Dr Bertram Mandelbrote: Psychiatrist who fought to establish therapeutic communities in place of conventional custodial care

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The Independent Online

During the 1950s forward-thinking psychiatrists interested in combating the effects of "total" institutionalisation strove both to prevent unnecessary admission to hospital and to rehabilitate patients who were needlessly languishing in custodial care. At the same time the idea of liberalising the authoritarian social structure so that rather than inflicting damage it became a positive influence for mental well-being – a "therapeutic community" – took hold. Many of the pioneers in this process were charismatic extroverts, but Bertram Mandelbrote's engine for social change was a quiet humanitarianism linked with commitment to patients, trust in staff (he prided himself on selecting good people) and an ability to tolerate considerable amounts of anxiety.

Born in Cape Town in 1923, Bertram Mandelbrote was the eldest of three children and only son of an academic, Harry Mandelbrote, and his wife Ann (née Sachs). Both parents were emigrants, part of the mass exodus of Jews from Lithuania that occurred around the turn of the 20th century. Mandelbrote attended the South African College School and went on to study medicine at the University of Cape Town, where his father held a chair in history. After qualification Mandelbrote left South Africa, as it turned out for good, to pursue research on the metabolism of copper at Merton College, Oxford, where he was a Rhodes scholar. Although he started his career as a general physician at the Hammersmith Hospital, gaining membership of the Royal College of Physicians in 1948 (Fellow, 1964), he realised that his true vocation lay in psychiatry.

Following a period of training at the Maudsley Hospital, which by then was an internationally renowned centre for teaching and research, Mandelbrote spent a year at McGill University in Montreal investigating psychosomatic aspects of ill-health. In 1954 he returned to the UK to work as an assistant to TP Rees at Warlingham Park Hospital, Croydon, at that time one of only three "open door" hospitals operating in Britain. There he gained first-hand experience of the dramatic changes in atmosphere that liberal management policies could achieve: open wards, easy informal relationships between patients and staff and a pervasive enthusiasm, where previously there had been stagnant hopelessness. Within a year, and with Rees's encouragement, he took on the challenge of turning around two of the worst examples of restrictive institutional care in the country, Horton Road and Coney Hill in Gloucester.

He understood well that in order to achieve success, working to reduce prejudice in the outside community was as important as dismantling restrictive regimes within. At the same time as increasing numbers of patients were enabled to leave, local community leaders and county officials were admitted to serve on the hospitals' league of friends. A range of innovations that included daily meetings, delegation of increased responsibility to both nurses and patients, the introduction of out-patient and day-patient care and the expansion of rehabilitative occupational therapy, resulted in significant improvement over a short period of time.

Mandelbrote took up the post of Physician Superintendant (and residence in the grounds) at Littlemore Hospital, Oxford, in 1959 and served as clinical lecturer in psychiatry at Oxford University from 1961 until retirement. His appointment coincided with the introduction of a new Mental Health Act which, by enabling short-term voluntary admission, created a more permeable boundary between the institution and the outside world. Once again, together with Dr Ben Pomryn and with the help of staff who had worked with him in Gloucester and the local League of Friends, he presided over the rapid transformation of a closed hospital to an open-door community, introducing pre-admission assessments, group homes and hostels and promoting work opportunities for patients with local employers. His enduring commitment to charitable work with the Oxford Rotary Club fostered many useful contacts.

But when it came to establishing "therapeutic community" principles within the hospital, he was unable to overcome the resistance of powerful traditionalists in the medical establishment. Two cultures persisted in Littlemore for many years, where one half of the hospital was staffed with biologically oriented, white-coated, stethoscope-swinging doctors, and the other, centred on Mandelbrote's Phoenix unit, was populated with psychologically minded and socially oriented psychiatrists.

Mandelbrote's innovative fervour was undaunted; he was to realise early on that if patients were to be treated outside hospital, imaginative alternatives were required in the community. During the 1970s and 1980s, together with Dr Peter Agulnik, he launched and supported two successful projects that have stood the test of time – the Ley Community for the residential rehabilitation of drug addicts and the Isis Centre, a walk-in counselling and psychotherapy service located in a busy Oxford shopping street. He enjoyed an active retirement, continuing to work in the assessment of drug addiction and to act as a consultant to the School of Health and Social Care at Oxford Brookes University, where he was also a favourite diner in the training restaurant.

Stephen Wilson

Bertram Maurice Mandelbrote, psychiatrist: born Cape Town 22 October 1923; married Kathleen Joyce Howard 1949 (two sons); died Oxford 25 November 2010.

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