Belated happy new year. Visiting the Royal College of Nursing headquarters in London last Friday ahead of a meeting of the Network for Psychiatric Nursing Research (NPNR) conference committee (more on that below) gave me an opportunity to pop into the ‘Out of the Asylum’ exhibition. I’m glad I did. Texts, photographs and other artefacts illustrate the history of mental health nursing.
Here are some of the pictures I took. These include a photo of the RCN’s copy of a sixth edition of the Red Handbook, displayed alongside nurses’ badges, a Bethlem Royal Hospital pamphlet, a syringe and other items of interest. For more on the Red Handbook see this earlier post, along with this post which includes material from my copy of a fourth edition of the same. Another picture relates a set of regulations for the bathing of patients.
One of the display boards makes the observation that ‘few mental health nurses now wear uniforms’. As an unfortunate aside, this may need some future updating. From what I’m hearing, the historic trend towards mental health nurses wearing everyday clothes at work is reversing, with numbers of NHS trusts and health boards contemplating a return to uniforms. I regret that. But sticking with the exhibition…
…a final photograph I’m reproducing here is the front sheet of an early 1930s examination paper. Look hard and you’ll see questions on bones, asphyxia and antiseptics (amongst other things).
The NPNR planning meeting, this being the purpose of my trip, was a productive one. This year’s event (the 22nd) will be taking place in Nottingham on September 15th and 16th. I’ll add more on this when I can, and include some regular updates on this site.
Perusing, for no particular reason, my fourth edition of the Red Handbook (published, I think, just after the start of the last century) I find this early reference to mental health nursing in people’s homes. Here are the relevant pages for those interested:
Note the sections implying that attendance in private houses is for the higher classes only, along with the description of all those things which should be done to reduce risk.
Interesting, too, that attendants are reminded that drinking alcohol on duty might not be the best of ideas. Advice like that never goes out-of-date.
For other posts drawing on this first-ever textbook for mental health nurses, try From ‘The Red Handbook’ to ‘The Art and Science of Mental Health Nursing’ and Exam time.
For students up and down the country it is examination season. Whilst students of mental health nursing are busy submitting their dissertations, writing up their reflective essays and achieving their practice-based ‘competencies’ I thought it might be interesting to share the ‘Regulations for the Training and Examination of Candidates for the Certificate of Proficiency in Nursing and Attending on the Insane’. I have scanned these from my copy of the Red Handbook:
In uploading these pages I have just noticed the mention (on page 147, the last-but-one reproduced above) of ‘Attendance of the insane in private houses’. Is it stretching things too far to suggest this as an early reference to community mental health nursing?
I also notice how much these regulations refer to the assessment and maintenance of bodily health (although I have no idea whatsoever what might be meant by ‘the insane ear’, a phrase appearing on page 146). Earlier this week, writing in an editorial for the BMJ Graham Thornicroft described the excess mortality of people with mental health problems as ‘a human rights disgrace’. He’s right, and whilst I’m glad we’re out of the age of the asylum and of ‘attending on the insane’ we might yet learn something from an historic nursing syllabus which placed emphasis on the importance of physical well-being.
Unbidden, but very welcome nonetheless, a freshly pressed copy of the third edition of Ian Norman and Iain Ryrie’s edited The Art and Science of Mental Health Nursing: a Textbook of Principles and Practice has arrived on my desk. This is a mighty tome indeed, and this latest version promises to cement the book’s status as a ‘must have’ for pre-registration students of mental health nursing.
A rather earlier text I also have a copy of is The Handbook for Attendants on the Insane, which Peter Nolan tells us was first published in 1885. This was the first book produced in the UK for the express purpose of instructing people we now uniformly call mental health nurses, and was produced at the instigation of the Medico-Psychological Association (MPA). The MPA later became the Royal Medico-Psychological Association, and eventually the Royal College of Psychiatrists.
No sooner had the Red Handbook (as it was often referred to) appeared than questions were being asked about the wisdom of educating attendants. This is a point Henry Rollin makes in this paper marking the centenary of the Handbook’s publication. In this extract, Rollin quotes from an (unnamed) reviewer writing in the Journal of Mental Science (now the British Journal of Psychiatry) in the year the Handbook went to print:
“We are not quite sure ourselves whether it is necessary or wise to attempt to convey instructions in physiology, etc., to ordinary attendants. Will they be the better equipped for their duties for being told that the brain consists of grey and white matter and cement substance?”, writes the anonymous reviewer. He adjusts his elegant pince-nez and continues, “We hardly see what is to be gained by superficial knowledge of this kind”.
Goodness knows what this anonymous reviewer would have made of Norman and Ryrie’s 728 pages of analysis, guidance and instruction, let alone the idea that mental health nurses now have to complete an undergraduate degree in order to register and practice.