throughout, to approximate as nearly as possible to home conditions. These conditions have also governed the furnishing and equipping of the buildings. Patients dine in their own unit dining rooms and the food is distributed from the Central Kitchen in insulated containers conveyed on electric trolley trucks. The progression of Administrative Buildings from North to South along the axial line consists of the Main Administrative Offices, Dental and Surgical Clinics, Dispensary,’ Central Kitchen, operated by electricity and steam, Cold Storage and Larders, Steward’s Store, the Recreation Hall, Central Boiler House, Maintenance Workshops, etc., with General and Staff Laundries situated on the West, close at hand. There are Occupational . Buildings for men and for women, in which patients receive instruction in trades and crafts of various kinds. The Mortuary comprises a Chapel, Visiting Room, Post Mortem Room,. and other necessary accommodation. The Nurses’ Home, part only of which is completed, is situated immediately to the West of the Main Administrative Offices, adjacent to the Main Entrance to the Colony from Harper Lane. It is planned to suit staff grades, with bedrooms, suites, lavatories, bathrooms, washing, and ironing and shampoo rooms; dining rooms, recreational rooms, quiet rooms and other amenities. It will eventually he enlarged to meet the extensions of the scheme. All food for the Nursing and other Staff is prepared in the Home Kitchen. The old 18th century house named Wild Farm, which lies on the South boundary of the site, has been adapted as a residence for the Medical Superintendent. Residences have also been provided for the Deputy Medical Superintendent and Senior Officers and a staff village situated

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East on the road frontage of the estate forms part of the scheme. The Colony shares with Shenley Mental Hospital a joint water supply from the County Council’s own well, and similarly a sewage treatment works. An Auxiliary Lighting Plant. is installed to meet the emergency of a failure from the Main Supply. The Electric, Heating, Steam, Domestic Hot Water, Cold Water, Telephone, Fire Alarms. Wireless and other services are distributed throughout the Colony from the Engineering Centre by means of several miles of. underground subways, which completely link up the whole system of buildings. The Recreation Hall has seating accommodation for 700, is equipped with Projection and Rewinding Rooms for Cinema performances and is electrically equipped for talking pictures and wireless relays to all buildings. A stage for dramatic and other entertainment is fully provided with all necessary mechanical and electrical equipment. The farm buildings are of considerable extent, well stocked for Dairy, Pig and Poultry keeping purposes. There are tennis courts and grounds for all kinds of sports and games, and open lands and woodland for the recreational exercise of patients. Approximately’ £360,000 has, up to the present time, been expended in developing, furnishing and equipping the Colony. County Alderman Sir Cecil De Saris, K.C.B., D.L., J.P., Chairman of the Mental Deficiency Committee and also of the Colony Sub-Committee is chiefly responsible for the development of the Colony up to its present stage. Since the approval of the County Council was given to the Scheme .for the establishment of the Colony his personal attention has been given to every detail of any importance in connection with the buildings, their equipment, the staffing of the Institution and the management of the land. . The County Council is greatly indebted to Sir Cecil De Salis for his valued help and guidance.


1927

Press Cuttings

1934

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1954

1951

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1937

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lower half on next page


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1958 1957

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1962

1961

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1962

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1963

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1969 1967

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1969

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1970 1969

1976

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1979

1978

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1977

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1982 1990

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1994

Daily Telegraph 7 May 1995

E.C.T. - continued from page 34

however, the series was much reduced. It always seemed to me that the wrong patients were receiving treatment if the reputation, of the Block was true, namely that only the most hopeless patients were to be found in these wards. We were, 'going through the motions' rather .than accomplishing something of a concrete nature. I once discussed it with a patient who had passed right through the psychotherapy and psychosurgical mills. In his time he had undergone every treatment it is possible to name, yet still his condition endured. He is still alive, one of thousands, quite forgotten, for he has no relations, and pondering his own private thoughts. 'What's

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your opinion of E.C.T.?' I asked him. 'My dear fellow,' he said wearily, 'your guess is as good. as mine. They've given me everything they know and I' still hear voices and I still see things.' He looked at the floor. 'I can't see anything at this moment, but tomorrow - well, there might be something. I don't know: All the treatment in the world doesn't seem! to stop it. If it's asocial or antisocial or whatever you like to call it to see things and hear things, then I'm asocial 'or antisocial.' 'What were you before you came here?' .'1 was a doctor,' he' said heavily. He was telling the truth. He had been a consultant specialist.‘


John Laing,

the builder of Shenley Hospital Extract from “Laing” by Roy Coad. Hodder and Stroughton, 1979, 2nd Ed, 1992 The largest contracted work during the first half of the thirties was the construction of the great Middlesex County Hospital at Shenley in Hertfordshire, a project which has taken its place in the collective memory of the older Company hands. The securing of this substantial high-grade work (the first stage to the official opening in 1934 cost £800,000, and the second stage which followed added a further £700,000) in fact proved of first importance to the later development of the business, for it meant the retention of a proved and efficient working team throughout the depression years; it was not for nothing that one veteran recalls of Shenley (as of Catterick in the twenties) that ‘practically everybody went to Shenley’. This contract was the first to see the regular use of contractor’s .mechanical plant, though on a small scale in comparison with that of today-and horses and carts were still much used. The Company’s first excavator, an Insley, was in use there, driven by Neville Reece who, during his time with the Company, was to man excavators (up to the vast machines used on the post-war open-cast coal workings) on sites throughout the country. Reece had joined the business in 1927 as a result of John Laing’s personal powers of observation; he had been working with his lorry on a job near the Company’s offices in Bunns Lane and was one day approached by John Laing. ‘I like the careful way you look after that lorry of yourswould you like a job with me?’ He was to stay for the rest of his life, one of the Company’s most trusted workers, whom John Laing would visit for a brief talk on every visit to a site where he was working. ‘Laings were everything to him,’ says his wife. The quality of the work at Shenley was after John Laing’s

own heart. Situated on high ground, with separate buildings connected by subways, and planned by the County Architect, W. T. Curtis, it took the best advantage of its magnificent site, on the Porters Park estate that Middlesex County Council had acquired some years before. When it was fully completed it had accommodation for two thousand patients with all the necessary staff and facilities that made it a selfcontained small town, with an outlying colony a short distance away. The brickwork and masonry were of high quality, and the Company’s most skilled men were employed on the work. Although successive work there lasted for a decade, the main contract required the hospital stage to be handed over in two years, ready for furnishing; in fact not only was it furnished, but also patients were in residence twenty-two months after start of the work. During that period, 50,000 cubic yards of earth had been excavated; 2 miles of reinforced concrete subways and 37,000 yards super of reinforced concrete roads were put down, with 1 1/2 acres of reinforced concrete paving and over 9 acres of suspended concrete floors and roofs; no fewer than 13 million bricks had been laid. The great square water tower, 140 feet high, was a special feature of the contract; eight skilled bricklayers raised the tower five feet every day, with special wage rates for the work. The superb organisation of the contract was in the charge of W.M. Johnson, remembered by one brought up under him in the Company as ‘like a father; next to the governor he had a remarkable way with men, tough but with absolute integrity and never unjustvery like Sir John himself’. There was the closest co-operation and trust between the architect and the team. As on the housing estates, detailed records of production were sent each day to the Company’s office, whether of measured concrete or brickwork or of the use of the plant, and the cost of the work was known in the office by the end of the day. Both quantity and costs were checked against targets, and

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John Laing himself closely monitored progress; he was also frequently at the site, usually arriving before work started at 8.00 a.m. Visitors were proudly taken around the site; the then secretary of the Cumberland Building Society, visiting London for an Association meeting, was one who remembers spending two hours on the site with his chairman and John Laing. The first section of the contract, the main hospital, was opened by King George V on 31 May, 1934, the seventh of John Laing’s contracts to have received the accolade of a royal opening.

Extract from “Life and Belief” by Godfrey Harrison; Hodder and Stoughton, 1954 One contract which he remembers with special pleasure was the building of Middlesex County Hospital at Shenley. It is a large group of buildings high among beautiful countryside in Hertfordshire, and was constructed under Mr. W. F. Curtis, architect, with his deputy architect, Mr. Robertson. The work employed varying numbers of men, at times reaching about 700. The delightful relationships on the contract are illustrated by the following incident. When the work was about three-quarters complete, Mr. Robertson asked if a meeting could be arranged at the office with a certain sub-contractor who had let him down. At that interview, Mr. Robertson explained that this contract had gone on for so long and there had never been one strong letter or one unfortunate word; there had been perfect confidence; and he did not wish one unpleasant word to be spoken for the remainder of the time. He had therefore called the sub-contractor so that he might in a friendly way draw attention to what had taken place and get it put right. There was one notable piece of organisation in that contract-the building of the water-tower. It is something like the campanile of St. Mark’s at Venice, about 150 feet high and four-square. The brickwork is thick at the bottom, diminishing towards the top. The manager, W. M. Johnson, chose eight skilled and loyal bricklayers


and told them he wanted a special effort from them. Two were to work on each wall, raising it to scaffold height (about 5 feet) every day. No one must be absent, for that would break the rhythm of the work. At the end of each nine-hour day labourers were to be standing by to raise the scaffolding and hoists ready for the start next morning. The bricklayers were promised a wage and a half to cover “height work” and to encourage their efforts. The weather was good; not a man lost an hour, and every day the work reached scaffold height. In the lower part each man laid 2,000 bricks a day and in- the upper part 1,000. All the brickwork was pointed inside and out. They were as busy as bees and full of enthusiasm: if you spoke to one of them he would answer without looking up from his job. They were happy while they worked, and proud of their achievement when it was done. It was just an example of team work. The whole hospital was completed, furnished and occupied twenty-two months after work began. It was opened in May, 1934, by King George V. After a contract is completed there is usually a maintenance period at the end of which the contractor is responsible for rectifying any faults that may have come to light. It was so in this case, and at the end of the maintenance period Mr. Robertson, with an assistant, had to look over the whole place and see what remedial work was needed. After half a day’s thorough inspection, he said: “This is marvellous. A contract amounting to over a million pounds and not a pennyworth of maintenance.” The explanation was that W. M. Johnson had wisely left a capable joiner in the place, and had told all the departments of the hospital to telephone the joiner’s office at once if they had the smallest trouble. So if a door or window stuck through some slight shrinkage of timber, or any other little fault appeared, it was put right immediately without waiting for the inspection. The hospital staff were saved all annoyance, and it was a very happy arrangement in every way.

Section of concrete subway with heating and hot water mains, cold water pipes. electric mains, running between buildings. There were over three miles of such subways

one of the male patient blocks

The men’s infirmary - there was a similar block for women

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Typical corridor, leading from the male entrance to the recreation hall building


Programmes from Events

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The following two pages have been condensed from the text and photographs of a report on a very different sort of occupational therapy that took place in Shenley Hospital from 1952 to 1957. It started because there were not enough facilities and buildings to provide any means for several hundred patients to occupy themselves - they lived a life of enforced idleness. This project used male patients to build four large buildings to be used for recreation and occupational therapy. It was a great success and led to a great improvement in the mental state of a number of patients who took part. Ironically, a few years later, such work and gardening by patients were stopped because patients were not being paid.


The Shenley Hospital Occupational Experiment Ever since the introduction of the National Health Service in 1948 there has been a steady increase in the number of occupied beds, of 50 beds a year, so that the hospital now has 2,300 patients using ward space which in 1939 was estimated to provide accommodation for under 2,000. In the same period the facilities for treating new in-patients have remained at their customary high level, and the services provided for out-patients have been considerably extended. The increased demand for accommodation has been found to result from a steady increase in the number of those in-patient’s who fail to respond to medical treatment, and who remain unfit to leave institutional care. With modem methods of treatment a mentally-ill person nowadays has a much better prospect of discharge from hospital than he had 20 years ago, Why is there this constant increase in the number of chronic or long-stay in-patients? Not the least potent reason is that modern methods of treatment are even more efficacious in preserving life than they are in restoring mental health - i.e. the death rate has been lowered more effectively than the discharge rate has been raised. Yet chronic patients, in spite of their lack of response to special medical treatment, do on occasion become fit for discharge, or at least adapt better to social life within the institution, when treated by methods which emphasise their social rather than their medical needs. The basic needs of a chronic or long-stay patient are a reasonable degree of domestic comfort, sufficient recreational activity to prevent monotony of daily routine and facility for undertaking, congenial occupation. In the old or ‘asylum’ days far more attention was given to the occupational need than in more recent times. The advent of voluntary patients in 1930, led towards making mental hospitals more akin to general hospitals where patients’ domestic comforts and recreational amenities have always ranked as more important than the occupational ones. Shenley was built to conform to that more modern orientation, and the hospital offers fewer occupational facilities to patients than do many much older institutions. In 1952 the Management Committee found that when all departments had absorbed their maximum of patient labour, even when good weather enabled the maximum number of patients to work on the land, over a hundred able-bodied men and some hundreds of ablebodied women were still in a continued state of enforced idleness. The amount of additional workshop space required to enable the institution to function efficiently was so vast that it required a building plan of a kind which would take several years to complete even without the restrictions on capital expenditure. However, after an appeal, the Regional Board in 1953 provided a capital sum to be used on an occupational experiment, whereby some male patients, working under the supervision of a nurse who had some experience of the building trade, would endeavour to erect a workshop which

thereafter offer permanent occupational facilities for an even larger number of patients. A start was made on the first building on the 26th January 1953 and it was completed within six months. It could be regarded as no mean achievement for any bunch of amateurs, but when it is considered in the light of the report on the patients who worked on it, it becomes a remarkable achievement. The next, building venture occurred because ward space which had been used to provide a handicrafts department for male patients was urgently required for beds. This would have deprived about 70 male patients of occupational therapy and there would be almost no occupational therapy for the recently admitted and therapeutically most responsive group of patients. The new building was much larger (86 x 42 feet) and structurally more elaborate than the first one. The building party commenced clearing the site on 7th July 1953 and by April 1954. they were putting the finishing touches to the completed building. Since then the building has provided adequate occupational therapy space for newly-admitted male patients. Female patients outnumbered males two to one. No department existed to cater for the occupational needs of acute cases such as that which the males now possessed. So the next step in the building programme would be to provide two buildings for female patients equivalent in size to Building No. 2. In the meantime the hospital had acquired a power-operated mould with which all sizes and shapes of concrete blocks could be made, and Messrs. John Laing & Sons kindly presented the building party with a power-operated concrete mixer. Armed with these useful tools the patients were kept busy making blocks while the plan for the next building was being prepared. Extract from first progress report of 22nd Feb 1954.’ “The most interesting feature of this experiment is the effect which it has had upon the patients who have been occupied in it. A total of 18 individual patients have been occupied on building at one time or another since January 1953.- 17 were drawn from wards accommodating disturbed patients who required night observation; five had come from the refractory ward which accommodates the most truculent and disturbed persons. 166 of the patients had been in hospital for at least one year from the date of their admission, and were suffering from chronic mental illness. All the patients had previously resisted every attempt by the nursing staff to get them occupied, and many had been unsuccessfully tried in various departments. Only two of the patients had any previous experience in the building trade. In less than one year twelve of the eighteen patients had-so improved mentally that they were transferred from observation to non¬observation wards. All twelve were fit for parole whereas previously most of them had been violent and destructive and had

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required the closest nursing supervision”. Two of these twelve patients were discharged from hospital about the time the report was presented. Of the ones that remained three showed Some improvement, but it was difficult to keep them fully employed when the real constructive work on the building finished., so they were transferred to the gardens where they have continued to work well. One, an epileptic, relapsed and became unemployable owing to frequent seizures. The remaining two had to be found lighter employment owing to their physical condition. Since the second building was finished, a further 19 patients have been occupied at various times on building work. Six of these have been voluntary patients, and even as regards those who were of the certified category not all of them were as chronic as the group described in the earlier progress report so that the beneficial effect of occupational therapy is not so striking in this latter group. Their progress in this form of occupation is best indicated by the fact that seven of them have been discharged, and all but one of those still in the hospital are much improved in their mental state and they remain contented members of the building party. Future Policy The next building will have interior equipment for instructing patients in domestic arts. The majority of female patients are married women. Hitherto those interested in domestic work have found that the hospital can offer only occupation in domestic work of a kind which is very remote from the interest of the average housewife, namely, work in the main kitchen, laundry, or sewing room where the emphasis is on massproduction. With the occupational department which is envisaged ladies will be instructed in cooking and other such domestic arts on a normal domestic, as distinct from an institutional, level. The Regional Board has approved of a scheme to supplement this occupational experiment whereby about six pre-fabricated residences will be erected on a site adjoining the occupational departments. These, “pre-fabs” should prove a useful amenity because there are a considerable number ofladies in the hospital who lack the confidence to return to their flats or apartments because they have no opportunity to test their domestic competence In advance ofleaving hospital. Others cannot live alone and need opportunity to test their ability to form a domestic partnership with fellow patients who are similarly handicapped. Thus the facility to experiment with “pre-fabs” should prove a useful supplement to the building, which it is hoped will serve as a domestic science department. Looking yet further ahead it is hoped that the patients will be given the opportunity to build more utility workshops whereby they may contribute to their own maintenance, and even perhaps one day become a self-supporting or “co-operative” community. March 1956


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Photographs Two photos taken by Mrs Beryl MacKay, chair of Shenley League of Friends from the top of the water tower before conversion to apartments, showing the hospital grounds

Music Therapy

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League of Friends holiday at Southsea

Villa 11a - Celebrations

League of Friends outing Waiting for the coach

Occupational Therapy - painting tiles

Working in the kitchen

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Christmas in the Ward

Resting in the Ward

League of Friends holiday at the seasdide


PATTERN OF USE OF SHENLEY HOSPITAL 1982

The following extract is taken from statistics compiled by Peter Jefferys, a psychiatrist at Shenley, and published in 1983

Broadstairs

Broadstairs

Patients on Holidays provided by Shenley League of Friends

Admissions During 1982, 994 patients (425 men, 569 women) were admitted to Shenley Hospital, a 19% decrease over 1981. This decrease was due to two main factors: First, the closure of the H Division acute admission ward in June 1982 with the transfer ,of acute admission service for Pinner and Edgware to the Northwick Park Psychiatric Unit: and second,there was restrictions on admissions from May 1982 until November 1982 because of a national campaign of NHS industrial action. Thus A and B Divisions between them admitted 10% less people than in 1981 and achieved a similar admissions figure to 1980. Almost half the hospital’s admissions (47%) were to A Division, just under two-fifths (39% to B Division and the remainder (14%) to H Division. TABLE A INPATIENT ADMISSIONS SHENLEYHOSPITAL Year A-Div B-Div H-Div Total 1973 504 423 618 1545 1974 504 399 408 1311 1975 511 436 265 1212 1976 490 444 248 1182 1977 534 472 296 1292 1978 507 458 280 1245 1979 451 372 289 1112 1980 464 382 260 1106 1981 504 444 285 1233 1982 464 385 145 994 Table B shows the originating address from which patients were admitted to Shenley since 1913. The significant change from the previous five years - apart from the decrease probably due to industrial action - was that the proportion of admissions from Brent increased to about twothirds (65%) at the expense of Harrow whose patients went to Northwick Park Hospital. TABLE B SHENLEY ADMISSIONS HOME: ADDRESS Year L.B. Brent L.B. Ealing L.B. Harrow Other Total No. % No. % No. % No. % No. % 1913 706 46 143 9 595 38 103 7 1545 100 1914 684 142 382 103 1311 1975 719 146 262 85 1212 1976 714 132 228 108 1182 1977 747 146 283 116 1292 1978 729 148 271 97 1245 1979 631 130 273 78 1112 1980 631 51 139 13 252 23 84 7 1106 1981 697 114 265 91 8 1233 1982 643 65 138 14 138 14 75 7 994

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Table C shows the proportion of elderly patients aged 65 or more admitted since 1975 to the different divisions at Shenley. The overall proportions of elderly admissions fell to 20% in 1982 (compared with a national figure of 24%) and there was an absolute decrease in admissions of 73 patients or 27% compared with 1981. A Division admitted fewer old people in 1982 than in any of the previous eight years and once again B Division admitted the smallest proportion (14%) suggesting that either the demand from the catchment area for dementia beds is unusually low or that B Division is least capable of responding to district demands for in-patient psychiatric care for the elderly. The H Division Psychogeriatric Unit was unable to offer respite admissions or planned inter-hospital or residential care transfer for much of the year and the H Division figures were seriously depressed as a consequence. TABLE C ADMISSIONS AGED 65 AND OVER TO SHENLEY Year A-Div B-Div H-Div Total No % of all No % of all No % of all No % of all admissions admissions admissions admissions 1975 110 21% 59 13% 91 34% 260 21% 1976 90 10% 44 10% 66 27% 200 17% 1977 92 17% 39 8% 80 27% 211 16% 1978 102 20% 62 13% 96 34% 260 21% 1979 96 21% 47 13% 92 32% 235 21% 1980 103 21% 49 13% 74 28% 226 20% 1981 95 19% 66 15% 111 38% 271 22% 1982 85 18% 55 14% 58 40% 198 20% Reduction in Patient Numbers Table D shows that over the 12 year period 1910 - 1982 the total Shenley patient population fell by 40% from 1701 to 1027 patients, male and female falling by a similar proportion. The fall between 1981 and 1982 was 4.5%, a similar drop to the previous year. Analysis of the fall in patient numbers in relation to their length of stay (see Table H) reveals that the 1981 - 1982 fall was very largely due to the closure of the Harrow acute admission ward, with short-stay patients. There was a fall of only 16 patients or 1.8% in the hospital’s long-stay patient population (all resident patients in for 12 months or more on December 31st 1982) over 1981. Between 1977 and 1981 a redistribution exercise between divisions was conducted with the result that by the end of 1982 36% of the resident patients were on A Division, 32% on B Division and the same proportion on H Division. H Division was the successor to the male division of Shenley and this is still reflected in the sex distribution of its patients even though some wards and patients have transferred over the past decade. In 1972 88% of the hospital’s male patients were on H Division. Now at the end of 1982 it is 50% (215 patients) and H Division houses only 19% (115) of the hospital’s female patients.

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TABLE D RESIDENT SHENLEY PATIENTS AT 31ST DECEMBER EACH YEAR Year A Division B Division H Division Total male Total 1970 503 509 679 715 986 1701 1973 456 413 643 656 856 1512 1975 437 397 551 581 804 1385 1976 381 379 539 539 760 1299 1977 373 366 512 535 716 1251 1978 346 361 468 518 677 1195 1979 364 338 467 487 682 1169 1980 366 382 375 474 649 1123

Total Female

Borough of Origin Table E shows the distribution of patients at the end of each year by borough of origin. At the end of 1981, 481 patients or 45% of the total originally came from Brent, 99 patients or 9% from Ealing and 275 patients (26%) from Harrow. A fifth of the hospital’s patients were originally admitted from’ other parts of London, most of them before 1950. TABLE E BOROUGH OF ORIGIN: RESIDENT PATIENTS AT 31 ST DECEMBER Year LB Brent LB Ealing LB Harrow Other Total 1976 548 42% 125 10% 307 24% 319 25% 1299 1977 530 119 309 293 1251 1978 522 122 292 259 1195 1979 506 114 296 253 1169 1980 504 45% 100 9% 286 25% 233 21%, 1123 1981 481 99 275 217 1072 1982 457 45% 113 11% 259 25% 198 19% 1027 The Divisions within Shenley have been trying to become more self-sufficient over the past five years and this is reflected in the distribution of patients between Divisions by their borough of origin, with 1976 figures contrasted with 1981. (Table F) Table F DIVISIIONAL DISTRIBUTION BY BOROUGH OF ORIGIN

Year Brent Ealing Harrow Other Division Division Division Division Year A B H A B B A B H A B H 1976 233 166 149 18 80 27 47 44 216 83 89 147 1981 234 164 83 19 66 14 44 43 188 74 71 72 1982 227 148 82! 27 75 11 48 41 170 68 63 67


E.C.T.

Patients received no breakfast the day they were booked to receive Electro-convulsive Therapy or E.C.T. was a treatment. Some were allowed commonly used treatment in mental hospitals. a cup of weak tea, hut most had An extract from ‘Brother Lunatic’ by Paul Warr’. nothing at all. Treatment time was Published in 1957, it is perhaps one of the most 10 a.m. and started as soon as important books on the subject of that decade. the doctor arrived. In the Block Paul Warr (a pseudonym) was a newspaper (where the author worked) patients reporter who decided to take up a career in were brought from other wards to a central point, where beds, psychiatric nursing (at Shenley) and recorded his heavily laden with rubber sheets, experiences during his training. Whilst what he and coarse linen were lined up in describes is frightening and appalling, it is also an annexe open to the view of all. very sobering as he gives an honest account of They were put between the sheets how he was sucked into behaving the same way and told to stay quiet. Meanwhile, as some of his nursing colleagues. nurses brought files of case papers for each patient; and these were ut what. is E.C.T.? In effect it consists of an deposited; in the clinic against the time when the doctor instrument known irreverently among nurses as the 'juke-box.' It is about the size of a table radio and it would make an entry to the effect that each patient had, has tuning dials and two leads, to the ends of which are in fact,. received treatment. It took the full-time services of four nurses to deal with fixed two electrodes. After the patient's temples have, been swabbed with a saline' solution-this gives quick the session. The first patient was straightened out - many and effective conduction-the electrodes are clamped to patients automatically assume a primitive foetal position the temples by means •of a semicircular metal band: in bed - and all pillows removed. The patient was then A rubber gag .is then inserted between the teeth to stretched out-and: the temples swabbed with saline. The stop the patient biting his tongue. The current is then electrodes were clamped in position by a nurse and the waiting doctor switched on the 'juke-box.' The duration switched on by the doctor in charge of treatment: The contraption rests. on a trolley so that it can be of the shock could be controlled, depending upon such moved from one bed to another on the assembly line factors as the patient's resistance and the result of previous treatments. While electrical current ,was actually of those booked to receive shots. This apparatus, consisting of a simple generator passing between the lobes of the brain, there was little enclosed in a box, creates an electric current which passes reaction from the patient; as soon as the electrodes were removed and the gag firmly secured between the teeth, in minute impulses across the lobes of the brain. E.C.T. sessions are frequent in most mental hospitals, and an epileptiform fit commenced. This passed through patients are given a series 'of progressive shocks until they separate phases, the patient first becoming flushed show improvement or remain at par. In the latter event the and finally cyanosed until peace came and the typical. course is discontinued for the time being and the case is snoring somnolence started. In the early days before the precise effect of E.C.T. was gauged, patients bit through reviewed . When I first saw E.C.T. administered I was horrified. their tongues, rolled about on their beds and managed to injure themselves to such an extent that precautions had

‘B

This scrapbook was produced by David Simmons

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to be taken. Even now, it is not unusual for a patient to arch his back during treatment then fall back on the edge of the bed' and damage his spine. Such happenings were common enough. Nobody seemed to worry. Patients do not know what happens to them .during treatment. Those .I questioned who were sufficiently coherent to talk with any good sense at all said that they clearly remembered lying down on the bed and seeing the electrodes before their eyes for an instant. The shock itself was unknown to them: It was part of the general oblivion. After E.C.T. the ward looked as though chaos and disorder had passed through it hand in hand. Patients were incontinent, no matter how great the precautions to keep food and drink away from them beforehand. Many of the beds dripped urine or were smothered in faeces. Some of the doctors did not mind this unpleasant sight, others protested that nurses should do their job better. One doctor, a female, came to administer treatment and carried the whole business through regardless., of how much degradation she saw, keeping .a perfectly straight face. She operated the E.C.T. apparatus as though it was a telephone switchboard, passing from bed to bed like a featureless automaton. In one case E.C.T. had a most peculiar effect upon a patient. Immediately after the shock had been given, he kicked off the bed-clothes and unconsciously exhibited an erection. The doctor did not bat an eyelid. The merriment-of the nurses was intense. […] It was not unusual for the wrong patients to be sent to the ward for E. C. T. Nurses new to one ward selected four patients at random and packed them off'. with case papers. The fault was never officially uncovered. When the nurses realised their faux.pas they made elaborate excuses to .the charge nurse, who rapidly erased entries on the case papers. It is said that in America E. C. T. has produced notable results, among depressed and suicidal patients .. On the average, a series of fifteen to twenty-one treatments were given at one institution. In my hospital,

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Hidden Minds Scrapbook