Location, Location 6

As promised in September, the Archivist now tells the story of the siting of the Maudsley Hospital (sister to Bethlem Hospital since the foundation of the National Health Service in 1948) in Camberwell, South London.

The 1867 conference of the Medico-Psychological Association (predecessor to the Royal College of Psychiatrists) heard a call from Dr J.G. Davey, a former medical officer at Colney Hatch Asylum, for the establishment in London of “a hospital for the insane poor”, which would embrace “all the means essential to the relief and cure of the disordered mind”, and would be restricted to 250 beds, in distinction to the great asylums of the metropolis, which (at best) were places of care and protection only, rather than treatment and recovery.¹

The fact that such a call was made is unsurprising in the light of the decision made ten years earlier by Bethlem Hospital (which had been committed, on paper at least, to the concept of curability for generations) to stop admitting paupers as patients. In the discussion that followed Davey’s paper, the need for psychiatric out-patient provision - what was then called a “dispensary” to which sufferers “may in their incipient condition apply to receive advice and relief”, or what might now be called “community-based early onset mental health interventions” - was discussed.²

Perhaps we should not be surprised, either, at the fact that nothing was done in direct response to this call, and the issue of preventative mental health interventions was not again brought to the fore of professional and bureaucratic attention for another forty years. In 1907, however, Dr Frederick Mott of Claybury Asylum took a proposal to London County Council’s Special (Housing and Treatment of Lunatics) Sub-Committee for the establishment of a “hospital for the care and treatment of acute recoverable cases of mental disease”, which would be for the reception of “early and acute cases only”; which would have an out-patient department; which would be equipped for 75 to 100 patients; and which would “be in a central position, and within three to four miles of Trafalgar Square”.³

This proposal (backed by an offer from a donor, whose name was initially known only to Mott, of £30,000 towards construction costs) eventually - after several more twists and turns - resulted in the 1923 opening of a hospital named after that donor, Dr Henry Maudsley. The location was a 4½ acre site on Denmark Hill, Camberwell, fractionally outside the stipulated 4-mile radius of Trafalgar Square by road though inside it as the crow flies - close enough to London, in other words, to make the vision behind the original proposal achievable. Its psychiatric outpatient department was not the first to be opened in London - that honour had been claimed by Bethlem Hospital in 1919 - but it proved to be more enduring, Bethlem later closing its outpatient services and moving from Southwark to Beckenham. The Maudsley’s urban siting, “not buried in the country, but situated in a populous inner London borough”⁴ (as described by a consultant psychiatrist in 1975, perhaps with half an eye to Bethlem in contrast) was an important factor in the continuing quality, relevance and visibility of its clinical care, teaching and research.