Doctor Jim Birley: Pioneer of local care who also changed the way we view schizophrenia - Obituaries - News - The Independent

Doctor Jim Birley: Pioneer of local care who also changed the way we view schizophrenia

 

Jim Birley was one of the most distinguished figures in British psychiatry, whose eminence and humanity brought discernible benefits to the global psychiatric scene. He combined an acute brain with a towering moral sense, a lack of pretension and an irresistible sense of fun. With Birley, the kindest, most generous-spirited of men, the joke was never far away.

Born in 1928 near Harley Street to a neurologist father famed for his work on fatigue in First World War pilots, Birley moved to his grandparents' house in Essex after his father died. He was educated at Winchester College, where he was head boy, and at University College, Oxford. He became interested in psychiatry while working as a (conscript) Junior Medical Specialist in the army in Germany. He returned to the UK and after further medical experience spent a year working with the controversial Dr William Sargant before taking a clinical position in 1960 at the Maudsley Hospital. He was to remain there for the remainder of his career.

One tribute referred to Birley as "the caring face of psychiatry", and those who knew him would readily testify to his warmth and humour. He championed the cause of social psychiatry, having spent three years at the Maudsley's MRC Social Psychiatry Unit. He learned much from Douglas Bennett on how to take social psychiatry from the blackboard into the real world. He became a consultant at the unit in 1968 and helped engender an ethos of what he later called "buck stops here" psychiatry, whereby the patient, often living locally, had their needs catered for on the spot with the help of the appropriate social structures.

Among these was the Windsor Walk Housing Association, which provided houses for loose-rein supervised accommodation. Birley secured the first house with a deposit from a local philanthropist, persuaded the council to provide the rest of the mortgage and had the residents in within months. Three more followed in the next four years, with more later. The revolutionary schemes involved houses with multiple occupancy and, instead of an authority-figure "warden", employed a manageress who lived locally. People would be treated as far as possible as residents rather than patients, and given as much opportunity as possible to live an autonomous life unhindered by family ties.

"These houses gave people their own space and much more freedom," he later observed. "They were expected to act responsibly in the house and indeed they did so, coping well with the crises which occurred there." This was unlike in a mental institution, said Birley, where people's natural capacities atrophy because they are never tested. "It was quite novel, in those days, to set up a house like this without any resident staff. But we were determined to do that and never regretted it." The association is in existence to this day.

Birley's own research made a major contribution to early studies showing how "life events" can be associated with the onset of psychiatric disorders. In 1960 he had conducted research which showed how patients suffering from psychotic attacks were likely to have recently undergone some sort of crisis. He noted with wry amusement years later that, so far-fetched was the notion that schizophrenia could be precipitated by a life event, the British Journal of Psychiatry rejected his article. But the American Journal of Health Behavior ran it, and it became the set text on the subject.

Birley also founded the Southwark Association for Mental Health. One facet of this was vigorous fund-raising at the local fête, held on the (now built-on) lawn of the Maudsley, which raised considerable sums and, in typical Birley fashion, persuaded patients, staff and members of the public to drop their inhibitions and muck in. It would amuse Birley to recall that among the most popular attractions was the fortune-teller, supplied by the Maudsley's most disturbed ward. "The long line of clients waiting to hear their fate was largely composed of Maudsley staff," he recalled with his throaty laugh.

He also pressed for local catchment area services, expanded outpatient and community services as an alternative to long-term institutional care. He ran the Maudsley's Emergency Clinic, which some felt got local GPs off the hook by providing a walk-in service. But research suggested that those referred by GPs tended to be less ill than those who came spontaneously, so it was serving its purpose. He was also the moving spirit behind the Thorn Nursing initiative, a training curriculum for community psychiatric nurses that aimed to include family and patients in deciding best care. The Maudsley's 18-bed facility for acutely ill women bears the name the Jim Birley Unit. He was later a part-time adviser to the Samaritans.

His main task was in confronting the Thatcher government at its most ideologically driven. "All of us, once we had read Working for Patients, realised that it had been written by people who didn't understand the NHS," he said. "Struggling with a government who quite clearly hadn't thought it out and weren't prepared to listen was a very unnerving experience." He failed to see the logic of encouraging both care and competition, which "results in Bradford providing care for learning disabilities in Surrey", and he spoke forcefully about the effect on morale and recruitment.

The latter stages of his career will be associated mostly with his work in the Soviet Union and Eastern bloc. In 1989 he represented the World Psychiatric Association, showing steel and diplomacy in persuading the Soviet delegates to admit to its political use of psychiatry in the past. The USSR was readmitted under strict conditions, observance of which he continued to help monitor. He was prominent among those who sought to help a battered profession as the Cold War came to an end.

He retired from clinical work at the beginning of 1991. He and his devoted wife, Julia, left London for an enviable retirement on the Welsh-Herefordshire border, where he tended a vast and rich garden and catered for his encyclopaedic knowledge of flora and fauna. They were visited frequently by their children and 10 grandchildren, in whose memory – his godson presumes to testify – he, for all his professional brilliance, will live on as the most benign, lovely and fun grandfather.

James Hanning

James Leatham Tennant Birley, psychiatrist: born London 31 May 1928; Dean, Institute of Psychiatry 1971–82; Dean, Royal College of Psychiatry 1982–87, President 1987–90; CBE 1990; married 1954 Julia Davies (one son, three daughters); died 6 October 2013.

Life and Style
tech
Arts and Entertainment
Robin Thicke's video for 'Blurred Lines' has been criticised for condoning rape
music
News
Paper trail: the wedding photograph found in the rubble after 9/11 – it took Elizabeth Keefe 13 years to find the people in it
newsWho are the people in this photo? It took Elizabeth Stringer Keefe 13 years to find out
Voices
Yes supporters gather outside the Usher Hall, which is hosting a Night for Scotland in Edinburgh
voicesBen Judah: Is there a third option for England and Scotland that keeps everyone happy?
PROMOTED VIDEO
Have you tried new the Independent Digital Edition apps?
News
ebooksAn unforgettable anthology of contemporary reportage
Arts and Entertainment
Matt Damon as Jason Bourne in The Bourne Ultimatum (2007)
filmMatt Damon in talks to return
News
peopleThe report and photo dedicated to the actress’s decolletage has, unsurprisingly, provoked anger
Arts and Entertainment
Evil eye: Douglas Adams in 'mad genius' pose
booksNew biography sheds light on comic genius of Douglas Adams
Life and Style
tech... and together they're worth at least £100 million
Arts and Entertainment
While many films were released, few managed to match the success of James Bond blockbuster 'Skyfall'
filmsDaniel Craig is believed to be donning skies as 007 for the first time
Arts and Entertainment
Fringe show: 'Cilla', with Sheridan Smith in the title role and Aneurin Barnard as her future husband Bobby Willis
tvEllen E Jones on ITV's 'Cilla'
Life and Style
Bono and Apple CEO Tim Cook announced U2's surprise new album at the iPhone 6 launch
tech(but you can't escape: Bono is always on your iPhone)
Sport
Tim Wiese
sport
Life and Style
Kim Kardashian drawn backlash over her sexy swimsuit selfie, called 'disgusting' and 'nasty'
fashionCritics say magazine only pays attention to fashion trends among rich, white women
Arts and Entertainment
TVShows like Agents of S.H.I.E.L.D are little more than marketing tools
Arts and Entertainment
Hit the roof: hot-tub cinema east London
architectureFrom pools to football pitches, rooftop living is looking up
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs General

Retail Business Analyst

£40000 - £50000 Per Annum: Clearwater People Solutions Ltd: Our retail client ...

Senior C++ Developer

£400 - £450 Per Annum possibly more for the right candidate: Clearwater People...

Retail Business Analyst - Retail-J

£40000 - £50000 Per Annum: Clearwater People Solutions Ltd: Our retail client ...

Internal Communications Advisor

£23000 - £25000 per annum + Negotiable: Ashdown Group: Internal Communications...

Day In a Page

Mystery of the Ground Zero wedding photo

A shot in the dark

Mystery of the wedding photo from Ground Zero
His life, the universe and everything

His life, the universe and everything

New biography sheds light on comic genius of Douglas Adams
Save us from small screen superheroes

Save us from small screen superheroes

Shows like Agents of S.H.I.E.L.D are little more than marketing tools
Reach for the skies

Reach for the skies

From pools to football pitches, rooftop living is looking up
These are the 12 best hotel spas in the UK

12 best hotel spas in the UK

Some hotels go all out on facilities; others stand out for the sheer quality of treatments
These Iranian-controlled Shia militias used to specialise in killing American soldiers. Now they are fighting Isis, backed up by US airstrikes

Widespread fear of Isis is producing strange bedfellows

Iranian-controlled Shia militias that used to kill American soldiers are now fighting Isis, helped by US airstrikes
Topshop goes part Athena poster, part last spring Prada

Topshop goes part Athena poster, part last spring Prada

Shoppers don't come to Topshop for the unique
How to make a Lego masterpiece

How to make a Lego masterpiece

Toy breaks out of the nursery and heads for the gallery
Meet the ‘Endies’ – city dwellers who are too poor to have fun

Meet the ‘Endies’ – city dwellers who are too poor to have fun

Urbanites are cursed with an acronym pointing to Employed but No Disposable Income or Savings
Paisley’s decision to make peace with IRA enemies might remind the Arabs of Sadat

Ian Paisley’s decision to make peace with his IRA enemies

His Save Ulster from Sodomy campaign would surely have been supported by many a Sunni imam
'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

Exclusive extract from Janis Winehouse's poignant new memoir
Is this the role to win Cumberbatch an Oscar?

Is this the role to win Cumberbatch an Oscar?

The Imitation Game, film review
England and Roy Hodgson take a joint step towards redemption in Basel

England and Hodgson take a joint step towards redemption

Welbeck double puts England on the road to Euro 2016
Relatives fight over Vivian Maier’s rare photos

Relatives fight over Vivian Maier’s rare photos

Pictures removed from public view as courts decide ownership
‘Fashion has to be fun. It’s a big business, not a cure for cancer’

‘Fashion has to be fun. It’s a big business, not a cure for cancer’

Donatella Versace at New York Fashion Week