‘From occupation to occupation therapy: Policy, practice and professionalisation in English mental hospitals from 1919 to 1959’

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Prof John Hall

Centre for Health, Medicine and Society, Oxford Brookes University

‘From occupation to occupation therapy: Policy, practice and professionalisation in English mental hospitals from 1919 to 1959’

(Introduced by: Prof Jenny Butler, Health and Life Sciences, Oxford Brookes University)

[Note: Ask for a word version of his handout]

[35min; 11 slides]


Paper presented to the International Research Symposium:

"Therapy and Empowerment – Coercion and Punishment:

Historical and Contemporary Perspectives on Labour and Occupational Therapy"

26–27 June 2013,  St Anne’s College, Oxford


Abstract: Immediately after the end of the First World War, there were a number of significant developments in policy and practice in English mental hospitals, all of which took place within a legal and administrative framework overseen by the Board of Control, the statutory regulatory body for all mental institutions in England. Among these developments were the growth of a number of new forms of work and occupation for patients in these institutions, within a new rhetoric of occupational therapy. Innovations in practice were dependent on the medical superintendents or directors of the institutions, and emerged from interactions between the Board of Control and the superintendents, mediated by the Royal Medico-Psychological Association (RMPA), the national professional body for psychiatrists. The analysis presented here suggests that the Board of Control was not only a regulatory body, but also a policy initiator and active promoter of good practice and research.

Related to the growth of new forms of therapy, but separate from it, were moves to professionalise the practice of occupational therapy, first through training, and subsequently through the formation of professional bodies. Both the forms new occupations took and the organisational context of most of the early English training courses reflects a crucial distinction between the interests and objectives of the larger understaffed public hospitals, and the smaller charitable and private institutions, which were in competition for patients. There was active contest between different groups, including mental nurses, for control of the new forms of therapy, compounded by both the rapid expansion in the provision of psychiatric occupation for servicemen during and after World War Two, and a new rhetoric of industrial therapy.

These shifts in the desired pattern of occupations, and who should provide them, illuminate the complex interactions between: the policies and rhetoric of the Board of Control, and of the RMPA in striving to maintain professional hegemony; the aspirations of emergent professional groups; and renewed political concerns which led to the 1959 Mental Health Act that signalled the final demise of the Board of Control.



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