Mad Worlds (26 page)

The
administrative settings
and people's
job titles
were different then. An outline of these should help you appreciate nuances in formal relationships.

Within the NHS were the
Mental Hospitals
– built in the 19
^th
and early 20
^th
centuries as the city and county asylums (and re-named in the 1930 Mental Treatment Act). In each of these the boss was the
Medical Superintendent
, a consultant psychiatrist by profession. The institutions varied a lot in their regimes. Many still reflected the harsh containment approach of most asylums, despite recent developments in drugs known to alleviate and control the worst behavioural symptoms of the major afflictions. Others (probably a minority) were relatively enlightened, with fewer constraints on patients' behaviour and efforts to heal and rehabilitate. As you'd see in the latter part of this drama, a Medical Superintendent's attitudes and personality would greatly influence the nature of a regime.

Within each local authority was the
Health Department.
Heading this up was the
Medical Officer of Health (MOH)
, a public health doctor by profession. In the MOH's empire were public health inspectors, health visitors, home helps, district nurses, midwives, and at least one duly authorised officer in mental health – the DAO (who carried enforcement powers).

Mental health liaison
between hospital and local authority tended to be quite minimal. In ‘Mad Worlds', at least our fictional MOH valued cooperation with Springwell, and DAOs could attend psychiatric lectures to student nurses. By the early 1960s, some close partnerships were developing – e.g. between hospital social workers and local authority mental welfare officers (as the ‘59 Act renamed DAOs).

The
legislative context
would soon change. Still in force was the 1890 Lunacy Act, reflecting a legal approach, with two main underlying premises – that only folk certified insane should be taken to an asylum, and that the public must be protected from such ‘lunatics'. To safeguard liberty, lay magistrates would be involved in certifying. The 1930 Mental Treatment Act modified this to allow people deemed ‘of unsound mind' to enter as voluntary patients, and advocated the setting up of outpatient clinics. The name ‘mental hospital' also came in then. By the 1950s in some areas the JP bowed to medical opinion. The DAO, with mental health knowledge and experience, was increasingly a key figure in emergencies. But the 1890 Act was not repealed until the 1959 Mental Health Act, which reflected a medical approach (without JP involvement) and was aimed at helping ‘mentally ill' people. In 1956-7, when the main action in this novel occurs, the 1954-7 Royal Commission on Mental Health was yet to report, and have its main recommendations adopted in the 1959 Act.

Bill Douglas