In April 1974 we produced the Critique Regarding Policy on St. Augustine's Hospital and circulated it within the hospital and the National Health Service. This document arose from our discontent and frustration with the state of affairs at the hospital and was critical of the service the hospital was offering to the community. We were at that time - and remain - greatly concerned with the lives and fates of the patients in the hospital and with the standards of care and treatment they receive. We wrote the Critique in an attempt to draw attention to the situation and bring about change.
The authorities have dismissed the case we presented. Although the Critique concerns policy, the authorities have focused on two words in the article, 'mistreatment' and 'malpractice', and insisted that we elaborate on these points. We would stress, as we have always done, that the Critique concerns policy for the treatment and care of psychiatric patients. Mistreatment and malpractice are two aspects of the report which have been used to divert attention from the main themes of the Critique. We feel that this is a tactic of the authorities designed to deflect responsibility from where it truly belongs with the administrative and management bodies onto nursing staff at ward level. We are aware, of course, that the authorities would consider the scapegoating of individual members of staff to be a simple solution to this affair. This would be a distortion of the problem and furthermore would be no solution.
We produced the Critique to expose the grave shortcomings of the hospital. The authorities instead of responding with energetic concern, have attempted to ridicule our criticisms with such dismissive remarks as the contents are immature', and 'the authors are confusing idealism with realism', and by describing the document as suspect and having no substance and the authors as being inexperienced.
Their sole communication to us has been a demand that we supply them with names, dates and corroborative evidence to substantiate our allegations of mistreatment and malpractice. They have shown no concern whatsoever for the main issues of the Critique concerning policy, treatment, care, mismanagement and maladministration.
We have brought into question serious aspects of the hospital's service to the public. What sort of jobs are these people doing that they can so flippantly dismiss the case we presented and state that unless we furnish them with detailed evidence they have no hesitation in refuting our allegations. These people are employed in a health service designed to serve the public.
They have a duty to the patients of St. Augustine's Hospital. The attitude they have shown and their dismissal of the case constitutes an abrogation of their responsibility to the patients of this hospital and to the community at large.
We have faith in the evidence of our own eyes. If we feel that something is wrong we must ask questions until we are satisfied. If we are not satisfied we must take appropriate action. We have stated and reiterate that something is wrong. The authorities have not taken appropriate action.
We have asked for an independent, wide ranging inquiry which would have offered ourselves as well as others at St. Augustine's the opportunity to come forward. This has been refused. We consider this refusal by the authorities to be quite irresponsible and devoid of any real concern for the lives of the patients at St. Augustine's Hospital. He are disgusted at the responses of the official bodies who have attempted to deny and dismiss our criticisms which have arisen directly from our experiences at this hospital. Who are these people to deny what we have seen with our own eyes? He have worked at St. Augustine's Hospital for a total of nearly six years. During this time we have seen, heard of, and been aware of such things as follows.
1. degrading and humiliating treatment to patients.
2. Patients being reduced to passive and submissive states.
3. Patients deprived of their rights.
4. Patients being labelled in derogatory ways.
5. Patients being made to feel and act as inferiors to staff.
6. Patients over medicated.
7. Patients physically assaulted by staff.
3. Patients being given electro-convulsive therapy (E.C.T. - shock treatment)
against their wills.
9. The misappropriation of patients monies.
10. The misappropriation of food and other provisions supplied for patients.
11. Patients deprived of their freedom.
12. Patients given inappropriate treatment.
13. The interests of the staff being put before the interests of patients.
He hold the hospital management and the medical and administrative bodies responsible for allowing such outrageous things to exist in this institution. It has been stated that terms such as mismanagement, maladministration, mistreatment and malpractice are vague and unspecific and we have been asked to elaborate on them and spell out exactly what we mean. Although we feel sure that those working within the hospital service know fully well what is meant, we now think it imnortant that we do illustrate our case. On the following pages we shall do this by citing examples reported by nursing staff. We are putting these illustrations in numbered paragraphs as quoted.
1. (i) A patient who was pacing the dormitory naked during the evening was threatened by a nurse: “If you don't get into bed I'll give you a fucking good hiding.”
(ii) A patient was secluded in a side room for agitated behaviour during the afternoon. At 7 p.m. I took this patient his supper, carrying it through the day room. The same nurse questioned where I was going with the supper and I replied that I was taking it to the patient. “Oh no you're not he stated.” I persisted in taking the patient his supper despite the nurse maintaining that you had to show such psychopaths that you meant business by depriving them of food.
(iii) The nurse arrived on the ward at 9 p.m. A slightly agitated patient was seated at the table. The nurse went over to the patient and repeatedly clipped him round the head saying 'How would you like a therapeutic clip round the head?' each time that he hit him.
(iv) At 7 a.m. after this nurse had been on night duty he told the day staff that a minor cut on his lip was caused by this same patient. Later in the morning, the day staff noticed that the patient had a black eye.
These four incidents relate to one nurse.
2. I was sent to an admission ward to assist staff with a 'violent patient' who was demanding his discharge. Discharge was refused even though the patient was informal. The ward doctor would not come to see the patient but had ordered an injection over the telephone and would come next day. The man was said to be suicidal because he had made remarks such as "I might as well be dead”. The ward staff were taking an aggressive line with him 'You're going to have the needle, etc. He was very upset and it seemed to me that the nurses were making things much worse. I intervened and tried to calm the man down and talk reasonably with him, listening to what he had to say. The S.E.N. in charge of the ward came blustering out, brushed me aside telling me that this was not my affair and ordered her staff to grab him, whereon he was manhandled into a room, pushed over a bed and given the injection.
This man was not violent or dangerous. He was in his mid sixties, small and thin. He was anxious and depressed and needed friendly help and reassurance. The treatment he received was disgraceful.
3. A relief charge nurse took charge of the ward one morning. Patients snapped to it when he was around - he got reaction by ordering patients around. A subnormal schizophrenic patient on the ward habitually went around with his fly buttons undone despite the consistent persuasion of the regular ward staff not to do this. The relief charge nurse told this patient to button his flies and when the patient ignored him and over-talked him he repeated the demand each time hitting him beneath the loner abdomen. The patient still ignored these demands and was told 'You're going into a room'. The patient's arm was twisted hard behind his back in an outstretched manner and in this way he was marched through the day room. I opened the dormitory door and the charge nurse posted this patient twice into the door frame in a vicious manner. With his arm still twisted hard behind his back against the joint he was marched to his side-room where he was pushed in and kicked up the backside.
4. An S.E.N. on the ward staff was sometimes left in charge of the ward. She was moody, unpredictable in attitude to patients and indifferent to their welfare. Examples of her behaviour are:
a) At tea time she was taking food around on the trolley to be dished out, forgot to dish out for twelve non-ambulant and helpless elderly patients. When I reminded her she said 'Well they don't eat much anyway, they don't need to, sitting in their chairs all day and doing nothing. I served six of these patients before she took the rest of the food to throw away.
b) A non-ambulant elderly patient, whilst we were both putting her to bed, the nurse said "I can't stand this one, she plays on my nerves' and slapped her buttocks.
5. On one occasion, the ward charge nurse took a patient who retained her urine and 'dribbled' to the toilet and I saw the ward charge nurse slap her face because she was not urinating. This patient disliked being made to go to the toilet and having her stomach pressed to make her release the urine. If permitted to do it in solitude and in her own time, she would respond favourably to members of staff who did not stand over her and press her stomach. We had been instructed by the ward charge nurse to use this method, though some of us as untrained nursing assistants felt and voiced objections based on fears of causing internal damage through ignorance. This patient would struggle if one attempted to do this.
On another occasion this patient was holding onto a door handle and partially blocking the doorway. The ward charge nurse wanted to go through the door and bent back the patient's fingers with unnecessary force. The patient was crying and saying,"Why are you doing this to me?"
Such behaviour on the part of the ward charge nurse caused considerable concern amongst nursing staff on the Hard.
6. I was sent to this ward much later in my training to assist with E.C.T. (electroconvulsive treatment). A patient in a depressed state was refusing to have E.C.T. although he had previously signed a consent form agreeing to have it. Three nurses went to fetch him and half-dragged, half-carried him into the dormitory struggling and pleading. He was forced onto the bed and the staff all struggled to hold him down. I strongly objected to this and questioned the right of the psychiatrist to administer E.C.T. to an unwilling patient. The psychiatrist and charge nurse reacted angrily, argued the point briefly, then dismissed me by saying "Well, if you are not going to help, go and do so-and-so. E.C.T. was administered. Those present were a psychiatrist, a charge nurse, a staff nurse and two student nurses.
7. Throughout the month that I was on this ward a patient was kept locked in a side room. This seemed a regular practice. He was only let out for a shave every morning, to attend toilet and to sit in the day room for perhaps one or two hours in the afternoon when he was kept under close observation. The patient had all his meals in his room. This room was a small, dull cell with one window which could be blocked by a wooden shutter closed and locked from inside the room. The thick wooden door to the room as locked and contained a peephole. The room had a bed and nothing else. It was bare, smelt of urine and had no heating in it. The explanation given for this 'treatment' was that he was a fire risk and had been violent in the past.
8. In seven weeks on a psycho-geriatric ward I only witnessed and/or aided in a maximum of ten baths. I estimate that on average the non-ambulant patients received only one bath during that time. No regular check or timetable was kept to. The other patients, ambulant but requiring some aid and/or completely able, I estimate to have received a bath at the same rate of 1 per seven weeks (approx.) although they did have daily strip washes 'under the arches'.
9. This was my first ward. 0n entering the ward on my first day I observed four nurses standing around a patient who was seated. One nurse would extend a hand, inviting the patient to take it and be assisted to his feet. When the hand was accepted and the patient half way to his feet, another nurse put his hand on the patient's head and forced him into a sitting position. This happened a number of times to the amusement of the nurses. The patient was a meek, submissive little man - the sort who has nobody to protect him and would never dare complain. He was being treated as a figure of fun.
10. On one long stay ward there were no therapeutic activities, no occupational therapy, no regular ward outings, no ward aims or individual treatment programmes identified. Just plain custodial care. Nurses did the bare minimum, sat around drinking tea. Patients food was put aside for elaborate meal breaks. Nurses had a bottle of beer (supplied for patients) each evening. The ward was generally dirty. Patients left to sit around and get on with it. There were no ward hand-over meetings for all staff and no ward meetings. The ward was a backwater.
11. Another occasion I recall was of a patient asking me humbly if he had to have E.C.T. (electroconvulsive therapy). He had signed a form of consent when first arriving at the hospital - just in case it was necessary (as the doctor put it) - without really understanding what it meant. Now the doctor informed him that he was to have the treatment and he was quite frightened and had no idea that he was free to refuse this controversial treatment.
12 The ward charge nurse was incompetent and inadequate, stayed in the office all day and had no contact with the patients. The charge nurse disrupted work by keeping a nurse in the office to chat with. Change-over was held in the office between the two ward charge nurses and other staff were not allowed to participate. Criticisms were disliked and discouraged. e.g. suggested that application be made for more flannels, questioning the hygiene of using them on several patients. The answer was that nothing could be done and it was pointless to try.
The ward charge nurse withheld patients' property and ward stock from distribution. Patients' Christmas presents like sweets, biscuits, soap and talc, etc. were locked up in a cupboard in the office and I never saw any distributed. The nursing staff complained quite often that the ward charge nurse withheld good quality soap and talc, locking them in a private locker, and they strongly implied that it was taken home. They would sneak into this locker when the ward charge nurse was not on duty in order to get some soap for the patients. Generally, ward supplie3 of fresh fruit, cheese, cake, were never distributed.
13. On a geriatric ward there were insufficient pyjama jackets despite requisitions being made for more and we were obliged to use shirts or vests instead, or to put old people to bed naked. Unsuitable bedjackets which did not unbutton open were supplied. These were difficult to remove from incontinent patients.
14. A patient on a long stay ward became very disturbed during the day, possibly due to the medication he had been put on by a new ward doctor. In the evening the ward charge nurse warned the nursing administration that he feared there was likely to be trouble with this patient during the night and he advised them to put two night nurses on the ward instead of the customary one.
He was told don't tell us how to look after psychiatric patients and no extra night nurse was placed on the ward. In the early hours of the morning the night nurse on this ward was beaten up by this patient and his head pummelled into a radiator. The nurse was consequently off sick for several weeks, received 29 stitches in his head and was permanently disfigured.
15. An incident on this ward concerned a patient who had been admitted on a section 29 following an attempted suicide by drug overdose, he awoke to discover that he was in a mental hospital and wanted to leave. He was informed by the charge nurse that he was on a section and that he couldn't leave. He was angry and frightened. He resented being there and was hostile to the staff who were keeping him there against his will. The charge nurse was sarcastic and supercilious with him.
He recorded in the man's notes that his behaviour was psychotic. This was plainly untrue.
This practice was not uncommon in the hospital. If a patient was rebellious or hostile to staff, this behaviour would be ascribed to his illness and termed psychotic, or paranoid, or it would be said that he was deluded. Also on this ward I remember patients referring to the night staff who were 'rough' with them, and there was always acute interest in who the night nurse would be.
16. Distress was caused to the more alert patients on one psycho-geriatric ward by the deprivation of their spectacles. They were unable either to read newspapers or watch television, which were their only two sources of occupation and entertainment. All the patients suffered from the absence of any kind of sensory stimulation or occupation or entertainment. There was no occupational therapy.
One woman liked to knit, but was able to do so for only half an hour a week when voluntary workers brought round a trolley of magazines and wool. She had to return the knitting needles and wool when they left the ward. A few of the more able-bodied would have benefited from occupational therapy, outings, and film shows for example. Some of the more confused and ward-bound would have appreciated dancing, records, or ward parties with male patients invited from other wards.
17. I criticised the ungenerous pocket money allowances for patients at a nursing assistants meeting held in Godfrey House at the hospital. I pointed out that I knew of some patients in the hospital who received as little as 30 pence in their hand a week. This was denied by a nursing officer present but supported with examples by a charge nurse present.
18. On a psycho-geriatric ward patients were often put to bed in vests, because there were no nightdresses. Clothing was generally in a dreadful state, torn, old, ill-fitting with no buttons.
19. There were hardly any flannels on a psycho-geriatric ward. Old towels, etc., were torn up to be used as flannels. One flannel was used on maybe ten to twenty old people on all areas of the body.
20. A serious incident occurred involving a student nurse. An old man who was a patient on an admission geriatric ward was found one evening to have a deep cut behind is ear which required six stitches. Two days afterwards I was told by a patient that he had seen this patient struggling in the bath with the student nurse. (This patient had complained to me previously that this same student nurse was in the habit of kicking his feet as he passed him sitting in a chair apparently asleep. I reported this to the charge nurse).
I related the incident to the staff nurse who informed the nursing office. Subsequently two other patients mentioned that they had witnessed the incident. They stated that they had seen the struggle, the patient naked in the bath, and the student nurse outside standing on the floor, that he had punched the old man, and that the old man had fallen in the bath during the struggle.
The police were called in and statements were made by the patients involved. Staff were not officially informed of the outcome, but although the student nurse concerned was taken off the ward, he continued to work on geriatric wards and to finish his training.
21. On one long stay ward you could spend the whole shift tea drinking and chatting with staff. There was no interaction with patients except for medication.
22. I was sent to this ward to assist nurses with a violent patient. The patient had attached another patient. He was in a side room with the door locked when I arrived. Seven nurses were present. They all went to the side room and the charge nurse opened the door and said Right lads, get in there."
The patient was sitting on the bed looking frightened. The nurses went in there and piled on top of him, one very heavy nurse on top of him with his full weight bearing down on his knees which were on the patient's upper chest and neck.
The injection was given.
No attempt was made to talk to the patient or to persuade him (or even ask him) to have the injection.
23. On one psycho-geriatric ward the more helpless old people received only three drinks a day; breakfast, lunch and tea-time. The standard of food was low and the quantity varied, often being inadequate.
24. In one long-stay ward a certain patient nursed a fellow patient who was bedridden for seven years. The former would help change, feed and comfort tie latter and they were friends. Then the hospital was reorganised in 1972 these two patients were put in separate wards. The patient tried to visit his bedridden friend on his new ward but was forbidden to do so by the charge nurse of that ward. This seems to me to be an extraordinary act of unkindness.
25. On this ward, when the students in the Introductory Block were visiting the ward they were given an exhibition of the patients, which was rather like visiting a zoo. Patients were called forth by the charge nurse and encouraged to 'perform' in front of the audience. Certain patients could be teased into performing and this was done. This exhibition was designed to cause amusement and lend prestige to the charge nurse in that it gave him the opportunity of showing how complete was his control over these 'performing' patients. This also happened on another ward. 26. Generally, the staff on this ward had little or no knowledge or understanding of mental illness. I frequently heard the statement “Geriatrics are all right. They're grateful for what they get. But I'd hate to work on any other ward - the rest of the patients in the hospital are a bunch of psychopaths”.
Minimal custodial care was provided - i.e. getting patients up, feeding, potting, strip-washing, etc. There was a rigid routine punctuated by several long tea breaks (seven or eight a day). Both staff and patients were totally institutionalised and unquestioning and did the bare minicar essential.
27. On one long-stay ward there was a patient who had been in the hospital for many years. His case notes show that in his youth he liked going out to the cinema and going for long country walks on his own. After spending several years on a rigidly run, repressive ward, he was fearful of even leaving the ward itself. Then he was moved to this long-stay ward no recognition or treatment of this agoraphobia was offered except through individual nurses' initiatives, who encouraged him to go out and took it upon themselves to go out with him.
28. Clothing was very poor, in bad condition, in short supply, old and torn. There were few geriatric dresses, insufficient nightdresses; pyjamas had buttons missing, woollens were ill-fitting, old and torn; stockings were odd and frequently torn: jackets and trousers were often stained, ill-fitting and old. A lot of fabrics were very inflammable - especially nightdresses. Underwear was often torn, stained and old.
29. When the Department of Health and Social Security authorised increases in patients' pocket money to £1.55 these increases were left to nursing staff at ward level to implement and the Administration did not ensure that such increases had been made. Some patients did not receive these increases to which they were entitled when they should have done so.
30. One ward was notorious in the hospital and two students in my block refused to do their three months' training there. The school did not insist upon it and they went elsewhere. On this ward there was a strict, heartless, oppressive regime which was carried out obsessively. Of the two charge nurses, one was akin to a dictator and ruled the ward with an iron hand as if it were his world. Patients were moved from point A to point B en block. No individualism was permitted and no freedom existed. From the moment the patients arose in the morning until the time they went to bed their day was an unchanging, number of moves from tables at breakfast to toilets; from toilets to wash-room, from wash-room to the wooden hut outside in the yard where they worked at absurd, monotonous tasks. At mid-morning they were allowed half a beaker of tea each - no more. At lunch the same procedure in reverse went into operation.
In the evenings and over the weekends they sat in rows in front of the television or -ere taken out all together into the yard to walk about. They were not allowed to wander freely at will either on the ward or outside. The pattern of their existence was strictly controlled and without relief. A nurse on the ward likened them to Toby Jugs sitting on a mantelpiece - just ornaments to be dusted down and moved into different positions. To me they were chronically institutionalised, completely passive, defeated creatures, degraded and alienated from everything we value as human. There was nothing on the ward in the way of books, magazines, games, personal possessions, or materials for therapeutic activities. All such things were discouraged. The patients did not go out to the patients' social club and when I insisted on taking some the idea was opposed and a quarrel ensued.
31. The regular S.E.N. on one ward had the appearance and manner of a member of the Gestapo. Coming on duty she swaggered into the ward and with legs outstretched and hands on hips surveyed the state of the ward and the inmates with an arrogant and pitiless glare. She was ill-tempered, impatient and bad-mannered with patients and made it clear that she thought them members of an inferior species. I once heard a young nurse ask her what was the matter with a certain patient. "Oh him", she replied in a loud, disdainful way, “he's a schiz! - Once a schiz, always a schiz!" The person whom this remark concerned heard it clearly.
On another occasion she wanted to give a patient some medication and he didn't want to take it. Nobody was permitted to question any issue with her she didn't make requests - she issued commands. When her commands failed to persuade the patient to comply she started to grapple with him in order to force the tablets upon him. When he lifted his hands in a protective way she shouted that he was fighting her and he was carted off for an injection. This was typical of the sort of monstrous scene she would produce. She would push people around and provoke them and if anyone stood up for himself she screamed that she was being attacked or that the patient was going mad and then the unfortunate patient would suffer for it.
On another occasion there was a young man on the ward who was not in the habit of allowing himself to be pushed around or of cringing to the nursing staff. Standing in the doorway one day she pushed him out of the way, putting him off-balance. He pushed her hack. At this she started a big scene, accusing him of being aggressive and reporting him. As a result of this he was admonished and no doubt the incident was entered in his case notes to his detriment.
None of the staff on this ward liked her presence on the ward and most felt that she was positively harmful and dangerous, but they could do nothing about it because the consultant of the ward favoured and protected her.
32. There was virtually no discussion of policy regarding treatment of individual patients on a therapeutic basis (on this ward), i.e. one patient took to her bed for a period of about four months. There was no discussion of tactics to talk to her, to try and discuss her problems - this was left to the initiative of the individual.
E.C.T. was repeatedly tried though nursing staff felt that after an initial 'recovery' following E.C.T. lasting 3-4 days, she relapsed into a state worse than before. One of the ward charge nurses expressed strong dislike of this patient "She's a typical psychopath, you can't do anything with them'. (her diagnosis was not 'psychopath'). ‘They don't show any gratitude for what you do for them'. One of the ward charge nurses forbade the nursing staff to feed this patient, claiming that this would make her get up. In fact, it made the patient more intractable and hostile, though it was kept up for several weeks despite the objections of junior staff. This patient was fed when the other ward charge nurse was on duty.
Differences in attitude, policy and treatment between the two shifts were very apparent, i.e. one shift would give food to a patient while the other shift would not, one ward charge favoured ward meetings, social outings and tea parties for the patients and the other ward charge did not, one shift would do aseptic dressings in one way, the other shift in a different way, on one shift the patients were allowed a certain flexibility in seating arrangements at the dining tables, on the other they were forbidden to change places; on the one shift patients tended to be given spoons instead of knives and forks - this produced a degree of confusion amongst both patients and the junior staff.
33. One patient - severely subnormal - was kept locked in a chair all day and every day and allowed out only to go to the toilet and to wash and bathe. It was said that he was dangerous and attacked people without warning, biting and scratching. He had previously had all his teeth removed because of his biting habits. To requests to take him out for walks the ward charge replied that he would permit it if he had sufficient staff but he had not. It was recognised to be quite wrong and inhuman to keep anyone locked constantly in a chair but responsibility was passed on to the nursing administration who supplied insufficient staff. And so this patient lived in a locked chair.
34. Patients were deprived of jam, tea, coffee, sugar, soap, Marmite, marmalade, Bovril, Horlicks, Ovaltine, razor blades, etc. etc. Provisions arrived on the ward but were not given to the patients. The ward charge attempted to justify depriving patients of provisions by such excuses as - pertaining to jam and marmalade - that they didn't like it and anyway they would make a mess with it, etc.
The patients' money, cigarettes and sweets were controlled by the ward charge and locked away in a safe in the office to which only he had the key. Only six patients received cigarettes or tobacco. Only two received sweets. The question of the patients money was a mystery and the pay sheets were kept locked away. What was abundantly clear, however, was that the majority of patients were not receiving their money nor were they receiving cigarettes or sweets or anything else in place of their money.
I had on several occasions criticised the manner in which the ward was run and aspects such as that above, but obtained no satisfaction either in replies or actions. I therefore made an official complaint to the Nursing Office. I was told by an assistant matron that the matter would be passed on to the acting Principal Nursing Officer and that he would subsequently want to see me. This did not happen. What did happen was that when I was going off duty that day I saw the acting Principal Nursing Officer in the ward office talking to the ward charge privately. Next day when I arrived on duty I was informed that there was to be a ward meeting to discuss certain problems that had arisen, meaning my complaints. At the meeting were the acting Principal Nursing Officer, the ward Nursing Officer, the two ward charge nurses, the S.E.N. and another student and myself. I was asked what my problems were and I repeated the criticisms I had made the day before. At each point I was interrupted by different members of staff who had formed a united front to combat my criticisms and deny the truth of what I said, to rebuke me for not understanding the 'true' situation, for not realising 'the sort of patients we are dealing with', and for not having the necessary experience, etc. When I walked out of that meeting I knew beyond doubt that the whole bunch of them were crooked and that corruption started at the top.
35. This was a psycho-geriatric ward of about sixty beds. There were not the proper facilities for nursing geriatric patients. The ward was grossly overcrowded and understaffed and basic nursing only as possible. By this I mean dressing, washing, shaving, feeding and bathing. Everything had to be done hurriedly and superficially. Looking back on it now I think that those poor old men must have thought they were in hell. About half a dozen bottles of beer came up every day for the patients and the staff used to drink these. Clothing was disgraceful. Nothing fitted anyone and there was never enough of anything. Meal times were pandemonium: imagine sixty old people at a meal, most of them confused, disorientated, twenty of whom had to be fed, with only a handful of staff and a limited time to get it done in.
The regular night nurse on this ward had a reputation for being cruel and callous to the patients.
36. On one long-stay ward the regular S.E.N. was a vindictive woman who by virtue of her ignorant presumptuousness and harsh attitude to patients contrived herself into a position of power and influence on the ward. It amazed me that such a person could he employed as a nurse in a psychiatric hospital.
(i) her knowledge of even basic nursing skills was negligible. She was incompetent in handling medication. She once gave a nursing assistant a tablet of Digoxin to give to a patient without telling him to take the patient's pulse before deciding to give the tablet. When the nursing assistant queried this she was vague and seemed not to realize the implications of giving this tablet.
She regularly overdosed a certain patient with Largactil and encouraged other nursing staff to do so.
She failed to ensure that all patients received their medication and gave and instructed the giving of injections in the wrong manner (certain patients avoided being given injections by her, preferring to be given injections by nurses on the other shift).
As a result of her incorrect bandaging of the ulcerated leg, of a patient his leg condition deteriorated and yet she complained to the Administration that there was no nursing care on the ward, the younger nurses being more interested in taking patients out.
(ii) She subjugated staff and patients on the ward. She was generally disliked by most of the patients and remained aloof from them. She frequently shouted at patients and on one occasion when she had laryngitis whispered “This is awful - I can't shout”.
At the drop of a hat she would threaten a patient with getting him prescribed extra medication if he displeased her, as for example when a patient asked for orange squash one meal time.
She conveyed her dislike of an informal patient in conversation with him and removed his clothes so that he could not leave the ward - which he was quite entitled to do.
She considerably upset a patient by telling him that he was “a dirty old man”.
She made irresponsible and fictitious remarks at ward meetings and when writing the ward report often exaggerated patients' behaviour and misrepresented the situation.
When left in charge of the ward she would not distribute the full cigarette allowance, she would lock the ward early, and often locked some patients in their rooms early to avoid the responsibility of them being in the day room.
(iii) She was generally unconcerned that patients received the allocated amount of food.
She persistently undercut patients' rations of jam, marmalade, tea and sugar despite her attention being drawn to the laid down allowances. She was always miserly and grudging with patients' food, cigarettes, etc. She siphoned off sugar and tea into her personal locker to give the impression that the ward was short of supplies to encourage nurses to undercut patients' allowances and kept pay sheets in her locker to block attempts by progressive staff to re-allocate patients' money.
She put patients' food aside for staff before serving patients.
She attempted to prevent the distribution of beer on a Saturday evening to all the patients on this ward and refused a patient a bottle of beer telling him that he was only a boy. This patient was twenty-eight.
(iv) This woman always opted for the soft work options and had her own little jobs such as tidying the staff room which she did instead of working with the patients. She interfered with all grades of nursing staff including ward charge nurse and was generally non-cooperative and a parasite on other people's work efforts. Many staff admitted to problems when working with her. She was incapable of teaching student nurses and quite unsuitable for this function and yet was permitted to do this. She did things in her own truculent way, even if it disrupted the patients' lives. She offered a nursing assistant on the ward a brand new jacket from ward stock, saying You might as well have it if you want it as these won't appreciate it'.
37. This ward was described to me by the charge nurse as the refractory ward. It was a locked ward at the time I was there. It was my first ward as a student. On my first day a patient refused to be shaved in the bathroom. Nobody could persuade him to take a shave and the staff seemed to behave as though it was essential. Eventually the charge nurse said something to the effect of “on him”, and the patient was restrained and shaved. All this first thing in the morning surrounded by the other patients.
The next incident involved a young schizophrenic patient who left the table at dinner time before the others and lit a cigarette. The charge nurse shouted at him - he objected to the cigarette. The patient walked out to the toilets - the charge nurse followed and I followed behind to see what might transpire, for the charge nurse seemed angry. The charge nurse grabbed him from behind on the back of the collar and flung him to the ground. I asked what was happening, and the incident ended. I was not at all happy with what was going on in the ward and complained to the charge nurse, accusing him of bullying the patients among other things.
He assured me that he had great affection for them and called the patients into the office, one by one, asking them whether they liked him and whether he was cruel to them, etc. Of course they answered as he wished and he couldn't see the contradiction. He arranged for the ward psychiatrist to talk to me on two occasions. The psychiatrist backed up the charge nurse and derided me.
On this ward there was an oppressive environment. There was no therapy carried out and there were no activities planned. The charge nurse just liked to get the patients out for a walk. To whatever one suggested, the reply would be that it had already been tried and hadn't worked.
All patients had to go to bed at 8.30 p.m. ready for the arrival of the night nurse at 9 p.m. The reason for this was that the dormitory was on the floor above the ward and they all had to be locked in for the night nurse.
38. During change-over meetings there was little or no actual information or discussion re patients. I felt somewhat handicapped by not knowing patients' diagnosis, background or medication. Quite often the ward charge nurse would make derogatory comments about patients either during the change-over or to their face, e.g. you dumbo, I'm sure you're being awkward deliberately'.
The adjective 'dumbo' was used often and patients were sometimes visibly upset by this. The ward charge nurse seemed to particularly dislike the more demented and incontinent patients or those who were regarded as 'awkward'.
39. The ward was characterised by an air of stagnation, the staff by indifference and apathy. No efforts at change and improvement have been made by them: a rigid routine and tea-breaks prevail and predominate. Doctors only
visited the ward when called upon specifically to see a particular patient.
40. The hospital hair cutter gave many patients who were incapable of complaining or indifferent, ludicrous haircuts, basin type style. He used to refer to his work as sheep-shearing. With such a haircut, a patient would be instantly recognisable as an inmate of an institution. It gave them the appearance of convicts.
I made a complaint to the nursing administration about this disgraceful conduct and was informed by the then acting Principal Nursing Officer that there as nothing he could do about it as the hair cutter did not come under his control. And so the practice continued.
41. A young man who was sub-normal had been a patient in the hospital since the age of 15. He had grown up in the hospital in an all male environment, and often a very disturbed male environment, having been placed on a long stay male ward in his youth. he has a certain innocence about him and spends most of his time in the ward. He left the ward several times and went to the medical secretaries offices, probably out of curiosity, and just stared at the girls. As a result of this the following 'treatment' was recommended,
(i) Return and confinement to the ward in a dressing gown and pyjamas
----- recommended by the nursing administration.
(ii) If he continued to behave in this way he should be confined to the ward or so heavily medicated that he did not behave in this manner
----- recommended by the doctor.
NO-ONE in authority showed initiative and recommended trying to educate this young man that women should be approached in a polite way or suggested attempting to get him to socialise with women in a reasonable manner.
What sort of behaviour would one expect from a sub-normal patient who has grown up on a disturbed male ward? It was left to individual nurses to try and persuade the ward doctor that something positive in the way of education should be done for this young man.
42. When the time came to put some old men to bed on a psycho-geriatric ward, the charge nurse said 'Oh well, time to get these men into their wanking pits'. I was sickened and disgusted.
43. I worked on a male psycho-geriatric ward in the hospital. It was overcrowded and had a heavy work load. Often there was a shortage of staff on this ward so one could offer only a bare routine to the old men.. getting them up, feeding, toileting, changing, medicating and putting them back to bed. The shortage of staff on this ward made everything a rush so patients suffered the indignities of rushed feeding, hurried toileting, etc.
No bed curtains in the dormitory allowed no privacy when patients were undressed and put to bed. It was pitiful to come on at 7 in the morning and see 48 old men peering at you from the serried rows of beds. People humiliated because they were old. As a patient of eighty-three years of age remarked to me “when those old boys wake up each morning and look around them, they must wonder what they fought in two world wars for”.
The bathroom contained two baths without any screens dividing them and often 4 or 5 old men would be in this room at once in various stages of bathing. At times there was a lack of pyjama jackets, vests, ties, socks, patients sometimes having to go to bed in vests alone or naked. The double incontinence of some patients was a known problem, but one still found oneself changing patients who had been incontinent and being obliged to put their urine soaked or faeces stained slippers back on as there were insufficient replacement slippers.
What sort of a 'health service' is this that can allow such indignities? Pillows were always in short supply and if they became urine-soaked were dried out on the radiator before reuse. On another ward I queried what to do with urine-soaked pillows and was told by the charge nurse that they were dried on the radiator. There were not proper facilities on the ward for doing sterile dressings. The ward was drab and impersonal. It was the end of the road for most of these old men and yet they had to tolerate this.
44. This unit (The Industrial Unit) as just not functioning properly. There was no assessment of patients capabilities or suitabilities. There was no review of patients' progress. The system encouraged institutionalisation. Patients came and did simple, repetitive jobs endlessly for pittances. The pay was from 3/- to £l a week. Pay increases given to good workers were pathetic and insulting, i.e. 2/- a week. Pay was not related to effort or to quality / quantity of work. The pay sheets were kept closely guarded by the charge nurse and we were not allowed to see them. The charge nurse used his privilege in either increasing or cutting pay as a power over the patients.
There were no staff meetings to discuss patients' conditions, requirements, improvement, and suitability for work.
45. There were different methods of treatment on the different shifts. For example, one shift used the aseptic technique with dressings, the other didn't. There was no delegation of duties on my shift. No responsibility was given to students. There was no discussion with the ward doctor. Nursing equipment was kept in the office and when the ward medical officer was in there with the charge nurse we were not allowed to get the equipment, so holding up treatment. The work was routine, caring for the physical side. The psychiatric side was ignored. There was no therapy on the ward.
I spent two months on night duty here. The regular night nurses rushed everybody to bed as soon as they came on duty. No matter what anyone was doing, as soon as the day staff had gone the television went off and all patients were hurried off to bed. For the rest of the night they did as little as possible. One incontinent round was done. If patients got out of bed in the night they were hustled back.
46. Patients' meals were often sub-standard, cold and delivered late. Once the patients' lunch was delivered thirty minutes late because the Hospital Management Committee wanted their lunch at mid-day. The meals that have been previously prepared for official luncheons have been of such a high standard of cuisine that patients have suffered by being given second best. The patients' Utility Fund has been misused. Money for ward outings has been refused while it has been spent on questionable means.
47. A section 60 patient had, for a long time been making a list of complaints about his medication and treatments and yet he had not been seen by his consultant psychiatrist for over six months. Another section 60 patient, on another ward, was kept in ‘dressing gown order' for eighteen months, despite frequent requests by many nurses to give him the self respect of dressing properly.
48. As far as ward management was concerned the priority was staff. Wards were managed and run mainly for the benefit of staff, with ward routine and tradition suiting the staff. There was never any discussion regarding whether it was suitable for the patients. There was an unspoken rule that staff should have an easy time. Patients had to conform and not disturb the routine. In my experience the patient always came last.
49. The wards are decorated in a dull and shabby way. Patients clothes are shoddy and institutional. A recent consignment of patients' nightclothes were not fireproofed, when the shortage of staff means that only custodial care is administered and many nurses do not have pass keys, one shudders to think what would be the outcome if a major fire were to strike a ward.
50. On admission wards treatment largely consisted of drugs and deprivation. If you deprive a man of his dignity, liberty, his status, his individualism, his contacts, etc. you have reduced him to almost nothing. If, on top of this you medicate him, (i.e. tranquillisers) - then you are really in total control.
51. One consultant, responsible for twenty-four patients on a long-stay yard, neglected his duty to these patients in a deplorable way. He rarely saw any of these patients and repeatedly declined requests by nursing staff to discuss his patients' conditions and treatment. Consequently, these patients were deprived of appropriate treatment.
52. Very little occupational therapy is undertaken on the wards, the industrial therapy unit is more concerned with making money and putting on a good front than in rehabilitating patients and keeping them occupied in a worthwhile way.
53. Drugs were given almost automatically to new admissions. They were often given excessively without proper control and not reviewed. Drugs were also prescribed by a doctor on the word of the ward charge nurse alone - without the doctor even seeing the patient.
54. Entries in patients' case notes made by psychiatrists were generally superficial, unsubstantial and unrevealing. They were often also mere repetition of what had been written before.
55. On no wards in my experience were patients encouraged to clean their teeth and this aspect of personal hygiene was not considered to be a nursing duty. As a consequence of this, on long-stay wards ninety-nine per cent of the patients never cleaned their teeth.
56. Ward medical staff spend very little time on the long-stay wards, seeing perhaps only the dangerously ill patients briefly. It is my opinion that many patients on long-stay wards could be discharged. If the medical staff have their reasons for not doing so then it would seem reasonable to discuss this at ward meetings.
57. E.C.T. (electroconvulsive therapy) was sometimes used as a punitive measure - although it was not openly admitted. I have heard the term ‘punitive E.C.T.' used in the hospital in reference to “that is what a patient needs”. Some psychiatrists had a certain faith in E.C.T. and at times patients were threatened with it.
58. In my experience there was practically no training given to nurses on wards. The great discrepancy between what was taught in the school of nursing and what went on in the wards was notorious. On a ward one was a worker, an attendant, one who kept the routine going. One was not there to learn or train.
59. The overcrowding in wards is well known, but what this means in human terms is that patients are forced to live in extremely difficult conditions, conditions which foster disharmony, and antipathy towards their fellows. It also means that the standards of services and care to which they are entitled are reduced to what at times approaches a bare minimum. These factors create a situation seriously detrimental to the lives of patients.
60. On one ward some patients had not had entries in their case notes for two and a half years, and these entries were only for physical check-ups.
61. On a psychogeriatric ward a blind patient was often teased and slapped around the back of the head by one nurse in particular. This would disturb the patient and cause him to shout out at random, since he did not know who had hit him or where the next blow would come from. The old man's helpless anger amused the nurse. The patient's behaviour (in reaction to such wicked treatment) was described in his case notes as 'paranoid'.
62. On one female geriatric ward the S.E.Ns used to take home the patients' fruit and other items. 'They fill up their bags before they go home'. Also they ate the patients' weekly cheese ration for their breaks, having welsh rarebit.
63. There were many reports and comments from both patients and staff about one ward where brutal incidents occurred. Patients were commonly hit and slapped. One was hit in the testicles with a broomstick. Another told me that when he was on the ward the regular S.E.N. used to 'take it out on me’ He said that if the man didn't like you he would have it in for you, and that while there both he and another patient were often hit.
64. On a male geriatric ward the regular night nurse used to hit patients if they got out of bed in the night or if they urinated on the floor. Old men were punched in the stomach, pushed onto beds and kicked.
65. On a long-stay ward a patient got out of bed in the night and went into the day room wanting to make a cup of tea. The night nurse set about him, punched him and chased him back to bed.
66. A patient on this ward flinched or ducked if anyone approached him directly, as if he anticipated a punch or slap. Some nurses who had worked there said that troublesome patients were taken out the back to the toilets for a ‘talking to'.
67. A woman was admitted to the hospital and diagnosed as an hysteric. She complained of a pain in her back. E.C.T. was ordered for her. She was unwilling to have this and she was carried struggling by several nurses and porters to the ward for E.C.T. Following administration of E.C.T. she continued to complain of pain in her back. This was investigated and she was found to have a broken back sustained prior to admission by falling down the stairs at home. This woman had been given E.C.T. while her back was broken. She was subsequently transferred to Kent & Canterbury Hospital.
68. A patient, visiting the ward of his female friend, was thrown out of the door by a nurse. He hit the small of his back on the window frame across the corridor. The nurse remarked 'I hope that hurt you’.
69. A young, female patient became disturbed and upset whilst in the Occupational Therapy Department. Despite being talked to and accepting help from a young male nurse, a doctor in an adjoining room was called out of a meting. Because he seemed irritated at being disturbed he summoned the sister of the patient's ward to come to the Occupational Therapy Department with an injection for her. Meanwhile the patient became quieter and less upset. Upon arrival at the Occupational Therapy Department the sister was seen to be angry and agitated at being called away from her ward, 'leaving all the others' and especially getting her shoes very muddy. She had an injection with her and shouted loudly 'Show me where she is', over and over again. She was shown into the office to divert her from the patient but still insisted that she must give the injection even though she was told that the patient was now quiet. 'I'm not having a wasted journey, getting my shoes muddy just for that bitch…'. Eventually the sister was persuaded to have a cup of coffee to calm her down and to leave without giving the injection. She had been intending to give the injection there and then in front of the other patients.
70. On one long-stay ward, two members of staff were concerned with another member of the ward nursing staff who had repeatedly abused and humiliated patients and was renowned for her continual mistreatment of patients. Feeling that something should be done about the situation, the two staff requested to see a senior member of the nursing administration and informed this person of their concern, giving details of the mistreatment and malpractice perpetrated by this nurse.
The two nurses registering their complaint were told "I know about Mrs. .. We have a Mrs. .. on other wards in this hospital. The two nurses were told that the nursing administration could do nothing about this woman as she would use the Union to defend herself. The nurses emphasised that it was not on to allow, a nurse to carry on in such a way. They were told by the nursing administration that the only thing possible was for them to make life so unbearable on the ward for this nurse, that she resigned. The two nurses pointed out that this recommendation was unreasonable as any such friction between staff would rub off onto the patients. This nurse continued to work on this ward and to continue with her unkindness and incompetence after this complaint had been made.
Even before this formal complaint was registered this nurse was notorious throughout the hospital for her total ineptitude and her hard-boiled vindictive manner.
The incidents described in the previous pages were witnessed by a handful of people. Other members of the staff have witnessed similar things too. Whether they are prepared to openly admit to this is another matter. We do not pretend to know the full extent of the corruption and shortcomings of the hospital, for what we have experienced can only be a fragment of the total picture. However, this fragment is appalling enough in itself and it is only the tip of the iceberg.
These illustrations clearly depict that:
1. The hospital is not what the authorities present it as being.
It is not a progressive hospital which practises therapeutic concepts in the care and treatment of patients.
It is a festering institution containing a profusion of shameful and deleterious practices.
2. The hospital does not fulfil its obligations to the community. It does not offer the service which it is obliged by statute to offer.
It does not care for patients in a humane way, nor does it offer the kind of treatment that patients have a right to expect.
3. The hospital presents a reassuring facade to the public that it is capable of providing a competent service for the mentally ill.
In fact it has neither the resources nor the right quality staff; neither the proper attitude nor the right aims.
It is neither competent nor capable of fulfilling its brief.
4. The hospital denies patients basic human rights', decency and respect.
5. Patients suffer indignities which are accepted by the hospital.
Patients are humiliated by the hospital, which hands out platitudes to try to excuse the inexcusable, to accept the unacceptable.
We indict the hospital Management and the Medical and Administrative Bodies for:
1. The abrogation of their responsibilities in allowing a defective situation to prevail wherein the incidents cited in this document can occur.
2. Failing to provide the kind of service which they are obliged to provide.
3. Failing to set proper standards of performance and failing to control and monitor such performances.
4. Deceiving the general public into a false sense of assurance and complacency by misrepresenting and denying the true situation.
5. Creating a climate in the hospital which discourages open, free discussion, and discourages patients and staff from publicly making criticisms and complaints.
6. The untold suffering, misery and degradation caused to fellow human beings within the hospital under the guise of psychiatric treatment.
"They told me I would be here for two weeks. That was forty years ago" -
Patient on geriatric ward
"It's not fair it isn't, move that madhouse at Chartham" -
Bill Danton
"When I peg out, and I'm in my box I'll be waking up and dreaming about this place for a month afterwards" -
Henry Fuller (aged 83)
"If you can't treat me with kindness, don't treat me at all" -
Brian Marshall
"Got any bacca? Got a farthing? Bollocks!" -
Bill Danton
"They told me I had come here to recover. All I have done since is discover" -
Henry Fuller
"I was alright till I came in here" -
Long-stay patient
"I wish to be repatriated to Canterbury so that I can be a joy to my mother and I will be self-contented then" -
Selwyn Burton
"I tell you one thing pop, we certainly landed in the shit when they brought us in here" -
Pincher Martin talking to Harold Link (aged 82)
"If I had known I was coming here I'd have got one of those Prussian guards to stick a bloody bayonet through me" -
Patient aged 83
"I tell you, the longer they're in here the worse they get" -
Patient on long-stay ward
"That's the trouble, no-one complains. They'll swallow any bloody thing in here" - Patient in the hospital for over 30 years
"Drop a big bomb on Chartham Hospital" - Bill Danton
"Give them men a chance" - Bill Danton
09 February 2025
