Yuppies take over the asylum: As a once-pioneering hospital for the mentally ill is turned into luxury flats, Nick Cohen asks where all the patients went

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John Conolly, social reformer and medical pioneer, is forgotten today. But in the 1840s his revolutionary views on the care of the mentally ill were at the centre of debate in the lecture halls that favoured enlightened speakers.

Instead of following the traditional practice of tying madmen to the walls, beating them and encouraging the public to come in and gawp and jeer at their antics, Dr Conolly insisted that the inmates of his Hanwell Asylum for the Insane Poor should be treated as patients not monsters.

Physical restraint was to be used only as a last resort at the hospital in what was then open countryside west of London.

The doctor preached the maxim that 'the only real substitute for restraint (of patients) is intractable kindness' to his staff and spread his views to a wider audience through the mid-19th century equivalent of the lecture circuit.

Many were impressed. 'It is a delightful and heart cheering spectacle to see madness for once not treated as a crime,' wrote Mrs Caroline Fox after a visit to the hospital in 1842.

Gradually, Dr Conolly's liberal views and those of a few radical colleagues became orthodoxy. But even Dr Conolly may have been astounded if he could have foreseen just how far his doctrine would go in Hanwell today.

In the 1980s, the inmates of his asylum, by now renamed St Bernard's Hospital, were sent out by Ealing District Health Authority to be 'cared for in the community'. Some were; others found that care meant destitution and that the only community on offer was that of the homeless on the streets.

The number of beds at St Bernard's was cut from 2,000 to 400. Psychiatric patients, an authority spokesman explained, are admitted for short spells of treatment then discharged because 'there is no reason why they should not be cared for outside'.

Without patients there was no need for large parts of the hospital complex. Last week, the asylum for the insane poor was being converted into Osterley Views - 'luxury apartments' for the middle classes.

Pam, a pleasant sales representative who shows you round, pointed out the advantages of buying a piece of the Victorian- Gothic, Grade II-listed building.

On waste ground by the hospital, a leisure complex is being built by Comer Homes, the developers, complete with swimming pool, Jacuzzi, sauna, gym and solarium.

Included in the price of the apartments are ready-painted walls in magnolia, French kitchen units, hobs, fan-assisted ovens, dishwashers, fridge-freezers, washer-dryers, gas central heating, video entryphones, mock-Regency panel doors, satellite television sockets and panelled baths with Victorian-style taps.

After thieves broke into a show-flat and stole all the appliances, including the central heating system, Comer Homes installed electronic gates. 'The discerning purchaser who requires a distinctive property of high quality', to quote its brochure, should be able to enjoy the 'tranquillity and privacy' of Osterley Views without being troubled by the outside world.

'A lot of space was wasted when this was all wards,' Pam said. 'It doesn't seem to concern most people about it being a former mental hospital. They just look at the investment. Whoever puts their money in now is going to do very well.'

Despite the property slump, buyers agree. Nearly all the one-, two- and three-bedroom flats - on offer from pounds 65,000 to pounds 145,000 - have been sold. The yuppies have taken over the asylum.

Philip Murray, a former patient at St Bernard's, does not own a 'distinctive property of high quality' and would not cheer the heart of Mrs Fox.

The brain-damaged ex-boxer has no home and no prospect of getting one.

His nose dribbles constantly and his eyes are dull. He was found, hungry and incontinent, in Acton, four miles east of the asylum, by a Roman Catholic priest. Community care has done nothing for him.

He says he lives in a council flat, but Annette Figueiredo, a support worker at a day centre run by Acton Homeless Concern, said: 'He'll say different things to different people. The truth is he's been on the streets for five years.'

Four years ago, the centre saw 11 homeless people a day and seldom encountered a psychiatric patient. Now, 200 people pass through each day. Half have psychiatric disorders. At least two have committed suicide since 1990.

The recent Tomlinson Report on the future of hospitals in London confirmed the impression that the run-down in asylum beds has given thousands of mentally ill people squalor and destitution rather than the happy, independent lives that supporters of community care promised.

About half of the 60,000 homeless people either sleeping rough or in bed-and-breakfast accommodation in the capital had 'significant psychiatric problems', the inquiry found.

Ms Figueiredo said that homelessness was an entirely predictable result of the policy. Many of the people she has seen found they could not cope with the forms needed to get a council flat because 'they could not read or write' and did not know how to handle the bureaucracy, she said.

Others had been driven out of bed-and-breakfast hostels by residents who did not like psychiatric patients living next to them.

She said: 'These people had, and needed, a high level of support in hospital. Suddenly they were told told they had to look after themselves. Each patient is meant to have a social worker assigned to help them, but in reality half of our clients don't'

For 120 other St Bernard's patients, community care did not mean ending up on the streets but being bused to private residential homes far from their families.

Twenty-two were found in Lytham St Anne's, Lancashire, in a home not registered for psychiatric care. The general manager of St Bernard's was suspended and resigned in 1990 when the case came to light.

Some of the homes where patients were sent were owned by past or present members of St Bernard's staff. A North West Thames Regional Health Authority inquiry found no evidence of financial impropriety.

Dr David Wingfield, a GP who runs a weekly clinic at the Acton centre, said the removal of the asylum by the proponents of community care had left a gap in the help that he could offer.

He said that a minority of the homeless people he sees with schizophrenia, mania, paranoia, untreated wounds, chest diseases, lice and scabies 'need asylums where they can find someone to look after them'. Dr Wingfield added: 'They need places to escape to, but these just don't exist anymore.'

His views are a rarity. Ealing District Health Authority and Ealing Council Social Services Authority, like health and social service authorities all over the country, are committed to community care and have no intention of changing their policies.

Marjorie Wallace, chief executive of the mental health charity Sane, which more than any other pressure group was responsible for putting forward the arguments which led to Virginia Bottomley's limited review of community care last week, said that the limitations of the theory behind the closure of psychiatric beds had not been grasped.

'Community care can only work with less severe mental illnesses,' she said. 'The really ill cannot manage.

'It's as if a surgeon after a battle decided to only help people with grazes while leaving those with gaping wounds to die.'

(Photograph omitted)