Mental Health and Learning Disabilities: Heritage and Stigma

Research into the history of mental health care has encouraged a broad range of stakeholders and individuals to challenge their values and beliefs about people who live with mental health issues and the services they use.

What was the problem?

Cost, equality, diversity and stigma are central to the modern-day provision of mental health care. Research by Dr Rob Ellis has shown how the lessons of the past can enhance understanding of such concerns with a view to informing current thinking in this field.

Benefits of this research

This research into mental health history has informed current practice by challenging longstanding notions of cost, stigma, equality and related concerns. Exemplifying the unit's key strategic aim of partnership working, this influence has been achieved through collaborations with a wide range of stakeholders, including the NHS and the third sector, and via extensive outreach that has successfully engaged both specialists and the public.

It has contributed to modern-day policy, practice and perceptions through a series of collaborations with health officials and practitioners, third-sector organisations, service users and the wider public, including museum exhibitions, online engagement and bespoke teaching and learning materials. Beneficiaries have credited the research with helping to "break down the barriers and stigmas" that surround mental health and with developing positive attitudes towards the issue.

What did we do?

This work can be traced back to 1998 and the development of original research carried out by Dr Ellis. He returned to Huddersfield as a Research Fellow in the School of Applied Sciences in 2006, moving to History in August 2009. Publications in 2006 and 2008 built on Dr Ellis's PhD research and led to two significant grant applications that allowed innovative collaborations with partners in the heritage and archives sector. These activities form a central pillar in the strategy of the department and especially the work of the Centre for the History of Public Health and Medicine.

A consistent theme of Dr Ellis's studies has been consideration of orthodox views of the physical and social separation of the insane in 19th-century lunatic asylums. The initial research, which focused on patients and their families, argued for a more nuanced understanding of asylums as both therapeutic institutions and places of custody. He showed that the idea of therapy was an important driver behind the committal of many individuals. He demonstrated that, though issues of stigma relating to "madness" and pauperism were important, the relatively short stays of many asylum patients are noteworthy while the role of non-"heroic" treatments such as rest cures have been under-valued. Specific research on the role of the Poor Laws, Poor Law finance and the general cost of caring for the mentally ill challenged the conventional view that subsidised asylum care led families to pass over the responsibility of their kin to the medical profession and that patients, once committed, were left to rot and never seen again. Using qualitative and quantitative archival research, Ellis argued that the asylum system would not have grown at the rate it did if this was its only function.

Dr Ellis's 2006 paper developed this further with case studies of 19th-century committals, while his later research showed that, in spite of a national legislative framework, regional differences in the development of facilities and treatments remained. Subsequent work has expanded on these themes to address the issue of stigma in relation to both the institutions and the people who used them.

Overall, the research has consistently demonstrated that the process of getting into and out of an asylum was guided by a number of factors, of which custody might have been only one. Similarly, while treatment could be invasive for some and barbaric for others, the absence of medical intervention in certain cases showed asylums could act as a refuge. In addition, the focus on finance and its relation to committal and discharges illustrated how families played a significant role in decisions about the care of their kin. These themes have proved to be particularly appealing to current practitioners and those in the heritage sector anxious to explore issues of equality and diversity with hard-to-reach groups.

What happened next?

Since 2012 Dr Ellis has collaborated with the South West Yorkshire Partnership NHS Foundation Trust as part of its Change Lab programme. One of Change Lab's flagships has been 'Breaking Down Barriers to Wellbeing'. Using the volunteer-led Stanley Royd Museum in Wakefield as a focal point, Ellis was invited to devise and deliver teaching and learning activities for a diverse group of visitors. The Trust's Programme Coordinator has described Ellis's contribution as clearly demonstrating "that the museum can play a significant role in fulfilling the Trust's mission and objectives". This has led to further investment — including refurbishment, the appointment of a professional curator and greatly extended opening hours. As a result, the Trust has been able to convert an under-used and under-resourced museum into a vibrant hub to meet Change Lab's aims of "engaging others in thinking about mental health and breaking down the barriers and stigma that surround it". The Trust has confirmed that the "learning activities that [Ellis] developed had a positive impact on attitudes towards mental health and learning disability".

This collaborative venture built on earlier partnerships developed by the History team, in particular the Out of the Shadows exhibition at the Thackray Medical Museum in 2010. Dr Ellis was invited by the Thackray and Leeds City Museums to act as academic lead. The aim was to enable and encourage debate on mental health provision. His research led to participation in the project by those who might otherwise be excluded from heritage initiatives, and visitors to the exhibition included current service users. This has enabled Leeds Museums to follow up Out of the Shadows with other exhibitions, extending the initial reach. The project also led Dr Ellis to act as PI on a joint bid with the Thackray for an AHRC collaborative doctoral award, securing £50,000 to explore further the themes that emerged from the project.

In 2011 the University of Huddersfield Archives Service and the West Yorkshire Archive Service (WYAS) submitted a joint application to JISC, with Ellis invited to be academic lead on History to Her story, a project to document the lives of Yorkshire women from 1100 to the present day. The aim of the bid was to repurpose an existing database of archival material for an interactive website, with Women and Mental Health among eight key themes. Dr Ellis's role was to coordinate the development of non-HE learning materials. Since its launch in October 2011 the website has averaged 40 new visitors a day and has been featured by BBC History Magazine, The Guardian and various local media, including BBC radio.

Through Huddersfield's successful Connected Communities project Sound Craft Vision Place, Dr Ellis worked with mental health charities to develop individual projects. St Anne's Our Minds, Our Histories and Mencap's Social History of Learning Disabilities were awarded Heritage Lottery Fund funding of £8,000 and £9,500 respectively following these collaborations. Dr Ellis's supplementary bid in 2013 to the AHRC to enhance these projects has led to wider engagement and dissemination, including further work with Leeds City Museum. In 2013 Ellis's work on stigma and mental health also led to engagement with the Orleans Gallery, a local-authority-run gallery in Richmond-on-Thames, allowing it to frame an exhibition on 'outsider' art within a broader context and so draw on wider funding, raising the profile of both 'outsider art' and the gallery itself.