Herdmanflat Hospital and East Lothian Mental Health Services
Dr Lindsay Waddell, Haddington
(formerly Physician Superintendent, 1972-1994)
Herdmanflat Hospital was opened in1866 as the East Lothian County Asylum. I understand that, prior to the establishment of the East Lothian Hospitals Board of Management, Rosslynlee and Herdmanflat came under the same Board of Management. Dr Andrew Hegarty, physician superintendent at Rosslynlee, was visiting Consultant and Dr Eric Lundholm was SHMO (Senior Hospital Medical Officer) at Herdmanflat.
In 1964, Dr Bill Boyd was appointed as the first Consultant Psychiatrist to Herdmanflat, followed in 1968 by Dr Colin McGregor as the first Physician Superintendent. Between 1972 and 1994, Dr Lindsay Waddell was Physician Superintendent initially with two registrars and two GP Clinical Assistant sessions with a third registrar added in 1974.
Also in 1974, Dr Heti Davies (five sessions) and Tom Pilkington (three sessions) started working in East Lothian based in the (then) Mental Handicap Service together with a registrar for the Mental Handicap Service. The four registrars were then pooled into an internal rotation system with one of the four seconded to the Royal Edinburgh staff pool to allow a six-month rotation to gain experience in a larger hospital. At that time the medical staff team at Herdmanflat was responsible for covering Herdmanflat, East Fortune and St Joseph's Hospital - a total of 550 beds.
There were always close links with the Royal Edinburgh Hospital for educational purposes and by the early 1980s, trainees were appointed to the Royal Edinburgh Hospital and rotated out to East Lothian, three at a time.
In 1979 Drs Heti Davies and Tom Pilkington returned to the Mental Handicap Service full-time and Dr Peter Fawcett was appointed as Consultant to Herdmanflat with seven sessions, and four at the Royal Infirmary of Edinburgh. He was replaced, on his retiral in 1994, by Dr Tim Rogers. Initially, the catchment Area for Herdmanflat was the old East Lothian County. In the mid-90s, Musselburgh was incorporated, increasing the catchment population from about 63,000 to about 88,000.
At the turn of the 19th/20th Century the hospital had around 300+ beds with about 10 private patients. The rest were defined as 'pauper. (Note - common causes of death recorded in the old hospital notes were 'phthisis' and 'manic exhaustion' ). By 1972, [with the development of more active treatment for people with mental illnesses] the number of beds had reduced to 240 beds in nine wards (no locked doors then!), including two wards in the former Vert Memorial Maternity Hospital. This was eventually emptied and sold.
By 1994, the total had reduced to about 100 beds in five wards with only half a ward for long-term (under 65: in for over two years) patients of whom, at that point, there were two females and eight males.
Geographical and historical factors in East Lothian lent themselves to an early development of community psychiatry which helped a gradual steady bed reduction mostly without any fuss or public reaction. [Unfortunately one of the voluntary organisations providing a home for a small group of patients experienced negative reactions from their neighbours when the development was proposed].
The following helped in the development of the community-based service:
- Out Patient Clinics were established in the 1950s and 1960s at Roodlands Hospital and at the Health Visitors' Clinics in Tranent and North Berwick. Later the sessions were moved into the GP Health Centres in Tranent, North Berwick and Port Seton.
- Close personal links with GPs who were almost universally enthusiastic and helpful. Several spent time working in the GP Clinical Assistant slot and several trainees who had spent six months on placement at Herdmanflat ended as GPs in East Lothian.
- Community Psychiatric Nurse (CPN) Service: three posts were established in 1973/74 with further expansion later. Gradually, they organised attachment to the various GP Health Centres (taking direct referrals) and to the Tynepark Mental Health Resource Centre (voluntary body).
- Day Hospitals. In 1976 a converted ward was opened as a Day Hospital, eventually with 25 places and 55 to 60 patients attending per week. From the late 1960s, up to 40 day patients per week had been integrated into the Acute Admission Unit and the Ambulance Service provided transport. In the late 1980s, another converted ward opened as a Day Hospital for dementia sufferers and their carers.
- Paramedical staff. Multidisciplinary teams were able to work fairly efficiently in rehabilitation, partly because of the small numbers in each department (often one or two persons) - social workers, occupational therapists, Community Psychiatric Nurses (CPNs), a Principal Psychologist who took direct referrals from GPs.
- About 1978, a Music Therapist (Julienne Cartwright) was appointed - the first in Scotland.
- The Mental Health Act (1960) encouraged informal admissions and the many detained patients were gradually transferred to informal status. At the same time the new psychotropic medications were becoming established.
- Outside Agencies. Again, for various historical and geographical reasons, there were, over many years, close and personal contacts with the Social Work Department, Housing (who were surprisingly generous in allocating council houses when asked), Employment and later Education. Other links were with various voluntary agencies - Tynepark, CRUSE, Alcoholics Anonymous and so on. AA met three evenings per week in the Herdmanflat Day Hospital and also in other times in the County.
Mental Health Services - East Lothian
An interesting feature was the decanting of long-term patients from other, overcrowded hospitals, mainly Bangour Village Hospital, to Herdmanflat and occurring at various times. As a result, a significant proportion of long-term psychotic patients in Herdmanflat, male and female, had addresses in Edinburgh, West Lothian and even Lanarkshire. To this day, one occasionally meets such patients, now resident in Haddington. In 1971, 21 elderly graduate [ie a 'graduate' patient is one who has spent many many years in hospital, whose illness is no longer requiring in-patient care but who has become institutionalised and cannot live independently] or demented female patients were decanted from Bangour into the Vert Hospital.
The 120 mentally handicapped (so-called then) patients in East Fortune had also been decanted (from Gogarburn, I believe) and were not from East Lothian. East Fortune was gradually emptied and those beds closed while the patients transferred to the newly opened 72 bed Hopetoun Unit in 1983. The patients were gradually shifted from there into the community and the Unit closed during the 1990s. The opening of this unit caused some controversy as it was erected in the same grounds as Herdmanflat. Among other things, the Mental Health Act of 1913 required that mental illness and mental handicap beds be established on separate campuses. The trend was therefore reversed.
The old link with Rosslynlee was re-established when it and Herdmanflat became part of the Mid- and East Lothian Health Trust: the five Consultant Psychiatrists involved held joint management meetings and provided night and weekend cover for each other's catchment areas. Dr Andrew Hegarty enjoyed a very long retirement from 1964, I think. I attended his funeral in North Berwick in 2001.
My first pre-registration post was as House Officer to James McLean Ross and from there made occasional visits to see ill patients in Herdmanflat. Mr Ross was sole Consultant then with a Registrar and House Officer. There were 34 acute surgical beds with convalescent beds at East Fortune and A & E services were provided. There were six gynaecological beds looked after by Tony Anderson. There was a medical house officer with 22 beds and visiting Consultant (Dr Bruce) and a registrar from the Eastern General Hospital.
Dr Bill Murray used to visit the wards regularly to see possible cases of tuberculosis.
At that time (October 1960 to April 1961), knowing that sometime in the future I would be a likely candidate for surgery on the stomach and observing the very high standard of gastric surgery while assisting, I concluded that Roodlands would probably be the place of choice. As it happened, Graham Meikle performed a pyloroplasty and vagotomy on me in 1979 - successfully and with a good long-term outcome.
I remember that the Vert Hospital had, for a while, the unusual joint function of housing a maternity unit and a ward of 21 psychogeriatric female patients.
- Over the years, the range of types of patients referred to the Mental Health Service expanded dramatically. Apart from the increase in the elderly, much greater numbers of young people appeared, as did those with marital, family and personal problems, adjustment reactions, personality disorders and those abusing alcohol and drugs.
- Peter Fawcett and I often used to ask each other, in the light of all the new management structures and changes taking place, if the patients were or were not getting a better deal. Our answer always seemed to be positive.
- After the appointment of Dr Fawcett in 1979, Dr Adrian Lodge took up the newly organised four Consultant sessions in Mental Handicap for East Lothian.