Verusca Calabria explores oral history as a vital method to research histories of mental healthcare.
In recent decades in the UK, interest in oral history as a research method has expanded, both as a community initiative and as a form of academic inquiry across the humanities and the social sciences (Calabria and Harding, 2023). The unique quality of oral history is its ability to give voice to marginalised and disenfranchised groups often forgotten by traditional documentary history; by enabling individuals to share their stories in their own words. In this sense, it can challenge the traditional orthodoxy of knowledge-making by opening up new areas of inquiry into the everyday practices of ordinary people.
As a social scientist and an oral historian working across the disciplines of mental health, history and heritage, oral history has proven invaluable when researching the social history of mental healthcare. With patient experiences of care in institutions still a relatively unexplored area, my work echoes the call made by British historian of medicine Roy Porter (1985), now made over 30 years ago, for a medical history from below.
As this piece explores, the personal testimonies from interviews that I have undertaken with former patients and staff of the now defunct old state mental hospitals[i] have helped debunk assumptions surrounding mental health’s policy’s progress. The piece also considers a new research project which documents a mental health activism campaign in Nottingham through the collection of oral histories.
Institutional Oral Histories
My initial research during my PhD studies aimed to understand the impact of the transition from institutional to community care following the modernisation of mental health services, due to the advent of the NHS and Community Care Act 1990. Between 2016 and 2018, I collected 30 oral history interviews with former patients and medical and non-medical staff who received and gave care in the now closed mental hospitals in Nottinghamshire, 30 years after the hospitals’ closure.
The oral testimonies of former patients, medical and non-medical staff, revealed several positive aspects of care within these mental hospitals. They also illuminated regrets about the demise of the different institutions, characterising hospital communities as places of safety and belonging. These more positive accounts of the old system of mental healthcare are not typically acknowledged in official reports about institutional care of that time, because they do not fit with government policies on deinstitutionalisation.
My findings are particularly useful in making sense of the issues experienced in mental healthcare today, as the testimonies reveal shortcomings in current mental health policy. For instance, former patients, who still rely on mental health services, remembered having unlimited access to the vast grounds in the old state mental hospitals.
They also recalled that as inpatients they had the ability to freely move within the hospitals’ internal and external spaces. They lamented the return to locked wards in the current inpatient system as a step backwards in mental health policy. They also recounted the pleasure of spending time in the extensive park-like grounds in the old-state mental hospitals, which aided convalescence and had the effect of fostering a more relaxed treatment environment than the new acute units within the general hospital.
In this way, the oral histories helped to challenge the underlying assumption that health and social care has positively progressed, in contrast to the dominant perception of residential care provided in institutions being outmoded (Jones and Fowles, 1984). This became a common sense view that underpinned public policy and professional practice, and a self-evident truth for many health and social care professionals alike in the latter part of the twentieth century (Kritsotaki, 2016).
The recent review of the Mental Health Act (Wessley, 2018) made specific recommendations to improve the dire state of current mental healthcare. These included the reduction of prison-like environments within inpatient units by modifying the built environment, meaning that internal and external spaces could facilitate informal social connections. This, in turn, would improve the atmosphere of the wards, creating a more welcoming environment while increasing meaningful therapeutic activities to aid recovery. These were all care practices that were embraced by the Nottingham mental hospitals in the latter part of the twentieth century. Indeed, one former patient recalled the wards in the previous mental hospital as having a relaxing atmosphere, an atmosphere which was entirely missing in the the psychiatric ward built on the site of a general hospital where he was hospitalised years later.
Day Centre Oral Histories
In my current research, part of a project funded by a £98,000 grant from the National Lottery Heritage Fund, I employ oral history methodologies to explore and document a campaign to resist cuts in mental health services and save a mental health day centre, the Middle Street Resource Centre, in Nottingham. The centre has a long history of providing care for people with mental ill health. Built in 1972 as a psychiatric day hospital, it was run as a day centre until the 2000s, when it was threatened with closure several times. It was then saved by a 3-year campaign, run between service users and local professionals. The unexpected result of the campaign saw the centre being handed over by the local council to be run independently by service users and their allies.
The project team I am leading is collecting the combined oral histories of former and current service users, workers and volunteers of the centre, documenting this new wave of mental health activism in which service user groups and their allies fight to keep services open. To date, 15 people have been interviewed on the site of the day centre with a plan to record a minimum of 30 oral history interviews. The oral histories will inform a touring exhibition and a documentary about the centre and will be deposited at the Nottinghamshire Archives at the end of the project.
While patient movements in the 1970s fought to abolish the traditional mental health system (Crossley and Crossley, 2001), these groups are now demanding access to them. Together, the testimonies I have collected demonstrate a lack of investment in long-term therapeutic community-type services in the new system, both locally in Nottingham and at a national level, as these were never invested in since the advent of community care in the 1990s.
Through public engagement events, the project aims to raise awareness of the rich history of activism in mental health alongside the importance of social support for people with long-term serious mental health problems – connecting seldom heard service user groups to a wider range of people in the community, such as Beeston Women’s mental health group and Rushcliffe mental health carers.
Importantly, the testimonies reveal how service users have sought to safeguard opportunities for peer support in safe places. Their experiences challenge the imperative of the Social Inclusion Agenda (2008), introduced as part of the modernisation of mental health policy with its emphasis on the use of mainstream facilities instead of day services, which are seen as inhibiting social inclusion. The policy of social inclusion, which provided the impetus for the closure of day centres across the country, does not necessarily reflect the views and concerns of people using services, as it fails to take into account the difficulties individuals with long-term mental health conditions face in accessing safe spaces in the wider society.
The history of deinstitutionalisation, namely the closure of the old large-scale institutions to be replaced with the provision of care in the community, has largely been told in positive terms. Yet together, the oral histories I have collected highlight the positive aspects of care in the old system which were overlooked with the closure of institutions and the shift to community care practices. Prioritising the lived experiences of these key actors, individuals who were at the receiving end of the changes in mental health care policy, can help create more equitable research which in turn puts individuals and communities at the heart of resulting public programming.
For anyone interested in learning more about oral history and interviewing processes, the Oral History Society’s webpage is a brilliant resource through which to learn about best practice in the field of oral history. The Society is made of community-based and academic oral history practitioners and others interested in dissemination of oral history, personal testimonies and memory-based methodologies. The Society publishes the world’s oldest oral history journal and organises annual conferences. The next Oral History Society’s annual conference at Nottingham Trent University on 23-24 June 2023, entitled “Making Histories Together”, marks the Society’s 50th anniversary.
About the author
Verusca Calabria is a Senior Lecturer in Health and Social Care at Nottingham Trent University. She is an oral historian and a trustee of the Oral History Society and co-founder of Nottingham Trent University’s oral history network. You can follow Verusca’s work on @Verusca and @HealthMemories (Twitter), @50yearsMSRC (Facebook). Her latest oral history project can be viewed here: Hidden Memories of Mental Health Care.
Bacopoulos-Viau, Alexandra and Fauvel, Aude (2016). The Patient’s Turn Roy Porter and Psychiatry’s Tales, Thirty Years On. Medical History, 60(1), p 8.
Calabria, Verusca, Harding, Jenny, Meiklejohn, Louise (2023 forthcoming). ‘Oral History in UK Doctoral Research: Extent of Use and Researcher Preparedness for Emotionally Demanding Work. Oral History Review, vol 50.1.
Calabria, Verusca (2022). ‘With Care in the Community, Everything Goes: Using Participatory Oral History to Re-examine the Provision of Care in the Old State Mental Hospitals. Oral History. 50(1), pp. 93-103.
Calabria, Verusca, Bailey Di and Bowpitt, Graham (2021). More than Bricks and Mortar: Meaningful Care Practices in the Old State Mental Hospitals. In Voices in the History of Madness: Patient and Practitioner Perspectives, eds. Rob Ellis, Sarah Kendall and Steven J. Taylor. Cham, Switzerland: Palgrave Macmillan, pp. 191-208.
Crossley, Michele L. and Crossley, Nick (2001). Patient Voices, Social Movements and the Habitus; How Psychiatric Survivors Speak Out. Social Science & Medicine, 52(10), pp. 1477-1489.
Jones, Katherine and Fowles, A.J. (1984). Ideas on institutions: Analysing the Lliterature on Long-term Care and Custody. Routledge.
Kritsotaki, Despo, Long, Vicky and Smith, Matthew (2016). Deinstitutionalisation and After: Post-war Psychiatry in the Western World. Palgrave Macmillan.
National Social Inclusion Programme (2008) From Segregation to Inclusion: Where are we now? A review of progress towards the implementation of the mental health day services commissioning guidance. London: Department of Health.
Porter, Roy (1985). ‘The patient’s View: Doing Medical History From Below. Theory and Society. 14(2), pp. 175-198.
[i] The Mental Treatment Act 1930 was an Act of Parliament which replaced the term “asylum” with “mental hospital” alongside other sweeping reforms, such as voluntary admission.