Maudsley Hospital

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Maudsley Hospital
South London and Maudsley NHS Foundation Trust
South London and Maudsley NHS Foundation Trust logo.jpg
Maudsley Hospital Main Building.jpg
Geography
Location Denmark Hill, Southwark,, London, England, United Kingdom
Organisation
Care system Public NHS
Hospital type Specialist
Affiliated university King's College London
Services
Emergency department Via hospital A&E
Beds 250
Speciality Psychiatric hospital
History
Founded 1923
Links
Website www.slam.nhs.uk
Lists Hospitals in England

The Maudsley Hospital is a British psychiatric hospital in South London. The Maudsley is the largest mental health training institution in the UK. It is part of South London and Maudsley NHS Foundation Trust, and works in partnership with the Institute of Psychiatry, King’s College London.[1] The hospital was one of the originating institutions in producing the Maudsley Prescribing Guidelines.

History[edit]

The Maudsley story dates from 1907, when once leading Victorian psychiatrist Henry Maudsley offered London County Council £30,000 (apparently earned from lucrative private practice in the West End) to help found a new mental hospital that would:

  1. be exclusively for early and acute cases rather than chronic cases,
  2. have an out-patients' clinic,
  3. provide for teaching and research.

Maudsley's associate Frederick Walker Mott had proposed the original idea and he conducted the negotiations, with Maudsley remaining anonymous until the offer was accepted. Mott, a neuropathologist, had been influenced by a visit to Emil Kraepelin's psychiatric clinic with attached postgraduate teaching facilities in Munich, Germany.[2] Both Maudsley and Mott were adherents of degeneration theory.

The Council agreed to contribute half the building costs - eventually rising to £70,000 - and then covered the running costs which were almost twice as high per bed as the large asylums. The hospital also incorporated the Central Pathological Laboratory, transferred from Claybury Asylum, run by Mott.[2]

During World War I the building was used to treat war veterans. It was then returned to the control of London County Council and finally opened as the Maudsley Hospital in February 1923. It remains notable that a specific Act of Parliament had to be obtained (1915) to allow the institution to accept voluntary patients without needing to certify them as insane.

The first superintendent was psychiatrist Edward Mapother, while Frederick Golla took over the running of the pathology lab from Mott. Both were more skeptical of the Kraepelinian categories of diagnosis, and took a more pragmatic and eclectic view on causation and treatment.

In the interwar period the Maudsley engaged in widespread experimentation with animal hormones, both in small doses to rectify supposed deficits and in overdoses as a shock therapy.[3] Numerous psychoactive drugs and procedures were tried out, in what has been described as 'unconstrained experimentation'. One of those involved, as a trainee and then junior doctor, was the notorious William Sargant.[4]

The hospital's nursing staff comprised 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. It had a good reputation for training nurses and some applicants even travelled overseas to train there. A report (held at Bethlem's Archives & 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 Maudsley Hospital Medical School was established in 1924 and eventually became a well-respected teaching centre. In 1932, Mapother described it as "the main postgraduate school of mental medicine in England." The Maudsley Hospital had initially struggled to secure funding from the Medical Research Council, and, in order to undertake further research and develop the Medical School, a substantial grant was obtained in 1938 from American charity the Rockefeller Foundation.[5] The medical school was renamed the Institute of Psychiatry in 1948.

The 1920s and 30s saw a rapid growth in the number of patients treated. The growth of the Maudsley led to an on-going building programme. In 1933, a purpose-built outpatient department was added, two years after the completion of a secure unit.

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: '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.

Both Mapother and his deputy Aubrey Lewis was supporters of eugenic sterilisation and castration of those deemed to have degenerate genetic lines, unequivocally recommending it to the Brook Committee in 1932. However, with the spread of National Socialist (Nazi) laws in Germany through the 30s, they backed away from their claims. The Maudsley maintained its links with Germany, taking on both pro-Nazis and Jewish emigres, though it was the latter who become dominant and helped secure vital funding from the American Rockefeller Foundation.[4]

At the outbreak of the Second World War, and 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 National Health Service (NHS). This partnership saw the introduction of more community-based services and a gradual expansion of the south London catchment area, to become South London and Maudsley NHS Foundation Trust in 2006.

Influential psychiatrist Aubrey Lewis was clinical director of the Maudsley from 1936, and professor of psychiatry at the IOP from 1946 until 1966.[6][7]

The Maudsley pioneered the development of some new treatments. Breakthroughs included the introduction of clinical neuroscience in the 1950s which was partly led by Denis Hill, a senior lecturer at the Maudsley and the Institute of Psychiatry (IoP), and the use of group talking therapies which is still practiced today. In general the Maudsley and IOP were associated with an anti Freudian anti-psychoanalysis approach, instead focusing on medications and behavioural therapy.

In the 1960s a group from the Maudsley Hospital attacked the use of lithium for mood disorders. The head, Aubrey Lewis, called it "dangerous nonsense", and colleagues published that it was therapeutically ineffective. Their objections have recently been described as 'poorly grounded' and having steered practitioners away from a beneficial agent.[8]

Sharing the Maudsley site is the Institute of Psychiatry, now a postgraduate institute of the University of London and, since August 1997, a school of King's College London. It is the only postgraduate institution in the UK that is devoted to the study and practice of psychiatry and related disciplines.

Current hospital[edit]

The Maudsley continues to provide in-patient and community mental health care to local people in Southwark and Lambeth and nationally across the UK. It is also a contributor to both psychiatric research and the training of mental health care staff. As part of the South London and Maudsley NHS Foundation Trust (SLaM) it also has close links with Bethlem Royal Hospital - the original "Bedlam". In June 2013 a new learning centre was opened on the hospital site.

Academic Health Sciences Centre[edit]

SLaM is part of King's Health Partners Academic Health Sciences Centre (AHSC) - in partnership with King's College London, Guy's and St Thomas' NHS Foundation Trust and King's College Hospital NHS Foundation Trust. King's Health Partners aims to promote health in mind and body. An AHSC is one of several terms which are used to describe an organisation which delivers both healthcare to patients and health-related science and research, usually with a well-developed teaching and education role as well. This type of organisation is fairly common amongst the leading hospitals and universities around the world. There are currently five AHSCs in the U.K.

Biomedical Research Centre[edit]

The trust manages one of the UK’s only Biomedical Research Centre specialising in mental health.[9] The centre, managed in partnership with the Institute of Psychiatry, King’s College London, is based on the Maudsley Hospital campus and funded by the National Institute for Health Research (NIHR).

Media[edit]

In 2013 South London and Maudsley NHS Foundation Trust (SLaM) took part in a Channel 4 observational documentary controversially entitled 'Bedlam'. SLaM staff and patients spent two years working with television company The Garden Productions. The four part series started on 31 October. The first programme, Anxiety, followed patients through Bethlem Royal Hospital’s 18-bed Anxiety and Disorders Residential Unit. The next programme was called Crisis; cameras were allowed in to Lambeth Hospital’s Triage ward for the first time. The third programme, Psychosis, filmed a community mental health team. The final programme, Breakdown, focused on older adults, including those admitted to the Older Adults Ward at Maudsley Hospital. In May 2014 'Bethlem' was awarded a BAFTA television award in the 'best factual series' category.

References[edit]

  1. ^ "Who we are". www.slam.nhs.uk. Retrieved 2010-01-23. [dead link]
  2. ^ a b The Maudsley Hospital: Design and Strategic Direction, 1923–1939
  3. ^ ORGAN EXTRACTS AND THE DEVELOPMENT OF PSYCHIATRY: HORMONAL TREATMENTS AT THE MAUDSLEY HOSPITAL 1923–1938
  4. ^ a b Chapter 4: Germany and the Making of "English" Psychiatry: The Maudsley Hospital, 1908-1939 in International Relations in Psychiatry: Britain, Germany, and the United States to World War II.]
  5. ^ [1]
  6. ^ [2]
  7. ^ [3]
  8. ^ The history of lithium therapy Edward Shorter, Bipolar Disord. Jun 2009; 11(0 2): 4–9. doi: 10.1111/j.1399-5618.2009.00706.x PMCID: PMC3712976 CAMSID: CAMS3186
  9. ^ National Institute for Health Research / Biomedical Research Centres

External links[edit]

Coordinates: 51°28′08″N 0°05′28″W / 51.4688°N 0.0912°W / 51.4688; -0.0912