7th Annual Mayor Medical Lecture
Read MoreMy research on the Worcester Development Project: An Overview
For the past few months, I have been researching the history of mental health care within Worcester, which has led to me finding some boxes of documents in The Hive detailing the Worcester Development Project (the project undertaken in the 1970s-80s to modernise mental health care within the district). The Project proposed was the closure of the large mental hospital, Powick, that had served Worcester and the surrounding areas since 1847, and the replacement of this with an integrated system of day units, general hospital wards, rehabilitation hostels and purpose-built mental health units within the community[1].
Closure of Powick was planned for 1980[2] and was marketed as a positive, revolutionary change for the treatment of mental health in Britain; however, the response to the closure of Powick and the new system was varied within the community. Some viewed community care as a logical extension of the previous changes to mental health care such as the introduction of drugs which made institutionalisation less necessary overall, whilst others saw it as the unnecessary closure of a community itself without enough consideration to the effect this would have on the patients[3]. Powick was finally closed in 1989 after substantial delays and the new system of community care was launched[4].
In 1968, Powick was a large site with 949 beds that served both short-term and long-term patients. Powick was actually performing better than the national average, with only 16% of patients classed as long stay[5]. Despite this positive performance, there was a growing philosophy among politicians and some professionals that the old style mental hospital led to isolation from the community and as a result, the institutionalisation of many long-term patients. The growing condemnation of mental hospitals is displayed in the 1968 World in Action documentary featuring Powick, which arguably set out to present a negative portrayal of the hospital in order to further condemn mental hospitals and rouse support for community care[6]. Along with this public condemnation of institutionalisation, there was a focus on the positive effects community-based care could have and a general sentiment that community care would be a more effective way of treating mental health. For instance, whilst the World in Action documentary displayed a lack of privacy and dignity for patients, documents found in The Archives included rhetoric based around promoting the ‘self-determination and autonomy’ and the ‘dignity’ of patients through community care[7]. It would seem that although not everybody agreed with the closure of Powick, the direction of political and public rhetoric pushed the community care agenda until it was recognised as the next logical step for mental health care. In 1983, the Griffiths Report on the NHS recommended that the closure of mental hospitals was necessary, and so this is what eventually happened[8].
Before the implementation of community care, mental health services in Worcester and the surrounding area were primarily comprised of Powick Hospital, Worcester Royal Infirmary, Kidderminster General and a day unit in Evesham, Malvern. This was supported by just a few rehabilitation hostels such as Perryfields hostel which provided 12 beds[9]. Some community services were already in place but this was more of a fragmented system, which was to be replaced by a complete system of care. The government and the Health Authorities were aiming for smaller, dispersed units throughout the area where patients would be treated in the locality, giving them access to the amenities of the local community. It was thought that this style of mental health care would foster greater independence and ability for patients to re-join the community after treatment.
For instance, one unit set up as part of the Worcester Development Project was the Franche Road mental health hostel, which opened early on in the project in 1976. It was initially built to accommodate 12 residents and then later increased to a maximum of 15. The aim of this hostel was to provide rehabilitation care and eventually aid the transition of residents into independent living. Out of 71 former residents surveyed, the majority of them had moved on into independent facilities such as council houses, privately rented accommodation or purchased their own house[10].
Complete information for every single unit set up could not be found but the below table sets out information on a number of the units that were provided as part of the Worcester Development Project and shows the breadth of the Project. Many more day units and hostels were established as part of this project, going some way to make up for the loss of beds at Powick.
(information for the table found in BA12248/1 (v) 'NHS Advisory Service and DHSS Social Services Joint Report'; bA12247/2 (ii), 'Folder of notes on the Worcester Development Project'; P. Hall and I. Brockington, The Closure of Mental Hospitals, 1981)
Furthermore, although less long-term beds were provided, it was found that the number of contacts between patients and day hospitals/units had increased exponentially between 1971 and 1988, the years in which Powick was run down. The attendance at day hospitals is particularly notable – with an increase from 189 attendances in 1971 to 25,772 attendances in 1988. Clearly the new facilities that were set up were utilised by many more patients than they had previously, providing support to previous long-stay patients. The below table, taken from Hall and Brockingon's The Closure of Mental Hospitals, details the increase in importance of day units as the number of beds at Powick was decreasing.
Source: P. Hall, I. Brockington The Closure of Mental Hospitals, 1981 p. 84.
Whether or not the population of Worcester thought this new style of care was better or worse than the treatment provided by Powick is not an easy question to answer, with a variety of opinions depending on each individual circumstance. Some thought that implementation of community care was a necessary modernisation of mental health services. Conversely, some disagreed with the ideals of community care as they thought for some patients, the routine and the safety of Powick was a positive thing. This research instead serves to provide information on the topic based upon documents contained in The Hive, piecing together why the Worcester Development Project was undertaken in the first place and what units were set up as part of this project.
Fern Evans
[1] P. Hall, R. Gillard, ‘The Worcester Development Project’ International Journal of Social Psychiatry, Volume 28, 1982, p. 163-172.
[2] Archive Reference BA12248/1 (viii) ‘Powick Task Force final draft version, 25 May 1987.
[3] BA12248/1 (xvi) – Dream or Nightmare? The Closure of Long-Stay Mental Hospitals and Community Care.
[4] P. Hall, I. Brockington, The Closure of Mental Hospitals, 1981.
[5]BA12248/1 (i) ‘Draft Feasibility Study for the Worcester Development Project, June 1969.
[6] TV Documentary, ‘World in Action’, 1968.
[7] BA12248/1 (xii) ‘Worcester Mental Health Unit – Community Staffed Homes in Worcester, Operational Philosophy’.
[8] BA12248/1 (xvi) – Dream or Nightmare? The Closure of Long-Stay Mental Hospitals and Community Care.
[9]BA12248/1 (i) ‘Draft Feasibility Study for the Worcester Development Project, June 1969.
[10] BA12248/1 (iv) January 1985, Comprehensive Operational Report on the Mental Health Hostel in Kidderminster.
DON'T DESTROY THE MEDICAL MUSEUM!
The collections now held by the George Marshall Medical Museum were nearly done for!
A clipping from the Worcester Evening News on Monday 17 February, 1997.
The ‘Worcester Development Project’ and the transition from institution to community care
For the past few months I have been researching Worcester’s modern medical history (using the Archives at The Hive), with the aim of developing a final topic of discussion based around the NHS and health authorities within Worcester. Within the primary resources I found at The Archives, I found myself drawn to the resources regarding the treatment of mental health. With some more research, I found that a project had been undertaken in the 1970s and 1980s with the express aim of making the transition from the more traditional style mental hospital, Powick, to a new idea of ‘community care’. This became the Worcester Development Project.
The Worcester Development Project was devised in the early 1970s and was initiated by the Department of Health in 1978. It was termed a ‘test-bed’ for a new style of mental health treatment, in an attempt by the government to move away from the previous use of large mental hospitals and move towards a system in which treatment of mental health would be carried out within the community. This was primarily to be done through the closure of Powick Hospital and the establishment of a complex system of replacement units such as day centres, wards attached to general hospitals, and residential hostels[1]. Originally built in 1852, Powick was a large institution that in relation to the national performance of such hospitals, was performing above average; a draft feasibility study compiled by the Department of Health and Social Services in 1969 indicated that only 16% of patients at Powick were classed as long-stay, performing better than the national average[2]. Despite this, the idea of treatment within the community instead of more isolated institutions was growing amongst the government and the public and ultimately, a new system of care was developed with Worcester.
Previously unaware of the use of Worcester by the authorities as an ‘experiment’ of a new way of treating mental health, the topic intrigued me. The focus of my attention for the remainder of my research will therefore be on the transition from institution to ‘community care’ carried out within Worcester during the Worcester Development Project.
Within this broader area of discussion, I have identified three key areas of research necessary; the reasons for community care and the driving forces behind this, a comparison between the initial plans for the project and the eventual outcome, and thirdly the public reception of ‘community care’ and responses to the Project from a variety of different sources. Through this, I am hoping to find and present an interesting account of the transition from institution to community within Worcester, taking into account different sources with different agendas, focuses and viewpoints.
Powick Hospital from the air, ©Charles Hastings Education Centre