|LOST HOSPITALS OF LONDON|
1 Ham Common, Richmond TW10 7JF
|1921 - current
The financier and philanthropist Sir Ernest Cassel (1852-1921) had been greatly affected by the consequences of WW1, especially by those who had been shot for cowardice instead of being recognised as having shell-shock (traumatic neurosis). He discovered that civilians also were affected by similar functional nervous disorders, but had nowhere to go for help.
In 1919, with the help of Sir Maurice Craig (1866-1935), he purchased Swaylands, a large country house in Penshurst, Kent, in which to establish a hospital for civilian psychological casualties affected by the war. Following the house purchase and equipping of the hospital, some £173,000 of his £225,000 endowment remained, and this money was set aside to be used to help less well-off patients.
The Cassel Hospital for Functional Nervous Disorders opened in May 1921 to provide systemic treatment for the psychoneuroses. Dr Thomas Arthur Ross (1875-1941) was appointed its first Medical Director.
The Hospital could accommodate 60 patients, primarily members of the educated classes who were unable to afford the expense of care and treatment in a nursing home. Although the upkeep of the building and cost of treatment were borne by the institution, patients stayed between two and six months and were charged a contribution towards their own maintenance.
As the Hospital developed, it began to provide treatment for a variety of mental disorders, including psychosomatic conditions, depression, obsessional neurosis, drug addiction, anorexia, anxiety states and hysteria. The treatments were eclectic. but loosely based on a belief in the unconscious - interpretative therapy for long-term patients, while the short-term ones were treated by education or persuasive methods.
Patients were not ecouraged to speak to the nurses about their illnesses, but to associate with the other patients to 'relearn the value of cooperation'. Work was encouraged - keeping the cricket pitch and golf course tidy - as well as organised games (cricket, golf and tennis) against neighbourhood clubs.
During WW2 the Hospital was evacuated to Stoke-on-Trent.
In 1947 the Cassel Foundation purchased the Lawrence Hall Hotel, a late 18th century building originally known as Morgan House, at Ham Common in Richmond.
The Hospital reopened there in 1948, becoming part of the NHS under the control of the South West Metropolitan Regional Health Authority. Dr Tom Main (1911-1990), who had been appointed Medical Director in 1946, was determined to develop it as a therapeutic community to treat personality disorders, following experiments at the Northfield Military Hospital, a large military psychiatric hospital just outside Birmingham.
In 1949 a patient about to be admitted due to a severe psycho-neurotic illness asked not to be separated from her baby as there was no-one at home to look after it. Thus, the first mother and baby were admitted and, in the following months, other mothers were admitted with their children. Later it was noted that fathers visiting their wives and children also played a part in the family dynamics, and the Familiy Service developed from this. It enabled the whole family affected by the impact of sexual, physical or emotional abuse to be assessed and treated.
In 1974, following a major reorganisation of the NHS, the Hospital was transferred to the North West Thames Regional Health Authority, under the control of the South Hammersmith (Teaching) District Health Authority. (Even though the Hospital was geographically in Richmond, it was felt that its needs would be better served by being attached to a larger organisation than could be provided locally.)
In 1982, after yet another reorganisation, the Hospital came under the control of the Mental Health Unit of the Riverside District Health Authority in West London. It had 55 beds.
By 1990 the future of the Hospital was in doubt. It cost £1.25m a year to run, and the District Health Authority recommended its closure on economic grounds. Following objection to this plan by former patients, the media, politicians and the general public, the threat was withdrawn in July 1991.
From 1993 the Hospital offered an integrated package of care for adults in Greater London. This combined six months of in-patient treatment followed by two years of group therapy and psychosocial nursing. In 1994 a separate Adolescent Service was established. A new building with 25 beds was erected in 1995 to house from 10 to 13 families. A Children's Centre provided specialised education and nursery facilities for the children of in-patients.
By 1999 the Hospital came under the control of the newly formed Ealing, Hammersmith and Fulham Mental Health NHS Trust. Three units made up the therapeutic community - the Adult Service (with 17 beds), the Adolescent Service (12 beds) and the Families Service (31 beds). In the Adult unit, some 90% of patients had a personality disorder, 70% of whom had been diagnosed as having borderline personality disorder. Violent or psychotic patients were not admitted because of the risk to others, and unacceptable behaviour was dealt with by discharging the patient back to the care of the referring source.
In 2006 a re-interpretation of Section 38(6) of the Children Act, 1989, by the Lords of Appeal removed the obligation for local councils and Primary Care Trusts to pay for 'psycho-social' treatment. Referrals to the Hospital began to decline and, in 2007, the Hospital was again threatened with closure. Another campaign saved it, and there was a call for it to be centrally funded.
In 2008 the Henderson Hospital closed, and its remaining patients were transferred to the Cassel Hospital.
The Hospital continues to provide in-patient and out-patient psychotherapy for families, single adults and adolescents. It is now under the control of the West London Mental Health NHS Trust.
Update: December 2010
In 2010 the Family Service is threatened with closure because of lack of referrals from the courts and social services (themselves affected by financial restraints). It is the only NHS specialist centre to provide treatment for vulnerable families whose difficulties are so extreme that it is used by courts and social services as a last resort before children are taken into care.
The Adult and Adolescent Services, now known as the Emerging and Severe Personality Disorders service for patients aged 16 years upwards, remains as yet unaffected.
The Hospital, as seen from across the Common.
The main entrance.
Signage remains from the South Hammersmith Health District era.
(Author unstated) 1921 A unique enterprise. British Journal of Nursing 14th May, 277.
(Author unstated) 1925 Far from their enemies and their friends. British Medical Journal 1 (3363), 1092-1093.
(Author unstated) 1940 The Cassel Hospital in wartime. British Medical Journal 2 (4151), 131.
(Author unstated) 1980 Two jubilees in psychotherapy. British Medical Journal 2 (6235), 256-257.
Coome P 1996 The Cassel Hospital, London. Australian and New Zealand Journal of Psychiatry 30, 672-680.
Farquhar Buzzard E 1940 The Cassel Hospital. British Medical Journal 2 (4173), 919.
Iveson-Iveson J 1985 Hospital histories. 6. The Cassel Hospital. Nursing Mirror 160 (16), 16.
Kennedy R 2002. Psychoanalysis, history, and subjectivity: now of the past. London, Routledge.
Ramsay R 1991 The Cassel saved. Psychiatric Bulletin 15, 7-8.
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