Sunday, January 14, 2024

Mental Hospitals: Another column for the Journal of Critical Psychology, Counselling and Psychotherapy

More about the JCPCP on the Egalitarian Publishing site. I've slightly lost the thread of which issue which column has appeared in, but this one came out some time last year.

I reviewed The Premonitions Bureau on this blog.


The hospital consumed 865 pints of milk per day. The grounds were infested with feral cats, which were a source of ringworm. There was a single post box, by the front door, for patients, staff and the hospital itself, which was often full to overflowing, meaning that letters often went missing. Nurses smoked constantly, in part to block out Shelton all-pervading smell: of a house locked up for years, in which stray animals had occasionally come to piss. The kitchen had a butcher with an attitude problem and the laundry sometimes went wrong, meaning that patients were forced to wear socks shrunk to half their normal size.

That’s Sam Knight writing about Shelton Hospital, Shrewsbury, in the 1960s in his The Premonitions Bureau. 

And could anyone agree what such county asylums were for? Was it cure? Containment? Elimination?

Around a dozen people died every month at Shelton, mostly from old age. But every few weeks, someone would throw themselves out of a bathroom window, or hang themselves from a tree by the cricket pitch, or escape and throw themselves in front of a car. The primary means of discharge was death.


It was Enoch Powell, as a health minister in Harold Macmillan’s government, who brought the questioning of the need for these strange institutions into the political mainstream. In a speech to the National Association for Mental Health in 1961, emboldened by the promise of newly introduced psychiatric medication, Powell talked of his desire to see greater provision of community care for mental health patients.

He estimated that the number of psychiatric beds could fall by 75,000 within 15 years, with the result that many institutions would no longer be needed. He emphasised that their buildings were not fit for purpose and should be closed rather than found other functions.

Powell continued in what one wishes were the words he is best remembered for:

"This is a colossal undertaking, not so much in the new physical provision which it involves, as in the sheer inertia of mind and matter which it required to be overcome. 

"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."


Why did these hospitals have those gigantic water-towers and chimneys? Dr Claire Hilton, the historian in residence at the Royal College of Psychiatrists, once discussed the question on the college’s website.

One reason was the institutions’ remoteness, whether this was dictated by a Victorian faith in the restorative powers of country air or a more 20th-century desire to hide the unfit away. It meant they often lacked mains water – many villages were not connected until after the second world war – so pumping water up to a storage tank at the top of a tower was the only way to ensure a sufficient and reliable supply. And the size of the asylums, which might have over 2,000 residents, dictated that those tanks would be huge.

Hilton quotes an 1894 book on the management of asylums as recommending the water tower be at least 20 feet higher than the highest part of the rest of the building and the tank capacious enough to hold at least 48 hours' supply. And in those days, the pumping this entailed meant the hospital needed a powerful steam engine – hence the chimneys.

The water supply had another use: fighting the fires to which their conditions made these buildings vulnerable. Many asylums, says Hilton, formed their own fire brigades of staff and patients.


If you had an engine in steam every day, then you got through a lot of coal. And that coal had to be brought to the hospital, often over inadequate rural roads. The solution many hospital boards and councils came up with was a railway: sometimes a whole complex of lines.

In 1896 the London County Council purchased the Horton Estate in Surrey with the intention of building a cluster of mental hospitals and other institutions there. A railway system, linked with the main line, was built to carry materials for the construction of the hospitals and then carry the coal and other goods they required for day-to-day operation. The cluster, naturally, had its own power station.

In the 1920s the volume of coal and coke delivered to the power station, and to glasshouses at one of the hospitals, reached a peak of 15,000 tonnes per year.

This railway system was little used during the second world war, when some of the hospitals were given over to wounded and recuperating soldiers, and it was scrapped not long after hostilities ceased. But before it closed, enthusiasts in sports jackets and flannels came to photograph the operations for railway magazines. It is said you can still find traces of the lines among the housing estates, private roads and golf courses that now occupy the Horton Estate.


By 1968 Shelton had long relied on the Shropshire Fire Brigade to fight its fires, but whatever fire-prevention measures it had in place that year failed. Soon after midnight on 26 February, a blaze broke out and 21 female patients died.

An investigation found staffing at Shelton to be ‘on the low side’, the night staff had no training in evacuation and locking patients into wards was accepted practice. The Shrewsbury Fire Brigade reported that the 10-minute delay between a night nurse discovering the fire and the alarm being raised contributed to the death toll.

In The Premonitions Bureau Knight says:

The fire alarm system, which had been installed in 1962, was tested every day at noon. Three large bells and a siren, mounted on the hospital roof, sounded across the grounds. But barely anyone knew how it worked.

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