The Royal College of Psychiatrists was founded at a meeting in
Gloucester in 1841 and was originally named the Association of
Medical Officers of Asylums and Hospitals for the Insane. Samuel
Hitch, the Resident Physician at the Gloucestershire General
Lunatic Asylum organised the meeting and stated in his letter of
invitation that his aims were 'that the Medical Gentlemen connected
with Lunatic Asylums should be better known to each other, should
communicate more freely the results of their individual experience,
should co-operate in collecting Statistical information relating to
Insanity and above all should assist each other in improving the
treatment of the Insane'. (1)
The Association gradually became established and by the 1860s
it was flourishing. The annual meetings were well attended and held
at different asylums throughout the British Isles, with regular
regional meetings in Scotland and Ireland. A Council body was set
up in 1865, quarterly scientific meetings began in 1868 and the
Association's journal, The Journal of Mental Science (now
the British Journal of Psychiatry), first published in
1854, came to be highly regarded.
The Association of Medical Officers of Asylums and Hospitals
for the Insane changed its name to the Medico Psychological
Association (MPA) in 1865. In 1926 it was granted a Royal Charter
and became the Royal Medico Psychological Association (RMPA). In
1971 the RMPA was granted Royal College status and became the Royal
College of Psychiatrists.
The development of the Association can be traced from the
reports of its meetings in the Journal of Mental Science
and by the 1870s these reports showed an increasing interest in
asylum attendants. In 1870 the Journal printed a letter
from 'Asylum Chaplain' (probably the Reverend Henry Hawkins of
Colney Hatch, founder of the Mental After Care Association)
suggesting systematic training of attendants but there is no record
of any immediate response to this (2). Then, at the annual meeting
in 1876, Dr Thomas Clouston, the recently appointed Physician
Superintendent of the Royal Edinburgh Asylum, spoke on 'The
Question of Getting, Training and Retaining the Services of Good
Asylum Attendants' (3). The discussion that followed showed that
the Association was becoming increasingly aware of the need to
recruit 'the best material possible, and to manufacture out of it
the best asylum attendants possible' but the participants seemed to
consider that training should be provided by the asylums (4). After
this meeting, an 'Association or Registry of Attendants Committee'
was set up but there is no evidence that it ever reported. Then in
1883, Dr A Campbell Clark spoke on 'The Special Training of Asylum
Attendants'. He described in detail the lectures and examinations
he had introduced in the Glasgow District Asylum and the 'elevating
influences' that had resulted and suggested that the Association
should consider his plea for 'a more extended application of the
system'.(5)
The result was a Handbook and Training of Attendants
Committee. This worked quickly and proofs of the 'The Handbook for
the Instruction of Attendants on the Insane' were shown to the
Associations' quarterly meetings in 1884. The Association agreed
that it would be printed and 1000 copies would be distributed. It
was first published in 1885 and for the next sixty years and more
was known as 'The Red Handbook'
Five years elapsed between the publication of the first
Handbook and the first examinations. Meeting reports for the late
1880s contain some references to lectures and teaching and in 1889
Dr Campbell Clark spoke again of his own examinations for
attendants. Once more the Association appointed a committee, this
time 'to inquire into the question of the systematic training of
nurses and attendants in asylums for the insane ' (6) which soon
recommended that attendants should have two years training,
followed by examinations organised by the MPA. The MPA would also
issue certificates and keep a register. The Committee's scheme for
a nursing proficiency certificate was accepted at the 1890 annual
meeting and the first examinations were held the following year.
The first Registrar, Dr Beveridge Spence of Lichfield, was
appointed in 1892.
The examinations rapidly became established. In 1899 Dr
Beveridge Spence was elected President of the Association and
reviewed what had been achieved in his Presidential Address.
Despite 'the new system not in the beginning being enthusiastically
welcomed by many of those in charge of asylums, the steady progesss
which has been made of late years is a silent but eloquent
testimony to the fact that a want has been supplied'. Five or six
hundred certificates were being issued every year and candidates
from more than a hundred asylums were taking part and the position
of asylum nurses had 'unquestionably improved' (7).
The Association took its nursing examinations seriously and,
despite not having a permanent headquarters or paid staff, retained
records of their administration. The general administration of the
examinations was the responsibility of the standing Education
Committee. This committee was first appointed in 1893 when the MPA
was planning its own qualification for doctors but the attendants'
examinations quickly became a large part of its work. The Education
Committee met three or four times a year, and its reports and the
reports of the Association's Council regularly recorded the
appointment of other committees to deal with specific training
matters.
One of the main responsibilities was preparing and publishing
the handbook. This was the basic textbook for the examinations and
was almost permanently under revision. A revision committee was
appointed in 1892 and the second edition appeared in 1893, followed
by a new and revised edition in 1898. Frequent revisions and
reissues followed, prepared by a succession of Handbook Committees,
and when a new (seventh) edition appeared in 1923, it was renamed
The Handbook for Mental Nurses. An American edition was
considered in 1892 and in 1906 and printing in Dutch, for South
Africa, was suggested in 1925. A further revision was begun in 1932
but the eighth edition did not appear until 1954, despite the fact
that the Handbook Committee was one of only two of the
Association's committees to meet in the early years of the War.
Much of the stock of handbooks was destroyed by enemy action in
1941 and a licence for paper to print more copies was refused. The
eighth edition came out in 1954 (preparation having been so slow
that revisions were needed before it was printed) and the ninth in
1964. Finally, in 1979, nearly 30 years after the RMPA's last
nursing examinations, the College's Education Committee decided
there would be no further editions. Meanwhile, the Association's
Advisory Committee on Mental Nursing had begun considering a
handbook for mental deficiency nurses in 1928 and the Manual
for Mental Deficiency Nurses known as 'The Green Handbook',
was published in 1931. This, too, was soon under revision. Like the
Red Handbook, further editions of the Green Handbook were discussed
after the examinations had been discontinued and a revision
sub-committee was appointed as late as 1965. An addendum to the
Handbook for Mental Nurses covering occupational therapy
was issued in 1938.
The examinations were regulated by the Association's Education
Committee, Nursing Committees and various sub-committees. Like the
handbooks, the regulations were kept under review and became
increasingly comprehensive. New or revised ones were brought into
force in every decade, including the 1890s, and modifications were
agreed for people in the armed services in 1915 and 1939. They
covered all general matters such as eligibility, recognition of
training institutions, age at entry, length of training, conditions
for holding examinations, payment of examiners, entry on and
deletion from the register, disciplinary matters, fees,
certificates, badges and medals. Amendments were discussed by
committees and were recorded in varying detail in the Education
Committee minute books. In the early 20th century the regulations
were printed and made available to candidates; in 1911 it was
agreed they should be printed in a form suitable for display in
nurses' homes; in 1912 they were redrafted and reprinted following
suggestions by the Association's solicitor and they were issued as
pamphlets in the 1920s and 1930s.
The Education Committee minutes occasionally record
discussions about applications for exemption from the regulations,
about cases of misconduct and about attendants whose certificates
were to be forfeit for some reason, such as non payment of
examination fees. From time to time, disciplinary sub-committees
were appointed and occasionally their reports to Council are in the
Council minute books. In 1902, the Copying in Examinations
Committee not surprisingly recommended improvements in seating and
supervision but, in general few disciplinary incidents are
recorded. It is not clear if this is because they did not take
place or because they were considered the responsibility of the
hospital or asylum concerned.
The extension of training from two to three years was first
recommended in 1897 and began in 1906. A preliminary examination
was introduced in 1908. There was considerable discussion in the
1920s about the length of training and the precise nature of
nursing qualifications. The position of nurses with some general
training entering mental nurse training and the relative position
of asylum and hospital trained nurses became a point of issue with
the GNC.
At first, the names of successful candidates were printed in
the Journal of Mental Science. They were issued with a
certificate and entitled to a badge or medal (the terms seem to
have been used interchangeably). After 1918, certificates were no
longer issued to successful candidates in the preliminary
examinations; instead, to avoid them using the certificate to claim
full qualifications, their names were entered on a register. Final
certificates continued to be issued. The first Nursing Badge
Committee was appointed in 1893 and the design they agreed on
showed Psyche, respresenting the soul or spirit. In 1903 the
Education Committee gave figures for the issue of badges and medals
and agreed they would be engraved with the recipient's name instead
of their number. In 1909 it was agreed that the words 'with
distinction' would be added where appropriate. In 1926 the design
was changed when the MPA received its royal charter and Psyche was
replaced by the newly acquired coat of arms. At the same time, the
addition of an optional ribbon was approved, blue to correspond
with the colour in the President of the Association's badge of
office. In 1928 an additional badge to be worn on outdoor uniform
was suggested. Also in 1928, after much discussion, an honorary
nursing medal and certificate was presented to Princess Mary , who
had shown a keen interest in nurses' training and welfare.
Before the end of the 19th century, the Association considered
extending its examinations abroad, first to South Africa in 1892
and then to both British colonies and other overseas countries. It
was agreed in 1903 that the MPA certificate would not be promoted
in areas where training and examinations were already established.
Candidates from South Africa were soon admitted and although
independent South African examinations began in 1921 the MPA
certificate continued to be recognised there. The Education
Committee appointed a sub committee in 1916 to consider the
recognition of examinations then being held in southern Australia
and this matter became part of the Association's wider discussion
on setting up colonial branches - a regular, if infrequent,
suggestion that never became a reality. Help with examinations for
a mental hospital in Canada was authorised in 1926 and in 1920
Danish trained nurses were recognised. This was possibly the only
time European qualifications were recognised although parts of the
handbook had been translated into French when the French were
developing their own training systems.
A separate examination for the nurses of mental defectives was
suggested in 1896 and again in 1917 and the first such examination
was set in 1918. Further examinations for attendants on mental
defectives and a diploma in training medical officers in mental
deficiency institutions were discussed in the 1920s and 1930s but
were not developed. Much of the administration was covered by the
existing regulations and was carried out by the Mental Deficiency
Committee, the forerunner of the College's present Faculty for
Learning Disability. In 1939, half the committees reporting to
Council were concerned with training and examinations, a reflection
of the amount of work, all voluntary, that was involved.
While the MPA develop its own training, the movement for state
registration of nurses also grew. A MPA committee to consider the
admission of mental nurses to the British Nurses Association was
set up in 1896. When a Parliamentary Select Committee was appointed
in 1904 Dr Ernest White of the MPA gave evidence and the MPA
President, Dr Outterson Wood, spoke on this in his Presidential
Address in 1905. The Select Committee reported in favour of state
registration and of recognising the MPA examinations as qualifying
for registration. The need for urgent action by the Association to
assure proper representation for its nurses was repeatedly stressed
and when state registration of nurses became law in 1919 the
Parliamentary Committee considered fair representation of mental
nurses had been secured. Asylum trained nurses were included in a
supplementary part of the register begun by the newly formed
General Nursing Council. Nevertheless, in 1916 the Association had
passed a resolution that the proposed College of Nursing should be
'watched' so as to safeguard the position of mental nurses and in
1920, the Association, not wishing 'to remain passive or
inarticulate when danger appeared' appointed a committee to 'watch'
the GNC (8).
Soon the position of mental nurses was causing concern and
meetings with the GNC and discussions on nurses' registration and
the position of the Association's examinations were held from the
1920s onwards. The RMPA did not claim to be a registration
authority but wished to remain an examining body; nevertheless
adjectives such as 'inflexible' and 'unsatisfactory' were at first
used to describe these meetings, although by 1928 'a general
feeling of goodwill seemed to prevail' (9).
The Association tried hard to retain its own examinations
despite a 'revolutionary' resolution submitted by the Scottish
Division in 1937 suggesting that they should be abandoned in favour
of the GNCs. However in 1945 the Athlone Committee recommended they
should end, the Council reported that relations with the GNC were
improving and an agreement was reached in 1946. The RMPA received
letters of complaint and regret and the related loss of revenue
from fees and the handbook was criticised but the last examinations
were held in 1951.
In 1952, the Registrar, Dr Iveson Russell of York, informed
the Council that a total of 50,021 mental nursing and 5,256 mental
deficiency nursing certificates had been issued and there had been
no year since 1891 when the examinations had not been held. He
continued 'the Association could look back on this work with some
pride. The services involved more than the organisation of
examinations at a time when no other branch of nursing had any
other national standard or qualification. It standardised the
syllabus of training in all the mental hospitals and mental
deficiency hospitals of the country, and was almost entirely
responsible for the training of mental nurses before the passing of
the Nurses' Registration Act in 1919' (10).
For a while the Association advised the GNC about the syllabus
for both the mental nursing and the mental deficiency nursing
examinations, especially on the inclusion of psychology. In 1954 a
committee was appointed to consider the shortage of mental nurses
and the possibility of starting RMPA examinations again. It
produced a report on the shortage of mental nurses and it seems
that a new examination was planned.
For a while, too, the RMPA and GNC needed to work together on
disciplinary matters. An RMPA nurse, if struck off the GNC
register, could still in theory use the title 'nurse' so in 1962 it
was agreed the GNC would take over all disciplinary matters and put
in place unifying procedures.
The Association also briefly ran an occupational therapy
examination. Planning began in the 1930s and there were five
successful candidates in 1939. Possibly the war prevented this
examination developing. Although the Association put its view to
the post war Rushcliffe Committee that occupational therapy was a
nursing duty and tried to restart this examination, negotiations
for abandoning had begun by 1946 and it was abolished in
1947.
In addition to the badges available to successful candidates,
two medals were also awarded. The Campbell Clark medal was
instituted in 1933 in memory of Dr Campbell Clark. It was awarded
each year in May and November to the candidate with the highest
marks nationwide in the final mental nursing examination. It was
discontinued in 1951 as the Association's examinations came to an
end.
The Eleanor Finegan medal was instituted by Dr Arthur Finegan
in memory of his wife and was originally awarded to the nurse, male
or female, at the Mullingar District Asylum, West Meath, Ireland,
who had the highest examination marks. This was later changed so
that the Prize (worth £5 per annum) could be awarded to the nurse
with the highest mark in the examination wherever it was held and
this too was discontinued in 1951.
In addition to summarising the history of the nursing
examinations run by the (Royal) Medico Psychological Association,
the purpose of this paper is to draw attention to the sources
relating to these examinations that survive at the Royal College of
Psychiatrists, the successor of the RMPA. The College did not have
its own headquarters until it moved to Belgrave Square in 1974 and
its predecessor bodies had rented a series of rooms with various
other medical organisations. Consequently there was no systematic
provision for archive keeping and the surviving records are small
in comparison with the age of the organisation. Correspondence and
financial papers are the main gaps in the College archives but
mental nursing is well represented among what has survived.
The College holds a complete set of the Journal of Mental
Science, now the British Journal of Psychiatry, and
an almost complete set of its associated Year Books. The Education
Committee presented a report to the annual meetings. Additionally,
educational matters were sometimes referred to at the quarterly and
regional meetings. There are no manuscript minutes of these
meetings. Minutes of annual, quarterly and regional meetings are
printed in the Journal or in the related Year Books and
have been abstracted onto an in house database (the Meetings
Database). The names of successful examination candidates were
included in the Journal until the 1930s but they are
listed by hospital not alphabetically.
The archives include complete set of Education Committee
minutes from 1893 onwards. They cover all aspects of the
administration of the nursing examinations and a prime source for
the history of mental nurse training. It will be clear from the
history outlined above that the Association's reaction to any
suggestion or problem was to appoint a committee. Many of these
special and sub-committees were set up to consider matters relating
to nurse training and examinations and reported to Education
Committee. Their reports are sometimes inserted in the minute
books.
Other insertions include some of the Education Committee's
reports to annual and Council meetings and a few examination
question papers, syllabi, Registrar's reports and letters.
The Education Committee reported to the College Council. This
met three or four times a year (except in wartime) and the Council
minutes are complete for the period of the nursing examinations.
These too have been abstracted onto the Meetings Database. The
Council minute books also have some insertions, for example
Education Committee reports and reports from some other relevant
special and sub-committees.
There is one folder of Handbook Committee minutes and reports
to Council, 1930s to 1950s, with some related correspondence.
The Parliamentary Committee minutes also include relevant
information as nurses' registration, pensions, hours of duty and
other matters relating to working conditions were at times
parliamentary business. Legislation and Parliamentary Committees
were among the earliest to be set up by the Association (the
Parliamentary Committee celebrated its centenary in 1954) but
unfortunately the earliest surviving Parliamentary Committee minute
book dates only from 1906.
There are also registers of successful candidates for the
mental nursing and mental deficiency nursing preliminary and final
examinations, 1891 to 1951. The sequence is complete (25 volumes)
but is limited as an historical source as the volumes include only
the candidates names and numbers and the names of the hospitals
where they took their examinations. Finding information can be
difficult as, although each volume is indexed, there is no general
index or register of successful candidates. Until the late 1980s
the College received enquiries from hospitals asking for details of
the RMPA nursing certificates and for confirmation that the
qualifications potential employees were claiming were officially
recognised. Now the enquiries come from family historians.
There is also a single volume containing the names of the five
successful candidates for the short-lived examination in
occupational therapy, 1939.
There are printed question papers (but not written examination
scripts) for the Mental Nursing and Mental Deficiency Nursing
Preliminary and Final Examinations, 1928 - 1951, regulations from
the 1920s and 1930s and syllabi, 1927 and 1932. Earlier question
papers may be found in the Journal and inserted into
Education Committee minute books.
There is also a small collection of nursing medals, badges and
certificates. A few of these are identified and from time to time
others are sent to the College.
There is very little correspondence. There is a small folder
of letters, 1926-9 on relations with the GNC and the Scottish GNC,
mainly the future of the examinations, some more similar
correspondence and notes from 1946 -51 and correspondence, notes
and the RMPA report on the shortage of mental nurses, 1954
The series of handbooks includes both the red (mental nursing)
handbook, excluding the third and sixth editions, and the first
edition of the green (mental deficiency nursing) handbook.
Minute books and correspondence of the Association's Scottish
Division, containing references to training and examinations, are
held in Edinburgh University Library.
The College archives are open to serious researchers and as
the College is a membership organisation, there is a £10 day access
charge. Please contact the archivist if you would like to use the
archives or if you would like any further information.
- Royal College of Psychiatrists' archives: minute book 1
(2)
- Journal of Mental Science, volume xvi, page 310, 1870
(3)
- Journal of Mental Science, volume xxii, page 381, 1876
(4)
- Journal of Mental Science, volume xxii, page 499, 1876
(5)
- 'The Special Training of Asylum Attendants' Journal of
Mental Science, volume xxix, page 459, 1876 (6)
- Journal of Mental Science, volume xxxv, page 450, 1889
(7)
- Journal of Mental Science, volume xlv, page 635, 1899
(8)
- Royal College of Psychiatrists' Archives: Council minute book,
1914-23 (9)
- Royal college of Psychiatrists' Archives: Nursing Collection:
correspondence with GNC. (10)
- Royal College of Psychiatrists' Archives: Council minute book,
1949-54
Margaret Harcourt Williams
College Archivist
December 2001