Happenstance and regulatory culture: the evolution of innovative community mental health services in Oxfordshire in the late twentieth century

Abstract

This paper uses co-produced historical material to explore the evolution of two innovative mental healthcare institutions that emerged in Oxfordshire in the 1960s. We highlight how the trajectories of both institutions were driven by chance events occurring within social environments, rather than emerging out of evidence or policy initiatives. Both institutions found a role for spontaneity and an openness to chance in the way they worked. We argue that this kind of institutional history would be unlikely today; the paper develops and uses the concept of regulatory culture to explain why. We suggest that the role of regulatory culture has been neglected in the history of psychiatry.

Innovation in mental health care: Bertram Mandelbrote, the Phoenix Unit and the therapeutic community approach

“…3 This model did not fit well in a hospital setting and again, using the structure of a charitable organisation, the service gradually moved to a community setting, renaming itself the Ley Community. Its happenstantial origins and early development have been described by Agulnik and Wilson (2007) and are further elaborated in a companion article by Armstrong and Agulnik (2023). Mandelbrote's own reflections on the Ley Community are available in the oral history recorded following his retirement (Mandelbrote, interview, 1996, TC Voices/168).…”

“…Mandelbrote’s flair lay in his capacity to create rich, nurturing environments, insulated from external pressures, that allowed the evolution of local institutional innovations in response to local needs and constraints. In terms of the accompanying paper by Armstrong and Agulnik (2023) discussing regulatory culture and happenstance, the settings described above are ecological niches, facilitating environments that enable sustained institutional growth. The institutions and their cultures that resulted are examples of ‘bottom-up’ initiatives, growing in a setting of striking freedom and openness to new ideas, with minimal application of bureaucratic procedures.…”

“…The Isis Centre began in 1970 as an easily accessible, non-referral walk-in counselling service in a busy retail area in Oxford (Agulnik, Holroyd and Mandelbrote, 1976;Oldfield, 1983). As described in greater detail in another article in this issue (Armstrong and Agulnik, 2023), Mandelbrote's early work in Gloucester and Oxford had come to the notice of Leonard Elmhirst, founder of Dartington Hall and the eponymous school, college and glassworks. The Dartington Hall Trust, in conjunction with the University of Oxford, was financing a new building in central Oxford to accommodate faculties for the academic study of agriculture under one roof.…”

The development of a creative work rehabilitation organisation

“…It is against this background context that Restore was founded in 1977. As described elsewhere (Armstrong and Agulnik, 2023), its origins can be found in the happenstantial meeting between the late twentieth-century social entrepreneur Michael Young (later ennobled as Lord Young of Dartington) and psychiatrist Peter Agulnik. In 1976 Agulnik held a post as assistant psychiatrist to Dr Mandelbrote, taking his day-to-day psychiatric responsibility for people with severe and enduring mental health problems in both ward and community settings.…”

The processes and context of innovation in mental healthcare: Oxfordshire as a case study

“…The next paper describes innovations in the linked fields of non-hospital supported accommodation and of community psychiatric nursing (Hall, 2023), followed by another on the development of a creative work rehabilitation organization (Leach, Agulnik and Armstrong, 2023). A final article tries to address the historiography more directly, looking at how chance events occurring in a given regulatory culture can lead to the creation of a fertile setting in which institutional innovations can become established and flourish (Armstrong and Agulnik, 2023). We also include as a ‘Classic Text’ a chapter by David Millard 1 on ‘Maxwell Jones and the Therapeutic Community’, first published in 1996 in the second volume of 150 Years of British Psychiatry ; there is also a brief obituary of Millard, and a commentary discussing the happenstantial nature of institutional innovation at Northfield and Mill Hill (Fees and Kennard, 2023).…”