I have told this tale primarily to record and celebrate the great days of Fulbourn Hospital, an Open Door hospital for 30 years, which developed Social Therapy, Therapeutic Communities and Rehabilitation and was a centre of national and international reputation.
Much has happened to Fulbourn Hospital in the years since 1983. The number of people in mental hospitals over Britain has continued to decline. The attitudes of Margaret Thatcher, of denigrating public service, of running down public hospitals, building up private enterprise, and of mean-minded economising have filtered down through the NHS bureaucracy. At Fulbourn it had particular effects. All Ward operations were moved to the outlying villas. All patients were removed from the old main building and attempts were made to sell it off as a hotel, or as offices. Wards have been moved to and fro for administrative rather than therapeutic reasons elderly patients have been moved into the Ida Darwin, designed for mentally handicapped children, a psychogeriatric admission unit has been inappropriately squeezed into Kent House, and so on and so forth.
The administration, which now comes under Addenbrookes Hospital, has been chopped and changed about. Managers without any knowledge of the problems of psychiatry or the needs of long-term resident patients have been appointed, then shifted, then replaced as another administrative reshuffle takes place. Two Trusts have been set up in Cambridge, the Addenbrooke's Hospital Trust and the Lifespan Trust responsible for Community Services. This has split the network developed in the 1970s and 1980s by the Cambridge Psychiatric Rehabilitation Service.
Even more damaging to Social Therapy and risk-taking has been the development of a mean, carping, fault-finding spirit amongst the administrators and managers. Battered by public enquiries and outcries, pressured by harrassed Ministers, they have reverted to the kind of administrative behaviour that marked the worst of the asylum days issuing memoranda forbidding activities, putting up warning notices, setting up disciplinary enquiries and penalising staff who take risks or show initiative. Staff have learned to be cautious, to get everything in writing, to avoid initiative. As one student nurse of the 1990s put it to me The main message I learned on the wards at Fulbourn is CYA Cover Your Arse!
The Cambridge psychiatrists too have mostly retreated from Social Therapy. Many of them prefer working in the general hospital; several small psychiatric units have started at Addenbrookes and the psychiatrists now wish to remove all the other admission units there. When the Department of Health proposed to build a locked unit at Fulbourn they agreed and it was built in 1994 on the old playing field. Euphemistically entitled the Intensive Therapy Unit, it is ringed with flood-lit high fences and firmly locked, thus ending Fulbourns years over 30 as an Open Door Hospital.
Much of what we achieved has been lost and much is being forgotten. It was partly for that reason that I decided to publish this story, to put on record what we achieved.
Despite all the changes away from the liberal and open regimes of the 1960s and 1970s some of the spirit remains. On most wards the nurses are out of uniform; on many admission wards, ward meetings are still held (though the doctors do not attend them); nurses see their work as counselling and befriending the patients, and resist attempts to push them into counting, guarding and specialing patients. The spirit of the best of psychiatric nursing still persists despite the disinterest of the doctors, and the conformist pressure of the managers.
So before all that we did is forgotten, I have told this tale of what we were able to do at Fulbourn Hospital in the 1950s, 1960s and 1970s, and how we turned a dreary locked up asylum into an Open Door Hospital, a centre for Therapeutic Communities and Rehabilitation of world-wide repute.
The Human Nature Review © Ian Pitchford and Robert M. Young - Last updated: 28 May, 2005 02:29 PM