This chapter explores how the RWCI reassessed its staffing requirements and created new roles for nurses during a period of contested change following the implementation of the 1913 Mental Deficiency Act. The institution grew significantly in this period and new facilities were developed to house a changing patient population. For the first time patients who were severely disabled and/or showing symptoms of mental illness were accepted. Staff struggled to cope with these changes, which led to discussions about how to recruit and retain and train appropriately qualified nurses. Senior nurses were credited with many of the institution’s successes before 1939, but the way they worked also made them vulnerable to outside criticism. Rank-and-file staff were blamed for an increasing number of care and control failures in the 1940s, and investigations hinted that at least some parts of the institution had fallen into a culture of neglect and abuse. Central government pressed for a further medicalisation of care in response to these difficulties but this seemed to provoke a series of clashes between the new medical superintendent and the most senior nurses rather than resolve the recruitment difficulties and role confusion that plagued the institution’s nursing service for many decades.
This book seeks to integrate the history of mental health nursing with the wider history of institutional and community care for people experiencing mental illness and/or living with a learning disability. It develops new research questions by drawing together a concern with exploring the class, gender, skills and working conditions of practitioners with an assessment of the care regimes staff helped create and patients’ experiences of them. Contributors from a range of disciplines use a variety of source material to examine both continuity and change in the history of care over two centuries. The book benefits from a foreword by Mick Carpenter and will appeal to researchers and students interested in all aspects of the history of nursing and the history of care. The book is also designed to be accessible to practitioners and the general reader.
The working lives of paid carers from 1800 to the 1990s
Anne Borsay and Pamela Dale
This introductory chapter provides an overview of the working lives of paid carers over two centuries. The emergence of modern nursing is usually dated to the mid-nineteenth century. Its complex evolution and international variations were shaped by the relationship between nursing and the state, religious influences, economics, a concern with social welfare, class and gender issues, scientific innovation, the reform of hospitals, and the development of a distinct body of nursing knowledge. Such analysis tends to prioritise the experiences of the general nurse while the asylum attendant/ psychiatric nurse tends to be either overlooked or described in a way that suggests inferiority. A narrative of catching up and falling behind imbues these debates with general nursing serving as an exemplar. This perspective neglects to consider the appropriateness of general hospital attitudes and practices to the care of the mentally ill, the special qualities and specific skills that might be demanded of the asylum attendant/ nurse, and the distinctive problems presented by their working environment. The idea that nurses’ needs and experiences can shape their responses to patient needs, and thus wider care regimes, is only just gaining credence but is the starting point for this collection of essays.