Red Handbook

In the early asylums, the first attendants were either employed on the basis they were big and strong or if they were of good moral character. After evidence was beginning to emerge that trained attendants had a positive effect on the outcome of psychiatric illness, in 1885 the MPA (Medico-Psychological Association) produced The Handbook for the Instruction of Attendants on the Insane, commonly referred to as the ‘Red Handbook.’ This is the sixth edition of the handbook. It covered topics such as ‘The nursing of the sick’, ‘Mind and its disorders’ and the ‘The general duties of attendants.’ The Handbook was an important advancement in mental health nursing which served to focus and direct the attendant’s role. It represented a move away from the oral tradition from passing on nursing skills and was the beginning of a literature base of mental health nursing. By 1902, 15,000 copies had been sold.



When nurse training was introduced in the nineteenth century, lectures were given by doctors, with the content varying between institutions and often more to do with psychiatry than nursing. In 1889 the MPA (Medico-Psychological Association) elected to produce an examination with the Handbook as the basic training text. Nurses would complete both written and practical examinations, however this was not compulsory. When the General Nursing Council was set up following the 1919 Nurses Registration Act, they organised examinations and set the syllabus, and if nurses were successful they would become a Registered Mental Nurse. However, many nurses continued to do the MPA training until the 1950s, meaning there were two alternative training schemes for mental nursing. For some exams, nurses would be required to answer multiple choice questions using a very basic multiple choice answering machine.




The male hospital staff tended to be physically impressive, a lot of them having fought in World War I. This requirement was influenced by the fact that sport grew to be a very big part of institutional life and it was common for staff to be recruited on the basis of their sporting achievement. Staff and patients would play croquet, cricket, tennis or bowls (as well as performing in shows and playing music). Sport was considered to be healing. The sporting engagement of staff was seen to make them ‘good role models.’ The publicity of having a good footballer at the hospital was also coveted, for example. In the early 1900s the London Mental Hospitals Sport Association was set up and included Botleys Park, the Epsom mental hospitals, Banstead, Cane Hill, Holloway Sanatorium, Netherne and Royal Earlswood.



Training Certificate

This certificate was issued by Glenside and Barrow Hospitals Training School for Nurses. The school issued a separate certificate of training to their nurses who had passed a locally set examination within the psychiatric hospital. The (R)MPA training scheme stopped in 1951. The nurse issued this certificate also passed her General Nursing Council training to become a Registered Mental Nurse (RMN), which was the only form of mental health nurse training by 1969. There were also courses for SRN (State Registered Nurses), RSCNs (Registered Sick Children’s Nurses) and RNMD (Registered Nurses for the Mental Defectives.)

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