Similar to the admission process, relatives played an important part when it came to a patient’s discharge, as their release from hospital depended largely on the capability and willingness of family members to accept the patient back into their community. Research into the discharge from asylums has received considerably less attention than committal procedures, but available studies show that by no means all patients turned automatically into long-stay patients (Wright, 1999; MacKenzie, 1993), as had previously been assumed. It is noteworthy, however, that there was no after-care provision for discharged patients. Many would be released into the same environment they had come from, making them vulnerable to a recurrence of their illness. Ann’s case notes illustrate that she left asylums twice in her life and at least once must have resided with her family afterwards. Yet, as many other patients, she could not cope in the community, was readmitted, finally turning into a long-stay patient. Such readmissions – albeit short for many patients – contributed to the considerable overcrowding the DCLA and many other lunatic asylums across the country.
The release of a patient could occur in several steps. In order to facilitate the return to the community as well as out of the necessity to provide treatment for an ever-increasing patient population in the confined space of the hospital, Bucknill trialled a system of ‘boarding-out’ pioneered in Belgium (Bucknill, 1861), jeopardizing professional credibility and facing opposition by fearful local residents (Philo, 1987). This system would later be extended to ‘trial periods’. During these time periods of usually four weeks patients would leave the hospital and reside within their families, but would retain patient status, i.e. could be brought back to the hospital at any time should the trial in the community fail.
Another way of getting out of the asylum was by absconding. Employment in the vast grounds of the DCLA – as much an integral element of moral treatment as for the benefit of the asylum’s self-sufficiency – provided ample opportunity to escape. If not recaptured within two weeks, the patient would be discharged from the asylum’s books. Despite the opportunities, few patients did actually abscond from the DCLA and most were brought back shortly afterwards either by the police who had been alerted by the DCLA or other members of the community who had spotted the patient, or by the patient’s own family where they had sought refuge.
While most patients left the asylum within one year, a considerable number died in it. The mortality rate oscillated around 9% to 10% with two exceptions in 1860 and 1866. It would remain fairly constant until the outbreak of the First World War. Most deaths in the 19thcentury were attributed to infectious diseases, including typhoid, dysentery and phthisis, whose outbreak and spread were facilitated by the overcrowded conditions.