Posts Tagged ‘Mental Health’

‘Unlocking the Asylum’ project- Patient Files

March 18, 2019

As Project Support Officer for the ‘Unlocking the Asylum’ project, a large part of my work involves the listing and repackaging of approximately 23,000 patient files. These files begin in 1948 (when the NHS was formed), up to the closure of the North Wales Hospital in 1995.

Repackaging

Before a patient file is repackaged, all metal fastenings (treasury tags, pins, staples, paper clips, rubber bands etc.) are removed, and replaced with brass paper clips and plastic treasury tags. Metal fastenings can cause irreversible damage to the files, their removal will prevent future damage. Each file is kept in its original order, however depending on the length of stay and treatment a patient received, a file can be as small as one piece of paper, to a file that can fill 2 boxes. Each individual file is repackaged in archival folders, tied and safely stored in archival boxes.

Listing

Information extracted from the files are listed on a database, detailing the patient number, patient name, date of birth, admission and discharge/death date. The diagnosis (if given) is also listed, along with any additional details such as treatment given, outpatient information, psychiatric social work notes, number of admissions, referral information, notes/poetry/sketches made by the patient and psychiatric reports for court proceedings.

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As the development of medicine progresses quickly during the mid-20th century, there is reference to a wide range of treatments within the files; for instance Insulin Coma treatment, Electro Convulsive Therapy, Leucotomy, Malarial treatment, Aversion therapy, Psychotherapy, and the use of early Anti-depressants such as Largactil and Tofranil are all well documented.

The first Annual Reports of the hospital (1850-1860), list only five ‘forms of disease in all cases admitted’- mania, epilepsy, dementia, melancholia and idiot. In comparison, the database (so far) has over 800 different diagnoses, ranging from acute alcoholism to Wernicke’s encephalopathy. Long term patients’ diagnosis’s also evolved, one example is of a patient admitted in 1949 with Manic depressive psychosis, who was discharged from the hospital 45 years later in 1994, with a diagnosis of Bipolar disorder.

Metal Fastenings removed from patient files during February 2019

Metal Fastenings removed from patient files during February 2019

The most common and most frequent treatment used during the 1950s to the 1970s, was ECT (Electroconvulsive therapy), however its reputation made many people consider it more of a punishment than a treatment. Despite this, it is evident from listing the patient files, that ECT was still used at the hospital up until its closure in 1995. ECT is in fact a therapy that is still used today, psychiatrists and patients still consider it to be a safe and effective treatment for severe depression and bipolar disorder. Current practice, known as modified ECT, uses muscle relaxants to avoid the physical dangers of a seizure and anaesthesia to avoid pain from the electricity.

As a result of the Abortion Act of 1968, there is a marked increase of patient files containing referral for psychiatric assessment in the late 60’s early 70’s. It was now possible to obtain an abortion under the NHS if a psychiatrist was prepared to sign a recommendation that proceeding with the pregnancy could damage the patient’s mental health.

In addition during this time, Psychiatrists were required to produce reports for the justice system, with needs to respond to probation officers and legal officers in providing evidence for court reports. However psychiatric reports were not only needed for criminal cases, but also for divorce proceedings, Court of Protection applications and claims for industrial injury and road collisions, as the compensation industry was established and was rapidly expanding.

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Of the 22,800 files listed 8,015 were outpatients or referred to outpatients upon their discharge from the hospital. The work of the outpatient clinics expanded rapidly in the immediate post war years, in 1947 the medical superintendent said he regarded the outpatient clinics as the most fundamental service provided by the hospital. By the end of the 1950’s the hospital ran outpatient sessions in Rhyl, Bangor, Wrexham and Dolgellau. Several of the files include notes by the psychiatric social worker, who supported the outpatient clinics by spending time investigating the home environment of patients. The social worker evidently had a valuable role to play in the after care of the patient, ensuring a smooth re-entrance into family, occupational and community life.

Very notably during the late 70’s into the early 80’s that there is a sharp spike in those admitted for drug addiction and alcoholism. The admission of a growing number of patients with drug related problems had implications on hospital management. The needs of these patients were very different, some of them, usually quite young, could be disruptive, particularly to the already established routines on the wards. By the late 80’s so high was the demand for rehabilitation, the hospital had its own drug and alcohol unit for treatment and recovery of patients diagnosed with addiction.

These files clearly contain a wealth of information, and there is so much more to be discovered in relation to medical advances and social trends in the mid to late 20th century. Please note that due to NHS regulations records of patients containing sensitive personal information are closed to the public for 100 years. These records may be available to researchers who belong to an academic institution upon request. If you are interested in using the North Wales Hospital collection for academic research please contact us.

Rhian Evans- Project Support Officer ‘Unlocking the Asylum’

Lunacy Commission Patients Admission Registers, 1846-1912

March 12, 2018

Did you know that the Lunacy Patients Admission Registers are available to search on ancestry.co.uk? You can use this index, to search for patients who were admitted to The North Wales Hospital, Denbigh between 1846 and 1912.

These registers which provide details of asylum patients in both public and private asylums, were kept by the Lunacy Commission. In 1845, the Lunacy Act and County Asylum Act obligated counties to build county asylums for the poor and criminally insane and established the Lunacy Commission to oversee both private and public asylums.

Under the Mental Deficiencies Act of 1913 the Lunacy Commission were replaced by The Board of Control for Lunacy and Mental Deficiency; in 1948 the Boards functions were then transferred to the Minister of Health, under the National Health Service Act of 1946.

Records relating to the Lunacy Commission can be found within the North Wales Hospital collection; the Commission made annual visits to the hospital, and reports relating to their visits were included in the hospitals Annual Reports.

The admission registers themselves recorded the name and sex of the patient; the name of the hospital, asylum, or licensed house; and the date of admission and of discharge or death of each patient. This index, along with surviving patient records from the hospital, are excellent resources for family history, local history and academic research. Please note however that access to hospital records are closed for 100 years, due to privacy restrictions.

Denbighshire Archives offers free access to ancestry.co.uk, if you would like to visit the office to view the website, or to consult items within the North Wales Hospital collection, please visit our website to book a place.

Details of the ‘Unlocking the Asylum’ project can be found here.