Abstract
Minister of Health Enoch Powell’s Hospital Plan for England and Wales (1962) is a familiar landmark in twentieth-century psychiatry.1 In 1961 Powell’s ‘water tower’ speech to the National Association of Mental Health eloquently launches the ideas contained within the plan.2 It is an evocative portrayal of asylums as grand, obsolete monuments to Victorian ideas of mental-health care. There is much historiographical focus upon how the plan augurs the scaling back of mental inpatient provision, but much less on how it signals the broader uptake of a new model of integration between psychiatry and general medicine. This model, based upon the establishment of psychiatric units in district general hospitals (DGHs), involves a more intimate connection between general hospitals and psychiatry than do observation wards. The DGH psychiatric units promoted by the plan undercut the progressive status and bridging function of the observation ward.
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For example P. Sedgwick, Psychopolitics London, Pluto Press (1982): 104;
A. Rogers and D. Pilgrim, Mental Health Policy in Britain 2nd ed. London, Macmillan (2001): 64–5
E. Powell, Emerging Patterns for the Mental Health Services and the Public London, National Association for Mental Health (1961)
J.D.N. Hill, ‘Review of Policy on Psychiatric Research — Summary prepared by Dr. Denis Hill of the proposals made in his talk to Council on the 16 January 1959’; 16 January 1959: review of psychiatric research by Dr J D N Hull [sic], 1959 TNA: FD 9/91; see also G.M. Carstairs, This Island Now Harmondsworth, Penguin (1963) and
H.R. Rollin, ‘Carstairs, George Morrisson (1916–1991)’ in Oxford Dictionary of National Biography London, Oxford University Press (2004)
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N. Kessel and M. Shepherd, ‘Neurosis in Hospital and General Practice’ Journal of Mental Science 108 (1962): 159–66;
N. Kessel and H.J. Walton, Alcoholism Harmondsworth, Penguin (1965);
N. Kessel and G. Grossman, ‘Suicide in Alcoholics’ British Medical Journal 2, 5268 (1961): 1671–2
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For example, I.R.C. Batchelor and M.B. Napier, ‘Broken Homes and Attempted Suicide’ British Journal of Delinquency 4 (1953): 101
N. Kessel and W. McCulloch, ‘Repeated Acts of Self-Poisoning and Self-Injury’ Proceedings of the Royal Society of Medicine 59(2) (1966): 89 referring to N. Kessel, W. McCulloch, J. Hendry, D. Leslie, I. Wallace and R. Webster, ‘Hospital Management of Attempted Suicide in Edinburgh’ Scottish Medical Journal 9 (1964)
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In fact, Scotland has its own Mental Health (Scotland) Act (1960), but these are treated as almost identical by some researchers. See for example M. Woodside, ‘Are Observation Wards Obsolete? A Review of One Year’s Experience in an Acute Male Psychiatric Admission Unit’ British Journal of Psychiatry 114 (1968): 1013. In any case, the point here is about publicity and visibility, something much more relevant to the 1959 Act.
A.B. Sclare and C.M. Hamilton, ‘Attempted Suicide in Glasgow’ British Journal of Psychiatry 109 (1963): 609, 614
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Kessel et al., ‘Hospital Management’: 334; McCulloch and Philip, argue later that ‘persons unskilled in psychiatry tend to equate the severity of the physical state with the severity of the underlying problem. There is no such easy equation’. W. McCulloch and A.E. Philip, Suicidal Behaviour Oxford, Pergamon (1972): 31
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N. Kreitman, ‘The Coal Gas Story. United Kingdom Suicide Rates, 1960–71’ British Journal of Preventive & Social Medicine 30(2) (1976): 86–93;
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Millard, C. (2015). Self-Harm as a Result of Domestic Distress. In: A History of Self-Harm in Britain. Mental Health in Historical Perspective. Palgrave Macmillan, London. https://doi.org/10.1007/978-1-137-52962-6_5
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