Clifton Hospital Archive

Scope and Content

Administrative records, comprising Visiting Committee minutes, 1844-1948; House Committee minutes, 1847-1948; Building Sub-Committee minutes, including material relating to male nurses home alterations, 1929-1941; Supplementary Committee books, 1934-1949; annual reports, 1847-1947; unlisted modern files, including printed reports, committee minutes, and administrative files, c.1970s-1990s; rules, regulations and orders, 1867-1931; correspondence and papers, 1861-1967; visitors reports, 1847-1967; medical superintendent’s daily diaries, 1874-1935; suggestions books, 1847-1855; and monthly report books, 1905-1930; chaplains’ report books, 1907-1979, and chapel service books, 19th century; commemorative histories of the hospital, including video ‘Impressions of Clifton Hospital,’ 1947-1993; printed material, including press cuttings, general rules and orders, programmes and information booklets, 1930-1982; Friends of Clifton Hospital minutes and papers, 1981-1985; photographs, 1934-1980s.

Land and buildings records, comprising plans and drawings, 1844-c.1977, and related papers, 1844-1960s; work department records, including annual reports, 1928-1950; staff papers, 1928-1957; estimates and requisitions books, 1920-1953; sketch books, 1928-1951; official circulars and regulations, 1911-1960s; gardeners’ diary, 1960, 1964; and correspondence, 1954-1963.

Financial records, comprising general ledgers, 1891-1948; additions ledger, 1858-1890; cash books, 1907-1936; treasurers account books, 1896-1929; summaries of receipts and payments, 1845-1935; clerk’s cash account books, 1931-1949, and receipts account books, 1935-1951; finance order books, 1931-1945; day books, 1943-1948; housing accounts, 1939-1949; canteen and shop accounts, 1937-c.1967; material relating to patient accounts, 1901-1966; and material relating to salaries and wages, 1862-1948.

Stores and equipment records, comprising inventories, 1890-1959; provisions receipts and accounts, 1945-1951; crockery, hardware and brushes accounts and monthly requisition book, 1938-1952; clothing receipt and issue book, 1920-1952; uniform books, 1922-1974; work done book, 1920-1945; equipment book, 1939-1945; papers, press cuttings, drawings and accounts relating to furniture, c.1909-1952.

Establishment records, comprising staff books, 1920-1973; staff registers, 1894-1910; staff service registers, 1910-1970s; matron’s staff books, 1887-1922; nurses’ training syllabus, 1977; record of sick staff, 1956-1960.

Patient records, comprising admission forms and reception orders, 1847-1909; admission registers, 1847-1961; medical registers, 1907-1949; discharges, transfers and deaths registers, 1847-1949; case notes, 1850-1969, with indices of patients, c.1911-c.1971; discharge books, 1868-1951; absentees upon trial registers, 1889-1959; mechanical restraint registers, 1890-1919, 1950-1960; leave of absence for health registers, 1893-1928; epileptics registers, 1945-1947; mortuary registers, 1961-1964; post mortem notes, 1895-1908; coroners inquests, 1863-1948; medical certificates of causes of death, 1976-1991; burials and cremations forms, 1964-1986; weight books, 1932-1941, 1949-1952; annual summaries of patient statistics, 1929-1976; quarterly summaries of patient statistics, 1934-1951; daily numbers books, 1945-1976; ward report books, 1948-1978; registers of enquiries and visitors, c.1920-1960; ward group minutes and reports, 1982-1987; patient statistics, censuses and miscellaneous papers, 1897-1992; outpatients notebooks, 1931-1952; photographs of patients, 1889-1890s; York and North Yorkshire Branch of the Mental Aftercare Association account book, 1933-1957; York and District Association for Mental Health annual report, 1984-1985.

Administrative / Biographical History

In 1843, just over a year before the Lunatics Act of 1845 made the provision of county and borough asylums compulsory, the justices of the peace for the North and East Ridings agreed at their respective quarter sessions to unite together for the purposes of building and maintaining a county asylum. A Joint Committee of Visiting Justices was appointed on 7 January 1844 and a site was sought for the new building. A number of locations were looked at before a site bordering Shipton Road in Clifton, two miles north of the centre of York, was decided upon. The chosen architects were the firm of G.G. Scott and W.B. Moffat, well known for their asylum and workhouse commissions. The new asylum was three years in building, and it opened for patients in 1847.

The asylum initially had accommodation for 144 patients. The earliest reports of its first medical superintendent, Samuel Hill, stressed the homely, domestic family atmosphere, in contrast to the rougher conditions which had been experienced by some of its first inmates, previously confined in workhouses or private madhouses or in inadequate home environments. Inevitably, this early aim of homeliness was soon compromised by the need for strict economy and by rapidly increasing numbers of patients. The asylum was already overfull by 1850. The building of additions to the wings, this time by J.B. and W. Atkinson, a local firm of architects, began almost immediately after the asylums opening, and two new wings, to accommodate 140 extra patients, opened in 1851.

Expansion continued throughout the nineteenth and twentieth centuries. Additional wards for 166 patients opened in 1856; in 1879 two wards were built at either end of the asylum for epileptic and suicidal patients. In 1888 a further building for female patients, called the Annexe was opened. In 1890-1 an isolation hospital, later called the Villa was added and in 1910 male and female infirmary blocks, each for 100 patients, were completed. The early twentieth century saw, among other works, verandahs being attached to wards, the addition of a sanatorium for male TB patients, rooms for occupational therapy, and a second storey for the female admission ward. The asylum complex was also extended in other ways. A detached chapel was added in 1873, a recreation/dining hall in 1876-7, and a water tower in 1882-3. Farm buildings and workshops were built or extended. A nurses home was first erected in 1915, further extensions followed, with a major addition in 1939. A new, separate house for the medical superintendent, 'Southfield', was built in 1929. Staff cottages for the steward, gardener and other staff were being built in 1858-9 and many staff cottages were added in the late nineteenth and early twentieth centuries.

The North Riding Asylum, like other county asylums, developed a flourishing farming enterprise: much effort was initially put into the acquisition of land around the asylum building itself, neighbouring Rawcliffe Farm was purchased in 1884 as the nucleus of an asylum farm, and Ings Farm was purchased to add to the holdings in 1896. The hospital continued to maintain a farm until the Ministry of Health decided to end farming practice at mental hospitals in the early 1960s.

Numbers of patients began at 106 in 1847. This rose to 154 in 1850, 312 in 1855, 409 in 1860, 435 in 1865, and 560 in 1870 (figures calculated from patients resident on 31 December each year). Numbers stabilised at between 500 and 600 in the 1870s and 1880s, but rose again to between 600 and 800 in the 1890s and continued at this level up to the mid-1920s. There was another rise in the late 1920s and 1930s, so that during the 1930s the hospital had over 900 patients, rising to just over 1,000 after 1937. Thereafter numbers rose to over 1,100 in the 1950s before falling steadily from the 1960s onwards.

The majority of patients came, for most of the hospitals history, from the North Riding. Despite the fact that the asylum initially served both the North and East Ridings, this arrangement did not last long. On 1 August 1865 the union between the North and East Ridings was dissolved and the East Riding embarked on building its own asylum at Beverley to which East Riding patients were transferred when it opened in 1871. From the beginning, however, some patients were taken from outside the designated county areas by means of contracts made with other local authorities. Such patients were termed out county patients. Thus, for example, York Corporations pauper lunatics were housed at the asylum between 1847 and 1861 (a few further patients were later taken by contract in 1898, just before the building of York City Asylum at Naburn). Middlesbrough Borough patients were taken up to the late 1890s, when the increasing population of Middlesbrough meant that patient numbers became too great to accommodate easily: nearly 20% of the asylum population in the 1890s were from Middlesbrough Borough, which put pressure on available space for patients from the North Riding. In 1892, Middlesbrough was asked to withdraw its patients, and they left, to go to the new Middlesbrough Asylum, in 1898, although patients from the rural parts of Middlesbrough Poor Law Union continued to be housed at Clifton. Other contracts were made at various times with other counties and boroughs: for example, patients from Newcastle and Birmingham were taken during the First World War, and in 1930 contracts were in force with local authorities in Berkshire, South Shields, Chester, Birmingham and Staffordshire for the reception of specified numbers of patients.

The asylum was designed for pauper patients - ie ordinary working class men and women whose families would be unable to afford the ongoing fees of private asylum care. Patients entered the county asylum via the poor law unions, with the union boards of guardians undertaking responsibility for their fees.

However the asylum did additionally house a few private patients who paid fees. These private patients constituted a very small proportion of the whole - for example, there were only 12 private patients at the beginning of 1869 (2.3% of the total), 57 at the end of 1893 (7.9% of the total), and 56 in 1926 (7% of the total). Nevertheless, these private patients, together with the out county patients received under contract, were a source of extra revenue. Between 1847 and 1889 the North Riding gained ,50,208 from these sources.

After the abolition of the poor law union boards of guardians in 1929 and the transfer of their responsibilities to local authorities, the former pauper patients were henceforth classed as rate aided. Further changes took place after 1948. The catchment area was widened to take in certain areas within the new Leeds Hospital Region (this led to a rise in patient numbers during the 1950s), and henceforward all patients came under the NHS.

Arrangements and care of patients at the North Riding Asylum during the nineteenth century were no different from those at county asylums elsewhere. Males and females were strictly segregated, each separate side of the hospital thus being a mirror image of the other. Sedation and mild forms of restraint were employed (when the second medical superintendent tried to ban restraint completely, in 1867, controversy ensued after some well publicised incidents at the asylum). The large numbers of patients led to much emphasis on control and management. As far as possible, patients were kept occupied. There was much emphasis on work as therapy, which had the additional benefit of making the asylum self-sufficient and cheaper to run. Females helped with domestic duties, and in female occupations such as sewing - patients clothes, for example, were made at the asylum by inmates. Many male patients worked on the land or at useful trades. In November 1848 five sixths of the 149 patients in the newly opened asylum were being set to work: 36 men at gardening and farm labour and about the same number at various trades; females were employed in household work, laundry and needlework. In 1886 out of a patient population of 615 67% of the men and 81% of the women were engaged in work; of the 297 men in the asylum 108 were occupied on the farm and garden.

Although the regime at county asylums during the nineteenth century relied more on the concept of detention rather than of therapeutics, it would be a mistake to imagine that once patients entered the asylum they were detained indefinitely: on the contrary many patients were discharged after short periods, and others were discharged and re-admitted more than once. Inevitably, however, the asylum did become a home to many long stay patients who could not be accommodated easily elsewhere. The medical superintendent commented in 1887 that the recovery rate of 45.8% on admissions was satisfactory given the large number of patients who entered so reduced in mental and bodily health that in fact they ‘were only brought in to die’. Classification of patients was always the aim although this could be made difficult if there was overcrowding. In 1848 patients were classified according to their character and condition: orderly and cleanly, epileptic and refractory, idiotic, and dirty. The nineteenth century asylum was made up of a mixture of patients, including those who were capable of recovery and discharge; those who had been in the asylum before and were re-admissions; chronic patients, often elderly and infirm; those who were suicidal; epileptics; those who were ‘feeble minded’; those who were suffering from general paralysis of the insane. Some patients were quiet and tractable and could work; others posed great difficulties in terms of nursing and control. But life at the asylum, though austere, was not one of unrelieved gloom: entertainments and occasional outings were regularly provided for patients, as the annual reports reveal. One should also compare the asylum regime with regimes at other contemporary institutions, and with the difficult lives frequently led by patients in their own, often very poor or difficult, home environments, in order to put the asylum in perspective.

In terms of staffing, like everything else, the nineteenth century asylum was run on economical lines. Management was in the hands of a visiting committee of North Riding magistrates before 1888; a visiting committee of the county council thereafter. The asylum’s officers comprised a resident medical superintendent, a clerk and steward (later with an assistant), a clerk to the visitors, a treasurer and a chaplain. The medical superintendent’s wife at first performed the role of matron; later on she had an assistant, but in 1870 the post of matron was replaced by that of housekeeper who also performed the function of chief nurse until 1887.

The medical superintendent was the sole medical man at the asylum until the post of assistant medical officer was created in 1857; a second assistant’s post was added in 1886. Those who held medical superintendent’s and assistant’s posts were by this time making careers within the asylum system, and applicants invariably had, or would gain, experience at asylums elsewhere, or alternatively move up within the same institution. The third, fifth and sixth medical superintendents of the North Riding Asylum all previously held the post of assistant medical officer there before becoming chief. Many of the institution’s medical officers served for long periods. The narrow constraints of asylum doctors’ careers may in many ways have impacted on their personal lives. The first medical superintendent, Samuel Hill, retired with ‘the entire loss of mental and bodily health’ in 1866, after the death of his wife who had worked alongside him. The fourth medical superintendent, A.I. Eades, committed suicide in 1924. In some respects the life of the asylum staff could be as difficult as that of the patients. One of the assistant medical officers, William Nicholson, appointed in 1876, failed to move on to a higher post elsewhere: he eventually, and against the asylum rules, married, maintaining his wife and children secretly in York for some years while he resided at the asylum. This was discovered after he became ill in 1893 - he was by then an alcoholic - and he was forced to resign.

There was a total of ten attendants at the asylum in 1848: six male, including the head attendant, and four female, to manage 79 male and 70 female patients. As numbers of patients grew, so did the nursing staff: for example, in 1887 there were 608 patients, 46 male attendants and 40 female attendants. The ratio of staff to patients on the eve of the First World War was 1 to 8.7 patients. In 1925 there was a day staff of 60 male and 68 female nurses and a night staff of seven males and eight females, for a patient total of 769. In the early years there were no attendants for night duty: the first ones were appointed in 1867, and in 1888 there were three male and three female night nurses.

There were some difficulties in retaining attendants in service, particularly women, who would leave on marriage, and this was a matter of concern for the visiting Lunacy Commissioners. In 1895 the Commissioners found 37 male and 45 female attendants to manage 760 patients - 156 more patients and two fewer attendants than had been the case eight years previously. They noted that half the female attendants had been there less than twelve months, and they thought the turnover in female attendants ‘unequalled’ by any other asylum. Some staff in fact stayed many years: in 1908 53% of men and 27% of women had served upwards of five years although a further 38% had served less than twelve months. Staff cottages for married attendants were offered as an incentive, and from 1876 onwards females were paid as much as males; there were also pensions for those who retired after long service.

Before 1890 attendants were not specially trained, but courses of lectures began to be offered at the asylum in the early 1890s. In 1895, for the first time, a group of attendants and nurses entered the examination for the Certificate in Nursing recently devised by the Medico-Psychological Association, and 12 out of 13 passed. Many of the attendants, particularly the men, brought with them particular skills which fitted them to supervise patients’ work or take part in asylum activities: in 1904, for example, the list of paid staff included a shoemaker, a blacksmith as well as a bandmaster and organist. The asylum also employed a staff of artisans who were in constant employment maintaining the asylum fabric and grounds. In 1904 there were 54 male attendants, 60 female attendants and 24 artisans, and there were 708 patients in the institution.

The First World War brought a certain amount of disruption. Three asylum officers and 44 attendants and artisans served in the army; three were killed in action. Maintenance of the hospital fell into arrears due to lack of staff. Over 50 patients from Birmingham and over 90 from Newcastle were housed while their asylums were taken over as military hospitals. After the war, ex-service patients suffering from psychiatric disorders were a small but constant presence for several years.

During the 1920s, moves were made to allow patients greater freedom. Selected wards were declared open, more patients were allowed parole, and other efforts were made to improve the patients environment. A psychiatric out-patients department, served by all the medical superintendents from the asylums around York, was opened at York County Hospital. Aftercare for discharged patients began to be provided by the York and North Yorkshire Mental Aftercare Association. The term asylum was dropped from the hospital’s title in favour of the term mental hospital. After the passing of the Mental Treatment Act of 1930, which introduced the new classifications of certified, voluntary and temporary patients at public mental hospitals, voluntary patients were increasingly taken: in 1931, the first year of the working of the Act, more than 30% of direct admissions at the North Riding Mental Hospital were voluntary, which was the highest figure recorded in any public mental hospital in England and Wales. The emphasis at the hospital thus increasingly came to be on treatment and not just detention, and its regime was consciously modernised.

Efforts were also made to increase and improve the formal nursing training of staff. Although lectures had begun in the 1890s, relatively few attendants were qualified: 15% of the male and 6% of the female nurses had the Certificate of the Royal Medico-Psychological Association (RMPA) in 1923. Further encouragement was given by the medical staff, and a sister tutor was appointed to give practical demonstrations to supplement the lecture courses. For many years the RMPA Certificate in Nursing was more popular than the more recently instituted examination of the General Nursing Council, despite the fact that after the Nurses Registration Act of 1919 only the latter entitled the holder to registration. During the early 1930s more nurses were being encouraged to take the GNC exam, and in 1930 and 1931 the North Riding Mental Hospital was chosen as the state exam centre for the area. Slowly, the staff was becoming better qualified. In 1928 the hospital had 53 certificated and 19 uncertificated staff nurses, with 67 probationers. But it was still a common complaint that many probationers left quickly, without taking exams.

During the 1920s and 1930s, the hospital flourished under the regime of its influential medical superintendent, Dr John Ivison Russell, and it was viewed as particularly ‘go ahead’ in its methods. Russell strongly advocated the need for the public to overcome prejudice against mental illness: mental hospitals, he advocated, should be perceived as having the function of treating disease in its early stages, hence the importance of voluntary admission. Under Russell, the hospital became particularly well known for its pioneering work in the field of occupational therapy. This began modestly in 1925, providing therapeutic handicraft work for a few male and female patients, some of whom were previously regarded as unemployable. A first successful display and sale of work took place in 1927. By then the occupational therapy department had outgrown its accommodation and further rooms were adapted and the range of activities progressively expanded. After 1932, Russell introduced a complete and more ambitious organisation of occupational therapy, following methods recommended by Dr Simon in Germany. In 1933, 75% of patients at the North Riding Mental Hospital, compared with 50% elsewhere, were suitably occupied: seven occupation rooms were in use for men and six for women, and more workshops were being converted. By 1934 a vast range of occupations were being pursued and all types of patients, from convalescents to ‘imbeciles’ were being included. By 1937 89% of patients were occupied. By the early 1930s, interest in the organisation and benefits of occupational therapy in mental hospitals was growing. The North Riding Hospital scheme aroused the admiration of the Board of Control, and there were also visitors from other mental hospitals. The Royal Medico-Psychological Association and the College of Nursing sent representatives to see the work done, as a preliminary to devising a syllabus of training. The hospital became the first national training centre in this field for mental nurses, and Russell produced a text book on the subject.

There were other changes and new treatments introduced at the North Riding Mental Hospital, as elsewhere, during the 1920s, 1930s and 1940s. A pathological laboratory was opened at the hospital in 1925 and was used extensively both for research purposes and for routine analysis (enquiries being particularly carried out into carriers of typhoid and other similar diseases). Facilities for surgical operations were provided in the hospital, and in 1930 the centre basement was fitted up as a surgery, dispensary and dentists room (there was a visiting dentist from 1924).

New psychiatric treatments were tried. Malarial therapy, later with tryparsamide injections, was being given to a few general paralysis cases from the mid-1920s onwards (14 cases, for example, were treated with malaria and tryparsamide in 1929). In 1936 treatment by prolonged narcosis with somnifaine, insulin and glucose was commenced for a few patients (the medical superintendent noted in his report for that year that this treatment was widely recommended for certain psychoses). Hypoglycaemic shock and convulsive shock therapies for cases of schizophrenia were used for the first time at the hospital in 1937 (five patients were undergoing one or other of these treatments at the end of that year). The 1938 report noted that insulin and/or cardiazol had been employed in the treatment of 48 schizophrenic patients that year, while three cases of general paralysis had been treated with malaria. The Second World War led to some disruption in these therapies: in 1946 treatment by hypoglycaemic coma was being resumed, but initially, due to staff shortages, for males only. However the report for 1947 noted that both insulin shock and convulsive therapies were in use (although it added that figures for the past ten years showed that these treatments had been disappointing for most schizophrenic cases). In 1948 the first pre-frontal leucotomy operations were performed at the hospital, on four women patients.

The Second World War caused other disruption too: in particular it brought a temporary halt to the much lauded occupational therapy service. Meanwhile, parts of the hospital (Villa and the male infirmary block) were used as an Emergency Medical Services Hospital, treating, during the course of the war, 5,000 military psychiatric patients. The war also meant the abandonment of plans for the building of a new admission hospital and two convalescent villas on site, which would have played important roles in the ongoing modernisation process.

The North Riding Mental Hospital became part of the NHS in 1948, as the head hospital of York ‘B’ Group. It was renamed Clifton Hospital. The coming of the NHS brought various changes, although to some extent these continued existing trends. One immediate change was in patient numbers. In the 1940s there was an annual average of about 900 resident patients. In the first years of the NHS, this number rose steadily, partly due to alterations in the catchment area: although North Riding patients were still taken, patients were now also received from other areas in the new Leeds Hospital Region, notably the Harrogate, Ripon and Nidderdale districts. Patient numbers peaked at 1,154 in 1956. A large and increasing number of these were voluntary: over 60% rising to more than 70% during the 1950s. Numbers of annual admissions and discharges were also rising during this period.

New developments also affected the hospital population during the 1950s. The Mental Health Act of 1959 altered admission procedures, leading to the admission of many more patients on an informal basis (90% by 1970). The introduction of new drugs and techniques had a huge impact on psychiatric care, leading to quicker discharges and thus a higher turnover of patients, but also a consequent increase in re-admissions. New methods of treatment also meant that numbers of resident patients steadily fell: to an annual figure of around 750 by 1970, with numbers of long stay patients (ie resident for more than two years) also being reduced by the early 1970s. But proportionate numbers of resident patients aged 65 and over, which had risen dramatically since the 1950s (partly as a result of the other changes in the hospital population), remained high: around 50% in the 1960s and early 1970s. There were also other problems: nursing recruitment, of women in particular, was a major difficulty in the 1950s, despite the work of the mental nurse training school situated at the hospital. A nursing cadet scheme was introduced in 1952 to attract young girls to the profession. In the mid-1950s nurses from West Africa and the West Indies were recruited to fill the gaps.

The new developments at the hospital mirrored national and regional trends, as did the kinds of strategies evolved to deal with them. Such strategies, briefly indicated below, involved greater rationalisation on the basis of function, greater liaison between different hospitals and management bodies, the development of more specialised services for patients with different needs, a greater emphasis on the hospitals place within the community and a corresponding development of complementary psychiatric services outside the hospital itself. The overall aims were derived from concepts of therapeutic community and rehabilitation within the hospital, with a quick return of patients to their ordinary lives outside where fully integrated back up psychiatric services would also be available.

Services rationalised or centralised on the basis of function, and involving liaison between different hospitals in different hospital groups included, to take some examples, leucotomy operations (all such operations for both York A and B Groups were carried out at Clifton from the mid-1950s); path lab services (liaison continued between the path lab at Clifton and the lab at the York County Hospital); insulin treatment (a new joint insulin unit opened at Clifton in 1955); out-patient clinics (developed throughout the hospital catchment area, with clinics in the general hospitals at York, Harrogate, Scarborough, Ripon, Whitby and Thirsk); aftercare services (in which local authority mental welfare officers and social workers had key roles); liaison between the mental health services in both York hospital groupings (there was liaison via psychiatric consultations, and York B Group was an interested onlooker, if not a direct participant in the development of the integrated York Mental Health Service planned in 1953); and the development of integrated drug addiction services (Clifton was appointed by the Leeds Regional Hospital Board in 1967 as the regional drug addiction unit for the York area, offering in- and out- patient services).

The development of more specialised services and units for patients with different needs included, to take various examples, the acquisition of a house for convalescent patients at East Ayton Lodge near Scarborough (opened in 1947); the housing of some long stay female patients in Moorlands (a large house at Haxby, acquired in 1955); the opening in 1967 of Southfield (in the building which had formerly been the medical superintendents house) which offered in- and out- patient services for disturbed adolescents; and the modernisation and extension of the male and female admission wards in the 1960s.

The concept of the mental hospital as a therapeutic community led to some changes and new developments within the structure and organisation of Clifton Hospital. The last two wards with locked doors were opened up in the mid-1960s. There came to be more emphasis on multi-disciplinary staff teams and discussion groups: so, for example, a Medical Staff Committee of all medical and dental staff was formed in 1965 to discuss policy and procedures, and in the same year a Clifton Hospital Discussion Group was formed between medical and nursing staff to discuss and formulate ideas; ward groups later followed. A ‘rehabilitation unit’ for patients, mixing work and leisure (and distinct from the old established, and ongoing, occupational therapy department) was planned in the early 1960s, and out of this was set up the industrial therapy unit, employing able patients, for wages, on a five day week, doing industrial work taken under contract for firms: in other words, a unit which rehabilitated patients into a normal working factory environment. In the same year the catchment area was nominally divided into three, and the psychiatric services based at the hospital were reorganised into three clinical teams, each headed by a consultant and covering a different geographical area, with responsibility for the increasingly integrated in- and out- patient services.

An important working party was set up in 1972 to plan further improvements in the way the hospital was organised and to overcome some of the deficiencies arising from old fashioned mental hospital arrangements and the legacy of previous overcrowding. The hospital at that time had 750 beds and patients comprised roughly one third long stay patients, one third elderly with senile dementia and similar conditions, and one third acute psychiatric cases. The aims set out by the working party were to divide the hospital wards into two to match two consultant teams serving the catchment area, which was now divided into east and west. Two integrated admission units were to be created from three old single sex wards. The elderly mentally infirm were to be accommodated on the ground floor of the hospital and the elderly wards were all to be placed under the direction of one consultant. The practice of cross sleeping, whereby patients from different wards came together at night to sleep in large dormitories, often some distance from their living quarters, was to be abolished if possible (it was ended completely in 1985). Finally, a number of new units for particular categories of patients were to be created within the existing structure: these were a progressive care unit, a pre-discharge unit, a ward for the physically sick, and a mother and baby unit.

This programme was followed over the course of several years. The first stage included the creation of the new admission units (in the Villa and Ash Tree House); the establishment of the progressive care unit (in the former M9 Ward); and the opening, in 1976, of two newly built wards (Bedale Ward and Rosedale Ward) for the elderly mentally infirm. Other improvements included a new purpose built physiotherapy and occupational therapy block, and the renaming of wards (previously numbered and prefixed either M for male or F for female) after Yorkshire Dales.

However, continuing rationalisation and the matching of patient care to the therapeutic needs of different categories of patients, as well as the general shift in mental health policy towards psychiatric care within, rather than apart from, the wider community ultimately meant that Clifton Hospital, like many other large Victorian asylums, was wound down from the 1980s.

The hospital's annexes were closed: East Ayton Lodge had closed as early as 1978; the farm building, situated half a mile to the north of Clifton Hospital, which had been used as a long stay male annexe since the cessation of farming activities, closed in 1985; and Moorlands eventually closed in 1989.

A new strategy for mental illness services within York Health Authority was developed in 1984 and incorporated in the York Health Authority Strategic Plan of April 1985. This envisaged the closure of Naburn Hospital by 1988 leaving Bootham Park and Clifton Hospital both remaining open in the short term. In the meantime community services would be further developed allowing a continued reduction of in-patient beds.

A major issue concerning Clifton Hospital and one which complicated any future developments, was that it offered beds and services to four different health authorities: York, Northallerton, Harrogate and Scarborough. To facilitate the future devolution of beds and services to these different areas, Clifton Hospital, under the new strategy, was ‘sectorised’ in 1984/5. This meant that the services provided by the hospital were henceforth based on three sectors, covering the catchment areas of Harrogate, Scarborough and York/Northallerton. Up to that point wards had housed together patients from different districts and with dissimilar problems and needs. Under sectorisation, wards were arranged by sector and patients with similar needs were grouped together. In addition, large bedded wards were reduced. Three sector management teams were set up to manage services, each of which involved staff from Clifton Hospital and from the relevant district. It was envisaged that under the new arrangements, Clifton’s bed numbers would reduce to 585.

A comprehensive review of mental health services and a refinement of strategy was carried out and approved by York Health Authority in March 1987. This was part of a wider strategy developed by all authorities in the North Yorkshire ‘cluster’ which used Clifton Hospital. Under this strategy, the four districts of York, Northallerton, Scarborough and Harrogate would all make provision for acute, elderly and long stay patients within their own areas, and in smaller units. Clifton Hospital would be made redundant by 1993/4. After a major consultation exercise, York Health Authority gave formal sanction to the closure plan in March 1988.

Between 1988 and 1994, local services were developed. Thus, for example, within York Health Trusts area, acute psychiatric services were centralised at Bootham Park Hospital, while a strategy for other types of psychiatric patients incorporated a number of different elements: first, the provision of community units for the elderly (each centred in a particular area or suburb and offering residential, respite, domiciliary and day care for confused elderly); secondly, the organisation of a joint day care service between York Health Trust and Social Services (with a core unit at Moorlyn, Tadcaster Road, York); thirdly, the establishment of community rehabilitation homes (Stray Garth at Heworth and Red Roofs at Clifton); and fourthly the use of specialist units (both of which were situated on Clifton Hospital site, see below). Co-ordination of these psychiatric services was provided by four community mental health teams.

Numbers of patients at Clifton Hospital dropped steadily during the late 1980s and early 1990s as patients moved out into the community (ie into the new smaller units in York or to other districts in North Yorkshire). The hospital closed at the end of July 1994.

While the hospital and its estate was put up for sale, part of the site to the north of the main hospital block was retained for York Health Trust use. The retained site included the redundant old Clifton laundry building (converted for use by the Wheelchair Centre in 1996), the 1970s District laundry building (later closed in the late 1990s), and the old female infirmary building, which underwent modernisation to provide a specialist long stay unit, named Clifton House. Meanwhile, the former Southfield psychiatric unit for adolescents, at the other end of the Clifton site, was also retained as another specialist unit: since 1989 this had been called Limetrees Child Adolescent and Family Unit, after it took over the services of the closed child psychiatric unit at Fairfield Hospital.

After the closure of the hospital a few other departments and units remained on site temporarily in 1994 (including York Health Archives) but none were sited in the main building which was vacated. All these units were due for relocation as soon as suitable arrangements could be made for their transfer and by 1996 all had been relocated. The hospital was sold in 1995 and was redeveloped for housing and offices. Most of the former hospital buildings were demolished, with a very few exceptions: the former chapel, Ash Tree House (the former female Annexe) and Greystones (the former clerk’s house).

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The archive was deposited at the Borthwick Institute in 1995 as part of the transfer of York Health Archives to the Institute from their temporary home at Clifton Hospital. Further additions were made to the archive in 1996, 1997, 1998, 1999, and 2005.

Note

In 1843, just over a year before the Lunatics Act of 1845 made the provision of county and borough asylums compulsory, the justices of the peace for the North and East Ridings agreed at their respective quarter sessions to unite together for the purposes of building and maintaining a county asylum. A Joint Committee of Visiting Justices was appointed on 7 January 1844 and a site was sought for the new building. A number of locations were looked at before a site bordering Shipton Road in Clifton, two miles north of the centre of York, was decided upon. The chosen architects were the firm of G.G. Scott and W.B. Moffat, well known for their asylum and workhouse commissions. The new asylum was three years in building, and it opened for patients in 1847.

The asylum initially had accommodation for 144 patients. The earliest reports of its first medical superintendent, Samuel Hill, stressed the homely, domestic family atmosphere, in contrast to the rougher conditions which had been experienced by some of its first inmates, previously confined in workhouses or private madhouses or in inadequate home environments. Inevitably, this early aim of homeliness was soon compromised by the need for strict economy and by rapidly increasing numbers of patients. The asylum was already overfull by 1850. The building of additions to the wings, this time by J.B. and W. Atkinson, a local firm of architects, began almost immediately after the asylums opening, and two new wings, to accommodate 140 extra patients, opened in 1851.

Expansion continued throughout the nineteenth and twentieth centuries. Additional wards for 166 patients opened in 1856; in 1879 two wards were built at either end of the asylum for epileptic and suicidal patients. In 1888 a further building for female patients, called the Annexe was opened. In 1890-1 an isolation hospital, later called the Villa was added and in 1910 male and female infirmary blocks, each for 100 patients, were completed. The early twentieth century saw, among other works, verandahs being attached to wards, the addition of a sanatorium for male TB patients, rooms for occupational therapy, and a second storey for the female admission ward. The asylum complex was also extended in other ways. A detached chapel was added in 1873, a recreation/dining hall in 1876-7, and a water tower in 1882-3. Farm buildings and workshops were built or extended. A nurses home was first erected in 1915, further extensions followed, with a major addition in 1939. A new, separate house for the medical superintendent, 'Southfield', was built in 1929. Staff cottages for the steward, gardener and other staff were being built in 1858-9 and many staff cottages were added in the late nineteenth and early twentieth centuries.

The North Riding Asylum, like other county asylums, developed a flourishing farming enterprise: much effort was initially put into the acquisition of land around the asylum building itself, neighbouring Rawcliffe Farm was purchased in 1884 as the nucleus of an asylum farm, and Ings Farm was purchased to add to the holdings in 1896. The hospital continued to maintain a farm until the Ministry of Health decided to end farming practice at mental hospitals in the early 1960s.

Numbers of patients began at 106 in 1847. This rose to 154 in 1850, 312 in 1855, 409 in 1860, 435 in 1865, and 560 in 1870 (figures calculated from patients resident on 31 December each year). Numbers stabilised at between 500 and 600 in the 1870s and 1880s, but rose again to between 600 and 800 in the 1890s and continued at this level up to the mid-1920s. There was another rise in the late 1920s and 1930s, so that during the 1930s the hospital had over 900 patients, rising to just over 1,000 after 1937. Thereafter numbers rose to over 1,100 in the 1950s before falling steadily from the 1960s onwards.

The majority of patients came, for most of the hospitals history, from the North Riding. Despite the fact that the asylum initially served both the North and East Ridings, this arrangement did not last long. On 1 August 1865 the union between the North and East Ridings was dissolved and the East Riding embarked on building its own asylum at Beverley to which East Riding patients were transferred when it opened in 1871. From the beginning, however, some patients were taken from outside the designated county areas by means of contracts made with other local authorities. Such patients were termed out county patients. Thus, for example, York Corporations pauper lunatics were housed at the asylum between 1847 and 1861 (a few further patients were later taken by contract in 1898, just before the building of York City Asylum at Naburn). Middlesbrough Borough patients were taken up to the late 1890s, when the increasing population of Middlesbrough meant that patient numbers became too great to accommodate easily: nearly 20% of the asylum population in the 1890s were from Middlesbrough Borough, which put pressure on available space for patients from the North Riding. In 1892, Middlesbrough was asked to withdraw its patients, and they left, to go to the new Middlesbrough Asylum, in 1898, although patients from the rural parts of Middlesbrough Poor Law Union continued to be housed at Clifton. Other contracts were made at various times with other counties and boroughs: for example, patients from Newcastle and Birmingham were taken during the First World War, and in 1930 contracts were in force with local authorities in Berkshire, South Shields, Chester, Birmingham and Staffordshire for the reception of specified numbers of patients.

The asylum was designed for pauper patients - ie ordinary working class men and women whose families would be unable to afford the ongoing fees of private asylum care. Patients entered the county asylum via the poor law unions, with the union boards of guardians undertaking responsibility for their fees.

However the asylum did additionally house a few private patients who paid fees. These private patients constituted a very small proportion of the whole - for example, there were only 12 private patients at the beginning of 1869 (2.3% of the total), 57 at the end of 1893 (7.9% of the total), and 56 in 1926 (7% of the total). Nevertheless, these private patients, together with the out county patients received under contract, were a source of extra revenue. Between 1847 and 1889 the North Riding gained ,50,208 from these sources.

After the abolition of the poor law union boards of guardians in 1929 and the transfer of their responsibilities to local authorities, the former pauper patients were henceforth classed as rate aided. Further changes took place after 1948. The catchment area was widened to take in certain areas within the new Leeds Hospital Region (this led to a rise in patient numbers during the 1950s), and henceforward all patients came under the NHS.

Arrangements and care of patients at the North Riding Asylum during the nineteenth century were no different from those at county asylums elsewhere. Males and females were strictly segregated, each separate side of the hospital thus being a mirror image of the other. Sedation and mild forms of restraint were employed (when the second medical superintendent tried to ban restraint completely, in 1867, controversy ensued after some well publicised incidents at the asylum). The large numbers of patients led to much emphasis on control and management. As far as possible, patients were kept occupied. There was much emphasis on work as therapy, which had the additional benefit of making the asylum self-sufficient and cheaper to run. Females helped with domestic duties, and in female occupations such as sewing - patients clothes, for example, were made at the asylum by inmates. Many male patients worked on the land or at useful trades. In November 1848 five sixths of the 149 patients in the newly opened asylum were being set to work: 36 men at gardening and farm labour and about the same number at various trades; females were employed in household work, laundry and needlework. In 1886 out of a patient population of 615 67% of the men and 81% of the women were engaged in work; of the 297 men in the asylum 108 were occupied on the farm and garden.

Although the regime at county asylums during the nineteenth century relied more on the concept of detention rather than of therapeutics, it would be a mistake to imagine that once patients entered the asylum they were detained indefinitely: on the contrary many patients were discharged after short periods, and others were discharged and re-admitted more than once. Inevitably, however, the asylum did become a home to many long stay patients who could not be accommodated easily elsewhere. The medical superintendent commented in 1887 that the recovery rate of 45.8% on admissions was satisfactory given the large number of patients who entered so reduced in mental and bodily health that in fact they ‘were only brought in to die’. Classification of patients was always the aim although this could be made difficult if there was overcrowding. In 1848 patients were classified according to their character and condition: orderly and cleanly, epileptic and refractory, idiotic, and dirty. The nineteenth century asylum was made up of a mixture of patients, including those who were capable of recovery and discharge; those who had been in the asylum before and were re-admissions; chronic patients, often elderly and infirm; those who were suicidal; epileptics; those who were ‘feeble minded’; those who were suffering from general paralysis of the insane. Some patients were quiet and tractable and could work; others posed great difficulties in terms of nursing and control. But life at the asylum, though austere, was not one of unrelieved gloom: entertainments and occasional outings were regularly provided for patients, as the annual reports reveal. One should also compare the asylum regime with regimes at other contemporary institutions, and with the difficult lives frequently led by patients in their own, often very poor or difficult, home environments, in order to put the asylum in perspective.

In terms of staffing, like everything else, the nineteenth century asylum was run on economical lines. Management was in the hands of a visiting committee of North Riding magistrates before 1888; a visiting committee of the county council thereafter. The asylum’s officers comprised a resident medical superintendent, a clerk and steward (later with an assistant), a clerk to the visitors, a treasurer and a chaplain. The medical superintendent’s wife at first performed the role of matron; later on she had an assistant, but in 1870 the post of matron was replaced by that of housekeeper who also performed the function of chief nurse until 1887.

The medical superintendent was the sole medical man at the asylum until the post of assistant medical officer was created in 1857; a second assistant’s post was added in 1886. Those who held medical superintendent’s and assistant’s posts were by this time making careers within the asylum system, and applicants invariably had, or would gain, experience at asylums elsewhere, or alternatively move up within the same institution. The third, fifth and sixth medical superintendents of the North Riding Asylum all previously held the post of assistant medical officer there before becoming chief. Many of the institution’s medical officers served for long periods. The narrow constraints of asylum doctors’ careers may in many ways have impacted on their personal lives. The first medical superintendent, Samuel Hill, retired with ‘the entire loss of mental and bodily health’ in 1866, after the death of his wife who had worked alongside him. The fourth medical superintendent, A.I. Eades, committed suicide in 1924. In some respects the life of the asylum staff could be as difficult as that of the patients. One of the assistant medical officers, William Nicholson, appointed in 1876, failed to move on to a higher post elsewhere: he eventually, and against the asylum rules, married, maintaining his wife and children secretly in York for some years while he resided at the asylum. This was discovered after he became ill in 1893 - he was by then an alcoholic - and he was forced to resign.

There was a total of ten attendants at the asylum in 1848: six male, including the head attendant, and four female, to manage 79 male and 70 female patients. As numbers of patients grew, so did the nursing staff: for example, in 1887 there were 608 patients, 46 male attendants and 40 female attendants. The ratio of staff to patients on the eve of the First World War was 1 to 8.7 patients. In 1925 there was a day staff of 60 male and 68 female nurses and a night staff of seven males and eight females, for a patient total of 769. In the early years there were no attendants for night duty: the first ones were appointed in 1867, and in 1888 there were three male and three female night nurses.

There were some difficulties in retaining attendants in service, particularly women, who would leave on marriage, and this was a matter of concern for the visiting Lunacy Commissioners. In 1895 the Commissioners found 37 male and 45 female attendants to manage 760 patients - 156 more patients and two fewer attendants than had been the case eight years previously. They noted that half the female attendants had been there less than twelve months, and they thought the turnover in female attendants ‘unequalled’ by any other asylum. Some staff in fact stayed many years: in 1908 53% of men and 27% of women had served upwards of five years although a further 38% had served less than twelve months. Staff cottages for married attendants were offered as an incentive, and from 1876 onwards females were paid as much as males; there were also pensions for those who retired after long service.

Before 1890 attendants were not specially trained, but courses of lectures began to be offered at the asylum in the early 1890s. In 1895, for the first time, a group of attendants and nurses entered the examination for the Certificate in Nursing recently devised by the Medico-Psychological Association, and 12 out of 13 passed. Many of the attendants, particularly the men, brought with them particular skills which fitted them to supervise patients’ work or take part in asylum activities: in 1904, for example, the list of paid staff included a shoemaker, a blacksmith as well as a bandmaster and organist. The asylum also employed a staff of artisans who were in constant employment maintaining the asylum fabric and grounds. In 1904 there were 54 male attendants, 60 female attendants and 24 artisans, and there were 708 patients in the institution.

The First World War brought a certain amount of disruption. Three asylum officers and 44 attendants and artisans served in the army; three were killed in action. Maintenance of the hospital fell into arrears due to lack of staff. Over 50 patients from Birmingham and over 90 from Newcastle were housed while their asylums were taken over as military hospitals. After the war, ex-service patients suffering from psychiatric disorders were a small but constant presence for several years.

During the 1920s, moves were made to allow patients greater freedom. Selected wards were declared open, more patients were allowed parole, and other efforts were made to improve the patients environment. A psychiatric out-patients department, served by all the medical superintendents from the asylums around York, was opened at York County Hospital. Aftercare for discharged patients began to be provided by the York and North Yorkshire Mental Aftercare Association. The term asylum was dropped from the hospital’s title in favour of the term mental hospital. After the passing of the Mental Treatment Act of 1930, which introduced the new classifications of certified, voluntary and temporary patients at public mental hospitals, voluntary patients were increasingly taken: in 1931, the first year of the working of the Act, more than 30% of direct admissions at the North Riding Mental Hospital were voluntary, which was the highest figure recorded in any public mental hospital in England and Wales. The emphasis at the hospital thus increasingly came to be on treatment and not just detention, and its regime was consciously modernised.

Efforts were also made to increase and improve the formal nursing training of staff. Although lectures had begun in the 1890s, relatively few attendants were qualified: 15% of the male and 6% of the female nurses had the Certificate of the Royal Medico-Psychological Association (RMPA) in 1923. Further encouragement was given by the medical staff, and a sister tutor was appointed to give practical demonstrations to supplement the lecture courses. For many years the RMPA Certificate in Nursing was more popular than the more recently instituted examination of the General Nursing Council, despite the fact that after the Nurses Registration Act of 1919 only the latter entitled the holder to registration. During the early 1930s more nurses were being encouraged to take the GNC exam, and in 1930 and 1931 the North Riding Mental Hospital was chosen as the state exam centre for the area. Slowly, the staff was becoming better qualified. In 1928 the hospital had 53 certificated and 19 uncertificated staff nurses, with 67 probationers. But it was still a common complaint that many probationers left quickly, without taking exams.

During the 1920s and 1930s, the hospital flourished under the regime of its influential medical superintendent, Dr John Ivison Russell, and it was viewed as particularly ‘go ahead’ in its methods. Russell strongly advocated the need for the public to overcome prejudice against mental illness: mental hospitals, he advocated, should be perceived as having the function of treating disease in its early stages, hence the importance of voluntary admission. Under Russell, the hospital became particularly well known for its pioneering work in the field of occupational therapy. This began modestly in 1925, providing therapeutic handicraft work for a few male and female patients, some of whom were previously regarded as unemployable. A first successful display and sale of work took place in 1927. By then the occupational therapy department had outgrown its accommodation and further rooms were adapted and the range of activities progressively expanded. After 1932, Russell introduced a complete and more ambitious organisation of occupational therapy, following methods recommended by Dr Simon in Germany. In 1933, 75% of patients at the North Riding Mental Hospital, compared with 50% elsewhere, were suitably occupied: seven occupation rooms were in use for men and six for women, and more workshops were being converted. By 1934 a vast range of occupations were being pursued and all types of patients, from convalescents to ‘imbeciles’ were being included. By 1937 89% of patients were occupied. By the early 1930s, interest in the organisation and benefits of occupational therapy in mental hospitals was growing. The North Riding Hospital scheme aroused the admiration of the Board of Control, and there were also visitors from other mental hospitals. The Royal Medico-Psychological Association and the College of Nursing sent representatives to see the work done, as a preliminary to devising a syllabus of training. The hospital became the first national training centre in this field for mental nurses, and Russell produced a text book on the subject.

There were other changes and new treatments introduced at the North Riding Mental Hospital, as elsewhere, during the 1920s, 1930s and 1940s. A pathological laboratory was opened at the hospital in 1925 and was used extensively both for research purposes and for routine analysis (enquiries being particularly carried out into carriers of typhoid and other similar diseases). Facilities for surgical operations were provided in the hospital, and in 1930 the centre basement was fitted up as a surgery, dispensary and dentists room (there was a visiting dentist from 1924).

New psychiatric treatments were tried. Malarial therapy, later with tryparsamide injections, was being given to a few general paralysis cases from the mid-1920s onwards (14 cases, for example, were treated with malaria and tryparsamide in 1929). In 1936 treatment by prolonged narcosis with somnifaine, insulin and glucose was commenced for a few patients (the medical superintendent noted in his report for that year that this treatment was widely recommended for certain psychoses). Hypoglycaemic shock and convulsive shock therapies for cases of schizophrenia were used for the first time at the hospital in 1937 (five patients were undergoing one or other of these treatments at the end of that year). The 1938 report noted that insulin and/or cardiazol had been employed in the treatment of 48 schizophrenic patients that year, while three cases of general paralysis had been treated with malaria. The Second World War led to some disruption in these therapies: in 1946 treatment by hypoglycaemic coma was being resumed, but initially, due to staff shortages, for males only. However the report for 1947 noted that both insulin shock and convulsive therapies were in use (although it added that figures for the past ten years showed that these treatments had been disappointing for most schizophrenic cases). In 1948 the first pre-frontal leucotomy operations were performed at the hospital, on four women patients.

The Second World War caused other disruption too: in particular it brought a temporary halt to the much lauded occupational therapy service. Meanwhile, parts of the hospital (Villa and the male infirmary block) were used as an Emergency Medical Services Hospital, treating, during the course of the war, 5,000 military psychiatric patients. The war also meant the abandonment of plans for the building of a new admission hospital and two convalescent villas on site, which would have played important roles in the ongoing modernisation process.

The North Riding Mental Hospital became part of the NHS in 1948, as the head hospital of York ‘B’ Group. It was renamed Clifton Hospital. The coming of the NHS brought various changes, although to some extent these continued existing trends. One immediate change was in patient numbers. In the 1940s there was an annual average of about 900 resident patients. In the first years of the NHS, this number rose steadily, partly due to alterations in the catchment area: although North Riding patients were still taken, patients were now also received from other areas in the new Leeds Hospital Region, notably the Harrogate, Ripon and Nidderdale districts. Patient numbers peaked at 1,154 in 1956. A large and increasing number of these were voluntary: over 60% rising to more than 70% during the 1950s. Numbers of annual admissions and discharges were also rising during this period.

New developments also affected the hospital population during the 1950s. The Mental Health Act of 1959 altered admission procedures, leading to the admission of many more patients on an informal basis (90% by 1970). The introduction of new drugs and techniques had a huge impact on psychiatric care, leading to quicker discharges and thus a higher turnover of patients, but also a consequent increase in re-admissions. New methods of treatment also meant that numbers of resident patients steadily fell: to an annual figure of around 750 by 1970, with numbers of long stay patients (ie resident for more than two years) also being reduced by the early 1970s. But proportionate numbers of resident patients aged 65 and over, which had risen dramatically since the 1950s (partly as a result of the other changes in the hospital population), remained high: around 50% in the 1960s and early 1970s. There were also other problems: nursing recruitment, of women in particular, was a major difficulty in the 1950s, despite the work of the mental nurse training school situated at the hospital. A nursing cadet scheme was introduced in 1952 to attract young girls to the profession. In the mid-1950s nurses from West Africa and the West Indies were recruited to fill the gaps.

The new developments at the hospital mirrored national and regional trends, as did the kinds of strategies evolved to deal with them. Such strategies, briefly indicated below, involved greater rationalisation on the basis of function, greater liaison between different hospitals and management bodies, the development of more specialised services for patients with different needs, a greater emphasis on the hospitals place within the community and a corresponding development of complementary psychiatric services outside the hospital itself. The overall aims were derived from concepts of therapeutic community and rehabilitation within the hospital, with a quick return of patients to their ordinary lives outside where fully integrated back up psychiatric services would also be available.

Services rationalised or centralised on the basis of function, and involving liaison between different hospitals in different hospital groups included, to take some examples, leucotomy operations (all such operations for both York A and B Groups were carried out at Clifton from the mid-1950s); path lab services (liaison continued between the path lab at Clifton and the lab at the York County Hospital); insulin treatment (a new joint insulin unit opened at Clifton in 1955); out-patient clinics (developed throughout the hospital catchment area, with clinics in the general hospitals at York, Harrogate, Scarborough, Ripon, Whitby and Thirsk); aftercare services (in which local authority mental welfare officers and social workers had key roles); liaison between the mental health services in both York hospital groupings (there was liaison via psychiatric consultations, and York B Group was an interested onlooker, if not a direct participant in the development of the integrated York Mental Health Service planned in 1953); and the development of integrated drug addiction services (Clifton was appointed by the Leeds Regional Hospital Board in 1967 as the regional drug addiction unit for the York area, offering in- and out- patient services).

The development of more specialised services and units for patients with different needs included, to take various examples, the acquisition of a house for convalescent patients at East Ayton Lodge near Scarborough (opened in 1947); the housing of some long stay female patients in Moorlands (a large house at Haxby, acquired in 1955); the opening in 1967 of Southfield (in the building which had formerly been the medical superintendents house) which offered in- and out- patient services for disturbed adolescents; and the modernisation and extension of the male and female admission wards in the 1960s.

The concept of the mental hospital as a therapeutic community led to some changes and new developments within the structure and organisation of Clifton Hospital. The last two wards with locked doors were opened up in the mid-1960s. There came to be more emphasis on multi-disciplinary staff teams and discussion groups: so, for example, a Medical Staff Committee of all medical and dental staff was formed in 1965 to discuss policy and procedures, and in the same year a Clifton Hospital Discussion Group was formed between medical and nursing staff to discuss and formulate ideas; ward groups later followed. A ‘rehabilitation unit’ for patients, mixing work and leisure (and distinct from the old established, and ongoing, occupational therapy department) was planned in the early 1960s, and out of this was set up the industrial therapy unit, employing able patients, for wages, on a five day week, doing industrial work taken under contract for firms: in other words, a unit which rehabilitated patients into a normal working factory environment. In the same year the catchment area was nominally divided into three, and the psychiatric services based at the hospital were reorganised into three clinical teams, each headed by a consultant and covering a different geographical area, with responsibility for the increasingly integrated in- and out- patient services.

An important working party was set up in 1972 to plan further improvements in the way the hospital was organised and to overcome some of the deficiencies arising from old fashioned mental hospital arrangements and the legacy of previous overcrowding. The hospital at that time had 750 beds and patients comprised roughly one third long stay patients, one third elderly with senile dementia and similar conditions, and one third acute psychiatric cases. The aims set out by the working party were to divide the hospital wards into two to match two consultant teams serving the catchment area, which was now divided into east and west. Two integrated admission units were to be created from three old single sex wards. The elderly mentally infirm were to be accommodated on the ground floor of the hospital and the elderly wards were all to be placed under the direction of one consultant. The practice of cross sleeping, whereby patients from different wards came together at night to sleep in large dormitories, often some distance from their living quarters, was to be abolished if possible (it was ended completely in 1985). Finally, a number of new units for particular categories of patients were to be created within the existing structure: these were a progressive care unit, a pre-discharge unit, a ward for the physically sick, and a mother and baby unit.

This programme was followed over the course of several years. The first stage included the creation of the new admission units (in the Villa and Ash Tree House); the establishment of the progressive care unit (in the former M9 Ward); and the opening, in 1976, of two newly built wards (Bedale Ward and Rosedale Ward) for the elderly mentally infirm. Other improvements included a new purpose built physiotherapy and occupational therapy block, and the renaming of wards (previously numbered and prefixed either M for male or F for female) after Yorkshire Dales.

However, continuing rationalisation and the matching of patient care to the therapeutic needs of different categories of patients, as well as the general shift in mental health policy towards psychiatric care within, rather than apart from, the wider community ultimately meant that Clifton Hospital, like many other large Victorian asylums, was wound down from the 1980s.

The hospital's annexes were closed: East Ayton Lodge had closed as early as 1978; the farm building, situated half a mile to the north of Clifton Hospital, which had been used as a long stay male annexe since the cessation of farming activities, closed in 1985; and Moorlands eventually closed in 1989.

A new strategy for mental illness services within York Health Authority was developed in 1984 and incorporated in the York Health Authority Strategic Plan of April 1985. This envisaged the closure of Naburn Hospital by 1988 leaving Bootham Park and Clifton Hospital both remaining open in the short term. In the meantime community services would be further developed allowing a continued reduction of in-patient beds.

A major issue concerning Clifton Hospital and one which complicated any future developments, was that it offered beds and services to four different health authorities: York, Northallerton, Harrogate and Scarborough. To facilitate the future devolution of beds and services to these different areas, Clifton Hospital, under the new strategy, was ‘sectorised’ in 1984/5. This meant that the services provided by the hospital were henceforth based on three sectors, covering the catchment areas of Harrogate, Scarborough and York/Northallerton. Up to that point wards had housed together patients from different districts and with dissimilar problems and needs. Under sectorisation, wards were arranged by sector and patients with similar needs were grouped together. In addition, large bedded wards were reduced. Three sector management teams were set up to manage services, each of which involved staff from Clifton Hospital and from the relevant district. It was envisaged that under the new arrangements, Clifton’s bed numbers would reduce to 585.

A comprehensive review of mental health services and a refinement of strategy was carried out and approved by York Health Authority in March 1987. This was part of a wider strategy developed by all authorities in the North Yorkshire ‘cluster’ which used Clifton Hospital. Under this strategy, the four districts of York, Northallerton, Scarborough and Harrogate would all make provision for acute, elderly and long stay patients within their own areas, and in smaller units. Clifton Hospital would be made redundant by 1993/4. After a major consultation exercise, York Health Authority gave formal sanction to the closure plan in March 1988.

Between 1988 and 1994, local services were developed. Thus, for example, within York Health Trusts area, acute psychiatric services were centralised at Bootham Park Hospital, while a strategy for other types of psychiatric patients incorporated a number of different elements: first, the provision of community units for the elderly (each centred in a particular area or suburb and offering residential, respite, domiciliary and day care for confused elderly); secondly, the organisation of a joint day care service between York Health Trust and Social Services (with a core unit at Moorlyn, Tadcaster Road, York); thirdly, the establishment of community rehabilitation homes (Stray Garth at Heworth and Red Roofs at Clifton); and fourthly the use of specialist units (both of which were situated on Clifton Hospital site, see below). Co-ordination of these psychiatric services was provided by four community mental health teams.

Numbers of patients at Clifton Hospital dropped steadily during the late 1980s and early 1990s as patients moved out into the community (ie into the new smaller units in York or to other districts in North Yorkshire). The hospital closed at the end of July 1994.

While the hospital and its estate was put up for sale, part of the site to the north of the main hospital block was retained for York Health Trust use. The retained site included the redundant old Clifton laundry building (converted for use by the Wheelchair Centre in 1996), the 1970s District laundry building (later closed in the late 1990s), and the old female infirmary building, which underwent modernisation to provide a specialist long stay unit, named Clifton House. Meanwhile, the former Southfield psychiatric unit for adolescents, at the other end of the Clifton site, was also retained as another specialist unit: since 1989 this had been called Limetrees Child Adolescent and Family Unit, after it took over the services of the closed child psychiatric unit at Fairfield Hospital.

After the closure of the hospital a few other departments and units remained on site temporarily in 1994 (including York Health Archives) but none were sited in the main building which was vacated. All these units were due for relocation as soon as suitable arrangements could be made for their transfer and by 1996 all had been relocated. The hospital was sold in 1995 and was redeveloped for housing and offices. Most of the former hospital buildings were demolished, with a very few exceptions: the former chapel, Ash Tree House (the former female Annexe) and Greystones (the former clerk’s house).

Other Finding Aids

A typescript finding aid, to file level, is available for consultation in the searchroom of the Borthwick Institute.

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Archivist's Note

2015-07-29

Conditions Governing Use

A reprographics service is available to researchers subject to the access restrictions outlined above. Copying will not be undertaken if there is any risk of damage to the document. Copies are supplied in accordance with the Borthwick Institute for Archives' terms and conditions for the supply of copies, and under provisions of any relevant copyright legislation. Permission to reproduce images of documents in the custody of the Borthwick Institute must be sought.

Accruals

Further accruals are not expected.

Related Material

For related material held by the Borthwick Institute, see the archives of York B Group Hospital Management Committee and its successors which includes photographs, committee minutes, printed reports and other administrative and policy papers. Some plans and drawings relating to the asylum can additionally be found in the Atkinson Brierley architectural archive.

Additionally, North Yorkshire County Record Office holds material relating to Clifton's status as a North Riding institution before 1948, including plans, minutes and reports of the Committee of Visitors from the 19th to the early 20th centuries.

Additional Information

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