Today has been a strange one. No pressing deadline or booked meetings so it feels like I’m at a bit of a loose end. I do have things to do, people I should call and stuff that I could get on with, but, my thoughts have drifted back in time, back to when I stepped into the world of mental health care as a student nurse. It was 1985 and I believed (still do) that everyone is equal, we all deserve access to the same opportunities and to be treated with compassion. I knew that there was a stigma, a fear around people with mental illness but still I was completely unprepared for life in a big Psychiatric Hospital. 
 
Did you know, first large asylums were built in the early 1800’s, they were part of a new, more humane attitude to mental health care. This was on the back of a shift in thinking that mental illness might be cured or at least alleviated. By my time in 1985 the buildings were still imposing, but the care and treatment of people had become more humane, person centered and moral. I say this within the context of what the conditions would have been like in the 1800’s. 
 
My musings led me to reflect on how far mental health services have come in 35 years. Of course, there is still more to be done, we must keep evolving and improving the care and treatment of people with mental illness and we must carry on educating and adapting society’s attitude and approach to mental health challenges. 
 
Today though, I was reminded of one of the first patients I met, she was being cared for on a long term ward and it got me wondering, if she was born now what would her life be like? I’d like to tell you about her… 
 
Peggy was aged 90 when I met her, so she was born in 1885. She was admitted to the Psychiatric Hospital in 1912, aged 17. We’ve all heard of the young girls who were admitted to hospital or workhouse or prison because they became pregnant out of wedlock and although we can be shocked and not agree with this, we can see how a rule for living had been broken, whether from a religious, society or moral perspective. Peggy’s route to a lifetime in an asylum was very different. 
 
She came from a wealthy family, had a private governess. She was described by the governess and her parents as “silly, giggly, doesn’t conform to the rules, seemed distracted in Church” then the final straw came when she removed her cardigan on a public bus. 
 
She was taken to hospital and there she remained for the whole of her life. She had no home leave and had hardly any visitors. She grew up in the psychiatric system, so had episodes of being distressed, distraught, hysterical, aggressive and mute. She had every treatment going, from medicine to electroconvulsive therapy. She worked in the hospital dairy and she made a few friends. She lived in an institution all of her life and had no expectation of ever living anywhere else. 
 
My question today was what would have happened to her in 2020? As the mother of a daughter it reminded me of her teenage years, a bit rebellious, testing the boundaries and definitely not wanting to conform, desperate to be her own person. 
 
So, was Peggy a teenager going through those normal growing pains and hormonal challenges? Did she just not see the point of the rules, so broke them? Were the symptoms she displayed in hospital after incarceration a normal response to losing her freedom, her future and any hope for a normal life? 
 
Or was she in the early stages of a psychiatric condition that led to the symptoms she displayed in hospital? Perhaps she was a danger to herself? 
 
I suspect the first scenario, but I will never know. The truly tragic thing is that this young woman was removed from her community and life aged 17 with no expectation of ever being discharged to pick her life back up. Her parents did not expect her to come home and eventually neither did she. 
 
No expectations, no power, no voice. A life of communal institutionalised living. I wonder if you can imagine what that really means. No personal belongings, communal clothes including underwear and toiletries, no food choice and tea served from the one pot with the milk and sugar already added. This was less than half a century ago! 
 
We have come such a long way since then, the time I’ve described is not that long ago, so great strides have been taken. We need to celebrate that our society is becoming more permissive of difference, compassionate to those struggling and is growing in expectation and voice. 
 
I’m sharing this today because, on reflection, I consider myself very privileged to have nursed people who have lived this experience and I’m proud to have led and been part of some improvements in mental health care over the last 35 years. 

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