Approaches to mental health care in 19th and early 20th century England

In the mid-19th century, it was generally held by administrators and politicians that institutional confinement was the answer to many social problems. However, there were those both within and outside psychiatry who were concerned about what they perceived to be the limitations of the asylum system given that mental illness was poorly categorised – for example, it was uncertain whether alcohol abuse was an illness – the treatments unproven, and there were likely to be adverse effects of long-term institutionalisation. The size of institutions was questioned, as was the role of the private sector and whether the mentally ill could be entrusted to the care of poorly regulated facilities. This paper examines some of the expressed concerns about care of the mentally ill throughout the second half of the 19th century by reformers and psychiatrists with reference to the culture and management of institutions and private facilities, the exploitation of vulnerable people, and the emergence of home-based care provided by experienced and skilled nurses.