As unwelcome as the drone of a thirsty mosquito, the shrill cry of my bleep wakes me with a start. Bleary-eyed, I strain to see the numbers on the tiny grey display and realise that it’s been all of half an hour since I finally fell asleep. The ward needs me urgently. But this is no ordinary hospital. This is an Asylum.
As a junior doctor I was posted at High Royds Hospital, formerly the ‘West Riding Pauper Lunatic Asylum’, a magnificent gothic stone pile in Menston near Leeds which first opened its doors in October 1888. In many ways self-sufficient it boasted a ballroom, a butchery, a cobblers and even a linked railway.
Splendid in its heyday with its Italian mosaic floors, emblazoned with the Yorkshire Rose and black daisies, framed by burnished ochre and umber tiled walls, by the time I arrived at the end of the era, this grand “brick-mother” was snatching her dying breaths.
Hurriedly dressing in the dark before descending the oak-panelled staircase, I begin the brisk walk to the ward. These corridors are never-ending and, though I feel safe enough here, it’s an eerie place at night. I pass patients, some in groups socialising off the wards, fielding quiet nods of acknowledgement from those I pass with the occasional jibe and catcall, no-doubt lubricated by one smuggled beer too many. But contrary to the lurid stereotypes, from Arkham Asylum to the Baltimore State Hospital for the Criminally Insane, the only fear I feel in this asylum stems from it being an old dark building with a surfeit of shadowy corners.
But it was a place that did provoke fear for many patients. To borrow from the poet Neruda, I am sure its mirrors wept with shame and horror. Whilst, for some, it may have provided true asylum, a refuge of shelter and protection, for others it was a prison. The lives of those who lived and sometimes died in High Royds were often tragic and marred by the ubiquitous abuse, spanning ages, of those with psychiatric illness by society and also by supposed carers. Many early residents died alone, their farewell a pauper’s funeral. Forced to relinquish their fellowship with the world outside, they were laid to rest in the hospital grounds, the unclaimed asylum dead. Things improved over time and I witnessed both the best as well as the worst of humanity within those stone walls.
They were inglorious times. Prior to my arrival three psychiatrists, driven by compassion for their patients and fellow staff, had bravely voiced their unheeded concerns to the local press; the bed closures, understaffing and cramped conditions which they said were leading to outbreaks of violence in the hospital. MPs postured, as they do, and the Health Secretary commissioned an inquiry. It returned a scathing report. The fate of High Royds was sealed and she finally closed her heavy doors, after 115 years, in 2003. In 2001 the headline “Huge Cash Promise in Mental Health Care Shake Up” excitedly announced a £45 million investment in brand new state of the art mental health units in Leeds, possibly to be financed by a new “Private Finance Initiative”. We now know the hidden cost of PFI…
So it is with sadness but not surprise that I read about the current lack of investment in mental health services. A recent analysis by the Royal College of Psychiatrists concluded that, contrary to the Government’s assertion that spending on mental health is at “record levels”, in real terms funding is actually lower than in 2012.
On the frontline, it is patients who feel these cuts and this disinvestment is clearest for those with the most complex mental health problems. It is shameful that, instead of providing them with the psychiatric rehabilitation they need to be able to take their rightful place in society, more and more people are being warehoused without hope in out of area placements many miles from their homes and families.
These placements are colloquially known as “locked rehab” units. A deplorable term, the “lock” in question serves as a metaphor not only for an unyielding door but also for a life locked still and stripped of hope. A recent CQC report estimated that £356 million of the £535 million spent on psychiatric rehabilitation is being spent on such out of area placements which are mostly privately provided and that those receiving this care are less likely to recover.
It is a betrayal that we are still fighting for parity for mental health, arguing about unsafe staffing and cuts to beds. Surely it is time for the politicians of all colours to honour their broken promises in order that we can rid ourselves of institutions which by any other name are the new asylums.
Useful websites and helplines:
- Mind, open Monday to Friday, 9am-6pm on 0300 123 3393
- Samaritans offers a listening service which is open 24 hours a day, on 116 123 (UK and ROI - this number is FREE to call and will not appear on your phone bill.)
- Get Connected is a free advice service for people under 25. Call 0808 808 4994 or email: firstname.lastname@example.org