From Special Care to Specialist Treatment: A History of Muckamore Abbey Hospital

Patient art

From Special Care

to Specialist Treatment

A History of Muckamore Abbey Hospital

IAN MONTGOMERY

with JOE ARMSTRONG

ULSTER HISTORICAL FOUNDATION

A portion of the proceeds from the sale of this publication will support patient activities including the further development of memory books.

First Published 2009

by the Ulster Historical Foundation

Charity Ref. No. XN48460

E-mail: enquiry@uhf.org.uk

Web: www.ancestryireland.com

www.booksireland.org.uk

Except as otherwise permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted in any form or by any means with the prior permission in writing of the publisher or, in the case of reprographic reproduction, in accordance with the terms of a licence issued by The Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publisher.

© Ian Montgomery and Joe Armstrong

Epub ISBN: 978-1-908448-48-4

Mobi ISBN: 978-1-908448-47-7

Printed by W&G Baird Ltd.

Design by Cheah Design

CONTENTS

FOREWORD by Pat McCartan

TERMINOLOGY and ABBREVIATIONS

ACKNOWLEDGEMENTS

Chapter One

Bringing Special Care to Northern Ireland

Chapter Two

‘Working towards the patient’:

Developing the Special Care Service, 1949–58

Chapter Three

‘A village set on a hill’: Muckamore Abbey, 1958–73

Chapter Four

Reorganisation Stalls Development, 1973–87

Chapter Five

Towards a New Core Hospital, 1987–2007

KEY DATES

GRAPH SHOWING PATIENT NUMBERS

BIBLIOGRAPHY

ENDNOTES

INDEX

Patient art

FOREWORD

The story of Special Care and Muckamore Abbey Hospital is one that has to be told. This book is the complete validation of the case for us to provide full inclusion for people who have a learning disability. Every reader will share our aspiration that services for people with a learning disability can never again be under-resourced, or given a lower, or less urgent priority in health and social care, or in any aspect of a civilised society.

Amongst the estimated 17,000 people in Northern Ireland with a learning disability, those who have been residents and patients at Muckamore Abbey Hospital have benefited directly from exceptional care provided by dedicated teams of professionals.

Many staff, carers and users of services to people with a learning disability here in Northern Ireland and further afield have benefited from the research into outcomes and pioneering treatments developed and delivered continuously over the past 60 years.

Also, resettlement work by dedicated teams across hospital and community services has had profound effects, changing lives for individuals and their families to more inclusive community services which were unimaginable when the hospital first opened its doors.

The provision of modern assessment and treatment services in new purpose built buildings has provided a resource for the region which has been long overdue. The modernisation of the hospital also marks the shift away from long term hospital care towards supportive housing in the community.

The authors rightly record the dedicated work of early pioneers in seeking and providing special care for the first time in Northern Ireland before the National Health Service came into being in 1948, and the struggle to obtain some dedicated facilities for special care, other than charity.

They also record faithfully the fascinating journey and struggles of families and professionals to change social attitudes away from trying to hide the problems associated with learning disability and challenging behaviour to one of full inclusion.

Considerable satisfaction can be taken from the acceptance of full inclusion for patients and carers which forms the basis for the ‘Bamford Reports’ which made specific recommendations to our devolved government, the Minister for Health, Social Services and Public Safety, and the NI Assembly.

However, patients, carers and our professional staff are only too well aware through bitter experience of delays and disappointments, that it takes extraordinary inter-departmental action, and community involvement, to implement inclusion for people with a learning disability.

So, this publication is timely. It requires us all, Health and Social Care Trusts, those with a learning disability and their carers, public representatives and community activists, to renew and improve our services for people with a learning disability.

For those who will argue there is now a tough funding environment, this book is the evidence it was ever so for services for people with a learning disability.

All of us in Trusts must re-dedicate ourselves to ensuring that the support we provide continues to improve, with particular emphasis on quality as expressed by those who experience it. Let us always ensure the voices of people with a learning disability are heard, their rights to enjoy an ordinary and fulfilling life are foremost, and their choices are met.

It is in this way we will pay tribute to the authors, to the Muckamore Abbey Hospital Historical Interest Committee, and to all who have contributed to this excellent work.

PAT McCARTAN

Chairman, Belfast Health and Social Care Trust

A NOTE ON TERMINOLOGY

Today Muckamore Abbey is described as ‘a hospital for people with a learning disability’. The term ‘learning disability’ came into general use in the 1990s and was officially adopted in Northern Ireland in 1995 in the place of ‘mental handicap’.

Over the years a wide range of words, many of which are abhorrent to today’s ear, have been used to describe people with learning disabilities. ‘Natural’ or ‘natural fool’ can be found in legal texts from the seventeenth century onwards, although by the nineteenth century the medical profession preferred to describe the condition as ‘amentia’.

It may surprise many people to hear that the Mental Deficiency Act, 1913, gave the regrettable term ‘mental defective’ official sanction, with people so described subdivided into what in today’s language would be considered highly offensive, namely ‘idiots’, ‘imbeciles’ and the ‘feeble minded’.

When Northern Ireland adopted its own legislation in 1948, the phrase ‘person requiring special care’ was adopted. It remained the correct legal term until replaced by ‘mental handicap’ in 1986.

All of these terms, along with others like ‘cretin’, ‘moron’ and ‘mongol’, have precise legal or medical meanings and respectable Classical etymologies, even though they are better known today for their pejorative meanings. Clearly, the use of these words has not been confined to their proper medical and legal contexts and many of them have come to be regarded as terms of abuse.

The use of such terms to describe people with learning disabilities is now considered inappropriate and offensive. We have retained those words that have acquired a pejorative sense only in direct historical quotations that use such terminology.

ABBREVIATIONS

The following abbreviations have been used:

ACKNOWLEDGEMENTS

Our first and greatest debt is to the North and West Belfast Health and Social Services Trust for commissioning this history and the Belfast Health and Social Care Trust for arranging its publication.

The book was produced under the direction of Muckamore Abbey Hospital Historical Interest Committee: Dr Johnston Calvert (Chairman), Keith Baker, Oscar Donnelly, Dr Maria McGinnity, Dr Donald MacKay, Margaret McKeen, Margaret Matthews, Barry Mills, Carmel Tohill and Brian Turnbull. We are grateful to all the committee members for their support and patience during the researching and writing of the book.

The names of those people who agreed to be interviewed or provided written information about the hospital are listed in the bibliography. We are indebted to all of them and to the many others who shared their memories of Muckamore Abbey.

For help in locating suitable illustrations, we would like to thank Mrs Weir, Bill Canning and the PR/Marketing Department of the North and West Belfast Health and Social Services Trust.

We received information and assistance from many librarians and archivists including: Margaret Harcourt Williams, Archivist for the Royal College of Psychiatrists; Yvonne Hirst and staff at the Local Studies Library, Ballymena; Gerry Healey and staff at the Linen Hall Library, Belfast; and staff at the Belfast Central Library and Queen’s University Medical Library.

Most of the archival research was conducted at PRONI and we are grateful to many friends and colleagues for help, advice and encouragement. In particular we would like to thank Aileen McClintock, Director and Deputy Keeper of the Records, for arranging access to records and facilitating the necessary permissions to publish. Material held in PRONI is cited with the permission of the Deputy Keeper of the Records, PRONI. Reader services, document production and reprographics staff have greatly assisted us with their customary cheerfulness and efficiency. We are also deeply grateful to Dr Ann McVeigh for continually enquiring as to whether the book was finished yet. We believe it finally is.

Ian would particularly like to thank the staff of the Social Work and Behavioural, Vocational and Therapeutic Services Departments for providing him with a home during an enjoyable year at the hospital. From the commencement of the project, Ian had the help and encouragement of the late Michael Goodall. His unrivalled knowledge of Northern Ireland government records was of great benefit during the early stages of the project and Mr Goodall and Ian worked together to appraise and catalogue archive material in the hospital. Michael was for Ian not only a dedicated archivist and scholar but also a valued friend and colleague who is deeply missed by all who knew him.

Joe in particular would like to thank publisher Fintan Mullan of the Ulster Historical Foundation for his boundless patience and professional support while the writing and editing of the book was being brought to completion. His special thanks too go to Dr Maria McGinnity and Margaret McKeen, Librarian at Muckamore Abbey Hospital, without whom this book would not now be seeing the light of day.

We gratefully acknowledge the Heritage Lottery Fund for the grant it awarded The North and West Belfast Health and Social Services Trust to help finance this publication.

Ian Montgomery and Joe Armstrong

Chapter One

Bringing Special Care to Northern Ireland

Picture by Frank Holmes, Artist in Residence

‘Every advantage of wood and water’

Muckamore Abbey Hospital is situated in the townland of Oldstone, on the edge of the ridge of the high ground that separates the valley of the Six Mile Water from Lough Neagh. The hospital began life half a mile closer to Antrim in Muckamore Abbey House.¹

Maigh Chomair

The name Muckamore comes from the Irish Maigh Chomair, meaning ‘the plain of the confluence’, the ‘confluence’ being that of the Six Mile Water with Lough Neagh. The surrounding countryside was described by a nineteenth century observer as ‘comprehending every advantage of wood and water, and every variety of hill and dale, with a pleasingly undulating surface, and a soil of exuberant fertility’.

Despite the intrusion of modern housing and industry and the demands of scientific agriculture, it remains a ‘rich and extensive landscape’. The heavy concentration of raths (hill forts) around Muckamore suggests that the area was well populated in early times and it is not surprising to find an important monastery there as well.

Muckamore Abbey, AD 585

The original Muckamore Abbey was founded by Saint Colmán Elo (aka Colman-Eala), a nephew of Saint Columcille, around the year 585. Little is known about the Celtic monastery of Muckamore other than that it was burnt by the Vikings in the ninth century. An early description of ‘a great and fair monastery in a place in the middle of the wood, watered with many streams and beautiful with fields’ is rather vague. It was, however, adjacent to an important ford over the Six Mile Water and was therefore on a site of some strategic importance, a point which was not lost on the Norman settlers of the twelfth century.

Augustinian Priory, AD 1183

Muckamore was refounded, some time before 1183, by John de Courcy as an Augustinian priory dedicated to the Virgin Mary and Saint Colmán Elo. This medieval foundation was wealthy and influential, owning property throughout mid-Antrim. Although damaged during Robert the Bruce’s invasion of 1315, the priory survived until the Reformation. In 1621, the remains of the priory and its associated lands were granted to a Roger Langford and later passed into the hands of the Clotworthy family, who became the Viscounts Massereene.

Reports and Rumours in the Nineteenth Century

The ruins of Muckamore Priory have long since disappeared, but local tradition in the nineteenth century maintained that it lay under the walled garden adjacent to Muckamore Abbey House. There were reports that ‘ancient paved roads, spears … coins of silver and quantities of human bones’ had been found in the area and rumour had it that the Thompson family, who owned Muckamore House, owed their fortune to monastic ‘treasure’.

Identifying the Location of the Abbey, 1973

It was not until 1973 that the exact site of the abbey was established. Archaeological excavations, which took place in advance of roadworks in the area, showed that the nineteenth century walled garden attached to Muckamore House had indeed been constructed over the ruins of the priory.

The excavations uncovered the foundations of a number of buildings, including the priory church, and it was established that a small portion of the original church wall survives in the structure of the garden wall. The remains of a ‘necessarium’ or latrine were also identified along with the associated drainage system. A number of objects were located in this drain, including a group of 15 coins dating from the early fourteenth century, possibly the contents of a purse lost in the monastic sewerage system.

More Excavations, 1996

The remains of the monastic buildings stretch under the Seven Mile Straight towards the river. A further excavation was carried out in 1996, prior to the construction of new houses in this area, but little was found. The construction of mill buildings in the nineteenth and twentieth centuries evidently destroyed any remaining relics of the abbey.²

Picture of the Sixmile River by Frank Holmes, Artist in Residence

Muckamore Abbey House

Screened by trees from the main road and the industrial developments beside the river, Muckamore Abbey House stands back from the Six Mile Water. The origins of the house are obscure, but it was in the ownership of the Thompson family of Greenmount from the early part of the nineteenth century. Before buying Muckamore House, the Thompsons had developed the nearby bleach green (an area used for bleaching linen), before selling their interests in the green to the Chaine family of Ballycraigy at the end of the eighteenth century.

Under the ownership of the Chaines (and later the York Street Spinning Company) the Muckamore complex became one of the largest works of its type in Ireland. After disposing of the bleach greens, the Thompsons appear to have turned their back on business and to have established themselves as landed gentry.

Muckamore Abbey House

Description of the House by the Ordnance Survey, 1838

When the Ordnance Survey visited the area in 1838, Muckamore Abbey House was owned by Samuel Thompson Esquire. The house was described as ‘very old fashioned looking, two stories high and apparently, though not in reality, confined in its accommodation’. It had a high, pitched, thatched roof and narrow windows and the Ordnance Survey speculated that it might date back to the early seventeenth century. The house appears to have been extensively rebuilt during the course of the nineteenth century.

Oldstone, Idleness and ‘women of ill fame’, 1838

The present hospital was constructed between 1953 and 1960 on farmland beside the Abbey Road, near the hamlet of Oldstone. In the mid-nineteenth century, Muckamore parish was a relatively prosperous area and most of the farmers and labourers in the area lived well. There were, however, a number of poorer people, many of them concentrated in Oldstone village, who existed close to subsistence level.

The Ordnance Survey had been unimpressed with Oldstone when they visited the area in 1838, declaring that ‘The appearance of the hamlet is uninteresting in the extreme, consisting as it does merely of 47 cabins of an inferior description straggling along the highway.’ The townland also contained ‘a cluster of 7 or 8 of the vilest description of huts’ known as McGarrystown, which were ‘solely inhabited by women of ill fame’. Consequently, the area was ‘the haunt of the idle and lazy vagabonds in the neighbourhood, and … a source of much iniquity’.

The Ordnance Survey writers were not slow to place the blame for this poverty, declaring that ‘This class of people live wretchedly, preferring one meal a day with idleness to a comfortable existence obtained by industry.’ They described the ‘wretched hovels’ in which the poor lived in some detail: ‘Internally they are very dirty and externally … worse, their entrance being almost inaccessible from manure heaps and cesspools’. The inhabitants, particularly the children, were ‘equally slovenly and untidy’.

Important Annual Oldstone Horse Fair, Nineteenth Century

Despite its unprepossessing appearance, Oldstone hosted an important annual horse fair, which attracted dealers from England and Scotland. More than 600 horses were shown at the fair in 1838, along with cattle, pigs and sheep. The fair was also an important social event, ‘remarkable for the quantity of well dressed females’ who attended.

To entertain the fair-goers, there were ‘38 covered tents for the sale of whiskey … besides about 9 selling in private houses, all licensed except a few’. There were also more than 30 stands selling gingerbread, cheese and dulse and four selling ‘victuals’. The fair, which was held on 12 June each year, has long since ceased to be a yearly tradition. However, the Muckamore Hospital Annual Gala and Sports Day is held every June close to the old village of Oldstone.³

Muckamore Abbey House, Early Twentieth Century

During the Second World War, Muckamore Abbey House was used for a short time by the United States Army before becoming a civil defence store. The house and demesne, amounting to some 178 acres, were purchased from Captain Robert Thompson in 1949.

Muckamore Abbey Hospital Opens, 1949

Four teenage girls with learning disabilities came to live in Muckamore Abbey House on 1 November 1949. Each came from a different setting – one from a mental hospital, one from a remand home, one from a voluntary sector children’s home and the fourth from her own family home.

Their previous accommodations represented the only options available for the care of people with learning disabilities in Northern Ireland before 1949. In the absence of any specialist institution they remained in their own homes — if their family could look after them – or they were admitted to institutions such as the workhouse or a general hospital. People considered to be a danger to themselves or others ended up in mental hospitals or were sent to prisons or industrial schools.

New Beginnings

The passing of the Mental Health Act in 1948 marked the beginning of a new era in the treatment of ‘people requiring special care’ in Northern Ireland. For the first time people with learning disabilities received legal recognition and a government agency was made responsible for the provision of this care. The arrival of the first patients at Muckamore Abbey also marked a new beginning. An institution had been created which would grow into a hospital with over 800 beds providing special care for people across Northern Ireland.

The opening of Muckamore Abbey also marked the culmination of a long campaign to provide facilities for people with learning disabilities in Northern Ireland. The service was designed to meet a need that had been acknowledged officially some 20 years previously, although the need had existed long before that. The foundation of the new hospital as part of this service marked the recognition that the community had a responsibility to provide care and support for people with learning disabilities.

Protecting the Fairy Ring

The fairy ring at Muckamore Abbey has been protected from the outset of the first construction of the hospital. It was safeguarded even in the twenty-first century when the new buildings for the core hospital were being planned. Located near Firgrove to the south east of Muckamore Abbey Hospital, no one would consider knocking it down when the new buildings were being designed and built as recently as 2005.

While this feature is possibly not of any great antiquity, it is a very interesting landscape attribute belonging to the area’s historic past and has been maintained and protected as such. The fairy ring remains untouched to this day.

From ‘Idiot Hospitals’ to ‘Deficiency Institutions’

Public attitudes to, and understanding of, people with learning disabilities are shaped by different factors at any given time. Things that influence attitudes and understanding include the prevailing educational, medical and social thinking of the day. Other factors are religious, cultural, economic and philosophical influences. Legislation to protect and provide for people with learning disabilities is itself a further factor. Accordingly, the treatment and care of people with learning disabilities changes too.

It can seem hard to understand why changes which were introduced as advances and progress very quickly become denigrated and reviled. This is well illustrated by the shifting language which is used to refer to the group of people who are now described as having learning disabilities. For example, the word ‘idiot’, now exclusively pejorative in meaning, was originally a legal and medical term with specific meaning and purpose.

We Fear what we do not Understand

There are also emotional factors at work, mostly at an unconscious level. People often fear what they do not understand. Valerie Sinason has written widely on understanding the marginalisation and stigma that attaches to learning disability.⁴ She has explained that some of this is because we value our own capacity to learn and function independently. We can feel threatened that people like us do not have, or have lost, this capacity. It touches our personal vulnerability.

As a society we defend ourselves against painful realities by distancing (e.g., in institutions), denial (of finances for services, and of legal protections), minimisation (of specialist needs and policies of mainstreaming without resources) and, even worse, through denigration (especially through language and terminology, and through tolerating neglect and abuse).

Advances made Since 1948

This history illustrates the very significant advances that have been made over the last 100 years in Northern Ireland, especially since the first formal establishment of services in 1948. It describes how the origins of those services were different from the rest of the UK and Ireland and how developments were shaped by external and local factors.

Some of the external factors include increasing recognition of minority rights in the 1960s, leading to philosophical approaches like normalisation and the more politically generated deinstitutionalisation. Other factors include the change in the age and needs profile of the population given medical and social improvements. More recently, a fuller understanding of genetic conditions and the specialist medical, psychiatric and forensic needs of the population have been recognised. Locally, developments have been shaped by politics, economics, reorganisation of the National Health Service and personalities at both professional and voluntary level.

In Europe and the US, special provision for people with learning disabilities began in the nineteenth century. The legal system had made a pragmatic distinction between ‘idiocy’ (lifelong learning disability) and ‘lunacy’ (mental illness) from medieval times. The law, however, was concerned solely with property and inheritance. The care of people with learning disabilities was considered a domestic matter. People with learning disabilities who could not support themselves relied on their families or took their chances with whatever charitable or parochial care was available.

Benefits of Training and Education

The first institutions specifically designed for the care of people with learning disabilities date from the middle of the nineteenth century. The idea that people with learning disabilities could benefit from education and training is generally credited to the French doctor Jean Itard (1774-1838) and his pupil Edouard Séguin (1812-80). Itard’s work with the so-called ‘Wild Boy of Aveyron’ demonstrated that while what was then called an ‘idiot’ could not be ‘cured’ by education, he could acquire social and life skills.

The first specialist institution for the training of people with learning disabilities opened in Paris in 1828 and was followed by others in Switzerland and Germany. The earliest ‘idiot asylum’ in England, Park House, later known as Earlswood Asylum, opened in 1847 and was followed by four similar institutions in the 1850s. These asylums were fee paying subscription hospitals.

The first public authority establishments, the Darenth Training Schools, date from the 1870s. In Ireland, what is now known as Stewart’s Hospital was originally named the Stewart Institution for Idiotic and Imbecile Children. Based at Palmerstown, near Dublin, it opened in 1869 as a private home for Protestant children.⁵

Mental Illness versus Learning Disability

The medical profession took little interest in learning disability, as distinct from mental illness, until the middle of the nineteenth century. The French doctor Jean Esquirol (1772-1840) was the first to make a clear distinction between learning disability (or amentia) and mental illness. During the second half of the nineteenth century medical researchers began to turn their attention to the condition. John Langdon Down published his description of what is now known as Down’s syndrome in 1866 and by the end of the century the relationship between thyroid deficiency and ‘cretinism’ had been established.

The study of ‘mental deficiency’ had become a recognised medical speciality by 1900.⁶ During the eighteenth and nineteenth centuries, western societies increasingly institutionalised those sections of the community which were perceived to be either dangerous or in need of care. Consequently, people with learning disabilities were often sent to workhouses, asylums or prisons.

Active Life

The early institutions were largely positive in their approach. They were based on the premise that if their clients could not be cured, they could at least be helped to lead a more active life in society.

Fears in Society – Eugenics

Towards the end of the nineteenth century, however, both the social and medical view of learning disability began to change. Research into genetics, particularly that conducted by Sir Francis Galton (1822-1911), suggested that intelligence was a heritable factor. Other studies linked low intelligence with a propensity to crime and immorality and claimed that society was at risk from growing numbers of ‘degenerates’.

The response to these fears was an increasing reliance on institutional care, combined with strict segregation of the sexes. The introduction of compulsory elementary education in the later part of the nineteenth century had highlighted the number of children who could not benefit from a normal education. This led to the Elementary Education Act, 1899, which authorised the setting up of special schools in England for the education of ‘defective’ children. Some campaigners, however, advocated a system of ‘permanent care’, with so-called ‘defective’ children entering institutions where they would spend the rest of their lives. Colony settlements such as Sandlebridge featured a day school and a farm and provided training in manual work, with the emphasis on supervision and full occupation.⁷

Legislation and Language

In Britain a growing debate about the ‘problem’ of ‘mental deficiency’, fuelled in part by the eugenics movement, led to the establishment of the Randor Commission in 1904. The Randor Commission’s report eventually formed the basis of the Mental Deficiency Act, 1913, which created the framework for the care of ‘mental defectives’ in England and Wales until the late 1950s. This was to form the basis for Northern Ireland legislation to follow.

The act divided people with learning disabilities into four classes, each of which would rightly cause grave offence today: ‘idiots’, ‘imbeciles’, ‘feeble minded persons’ and ‘moral defectives’. The classes were defined in terms of social incapacity rather than IQ, although it became common practice to assign IQ ranges to each group. An administrative framework was established, with a central board of control and local mental deficiency committees responsible for ascertainment (that is, diagnosis) and for the provision of care institutions.

Delays Implementing New Law

The implementation of the provisions of the 1913 Mental Deficiency Act was delayed by the First World War and later by the reluctance of local authorities to bear the cost of new institutions. In 1927, there were only 5,300 beds available for around 60,000 ascertained patients in England and Wales. The abolition of the old Poor Law workhouses, some of which were transferred to the Board of Control, helped increase the available provision and by the end of the Second World War some 51,000 patients were housed in over 200 certified or approved institutions.

However, institutional care was not the only option available under the 1913 Mental Deficiency Act. Provision was made for people ascertained as