1900 - 2000


New NHS Trust formed

South London and Maudsley NHS Trust (SLaM) was formed following the reconfiguration of community and mental health services in south east London.

South London and Maudsley NHS Trust (SLaM) was formed from the merger of three organisations: Bethlem and Maudsley, Lambeth Healthcare and Lewisham and Guy's NHS Trusts. The Trust was established to provide mental health services and substance misuse services in the London Boroughs of Croydon, Lambeth, Lewisham and Southwark, as well as specialist services to people from across the UK.



The water tower speech

Minister of Health Enoch Powell's 'water tower' speech in 1961 marks the begining of the end of the asylum and a move to community care

In 1961 Minister of Health The Rt. Hon. J. Enoch Powell spoke at the annual health conference of mass reform of the mental health system and a 15-year plan to reduce the number of psychiatric beds to around 75,000, closing asylums and moving mental health wards to wings of general hospitals.  The speech marked the beginning of the transition to community based services, and the end of the asylum a period that would last some 30 years.

"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.

"This is a colossal undertaking, not so much in the new physical provision which it involves, as in the sheer inertia of mind and matter which it requires to he overcome. 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."



NHS formed

The National Health Service (NHS) was formed, providing free healthcare for all at the point of delivery.

In July 1948 the National Health Service (NHS) was launched as a way of making good healthcare available to all, regardless of wealth. It was the first time, anywhere in the world, that free healthcare was available to all citizens.

Health Secretary Aneurin Bevan, a former Welsh miner who became a Labour politician, fought passionately for the NHS. In parliament on February 9 1948 he said "take pride in the fact that, despite our financial and economic anxieties, we are still able to do the most civilised thing in the world: put the welfare of the sick in front of every other consideration".

In July that same year hospitals, doctors, nurses, pharmacists, opticians and dentists were brought together under the umbrella of the NHS - making healthcare free for all

Throughout the 20th Century, the Maudsley Hospital pioneered the development of new treatments including the introduction of clinical neuroscience in the 1950s partly led by Denis Hill, a senior lecturer at the Maudsley and the Institute of Psychiatry (IoP), as well as the use of group talking therapies which is still practiced today.

At the outbreak of the Second World War, with the threat of air-raids, the Maudsley closed and staff dispersed to two locations: a temporary hospital at Mill Hill School in north London and Belmont Hospital in Sutton, Surrey. Staff returned to the Maudsley site in 1945 and three years later the Maudsley joined up with the Bethlem Royal Hospital to become partners in the newly established NHS as a postgraduate psychiatric teaching hospital. The Maudsley's medical school became the IoP.

This merger saw the introduction of more community-based services and a gradual expansion of the south London catchment area.



The York Clinic

York Clinic was built with funding from the York Trust and being based within a general hospital, and forming part of a teaching school, it was the first clinic of its type in the UK.

In 1944, the York Clinic, Guy's Hospital opened. Designed to provide accommodation for 43 private patients of moderate means and to diagnose, investigate and treat nervous disorders or mental illness, in its first two years it was actually largely used to provide psychiatric treatment to officers of the armed forces.

The clinic aimed to provide the highest possible levels of nursing and medical care and to educate and train medical students and nurses in the principles and practice of treatment of functional nervous disorders and mental illness.

In 1999 the York Clinic became part of South London and Maudsley NHS Trust where it continued to provide inpatient services until 2010. These services then moved the Maudsley Hospital.  Some outpatient appointments are still held at Guy's Hospital.



Bethlem in Beckenham

In 1930, the Bethlem Royal Hospital relocated to Beckenham, where it is still based today.

The move in 1930 to a former country estate in Beckenham, Bromley  gave Bethlem its fourth incarnation. The wards, tastefully furnished and carpeted, were designed to appeal to middle class patients with the means to pay for their care. A 'free list' was, however, available to those who could not pay.



Institute of Psychiatry

The origins of the Institute of Psychiatry date back to 1924 when the Maudsley Hospital Medical School was established.

In 1932, Professor Edward Mapother, the first medical superintendent, described the Maudsley as "the main postgraduate school of mental medicine in England". In 1948 the medical school gained independent status within the University of London as the Institute of Psychiatry.Its first director was Professor Aubrey Lewis (1900 - 1975), who played a key role in establishing psychiatry as an academic discipline. The Institute became a school of King's College London in 1997.



Maudsley Hospital opens

The Maudsley Hospital, which had been requisitioned by the War Office during the First World War, was returned to the control of London County Council and finally opened in February 1923.

The hospital offered treatment for both early and acute cases and had an out-patient clinic. It also housed teaching and research. The Maudsley's nursing staff included a matron, assistant matron, six sisters and 19 staff nurses with at least three years' general hospital training, supported by 23 probationers and 12 male nurses. The Maudsley had a good reputation for training nurses and some applicants even traveled overseas to train there.

A report (held at Bethlem's Archives and Museum) from a nurse who trained at the Maudsley shows some of the work of a new trainee: "Apart from observation and simple treatment, nurses are trained in special investigations and therapy. They carry out many of the routine psychometric tests, help as technicians in the ward laboratories, and are instructors in occupational therapy".

The 1920s and 30s saw a significant growth in the number of patients treated at the Maudsley Hospital. Originally, there was no provision for the treatment of children and the rapid growth in this patient population was unforeseen. In 1928, a child guidance clinic was set up under the directorship of Dr William Moodie, the deputy medical superintendent.

The Children's Department was promoted as an example of the value of teamwork with psychiatrists to diagnose and to prescribe, psychologists for mental testing, social workers to deal with the environmental side and voluntary workers to observe the activities of the children in the play room. The demand for these services led to the construction of a dedicated building where children were seen as outpatients. In 1947 a dedicated inpatient unit for children was opened.

Henry Maudsley was committed to psychiatric research, and the hospital incorporated the Central Pathological Laboratory transferred from Claybury Asylum. Although the hospital initially struggled to secure funding from the Medical Research Council, in 1938, the Rockefeller Foundation made a substantial award to support research and education and the Maudsley has been an internationally renowned centre for research ever since.



Maudsley Hospital built

Work on the Maudsley was completed, after which the hospital was requisitioned for use by the War Office.

Construction of the Maudsley Hospital main building was authorised in October 1913 and completed two years later by which time building and site costs had risen to £69,750.

Six wards (two for assessment and four for treatment) housed 144 beds rather than the 108 originally planned. The red-brick Portland stone design resembled a district general hospital or town hall rather than a prison or asylum.

Yet the opening of the hospital to fulfil Henry Maudsley's original vision was still some way off. Before its completion, the hospital was requisitioned by the War Office to deal with the military casualties of the First World War. While physical injuries and disabilities were treated at King's College Hospital (or the 4th London Hospital General, as it was called by the military), those suffering from the serious and puzzling condition then known as 'shell shock' were sent to its subsidiary, Maudsley Hospital (or 'Neurological Clearing Hospital') on the other side of Denmark Hill.

There research was conducted into the pathology of the disorder, and patients were encouraged into carpentry, gardening and recreation in an attempt to restore their basic functioning and confidence. A specific Act of Parliament had to be obtained in 1915 to allow the institution to accept voluntary patients.

All patients labelled as 'neurological' (unwounded, but suffering from neurasthenia, the functional paralyses, hysteria or milder psychoses) were transferred to the Camberwell-based hospital. Patients received a short preliminary course of treatment, after which many recovered rapidly and could return to light duty.  The more serious cases were transferred to other hospitals provided for the purpose, such as the Springfield War Hospital in Wandsworth.  

In 1916 the King and Queen visited and were pleased with the arrangements and accommodation for the treatment of soldiers. By 1917 the hospital accommodated 185 soldiers and 18 officers with shell-shock, neurasthenia or acute mental disorder. After the war the hospital was demobilised but, from August 1919 until October 1920, it was funded by the Ministry of Pensions to treat ex-servicemen suffering from neurasthenia.

Henry Maudsley lived to see the hospital used during the war but died before it was open for civilian purposes.



Henry Maudsley

Dr Henry Maudsley, an eminent psychiatrist, urges the London City Council to establish a "fitly equipped hospital for mental diseases".

In 1908 Henry Maudsley, one of Britain's foremost mental scientists at the time, wrote to London County Council to offer £30,000 (subsequently increased to £40,000) towards the costs of establishing a "fitly equipped hospital for mental diseases". His vision was for an urban centre for a hospital rather than an asylum and for university psychiatric teaching and research.

In 1909, at Maudsley's suggestion, the LCC's Mental Hospital's engineer, W.C. Clifford Smith, undertook a fact-finding visit to Kraepelin's clinic in Munich to gather "hints as to the design, staffing and administration" of the proposed psychiatric hospital. Three years later, detailed plans were drafted.

Henry Maudsley's stipulation that the hospital should be within three to four miles of Trafalgar Square caused a delay in finding a site and was never quite met - the location settled on was Denmark Hill.



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