From 'asylum' to 'hospital' - an early move towards parity of esteem? By Dr Claire Hilton

1841 -  the Association of Medical Officers of Asylums and Hospitals for the Insane, the forerunner of the Royal College of Psychiatrists, proposed replacing the term ‘asylum’, with ‘hospital’. It did not happen.

1908 - the Report of the Royal Commission on the Care and Control of the Feebleminded reasoned that the word ‘asylum’ was misleading as it ‘savours of the mere detention of extreme cases’, and that institutions which aimed to treat patients should be called hospitals. 

1917 -  the London County Council stated that patients, their relatives and the broader public supported the name change, so it re-designated all its mental institutions as hospitals.

1918 -  the Board of Control, the central government body which oversaw mental health services in England and Wales, made a similar decision.  However, in the interests of economy, supplies of old headed paper had to be used up.

1930 - the Mental Treatment Act 1930 officially replaced the term 'asylum' with 'hospital' and all old forms and legal documents were taken out of circulation. 

Originally proposed by the ‘medical men’, the ‘alienists’ or psychiatrists of their day, the change was one early step on the long path towards parity of esteem.  It took almost 90 years to achieve it. A change in terminology could not change practice on its own, but it had potential to reduce stigma and reframe mental disorders and their treatment, by bringing the ethos of treatment into line with that for physical disorders.  

This, and other proposals made by psychiatrists, were initially ignored. To look towards the future of psychiatry and our patients’ needs, we need to consider possible reasons why this happened.  They might include:

• Psychiatrists were not persistent enough at campaigning to get their message across to the public and policy makers.
• Legislation may provide safeguards, but its inflexibility can create stumbling blocks to important changes, including those supported by wider society.
• Politicians and policy makers take a laissez faire attitude to people with mental illness.

Let me know at historian@rcpsych.ac.uk if you have other explanations, or suggestions as to how we can ensure that constructive proposals by psychiatrists, in conjunction with patients and other front line staff, are not overlooked.