The Moral State We’re In. Julia Neuberger

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СКАЧАТЬ of young women with learning disabilities, ostensibly to protect them from unwanted pregnancies but presumably also because of fears about the children they might produce. Broadly speaking, however, theories about degeneracy and contamination of the gene pool had become unfashionable because of their Nazi associations. Therefore the assumption had to be made, for want of any other theory, that mental ‘defectiveness’, as well as insanity, was a health issue. With the establishment of the NHS, local authority hospitals were transferred to the Ministry of Health, but there was little change in conditions.

      However, the drugs did change. Largactil, along with other anti-psychotic phenothiazines, appeared around 1955. It controlled symptoms without the sedative effects of the old drugs. Despite being a form of control, such drugs were widely used and community care became easier and less risky. In 1953, almost half the beds within NHS hospitals had been for mental illness or mental ‘defectiveness’. However, after 1954, the number of patients in mental hospitals began to decline and moves were made to change mental hospitals into institutions like those for physical diseases.

      In 1959, the Mental Health Act excluded promiscuity or other immoral conduct as grounds for detention under the Act. The idea of moral degeneracy was beginning to fade, as well as the beginning of a realisation that institutionalizing people was bad for them.

      No new large-scale asylums were built after the Second World War, but hospitals for mental ‘defectives’ continued to be built until 1971. And the old institutions remained. By 1966 there were still 107 mental illness and 66 mental handicap hospitals with two hundred or more beds. The following year Sans Everything was published, a collection of articles by Barbara Robb about how elderly people were treated in institutions, particularly in psychiatric and geriatric care. It caused a storm, and the official investigation, in 1968, substantiated most of what she said.

      The Era of Inquiries

      And so we come into the great era of inquiries, from the early 1970s onwards, and the gradual shaming of the institutions for the mentally ill and of those who worked in them. Virginia Beard-shaw’s later work for Social Audit in the late 1970s and early 1980s pulled together a great deal of the evidence from those inquiries about who blew the whistle on what was going on in some institutions for the mentally ill.

      For example, there is the case of Ken Callanan and Art Ramirez, two student nurses who were forced to stop training at Brookwood Hospital in Surrey after staff and management united to discredit them. In August 1978, Callanan, a former merchant seaman aged 29, began training as a psychiatric nurse at Brookwood Hospital School of Nursing. His introduction to nursing included a lecture on nursing ethics during which his Director of Nurse Education told the class that: ‘If I find that any of you have ill treated a patient or failed to report ill-treatment by other staff, your feet will not touch the ground. I will personally show you the door.’*

      After twelve weeks of training he was sent for his second practical posting on Tuke 4, a ward named after that great reformer of mental health services two centuries earlier. Tuke 4 was a ward for the chronically mentally ill–in other words, a long-stay ward. Here, in early 1979, Callanan witnessed repeated abuse of patients by the ward’s charge nurse, who had been at Brookwood for years and was well liked.

      Callanan’s next posting convinced him that what he had seen on Tuke 4 reflected systematic abuse and malpractice. A fellow student, Art Ramirez, told him that he had seen the same charge nurse kick a patient. So, in a confidential letter, Callanan told his unit Nursing Officer about the ill treatment he had seen. The investigation was delegated to the Senior Nursing Officer, who knew the charge nurse well. The investigation continued for about a month, but even before its results were known feelings against Callanan and Ramirez were running very high and staff threatened a walk-out unless the pair were suspended. Management ‘compromised’, as Beardshaw puts it. The two were sent to the training school, with nothing to do.

      After the SNO’s investigation, the charge nurse was completely exonerated. Callanan’s ‘inexperience’ had led him to ‘misinterpret’ what he had seen. Despite the official exoneration of the charge nurse, the other staff continued to threaten to walk out if Callanan and Ramirez were allowed back and the local branch of COHSE (Confederation of Health Service Employees, as it then was) voted to recommend Callanan’s expulsion from the union.

      Callanan and Ramirez were offered a deal: they could return to work if they were prepared to accept, sight unseen, the internal investigation’s findings and a new procedure for making complaints. The students agreed to the complaints procedure in principle, but could not agree to accept the internal investigation’s results without having seen it.

      On the Royal College of Nursing’s advice, the pair took their concerns to the Beaumont Committee, which Surrey Area Health Authority had set up to look more widely at conditions in mental institutions. A string of staff witnesses defended the charge nurse, both to the Beaumont Committee and to the General Nursing Council Disciplinary Committee, to which Callanan had referred the case. But the strength of the students’ evidence did convince a lot of outsiders. In February 1980, a year after the abuse was first witnessed by Ken Callanan, the charge nurse was finally struck off the General Nursing Council’s register, after five charges of ill treatment and drug abuse were found proven. He was dismissed from Brookwood. In April, the Beaumont Committee upheld the students’ allegations, saying that the pressure they had been put under by fellow and senior staff and the union was deplorable. Art Ramirez left Brookwood and trained elsewhere. Ken Callanan became an ambulance man, a great loss to mental nursing.

      We see the same pattern in inquiry after inquiry. A few brave staff members–people of great conscience, who are prepared to take risks with their own livelihoods and reputations for the sake of others–tell the authorities what they have seen and heard, but it rarely does them any good. Few of them ever reach any kind of senior position, even after allegations are proven.

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