Arrangements for early treatment

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In the UK , the start of a return to more liberal policies was signaled shortly before the First World War, by a substantial gift of money by Henry Maudsley, a wealthy psychiatrist, to provide for a hospital devoted to early treatment.

Unfortunately, the war interfered with the project, and the opening of the Maudsley Hospital was delayed until 1923. The hospital provided an out-patient service and voluntary in-patient treatment in surroundings in which teaching and research were carried our.

In the post-war years, the impetus for change increased. The Mental Treatment Act 1930 repealed many of the restrictions on discharge of patients imposed by the Lunacy Act 1890, and allowed county asylums to accept patients for voluntary treatment. The 1930 Act also encouraged local authorities to set up out-patient clinics and to establish facilities for after-care. Therapeutic optimism increased further as two new treatments were discovered: insulin coma (later abandoned) and electroconvulsive therapy. At the same time, efforts were made to improve conditions in hospitals, to unlock previously locked wards, and to encourage occupational activities. Similar changes took place in other countries.

In most countries, these reforms were halted by the Second World War. Psychiatric hospitals became understaffed as doctors and nurses were recruited to the war effort. They also became overcrowded as some were allocated to the care of the war injured, with the result that their patients had to be relocated among the rest. The effects of the war on an English county asylum have been described by Crammer (1990).