Life, Death and Deliverance at Callan Park Hospital for the Insane, 1877 to 1923

Abstract

This study examines the factors contributing to patient mortality and discharges in a large Australian mental institution, Callan Park Hospital for the Insane in Sydney, over the late nineteenth and early-twentieth centuries. New South Wales asylums during this period had multiple roles in public welfare provision, including significant responsibilities for the care of the aged, alcoholics, neurological conditions, and sufferers from end-stage syphilis. These responsibilities included medical care in hospital wards for patients who had a wide variety of serious and often fatal organic conditions. This spectrum of functions has been overlaid in historical and popular memory by the gloomier accounts of the more specialised (in terms of caring for affective disorders) mass institutions of later years, oral histories and fictional stereotypes. Without this now largely forgotten history, and the disaggregation of death rates by medical condition, the causes of the mortality gap for mental patients, trends in diagnosis over time, and the then broad perception of insanity, cannot be fully understood. Previous relevant Australian studies have been predominantly qualitative and have only presented aggregate figures on mortality and discharges. The very high mortality rates for virulent diseases common in asylums at the time but which are now far less prevalent, such as General Paralysis of the Insane, or tuberculosis, have significantly complicated comparisons between historic death rates for the mentally ill and contemporary death rates. These complexities obscure historical understanding of the functions and effectiveness of a mental institution of this kind.

To inform my research, I have compiled two parallel samples drawn from the patient records held at the NSW State Archives Collection. The Deaths sample is based on a one-in-twenty selection of deceased patients, comprising 152 patients, 100 men and 52 women. The Discharges sample was taken using the same sampling ratio; it comprises 127 men and 127 women. There are 406 sets of patient records in total in the samples, 227 for males and 179 for females. I look to the international literature for more detailed and specific analyses of mortality and discharges in comparable periods. Such comparisons are difficult because of varying diagnostic procedures and cultural practices, but the methodologies used in the international studies have nevertheless been helpful for my analyses.

I also use some more modern approaches to assessing mortality, such as Potential Years of Life Lost (PYLL), which have been little mentioned in historical writing on mental health care, although are in extensive use today in analyses of the effectiveness of hospital and medical care. I reinforce my arguments by examining the influence of nutrition and medical treatments on patient health, aspects which are less often discussed in the historiography of institutional mortality. This thesis substantially broadens and deepens our historical understanding of mental health care in Australia, before a sad period of severe underfunding and understaffing during the Great Depression and for many years afterwards.