Case notes reveal that psycho-pharmacotherapy constituted the biggest part of treatment during the final 25 years of the hospital with elderly people frequently sedated. By 1970, the number of antipsychotics used in Devon had increased to 27, that of antidepressants to 29, and that of anxiolytics only slightly to 8. Despite more potent drugs being on the market, Largactil continued to be used widely. Contrary to antipsychotics and anxiolytics, antidepressants established themselves only gradually on the medical market, constantly competing with electro-convulsive treatments (Healy, 2003).
The large number of drugs available from the mid-1960s allowed frequent medication changes – often in very short intervals, a reminder of the various unproven treatments administered during the first half of the twentieth century, leaving the impression that doctors were still experimenting. From about the mid-1960s, the Exminster section of Exe Vale Hospital, then a psycho-geriatric unit relied increasingly on patients staying for a short time only and complying with out-patient appointments. Once discharged into the community, however, it was even easier for patients to tamper with their medication, which depending on the severity of the illness and the degree of dependency often required rehospitalisation. It might have been partly as a response to this that ‘depot medication’, such as Moditen and Modecate (Cookson, Taylor & Catona, 2002) was introduced from 1968 in Devon. Contrary to tablets or syrups, these injections release the drug slowly, thus acting for up to a month. The benefits for the patients are that they do not have to remember taking oral medication on a daily basis, and if they miss an appointment for an injection, they will receive a reminder. However, some patients rejected this method, as it made them feel being subjected to an outside control over their body, ensuring their compliance with a prescribed treatment plan.
Similar to its predecessors, the 1959 MHA failed to solve the controversy surrounding consent to treatment. Informal patients – equal to the former voluntary patients – could refuse treatment, but the Act remained obscure with regards to whether detained patients had the same right, a particularly difficult issue where treatment was either irreversible or hazardous. There is very little evidence of how this issue was handled in Devon. Refusal was rare and concerned primarily ECT administered to informal patients whose refusal was accepted by staff.
The middle of the twentieth century was marked by a decisive shift in the pattern of care provided for those considered mentally unwell. Institutional care was increasingly abandoned in favour of smaller, less continuous service provided by a range of less qualified groups based in ‘the community’, including family, social workers and psychiatrists. One of the services provided for the mentally ill were out-patient sessions. They had been introduced in Devon as early as 1925 at the Dispensary in Queen Street, and were relocated in 1948 to the West of England Eye Infirmary. From the 1950s onwards, these services were available in most major towns in Devon, thus relieving the strain on the DCMH.