100 years ago: The opening of the Maudsley Hospital, 31 January 1923

By Dr Claire Hilton, Historian in Residence at the RCPsych.

The Maudsley Hospital in South London opened a century ago, on 31 January 1923. Centenaries of landmark occasions can prompt reflection, and since the establishment of the hospital was far from straight forward, I think it is worth considering some aspects of it today.

The Maudsley was the first publicly funded mental hospital of its kind in England. It was established to treat people suffering from recent onset of mental disorder of variable degrees of severity, on the principle that prompt and early treatment could stop an illness progressing, and hopefully “cure” it. This type of care had not previously been available to the majority of the population, who could only access psychiatric help if they were sufficiently mentally disturbed to be certified a “lunatic” and detained in an asylum under the Lunacy Act (England and Wales) 1890. (There is more about this in an earlier blog, Pauper lunatics were not paupers.) A minority, who could obtain psychiatric treatment for early or less severe symptoms, comprised mentally disturbed “shell-shocked” military personnel and well-to-do people who could afford private treatment. The Lunacy Act also determined how public healthcare budgets could be spent for treating people with mental disorders. It prohibited services for early treatment, although a few psychiatrists had managed to create out-patient clinics with funding from private, charitable or university sources.

The story of the Maudsley Hospital began around 1907 when the London-based scientist-researcher-physician Frederick Mott returned from a visit to Professor Emil Kraepelin’s University Psychiatric Clinic in Munich. Kraepelin’s Clinic functioned as a teaching hospital with patients admitted informally. It had about 100 beds, an out-patient department, library and laboratories, and patient care went hand in hand with research. Inspired to create similar in England, Mott discussed his ideas with Henry Maudsley, a wealthy, retired, West End of London, private psychiatrist. Maudsley offered £30,000, an extraordinary sum, considering that an asylum medical superintendent’s annual salary was around £1,000. Maudsley and Mott agreed a scheme for the new hospital: it would be in inner London to facilitate links with the University of London, would only admit uncertified “voluntary” patients, and, as with Kraepelin’s clinic, would have research and teaching facilities.

A suitable site was only acquired in 1911. New legislation, the London County Council (Parks, &c.) Act 1915, was needed to permit admission of voluntary patients paid for from the public purse. But as soon as the building was completed, in January 1916, it was requisitioned by the War Office for the treatment of soldiers suffering from shell-shock and for research into the causes of the disorder. After the Armistice, the hospital continued in military use, until cuts to government funding saw its closure in October 1920. Following that, the hospital needed repairs and renovations before being formally opened and made available for civilian patients.

A report in the British Medical Journal (BMJ) in 1923 commented that although the hospital bore Maudsley’s name, there was some doubt whether it would ever have come to fruition without Mott’s “untiring perseverance” in the face of much discouragement and “much delay, largely unexplained and not altogether creditable to the County Council, in finding a site and building the hospital”.

The Opening

A flimsy, postcard size “Order of Proceedings” for the opening of the hospital, is preserved, bound into a volume of London County Council (LCC) “Descriptive Pamphlets”. It is sandwiched between another Order of Proceedings of the same size and flimsiness, for the opening of the Eltham By-pass Road, and another, much larger, with coloured pictures on glossy paper for the opening of the LCC’s County Hall. Most of the large Orders of Proceedings were issued when royalty had agreed to perform the opening ceremonies, the small ones when a government minister or other official was to undertake the duty. The Ministry of Health had wanted royalty to open the Maudsley Hospital, but archival sources sources, suggest that civil servants mishandled the invitation.

Reconstructed, based on damaged original with numerous pen and pencil notes and underlinings. London Metropolitan Archives, LCC/CL/CER/03/007/115/A

In the absence of royalty, the honour of opening the hospital fell to the Minister of Health, Sir Arthur Griffith-Boscawen. There were numerous guests, including local dignitaries and some “distinguished mental experts”, among them, Drs. James Crichton-Browne, David Ogilvy and Helen Boyle. The opening ceremony took place in the lecture theatre, itself innovative and not a standard feature of mental hospitals. The Minister toured the building, including the out-patients' department and wards, the patients' sitting and dining rooms, and the kitchen, garden, nurses' home, and “pathological laboratory”. He also addressed the gathering, optimistically saying that he would like to “see an opportunity provided for other local authorities” to establish services similar to the Maudsley (Times, 1 Feb 1923 p.7). The Maudsley contributed to this goal early on by demonstrating the feasibility of offering “voluntary” in-patient and out-patient care financed from public funds. This helped inform debate leading to the Mental Treatment Act 1930 which permitted them country-wide.

The name of the hospital

Hospital and Health Review 1923 2(18):142-144. Creative Commons Attribution 4.0 International License

Maudsley died in 1918. In 1923 Mott was appointed lecturer in morbid pathology at the University of Birmingham, but nevertheless continued to teach at the Maudsley and remained director of medical studies there until his death in 1926. The hospital is still known by the name of the financial donor, yet that does not seem an accurate portrayal of its foundation, or of its early achievements, for which an additional key individual, Dr Edward Mapother, provided clinical leadership and direction. Each had a different, complementary, and vital, role. Maudsley gave the money. Mott devised the original plan and led the negotiations. He was also responsible for the therapeutic regime, providing an “atmosphere of cure”, which started while the hospital was still treating shell-shocked soldiers. Unusual for the time, Mott actively engaged patients in their recovery, including through occupational therapy, social activity, exercise, good diet and improving their physical health. Mapother adapted and extended this model and introduced out-patient services including some off-site. In the late 1920s, the Board of Control [which regulated the mental hospitals] noted that Mapother was: “quite incapable of seeing anything except the Maudsley and other possible Maudsleys in the future. He seemed to think that the only line of advance was to build Maudsleys everywhere and to keep them as far as possible outside the jurisdiction of the Board of Control and, indeed, of all Government departments.” Although Mapother’s fervent leadership sometimes caused friction with colleagues, this contrasted with his hostile relationship with a bureaucratic administration.

Some afterthoughts

Even though the 1914-18 war understandably delayed opening the Maudsley Hospital for civilian patients, a total of 16 years from conception to completion was an extraordinarily long time. The BMJ suggested that the LCC dragged their feet and did not understand the broader significance the project, or its pioneering nature and long-term objectives. The flimsy Order of Proceedings suggests that the Hospital’s opening was a relatively minor event in the hierarchy of LCC affairs, despite its significance for the practice of psychiatry.

Recently the RCPsych reported: “ Budget freeze could lead to a mental health catastrophe say top psychiatrists”. One wonders about past and present governmental understanding of mental health and their hierarchies of health priorities. Much has changed in psychiatry since 1923, but a century on we still need Mott’s and Mapother’s courage and determination to overcome obstacles and to provide exemplary and effective mental health services.

Further reading

• Edgar Jones. ‘An atmosphere of cure’: Frederick Mott, shell shock and the Maudsley. History of Psychiatry. 2014 25(4): 412-21.
• Edgar Jones, Shahina Rahman, Robin Woolven. The Maudsley Hospital: design and strategic direction, 1923-1939. Medical History. 2007 51(3):357-78.

Acknowledgements

Many thanks to Professor Edgar Jones for his advice and Fiona Watson for her editorial skills.