About the buildingAlderman William OwenGeorge Thomas Hine, ArchitectTreatmentThe End of the AsylumCare In The Community

About the building

Cefn Coed Hospital was one of the very last purpose-built hospitals, to treat Mental Health patients. It was opened by the daughter of King George V, the Princess Royal in December 1932 and today, in new buildings on the same site, it still serves the population of Swansea and wider.

The hospitals, then known as ‘Asylums’ were built to serve as a tranquil retreat for people within the county who were unable to pay for their treatment. The first Welsh asylum for the mentally ill was opened in Swansea at May Hill in 1815, followed in 1844 by Vernon House in Briton Ferry. 

The County Asylum Act 1845 made it compulsory for all counties to build an Asylum. Their purpose was to provide safety for both patients and the local community by keeping the two separate, but also offered a large means of employment for local people.

Before the 19^th Century, care was paid for by charitable bodies.  Patients, or ‘lunatics’ as they were called then, were housed in Workhouses or within private ‘Madhouses’. This often led to the mistreatment of many ‘lunatics’ as there was little understanding of their condition and due to over-crowding, lunatics may have been shackled in the early madhouses.

In Swansea, it took a long time for a suitable site to be found; Townhill was thought to be the best site until 1908, when Cefn Coed site was chosen.

The foundations were laid, but due to the Great War 1914-1918, there was a lack of labour and materials and the building was halted.

Building work restarted in 1928; it was reported that the queue for daily employment on the site stretched down almost as far as Gors Avenue. 

The first 250 patients to the new ‘Swansea Mental Hospital’ were transferred from other hospitals far afield including Talgarth Hospital, some 55 miles from Swansea. Besides the mentally ill, at first Cefn Coed also accommodated persons with learning disabilities, who needed permanent care.

In 2009, work started to build modern replacement mental health accommodation and facilities which saw the phased closure of the original hospital buildings in 2015. 

Alderman William Owen.

It is true to say that without the stubborn determination of Alderman William Owen, Cefn Coed would not have been built.  

William was the oldest of ten children, born in the early 1870’s in a house that stood where Swansea Library now stands.  

He was elected as Chairman of the Visiting Committee in 1927, which inspected the welfare of the patients being treated many miles outside of the county

He was an intelligent, fearless and driven man. Often unpopular but respected, he fought to get Cefn Coed completed when lack of money and unsupportive local councillors did not wish to continue the construction after the First World War.

The entertainment hall at the heart of the hospital was named after him and he was offered the freedom of the town of Swansea in 1938 – a year before his eventual death. 

George Thomas Hine, Architect 

George Thomas Hine was a trail blazer in Victorian asylum architecture and became such a specialist that designing these hospitals became “almost a distinct profession in itself”.

During the late 19^th century he entered ten asylum competitions, winning five and his incredible output included Claybury, Bexley, Horton, Long Grove, Hertfordshire, Lincolnshire, Surrey, East Sussex, Worcestershire and Cefn Coed Swansea. His expertise was recognised by his appointment as Consulting Architect to the Commissioners in Lunacy 1897.

Hine focussed more about the therapy and treatment of patients inside the buildings than how the building looked from the outside.

He was a champion of the revolutionary ‘Compact Arrow’ design, which had the front entrance and administration rooms designed as an arrow-head and then long corridors and wards radiated behind. The kitchens and entertainment hall were in the centre giving the hospital a light and airy feel, which was important to the well-being of the Mental Health patients. As male and female patients were segregated, the woodwork shop and tailors were working activities for the men and the laundry and sewing room, for the women.

Sadly, George Hine died in 1916 long before Cefn Coed was opened.

The First Medical Superintendent. 

Always forward thinking, Dr James Stuart Ian Skottowe firmly believed that a patient’s mental health was greatly improved by “extending the boundaries of normality”, e.g. shopping, carpentry, gardening, baking and physical training. 

An eminent Psychiatrist, Dr Skottowe, a natural extrovert and highly musical, commenced at Cefn Coed on the 1st January 1932 – nearly a year before the hospital would open for patients.  A Gaelic speaker he quickly learnt Welsh and would use it for rapport with his patients.

Noticeably one of his first entries in the Superintendent’s Diary was to issue a decree saying that there would be no padded cells in the hospital and to his horror he found that one had already been installed. He wrote to the suppliers – Pocock Brothers of London – and thanked them for the installation but informed them it had been dismantled and was now a marvellous storage room. 

Dr Skottowe’s daughter, Gillian, was born at Cefn Coed and he purchased a font for the Chapel for the christening. 

Treatment

When Cefn Coed opened, it attracted the best Doctors and Nurses in the UK; apart from caring for the mentally ill, mentally handicapped and epileptics, the hospital was one of the first in the UK to provide Psychiatric Services for children.

The hospital farm enabled patients to work in the open air which was felt to be beneficial as was playing games such as football and cricket. Occupational Therapy was important as this allowed patients to develop, recover or maintain meaningful activities .Treatment also included Psychotherapy (talking treatments), hypnosis and continuous sleep therapy.

In the 1950’s the first antipsychotic drug, Chlorpromazine (Largactil) was used – this reduced the need for long term institutional care. Also, new antidepressant drugs appeared, both monoamine, oxidase inhibitors and tricyclics. However, they were limited by side effect issues. At this time the Westfa Day Centre was opened in the Uplands, Swansea for the elderly mentally ill.

In the 60’s and 70’s, it was recognised that there was “a rising tide of dementia” and therefore the complexity of the elderly mentally ill required specialty care in bespoke accommodation.

In the 1960’s Lithium was used for treating bi-polar disorders. Electroconvulsive Therapy (ECT) was used for psychosis, which now, under modification, is an effective contemporary treatment for depression and psychosis. In 1969, an in-patient ward was opened for drug abuse and alcoholism. During this period Community Teams of Doctors, Nurses, Psychologists, Social Workers and Pharmacists were developed. Talking therapies, counselling, group sessions and anxiety management sessions were also used. The antidepressant Fluoxetine (Prozac) was introduced in 1988.  

The End of the Asylum

Over the course of the past 60 years, the range and nature of the treatment, care and support available to individuals suffering psychiatric illness has changed out of all recognition. 

One of the most important of these changes has been the move away from institutional care, towards care for the individual as part of the community. It is important to remember that when Cefn Coed opened in 1932, the range of treatments was extremely limited and consisted mainly of segregation coupled with crude levels of sedation. The hospital accommodated over 650 patients, in large wards of 60 or more beds, with no personal belongings or private space. 

The move away from such institutional care, which was increasingly recognised as detrimental to the mental health of the individual by stripping them of identity and self-worth, was a very gradual one. With the greater understanding and knowledge of mental illness, the dramatic developments in new drug treatments and the growing recognition of human rights, Parliament passed the ‘1959 Mental Health Act’. This Act became the foundation for the eventual development of ‘Care in The Community’. 

Care In The Community:

The Minister of Health, Enoch Powell, speaking in Parliament, in 1961, in support of the move away from institutional care, might have been describing Cefn Coed when he talked of getting rid of the Victorian asylums which were: “brooded over by the gigantic water-tower and chimney combined, rising unmistakable and daunting out of the countryside”.

In the mid 1970’s, Care in the Community became a reality for Cefn Coed. A number of important changes had taken place, notably the wide range of available medications and the growth of support services from Local Authority Social Services allowing dedicated Mental Health Social Workers to join with nursing staff as part of joint Community Mental Health Teams (CMHT). These teams, based within the respective communities work jointly to treat and support people as part of an individual care planning process tailored to the personal needs of the patient. 

The CMHTs, supported by a range of Day Services, remain the backbone of care for sufferers of psychiatric conditions, the majority of whom now receive treatment within their own homes and remain as part of their family and the wider community. 

Despite the problems facing today’s mental health services and the recognition that much more could be achieved, the nature and range of the support available is far and away more humane and effective than that which institutional care could provide.