Community Care and the Control of Mental Defectives in Inter-War Britain

The history of caring has traditionally concentrated on the role of institutions, but historians of the nineteenth and twentieth centuries are also beginning to recognize the importance of care provided outside of institutions by the family, neighbourhood support networks, and formal agencies such as the Poor Law. ¹ This ‘care in the community’ has always, in numerical terms, been the dominant form of care. On the other hand, it is also recognized that during the nineteenth century provision of institutional care began to dominate policy; reflecting this domination, the capacity of hospitals, reformatories, asylums, and workhouses expanded rapidly and the proportion of the British population in institutions peaked in the census of 1911. ² Unsurprisingly, therefore, historians of late nineteenth- and early twentieth-century social policy have concentrated on care provided inside rather than outside of institutions. As a consequence the historiography of care in the community remains detached from histories of the emergence of ‘community care’ as policy. There has been a vigorous debate over the timing of, and rationale behind, this policy shift from institutional to community care; in particular, and of primary relevance to this essay, there has been heated debate over the emergence of community care for the mentally disordered. The shift has been variously attributed to therapeutic advance, a liberal critique of incarceration, or a cost-cutting manoeuvre in response to a crisis of welfare capitalism. ³ Where historians are in agreement 199is that the transition occurs in the post-World War II period, probably in the late 1950s. ⁴ There is widespread acceptance of Titmuss's assertion that the first official use of the term ‘community care’ was in the report of the 1954–7 Royal Commission on Mental Illness and Mental Deficiency. ⁵