[Music] For over a hundred years, Britain's mentally ill were hidden from society in vast Victorian asylums. Those who were locked away have left their own testimony. I remember getting the first glimpse of the hospital. It's big looming place with a clock tower and that. And I remember then thinking, my goodness, what am I letting myself in for? In the last decades of the asylums, psychiatrists tried to cure as well as care for patients. Some of their attempts were barbaric. It was a disaster. They made a hole in the skull. It went into the brain and it waggled it a bit. That was it. This was a time when treatment was undergoing a revolution. Some patients felt science was being pushed too far. is switched the probe on and burnt a piece of my brain out. These institutions had to be shut down. When it happened, it was a moment of history that changed Britain. This is the story of the closing of the asylums and the often troubled lives they left behind. [Music] [Music] Hyoids in Yorkshire was typical of the great asylums. [Music] It was a village in its own right with its own farms, a butcher, a bakery, even a railway station that ran right to the center of the [Music] asylum. At its height, it held over 2,500 patients. It was just massive. You could walk around all day and and never walk around all of it. I was in a place with the longest corridors I've ever seen. There were miles of corridor. A lot of patients were socially inadequate. Not strictly speaking and mentally ill, not disturbed with voices, not suffering from delusions, not showing any thought disorders at all. Simply inadequate and couldn't cope. They weren't wanted. Those good burgers of Leeds and Bradford who'd sent the patients in here would certainly have thought that they were doing the right thing by the patients although really they were doing the right thing by their towns. I think that word dumped it's an awful word isn't it? But you you could think and I think rightly that a lot of patients were dumped here by their relatives by the community. They weren't wanted and Hyoids was a convenient place for them. It was not just hyroids. Many of Britain's asylums contained patients who had been locked up for no clear psychiatric reason. People got admitted on all sorts of dubious grounds that um didn't really have anything directly to do with their mental states. Um their families had abandoned them and there was no one to um to support them um outside the institutions. Even in the 1950s, some patients ended up in the asylums for a very long time. This patient used to be a skilled gardener. He came here 35 years ago. And here's an old soldier. He fought in the 1418 war. Many patients were admitted on genuine medical grounds. Some of them easily treatable outside hospital nowadays. Agrophobia, panic turns, mophobia. I knew if I went walking in the street anyway, I just clipped. [Music] After the war, Joan Tugwell had left the army and was suffering genuine mental distress. She was 25 and living with her foster parents. Panic attacks were making her life a misery. I went to bed one night and I thought I couldn't breathe. So, I kept screaming out to mom, I can't breathe. I can't breathe. St. John's Hospital near Alsbury was Joan's local asylum. For her family, it seemed to offer some hope of refuge. She was duly committed to care. My mother asked if I could go in, but she knew I wasn't well. Upstairs, they had two big dormies and each of them had about 30 beds in one dormy. So the top of one bed was down this way, the next bed up that way, and the next one down here, and then the next one up there so that they wouldn't breathe into one another because we so close we could get in to get a bed. I said, "We ain't got much room to move about." It was to be the start of a third of a century inside mental hospitals for Joan. In the early 50s, the regime was harsh. Some of those she met were not what she would have thought of as mad. You would wonder. You said, "Why are half of them in there? Nothing wrong with someone. I mean, there was nothing much wrong with me. The asylum life was empty and repetitive. After months on her ward, Joan asked the nurse if she could help with the beds. It was a way of occupying herself for a part of the day. I asked if I could make the bed. I couldn't stand here and watch her making 60 beds without giving her a hand. So, we both made all the beds. Alcohol offered an escape from her feelings of anxiety. One evening in the asylum, Joan got hold of some spirits and ended up drunk and in the wrong ward. I was supposed to climbed over the gate, went in and said good evening to all the staff and I passed out cuz I was drunk. When I came in, I was in a padded cell. They're frightening because you don't hear them and they can't hear you. Everything's all rubber and you have canvas night dresses and canvas blankets. If you shouted, they won't better hear you. Despite the vast majority of patients having committed no offense, life in the asylums was dominated by security. The wards were not opened. The doors weren't left opened. The doors was open to let the patient out and then closed after he' gone. There was a a quasi prison atmosphere there. The only um crime you could commit if you're wrong, the patient was to escape. In many ways, the large asylum still housed inmates rather than patients. Conditions inside had altered little in the last half century, but change was on its way. [Music] [Applause] This leaflet is coming through your letter box one day soon. Read it carefully. When the Labor government created the National Health Service in 1948, mental institutions were entirely separate from general hospitals. Is what it offers. Before the NHS was created, there was some debate as to whether or not the asylums and psychiatry would be included in the National Health Service. And it was decided finally that it would be included. And by including it, I think it did help to to bring the systems together. Hospitals and specialist services, medicines, drugs. It was the parting of ways with the old poor law ideology. Notionally the mental patient was being embraced by the NHS ethos, the whole idea of um equality of membership. While medical science had advanced rapidly in the years before the creation of the NHS, therapy for mental illness was still very limited. But now, psychiatrists began to experiment with new ideas and new treatments. You get an increasing view that mental illness is really the same as other physical illnesses and can be treated using the same sort of means using physical interventions that work on the body. One of these relatively new treatments was the controversial electroconvulsive therapy or ECT. It meant passing an electrical current through the brain to induce a seizure. It seemed to ease the symptoms of severe depression in some patients though psychiatrists could not explain how it worked. We put the wires here and here and then we switch on and then you'll go into a fit have epileptic fit. Whole ECT units were set up so that patients could be treated in large numbers until the early 1950s. The procedure was carried out largely without anesthetic. A member of staff would lean heavily on the knees, another one at the ankles, and one at each side holding the shoulders down. And the consultant applied an electrical charge through the brain. The patient, of course, jerked very, very violently. That's why we were holding him down because it had been known that this procedure could cause fractures and had caused fractures. Despite appearances, ECT was regarded as a step forward. It seemed to offer some patients a real hope of improvement. Here, insulin doses are being prepared and checked. Another of these so-called shock treatments was insulin therapy, where doctors induced a coma by injecting large doses of insulin into the body. Insulin coma treatment, to give it its full title, offers the greatest likelihood of relief and cure for some patients whose illness is of a deep-seated nature. I just use insulin in me arm, but um wasn't very nice to her, but they used some patients who go right into a coma. They would scream all the time. I mean, I think it made them feel queer. It would burn up all the sugar in their body and drop their blood sugar level very very low and they would go into coma and that was supposed to be beneficial in some way to the brain. In this condition the mind has a chance to be completely relaxed and the functions of the brain have the opportunity of as it were setting out on a new path when consciousness returns. Physical treatments like this advance the image of psychiatry as a fast-developing scientific branch of medicine. In reality, insulin proved a harmful medical failure. 44 people were killed from its effects during this period. Made me bad. Give me a fit. And I had to tell you, we we can't give you any more insulin because it's affecting you. Made you have a fit. But one form of treatment was more drastic than all the others, the [Music] labbotomy. Some psychiatrists believe that by removing sections of the brain itself, certain serious mental disorders could be permanently treated. At least 15,000 of these operations known as preffrontal lucottomies were performed in Britain. It was a disaster. There was a blind operation. They made a hole in the skull over which the so-called probe went into the brain and it waggled it a bit. That was it. There was no until much much later any attempt to refine exactly where the the cut was made. There was lots of patients walking around with two holes in either side of their forehead that you could see the actual dent where the skull had been uh trapanned away and an instrument had been put in. One wonders if they'd been better if they had been left alone. I had the misfortune to have recommended in all 16 of them, 16 patients who had the operation and it was of no benefit whatsoever to any one of them. And some of them had the tragedy of personality change. Towards the end of the 1950s, this crude form of prefrontal lucottomy was phased out. Little was then known about the workings of the brain. For most patients, there was no alternative to long periods in an asylum. They were vulnerable people, and the public was not interested. It could be a recipe for abuse. Derek McCarthy began his career as a psychiatric nurse in 1957 at St. Nicholas Hospital near Newcastle. He was shocked by the treatment routinely handed out to long-stay patients. The first time was on the first day on the first ward that I worked on when uh the charge nurse that was showing me around uh smacked an old little old blind man across the back of the head so fiercely that he flew across the room and hit the wall. I was very shocked because the charge nurse had been quite nice to me when I came on the ward and I I was a bit lost for words and he said um don't you know if you live among [ __ ] you become [ __ ] This kind of brutality was considered almost inevitable for some of the categories of the mentally ill on the ward for difficult patients. Derek's colleagues called this tough approach thump therapy. The patient had been um acting rather histrionically, sliding off his chair onto the floor. And this was during the unofficial staff rest time at dinner time. Eventually, the charge nurse of the ward got sick of this and disappeared into the toilet area. Um he came out with a enamel bucket full of cold water and threw it all over the patient in the day room among everyone to see and then ran the bucket over the top of the patient's head and within a few seconds the patient had slid back on the floor again. So he called the staff nurse and uh they dragged him by his collar across the floor into the bathroom area. They later shouted for me and I went in and they were holding him under the water in the bath, bringing her up and then pushing him under again. When they stopped, Derek had to dry the patient off. I went to the charge nurse who was then in the office and said, "He's completely dried down. I put new clothes on him. Can I have the key to get the socks and the shoes out?" and he said to me, "What do you think this is, but uh send him out as he is?" There was no evidence of this kind of treatment at Hyroids, but investigations in subsequent decades revealed persistent abuse at other asylums. I'm convinced it was endemic and in fact inquiries later on proved that the same things were going on in other male sides of mental illness hospitals right throughout the country. By the mid 1950s almost half the new NHS's beds were given over to mental illness or mental disability and the cost was mounting. Hope came from the laboratories of scientists working on a new generation of drugs. French psychiatrists started to use a drug called chloromazine which proved to be very effective in calming psychotic patients. Within a few years, lactyl as it came to be called here had spread right across Europe and America. [Music] It was the first in a new range of drugs now pouring out that were to revolutionize the way mental illness could be treated. These drugs promised the end of the locked doors and iron bars and ultimately the end of the asylum system itself. It was quite exciting. You know, this was something new and we as student nurses were allowed to get involved in it. It was a turning point. Some psychiatrists felt that the new drugs had solved the riddle of mental illness. Trouble is with anything like that that gets into the press and is hailed as a miracle, which it isn't. But um the air of optimism is quite important. We're not just um carers, we are curers. The new spirit of optimism was felt keenly at Hyroids. Doctors here became pioneers of the new drugs research, much to the benefit of the asylum's grim image. It had a pretty formidable reputation, you know, in the sense that uh it was run in some respects like a prison and there was a keen desire in the early 50s to change its image for the better. Dr. Roy Hullen started his career as a biochemist. He was invited to hyroids and given his own staff to research the effect of the drug lithium on the brain chemistry of patients. I wanted to do biochemical work on patients on the the manic depressive patients on whom I got some useful results with the idea was to do a balance of what went into the patient and measure what came out. Dr. Hullen's research proved a vital step in establishing lithium as one of the most prominent new drugs. It is still widely used today as a treatment. A range of new drugs are introduced during the 1950s and60s. But they're not just new. There is a whole new idea about them. And the new idea is that they are specific treatments for specific disorders. So that rather than just being substances that drug people or contain people, sedate people, which was what was thought about the old drugs, they are seen to be substances that somehow work on the underlying physical basis of mental disorder. It may have looked and felt like an old Victorian asylum, but Hyroids was now at the forefront of the drugs revolution. It was acknowledged as a research center for mental illness and its medical staff presented their findings all over the [Music] world. The new wonder drugs created hope for the future. But even before they arrived, some enlightened psychiatrists had started to develop a more humane approach to care on the wards. [Music] The first thing we did apart from improving the clothing and the decorations of the place was to find occupation. I worked on the principle that um unemployment was evil. Alongside the advances in treatment, some patients were now being given a new program of activity. Healing is the hallmark of the hospital. These handcrafts are one form of it. A piece of homemade cloth or a basket. These are proof to these ladies that they can still do some things as well as anybody. And even if the work is slow and clumsy, it's better than brooding. Occupational therapy, this is called. It's serious scientific treatment. But more fundamental reforms were taking place. The first hospitals were now starting to experiment with an open door policy, something that would have once been anathema to the ethos of the asylum. At one time, the patients had nothing to do except to walk around inside airing courts. Now, one of the first things I did was to saw down the railings. There is a move to open the doors of wards to let people come and go much more freely. The the asylums just physically were spruced up. They were decorated and made more homely. [Music] In the mid 1950s, there were over 150,000 patients in mental hospitals, more than at any time in their history. Politicians from all parties agreed that the asylum regime was very expensive. Its morality was now also being questioned. In 1959, the Conservative government passed a radical new act of parliament that introduced a more compassionate approach to the treatment of the mentally ill. Perhaps one of our greatest reforms is in the new mental health act, which interprets in modern terms the new approach to mental sickness, so that it is no longer an illness with a stigma, but one which should be treated with the same sympathy and understanding as any other physical disability. The nation's conscience had been pricricked. Britain was coming face to face with its asylums which had quarantined the mentally ill from society for over a hundred years. You had to justify not locking the doors but why you were locking the doors. It was it wasn't accepted that you simply lock them. That's what you'd always done. Why are you locking them? Why do these patients have to be locked in? The 1959 act represented the final break with the Victorian period. It was the turning point because it recognized for the first time that um the mental hospital um in the future was not necessarily going to be the main locus of care for people with mental health problems. The impetus for change was gaining strength. But it took a maverick politician to grasp the vision of a nation without asylums. Enoch Powell shared the sense that the old mental institutions were shameful relics of the past. In a prophetic speech in 1961, he made a dramatic pledge to tear them down. Now look and see what are the implications of these bold words. They imply nothing less than the elimination of by far the greater part of this country's mental hospitals as they exist today. It was a call to arms and Powell was under no illusions about the strength of the likely opposition to his plans. There they stand, isolated, majestic, imperious, brooded over by the gigantic water tower and chimney combined, rising unmistakable and daunting out of the countryside, the asylums which our forefathers built with such immense solidity to express the notions of their day. Do not for a moment underestimate their powers of resistance to our assault. The water tower became the defining image of the speech. Enoch pal was determined to remove everything it stood for and replace it with a new model of care based in the units of general hospitals and the community. He um foretold the end of the mental hospital regimes. At that time there were 100 or so in this country. None had closed. None of them had any intention of of closing at that time. So this was a visionary speech that was looking beyond the current regime to a completely different social landscape. It was a national social conscience that was awakened and it was the beginning of the end for places like this. Enoch Pal had drawn up a bold new plan for mental health outside the asylums. But as he predicted, it had little immediate impact on the echoing wards and endless corridors of Britain's existing mental hospitals. Here, altering the brain's chemical balance remained the focus. But the new drugs which had initially held out the promise of closing the asylums now seemed to be doing the opposite. In the 1960s, there was a growing recognition that drugs might not be ending the asylum culture, but prolonging [Music] it. A BBC documentary in 1969 found that conditions within mental hospitals were still disturbing. [Music] For many patients, the tranquilizing drugs were causing new problems. They are basically seditive drugs, but they produce a very special sort of sedation, which is a bit like having Parkinson's disease. So that not only do they sedate you, but they make you physically rigid and um they they physically slow you up and they mentally slow you up. To me, it were like the system came down on me so heavily straight away. It was just, you know, as if things like drugs and shock treatment was the answer to my unhappiness or whatever, which it certainly wasn't. It made things a lot [Music] worse. Gene Davidson was brought up in a workingclass district of Bradford at the end of the 50s. It was very much expected of me that I leave school and go to work in a factory or some kind of dead end job. And that um was difficult because I found it boring. And in her teens, she began to feel depressed and alienated. I was dissatisfied with my lifestyle. And I suppose that in a way was the start of it. this sort of feeling that I got that life was empty and meaningless. Gene felt that she needed someone to talk to. She asked her GP for an appointment with a psychiatrist who recommended that she spend a week of rest and observation at Hyroids, her local mental hospital. Right back from childhood, you sort of joked with other kids saying they'll take you away in a green van to Hyro. You know, it was the mental hospital that we all knew about. What stands out in my mind was walking up the drive and getting the first glimpse of the hospital in the sort of fading light. I think that made it look maybe more Gothic or whatever, this big looming place with a clock tower and that. And I remember then thinking, "Oh my goodness, what am I letting myself in for?" Gene arrived on a ward when medical confidence in the positive effects of drugs was at its height. The morning after she arrived, she was given her first taste of logactyl. No wonder it knocked me out and made me drowsy because that's what Lagactyl does. It's a really strong what they call antiscychotic drug. While heavily drugged, Gene was persuaded to sign up to a course of electrocomvulsive therapy. ECT was routinely being carried out with anesthetic. But the procedure was still terrifying for a teenager who had had no previous contact with psychiatry. You can't have any breakfast that morning. And a small ambulance comes and picks up other patients on the way and took me to another part of the building where they give ECT. We were given an injection in his arm that's to dry your mouth apparently and stops you swallowing your tongue as one nurse says when you're having a fit. I was scared. Yeah. I mean, I'm even scared of just having an anesthetic full stop. Never mind the thought of electric shocks going in into your brain. They came around with a hot water bottle and we'd put it on the back of our hands to make the vein stand out for the anesthetic injection. And I remember feeling really powerless laid on me back having this injection. I panicked and wanted it all to stop then and try to sort of fight them to stop them doing it then. And then the next thing I remember is um waking up being really confused, feel really disorientated. It's like everything's familiar but not quite right somehow. And the worst thing though I found was we're told that there might be temporary effects like that. But I I thought what if what if it's doing some permanent damage to me brain? This this that was was [Music] horrible. What was initially supposed to be a week of observation for Gene became a stay of several months on an inpatient ward at Hyroids. This turned into 5 years as a day patient. By the end, Gene felt that the hospital itself had become part of the problem, not the solution. I felt I'd just got sucked in to going along with their norms or whatever, you know, and it's strange really. It's like a yeah, a different world that you soon start starts becoming a part of your world in a way. Gan felt that ECT and the drugs were actually contributing to her depression. So, she began secretly cutting back on her dosage against the advice of Hyroid staff. It was an act of rebellion with positive effects. As I gradually cut down, I gradually got much much better. All this drowsiness, depression, lack of interest, the less drugs I were on, the more that started lifting. The change was amazing. Without the drugs, I'd almost forgotten what it felt like to be awake and alive. It again. That That was lovely. That was marvelous. Jean's resistance to her psychiatrists was part of a wider phenomenon. To many patients, doctors now seemed over reliant on pills, the new tools of their trade. They saw drugs being used as blunt instruments in a way that was out of step with the spirit of the [Music] time. Britain in the 60s was undergoing enormous social changes. There was a new freedom to break down barriers and challenge orthodoxy. The drive to close the asylums captured this rebellious mood. Mental hospitals were just another battleground in a power struggle with the establishment. [Music] There are obviously a whole raft of civil libertarian movements that get going. Ideas about what mental illness really is and how it should be treated become ideas of broad social interest. At the forefront of this radical new thinking was the controversial psychiatrist RD Lang. His books and speeches outlined a new approach to treatment in which the patient, not the doctor, knew best. But they wish I wouldn't blow the gap and shoot my mouth off on television and uh to the public at large. And this is exactly what I think that any of us who have got descent within our uh particular professors ought to do. His books and ideas caused a sensation. The general thesis of the politics of experience is that we live in a mad world and that a normal response to a mad world is to be mad and that the that the sanity that most of us manage to maintain is actually the more abnormal sort of response. But many powerful mainstream psychiatrists working in the asylums closed ranks against the new ideas. Lang's thinking was treated as peripheral. Meanwhile, some doctors were seeking progress along experimental lines, particularly in surgery. You find your eyelids getting rather heavy. In a minute, you'll go off to sleep. Okay. Psychiatrists at Hyroids were so confident about one pioneering form of brain operation that they gave permission for a documentary crew to film it being carried out on one of their patients. The documentary focused on Maggie Chapman, who had been admitted to hyroid several times as a patient during the early ' 70s. No more tablets, Margaret. Oh, I don't have this one at dinner time, though. Where's my agitation tablet? Which is your agitation table? That big white. Yours have been reduced a bit. All right. Maggie was a 42year-old housewife with five children. She was struggling to cope and was prone to violent outbursts. Jolly top. Anybody said to me, "Yeah, I did lash out." And anybody that upset me kids or I just lash out. It was just auto training. Every so every so often I just used to I couldn't cope anymore. I just stopped. So they shipped me off to the hospital. Hyroids infield mount. That doesn't look far off. During one of her stays at Hyroids, Maggie was approached about a new operation which doctors convinced her could end her fits of violence. Right. He was telling me out how my temper would eventually I would end up doing life in prison for murder or in a mental hospital for the rest of my life. Right? I was really down. I was at a low. I wanted to get off that smelly ward. Right? It was disgusting. and he was telling me how I'd benefit from this operation. It was to burn this part of my brain that would stop me from getting angry and and having outbursts uh being violent. Now, if we leave you as you are and don't do anything, then you're not going to spend a month a year in a mental hospital, which you are doing at the moment. You're the time spent in a mental hospital is gradually going to go on increasing and you're going to end up there. So, we're forever balancing the risks of an operation against the risks to the patient of not doing the operation. Can you put your head straight or is it It was terrifying surgery though the doctors regarded it as a huge leap forward. Maggie was taken from the asylum to the local hospital. there. Two nylon balls were fixed in her forehead to act as guides for electrodes which would pinpoint the crucial part of her brain. The electrode is attached to the electricity supply and the current is switched on stimulating the area at the bottom of the electrode. Cot stuck inside. Oh dear. Are we head shook inside? Yes. Right. Everything shook the eyes, everything. The noise that that made must be still in me head. If a motorbike goes past me or somebody's drilling in the road, it's like, oh god, I just can't stand. It's like everything shakes in me. Keep looking up. Yes. Keep looking up. Look up. When he got the response of fear in my eyes, the pupils were like cat's eyes dilated. That's when he knew that it connected to the part of me brain that reacts to fear. A new electrode is put in the correct position and to this will be attached a much larger current which causes the tip of the electrode to heat up. is switched the probe a bomb and burnt a piece of my brain out. Maggie's doctors regarded the operation as a success. It did at least get her out of hyroids, but she insists the effects of the surgery were debilitating. I was like a zombie for 4 years. I couldn't communicate with people. It were like my speech had gone and my body my body was all wobbly. Maggie is now a successful campaigner for local community causes. She is adamant that she has pulled her life together in spite of the operation, not because of it. Her experimental treatment is now a piece of surgical history. Maggie still bitterly regrets what was done to her and how she was persuaded to consent to it. I don't think I needed that treatment. Um, and I look at it this way, right, that there was more violence inflicted on me than I ever inflicted on anybody. That was GBH. What they did to my brain. I'll never forgive him for [Music] it. By the mid70s, Enoch Powell had hoped that many, if not all, the old mental institutions would have disappeared. But not a single asylum had closed. Britain had entered a recession, bringing drastic cuts in health [Music] spending. Numbers in the asylums had to be reduced. At many hospitals, the cull happened gradually, one ward at a time. It started in the early '7s when a ward would be shut down. If a person died in that ward or a patient was discharged from this ward, we physically removed the bed so that nobody could be admitted into it again. If GPS wanted to refer a patient for possible admission for observation, there wasn't a bed any longer. People had to be nursed in the community. They had to be cared for in the community. Throughout the 1970s, almost every asylum in Britain remained open. But as individual wards shut down, many former patients were tipped onto the streets to cope with life outside. In the early 1980s, the BBC's brass tax program found that it was left to charities like the Salvation Army to pick up the pieces. The salation of my heart. [Applause] 65,000 beds in long stay wards have been phased out in 20 years. But the community care that was supposed to take their place has scarcely materialized. The long-term mental ill are still with us, but now in many cases fending for themselves. and I will comfort you today and every day. Honor me. I ended up being a vagrant and diagnosed as schizophrenic and um I then became a revolving door patient. Heling Hospital in Sussex was home to Andrew Voice at various points in the 70s. He had had a nervous breakdown when he was 23 and ended up being committed then discharged several times in a row. I was never got right by the old asylum regimes. They would give me medication by injection. I found that I got a side effect called athesia and uh I would be extremely restless but uh sedated at the same time for a week day and night after that injection. It was an unbearable experience for Andrew and he was as anxious to avoid the painful symptoms as the asylum was to move him on. [Music] Like many others, he was a victim of a diminishing number of longstay beds. I would get paranoid. I would be living rough. I wouldn't be looking after myself. I'd be neglecting myself. And I would get returned to the asylum, usually by the police. And that was the nature of my revolving door life. Uh and when I got back into the asylum again, they would stop me on injections again. And they did this about 12 times between about 1975 and about 1990. Beyond the asylum walls, many patients found there was little organized care and no hope of a secure [Applause] [Music] life. But there was no going back. In the 1980s, the asylums finally began to close. That door will open a bit further. The revolution arrived swiftly with a momentum of its own. By 1990, 100,000 patients had been discharged into wider society. History is taking its revenge on the institutions. The mental hospital is becoming [Music] extinct. One after another, the great Victorian buildings began a process of shifting their patients on mass into the community and shutting their gates forever. Instead of doing things peace meal, uh things were all done in one rush. It was, you know, Wakefield have decided they're going to empty their psychiatric hospitals. Huddersfield have done the same. Wolverampton, Birmingham, all of them are going to do the same. So, we must keep up with them. So, everybody went out into the community. This was the start of care in the community as we know it today. The idea was that the majority of patients be placed out in the community with psychiatric support. An ITV film documented the closure of one mental disability institution in Stockport. Under the new system, there would still be beds for some acute cases. But for most patients, it was the start of a new life. Thank you very much for everything you've done for me. I don't know what I have done without you all these years. Thanks very much everybody. They're all packed nice and neat next to our nasal. The trickle of people who've been leaving hospital during the last decade is now a flood. The new rules mean that everyone has the right to a say in their own future. Freedom is government policy. The asylons were closed down by Mrs. Thatcher. She's a strange person to thank for an act of social justice, but we have her to thank for um uh emancipating us uh former psychiatric patients by closing down the old asylums. With the closure of the asylums came a new spirit among patients as they began to confront the realities of life outside. They found a new self-confidence. It was a chance to share in the individualism of the time. Once you actually stopped destroying people's lives by locking them up and destroying any kind of individuality, you actually did open the floodgates for saying, "Hang on, there's a set of people who believe they actually worth more than that." Amidst the wreckage of the asylums, a grassroots movement sprang up in which patients challenged doctors preeminent role in decisions about treatment. The user movement, as it was called, campaigned successfully for patients to be more than the passive recipients of psychiatry. Now we have a system where people expect to be and want to be knowledgeable about their problems and they want to be involved in the sorts of treatments that doctors prescribe. [Music] Joan Tugwell, who was first admitted into a mental hospital in 1953 because of her panic attacks, was now released into the outside world. She had been in one asylum or another for a third of a century. First thing we're being free. I mean, after 33 and 1/2 years is a long time. You got to know how to go about it when you're out in the community. So, you got to do things for yourself. Joan's transition to the outside world was filmed by her local health service to show the challenges of care in the community. Long-term patients had to get used to a life in which decades old daily routines were left behind. The reality wasn't all Joan had hoped for. When they put me out in the community, I had no bulbs. No balls, no line. I had no carpet. I had nothing to cook, nothing to cook on. I had nothing to put in the fridge. I had no money. And I was in debt. And that's how they left me with hardly anything. Want to get the milk out the fridge, Joe? Yeah. Like many other patients, Joan had to cope with a certain amount of stigma. With the shelter of the asylum gone, old prejudices came to the surface. When I used to appear off the bus and I was walking to my flat, they'd all call their children indoors until I was out of sight. Not nice really. I said, "Well, you think I'm going to hurt them or something?" Sometimes people will say to me, why don't you go back to Broadmore? So I used to say, if I was to kill you, then I would go back. But Joan has survived. She has made a life for herself in the community with the help of her carer and continued medication. In another era, she might have remained on a long-stay ward in an asylum until she died. Like many others, Joan has found a degree of freedom. I felt really optimism that um there was a future in the community for people and that um we could set goals for ourselves and we could achieve things and we could begin to take a bit of control over our [Music] lives. But the euphoria was short-lived. The political honeymoon for care in the community was over very quickly. In December 1992 at Vinsbury Park Tube Station in London, a recently released psychiatric patient stabbed a passenger in the eye and killed him. It was the most notorious of several disturbing incidents which jolted the public's ideas about the new form of care. It sparked panic in many parts of society. Uh, he was It's 11:00 a.m. in a North London police station. Officers are being briefed about a potential killer, not by a colleague, but by the man's psychiatrist. And the problem over the last 3 weeks has been increasing uh threats of violence and specific threats of wanting to kill variously his probation officer, his girlfriend, and his mother. In 1997, the BBC's Panorama program followed the work of a consultant psychiatrist in North London. you know, we think he is at the moment. It was a vision of psychiatric services that nobody involved in care in the community wanted to see. Straight over. Straight over. Both psychiatrist and police judge overwhelming force is necessary. releasing thousands of psychiatric patients into society raised a whole new set of problems. What seems to happen in the '90s is that people suddenly start to get cold feet about it all and and and start to fear that actually what this might mean is that you've got loads and loads of of people with uncontrolled mental illness running about society causing mayhem. The newly elected Labour government was clearly on the side of safety first. The health secretary, Frank Dobson, openly declared that community care had failed. The political response was ultimately restrictive legislation. Doctors were given powers to force patients in the community to take medication or risk losing their newfound freedom. To many people, it seemed like a step backwards. [Music] Hyoids was finally closed in 2003. It was one of the last relics of the asylum network and like many others was bought by developers to be turned into luxury [Music] flats. I felt it was past its best buy. It had done its duty. It had served its cause. But um people like these are are unfortunate. They still need to be cared for. This place did indeed provide refuge from the world for some patients. Asylum in the true sense. Some feel that this ideal of protection and rest has been lost that the community can never replace this kind of institution. My feeling is that the uh the whole concept of community care is a disaster. I don't think that the um community cares. Not on my patch though is the the motto. There are even those who think that the failure of the asylums has been exaggerated. But few people have time for nostalgia. I get very angry when I see people glorifying them. You know, these lovely estates in beautiful Victorian buildings in the country. They were awful places. They were demeaning, devaluing places. I know of no one who would love to go back to a 40-bed dormatory and their bed and their locker and their Gideon's Bible and the shared clothes. Britain's asylums are now closed forever. [Music] These were once extraordinary places, home to more than 150,000 people at their height. But they had outlived the ideals of their Victorian architects and too often had become dust bins of humanity. What they leave behind are the lives they transformed. I do realize that although I was in the system 5 years which seems an awfully long time for other patients 5 years can turn into 50 60 years or whatever in that sense I can see that I was one of the lucky ones. I suppose I always feel angry about it but I just don't let it get in my way. I can't. Can I got to get on with my life? Haven't I? If I started dwelling on feeling anger all the time, my life wouldn't be worth living, would it? [Music] The Open University has produced a CD exploring creative responses to mental health. For your free copy, go to bbc.co.uk/adroom UK/adroom or call 08453668015 [Music] [Music] [Music] [Applause] [Music]