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Abandoned Asylums and Community Psychiatry

Updated on August 27, 2013

An Urban Explorer's Photgraphic Dream

St Johns Hospital, formerly The County Pauper Lunatic asylum in Bracebridge Heath, Lincoln UK
St Johns Hospital, formerly The County Pauper Lunatic asylum in Bracebridge Heath, Lincoln UK | Source

The word ‘asylum’ conjures up thoughts of madness, lunacy, insanity and bedlam. Pictures of deranged people screaming or foaming at the mouth spring to mind, whilst electric shock treatments, lobotomies and padded cells are not far behind. The above is a photo of an abandoned asylum, that of St John’s Hospital near Lincoln in the UK. This is where psychiatric patients were treated up until 1989/1990 when it closed its doors for the last time.

St John’s Hospital would have originally been intended for 200-300 pauper lunatics when it opened in 1852 but over the years it extended regularly to treat many more. Its name changed regularly too and it wasn’t called a hospital until the early 1960’s. It was set in 120 acres of land, some of which was used for farming and a cemetery. In the early days, patients would have been selected for admission by the local doctor after they had officially been declared ‘insane’. What constituted insanity would largely have been left to the doctor’s educated opinion but mild depression, anxiety (considered neurotic), or even being single and pregnant alone could have seen you admitted to such a place!

Exploring Old Asylums

A markerBracebridge Heath, Lincoln, Lincolnshire LN4 2JZ, -
Bracebridge Heath, Lincolnshire LN4 2JZ, UK
get directions

St. John's Hospital in Bracebridge Heath, Lincoln UK.

Now, most of the asylums in the UK have been closed and lay either derelict or demolished. Urban explorers frequent the buildings in search of photos from the past and ghost hunters are naturally drawn to them by the many deaths either by suicide, natural causes or mistreatment. They are indeed spooky places, having visited an abandoned one myself and in my youth I was a patient in one for almost two years! I had depression but was placed on an acute ward with some of the most mentally ill. I can vouch for the isolation and fear that these mental institutions once held. You did indeed often hear shouting and screaming and if you happened to be in one of the long corridors at the time, the sounds echoed in a horrifying way.

Chilling Memories!

Asylums were usually built on the outskirts of cities or in the countryside and thus mental health patients were isolated from mainstream society. The fact that asylums were designed to be self contained further isolated those with mental illness. They could work within the asylum, eat and sleep all at the same time as receiving treatment with little or no contact with the outside world. This suited society as stigma, discrimination and fear of mental illness was high in the 1800’s. Building the asylums would have been a great relief to society but the confirmation of total control by the medical profession towards those with a so-called ‘mental illness’. There was no community care as such in the early days and mental health treatment was not about helping people to recover.

Why Were Asylums Closed?

  • Changes were instigated when the National Health Service (NHS) was introduced in 1948. It became recognized that patients were being held in asylums long after they were actually fit enough to be discharged. Originally, most would have been inpatients for life but it became clear that after an acute phase of illness there was often no legitimate reason for these patients to be held any longer.
  • The Mental Health Act 1959 recognized that patients had rights and that it was an infringement of their civil liberty to be held in an asylum against their will. There was a great need to differentiate when a patient could choose for themselves whether to accept treatment for mental illness or not. i.e. voluntary admission against involuntary admission.
  • From the 1950’s and 1960’s more controlling psychiatric drugs became available and this meant that patients could take these at home once a crisis had been resolved.
  • Charities began to back the rights of those with mental illness bringing a shift in social attitude.
  • The asylums were becoming run down and extremely costly.

Psychiatrist R.D Laing began challenging the idea that all mental illness had a biological cause and that there was a psychosocial element to address with mental illness. Although this wasn’t a primary reason, it was pivotal in opening new opinions on the treatment of mental health. He suggested other factors such as social and cultural could play a part, dispelling the myth that to lock up and medicate was the only way. A more holistic way of treatment was encouraged. His eye opening film ‘Asylum’ caused much debate around that time.

The Beginning of Modern Community Care

In the 1960’s Sociologist Erving Goffman wrote of the effects of institutionalization on the minds of mental health patients. The Minister of Health Enoch Powell gave his famous Water Tower Speech in 1961 in which he spoke of the isolation of asylums and the need for community care to become involved in the treatment of mental health. He spoke of bringing together the social services with the hospital environment, indeed, giving it a driving element outside of the hospital service.

It wasn’t until the 1980’s that asylums were condemned and closed but before then, community provision slowly began to emerge.

After the 1983 Mental Health Act there came the Mental Health Act Commission set up to protect inpatients. Controls over ECT treatments, surgery and drugs were legally changed to benefit choice by patients. National bodies and charities became involved in giving more rights and support to patients too. Community care evolved by way of supported housing projects, day care services, community mental health nurses and community psychiatric social workers. The National Service Framework for Mental Health has been responsible for setting standards in community mental health with models being proposed. This body has grouped mental illnesses and set standards and models for those groups.

Is the Closing of Asylums a Good Thing?

Going Home

When asylums closed, each was treating literally several hundreds of patients. Suddenly, provision had to be found for all these patients. Some didn’t even have a home to go to. Some were moved to psychiatric units or wards within local general hospitals. Accommodation was built in anticipation of the closures but many were released to live alone, in group dwellings, care homes or back to family. Asylums did take the responsibility away from families much more than the mental health service does today. Is this a good or a bad thing? Carers do have some support but is this enough? Has enough cash been injected into support for those caring for a mental illness sufferer? Sadly I feel carers would say it has not as much support comes from charitable sources

Has the closures of asylums meant more with mental illness living on the streets?
Has the closures of asylums meant more with mental illness living on the streets? | Source

Institutionalization

Many of the patients were institutionalized when the asylums closed. Their lives had been routinely dictated for many years. Imagine the shock of all the routine, and what would have been perceived as safety, being taken away overnight. They were told when to eat, what to eat, when to go to bed, when to get up and so on for many years. It would have felt like a huge culture shock to many. Rumour has it that many patients ended up on the streets! For some patients, the confusion that ensued and feeling of being discarded must have been immense. Each patient who was in an asylum before it closed was deemed to be unfit to be out in the community. Was the drastic change too abrupt?

Living in the Community with Mental Illness

Many will say it must be one of the greatest moves in mental health to close asylums and to a large extent I certainly agree. Freedom and choice empower us in our lives and some patients must have improved greatly for this alone. How does society see this change? Has the fear of having so many more psychiatric patients in the community reinforced some of the remaining stigma and discrimination? Do the public at large hold more fear now as they did pre asylum days because many psychiatric patients walk the streets? Probably!

The Debate in Mental Health Care

It will be argued that whilst there are some huge improvements in mental health care, there are also failings. Psychiatric inpatient care is dwindling in the UK and is increasingly being replaced by community care initiatives. Cost cutting reigns constantly and many community services have failed at times with the consistency and quality of care. Would it have been more cost effective to use these huge asylums as new kinds of treatment centers with better therapy services?

New ideas about how to care for the mentally ill in the community have come and gone. Patients get used to one way of being treated and then are forced with another change which can feel very unsettling and cause more mental distress. In my local area outpatient facilities and actually seeing a psychiatrist on a regular basis have all but stopped for many because the community teams are now on the front line even more. Community care will only ever be as good as the staff who are providing it but the truth right now is that many are overworked, understaffed and in my opinion under a lot of pressure and therefore stress!


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    • billybuc profile image

      Bill Holland 4 years ago from Olympia, WA

      Very interesting! There are several around here and I wondered why they had closed. Great research!

    • greatstuff profile image

      Mazlan 4 years ago from Malaysia

      This is another awesome and interesting article from you. As I was reading your article, the film, 'One flew over the cuckoo's nest' came to mind and I can imagine how horrifying it can be for you. Voted useful, interesting and Shared.

    • CassyLu1981 profile image

      CassyLu1981 4 years ago from Spring Lake, NC

      Oh my goodness, I can't even tell you how much "An Urban Explorer's Photgraphic Dream" comes to mind reading your hub! I'm not sure what it is but every time I see something on tv or the internet about abandoned buildings, I just want to take pictures! Excellent article with tons of information. Makes me kind of sad though. Voted up and Shared!

    • gsidley profile image

      Dr. Gary L. Sidley 4 years ago from Lancashire, England

      Another superb hub, meloncauli.

      I found the information and video about the Lincoln asylum brought back memories of when I worked for 6 years at Prestwich Hospital (Manchester) in the 1980s; I think it could be described as being thrown in at the deep end for a young man in the infancy of a career in mental health services.

    • lambservant profile image

      Lori Colbo 4 years ago from Pacific Northwest

      For many decades the treatment in asylums was bizarre and abusive. ¥es, definitely good they are gone. But you are right that with dwindling monies (I am in the U.S.) there are many falling through the cracks. In my county and state, there are many outpatient clinics, but hospitalization is only for those with regular insurance, not state benefits or medicare, unless you have to be involuntarily committed. The powers that be say this is a great thing that they are cutting hospitalizations drastically and steering people to 24 - 48 hour crisis facilities with a focus on recovery. Recovery of course is good, but these facilities are not good enough for someone who needs hospitalization. Their attempt to make it look like they are doing a good things is utter hypocrisy when someone with insurance can get inpatient for just about anything, but severely mentally ill in crisis, and suicidal welfare people have to tough it out in a 24 hour facility. As one who had to suffer through this, I can tell you in no way was 48 hours enough for me.

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      @billybuc - thanks for your comment.

      @greatstuff - many thanks. Yes, that film conjures up so much of what we fear in a mental health hospital environment.

      @CassyLu1981 - thanks for your comments. I must admit I'd find photographing abandoned buildings a fascinating hobby.

      @gsidley - thank you. The difference between an old asylum building and a modern day psychiatric unit is nothing short of amazing.

      @lambservant - with inequality within mental health services based on how wealthy you are, the service is seriously flawed. I expect we should be grateful that we have the NHS but believe me, as with anything these days, spending cuts are definitely forcing a decline in standards in my opinion.

      You are also right that we all tend to be hoodwinked by politicians into believing that things are always done for the best, for improvement and yet lack of money so often is at the bottom of 'change'.

      If the politicians had to deal with bipolar disorder, schizophrenia etc, things may be handled differently.

      More patients are speaking out over here but so far most of what is said is falling on deaf ears!

    • eHealer profile image

      Deborah 4 years ago from Las Vegas

      I was working in the professional mental health area back then, and when Reaganomics cut medicaid dollars on the mental health arena, it left a lot of ill people without access to care. The homeless population skyrocketed as well. There were some good things that came from it though, you couldn't force someone into treatment or take their medication (unless they are a danger to themselves or others),and the mentally challenged had more free will. Thanks for the Hub, Voted up!

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      Hi eHealer and thanks for the comment. The pros and cons seem to be split right down the middle. I expect crime rates rose also and more people with mental illness were put into jail - another sad downside.

    • krsharp05 profile image

      krsharp05 4 years ago from 18th and Vine

      I knew this was going to be good when I read the title. You did a good job of discussing the difficulties people are having simply because they suffer from a mental illness. Stigma is an ugly color, face, taste - no matter how it's served and there's no escaping it. You bring up that point as well.

      Your hubs are always thorough and interesting. Very well written -K

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      Thanks for your comment K!

    • lindacee profile image

      lindacee 4 years ago from Southern Arizona

      Wonderful insight and history on this subject. I do wish there were more options here in the States to treat patients in need of mental help. It is tragic that many homeless persons are in dire need of psychiatric care. However, holding them captive in a hospital is not the answer. Unfortunately, it is a very difficult subject with no easy answers.

    • Simone Smith profile image

      Simone Haruko Smith 4 years ago from San Francisco

      I've not read much of anything about this transition from asylums to community care. Very interesting. Now I want to learn more!

      Thanks for the great Hub, meloncauli.

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      You're welcome Simone!

    • LadyLola profile image

      Lanie Robinson 4 years ago from Canada

      Only people who have experienced this problem will feel any sympathy. There are huge misconceptions about mental illness. I work in an area that has a lot of homeless people, and many of them need help. People look down on them and even think that they somehow deserve to live like that. "Get a job you bum" they say. As if that will solve their issues! Thanks for writing this, I am hopeful that the message will reach the right folks.

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      Thanks for dropping by again LadyLola. There are usually very good reasons for people to have found themselves homeless and my heart goes out to each and every one of them. I don't know what resources there are over in Canada but here in the UK the resources are not good to say the least. I'm afraid there is stigma attached to homelessness here too.

    • profile image

      Stephen 4 years ago

      This is a great write up, I used to live in a new housing estate at the front of St. John's hospital 14 years ago, me and my friends made friends with the security guard who looked after the hospital and he used to let us in, things have chafed there so much now, you can't get close to it due to all the fences, I'm glad I had the opertunity to play in there when I was a teenager, also the graveyard for the hospital is out the back of the hospital, there is a wall that runs alongside the road follow that till you get to the arch way in the wall and that's it the headstones are still there you just have to find them under all the leaves ect

    • meloncauli profile image
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      meloncauli 4 years ago from UK

      Hi and thanks for adding that information. I believe most of it is now a new block of accommodation.

    • profile image

      Eddie 2 years ago

      This has made my day. I wish all pogntiss were this good.

    • profile image

      Shamim 2 years ago

      I love that purple eyleet lace top. It's so pretty without being overly girly!In your research about the history of mental institutions, have you come across the Harlem Valley Psych Center in Dover, NY? I think there are a few locally published books that have some information on it - I'd be happy to track down a few titles for you, if you'd like. It also can't be too far from you if you're within three hours of NYC.Hope your Internet woes clear up!

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