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

Abstract

Bertram Mandelbrote was Physician Superintendent and Consultant Psychiatrist at Littlemore Hospital in Oxford from 1959 to 1988. A humane pragmatist rather than theoretician, Mandelbrote was known for his facilitating style of leadership and working across organisational boundaries. He created the Phoenix Unit, an innovative admission unit run on therapeutic community lines which became a hub for community outreach. Material drawn from oral histories and witness seminars reflects the remarkably unstructured style of working on the Phoenix Unit and the enduring influence of Mandelbrote and fellow consultant Benn Pomryn’s styles of leadership. Practices initiated at Littlemore led to a number of innovative services in Oxfordshire. These innovations place Mandelbrote as a pioneer in social psychiatry and the therapeutic community approach.

Keywords

Bertram Mandelbrote institutional innovation Littlemore Hospital Oxford Phoenix Unit therapeutic community

Get full access to this article

View all access options for this article.

References

Physician Superintendent’s Report to the Management Committee of the Littlemore Group of Hospitals (1958–1961), HMC 2 A1/2/9.

Haigh

(1995) Written extract from a presentation delivered at the ATC Windsor Conference; ref: PHOENIX/3.

Mandelbrote

(1995) Oral history interview with Craig Fees, 24 May, Mulberry Bush TC Voices/138.

Mandelbrote

(1996) Oral history interview with Craig Fees, 30 April, Mulberry Bush TC Voices/168.

Oxford Therapeutic Communities Witness Seminar (at Littlemore), 25 April 2013, Ref: CF0923-0924.

Oxford Project Witness Seminars (at Littlemore; recorded by Craig Fees): 6 February 2014, Ref: CF0996-0997; 26 March 2014, Ref: CF0998-0999.

Elmore Community Support Team Witness Seminar (at Littlemore; recorded by Craig Fees), 15 January 2015, Ref: CF1049-1050.

Phoenix Unit Reunion Witness Seminar (at PETT Archive), 19 October 2016. Ref: CF1161-1165.

Agulnik

Wilson

(2007) The early history of the Ley Community – personal account. Therapeutic Communities 28: 11–16.

10.

Agulnik

Holroyd

Mandelbrote

(1976) The Isis Centre: a counselling service within the National Health Service. British Medical Journal 2(6031): 355–357.

11.

Armstrong

(2018) What leads to innovation in mental healthcare? Reflections on clinical expertise in a bureaucratic age. British Journal of Psychiatry Bulletin 42(5): 184–187.

12.

Armstrong

Agulnik

(2023) Happenstance and regulatory culture: the evolution of innovative community mental services in Oxfordshire in the late twentieth century. History of Psychiatry 34(1): mm–nn.

13.

Baker

Jones

Merry

Pomryn

(1953) A community method of psychotherapy. British Journal of Medical Psychology 26(3/4): 222–244.

14.

Balint

(1964) The Doctor, His Patient and the Illness, 2nd edn. London: Pitman.

15.

Boulton

Sandall

Sevdalis

(2020) The cultural politics of implementation science. Journal of Medical Humanities 41: 379–394.

16.

Clark

(1964) Administrative Therapy. London: Tavistock.

17.

Clark

(1965) The Therapeutic Community – concept, practice and future. British Journal of Psychiatry 111: 947–954.

18.

Crammer

(1996) Felix Letemendia (Obituary). Psychiatric Bulletin 20(5): 318–319.

19.

Forman

(1992) No fixed abode. British Medical Journal 304: 1185.

20.

Freeman

(ed.) (1965) Psychiatric Hospital Care – A Symposium. London: Ballière, Tindall & Cassell.

21.

Gruenberg

Boudreau

(1960) Reports on group visits to Great Britain’s community-based, open mental hospitals. In: Steps in the Development of Integrated Psychiatric Services. New York: Milbank Memorial Fund, 5–86.

22.

Gruenberg

Turns

Segal

Solomon

(1972) Social breakdown syndrome: environmental and host factors associated with chronicity. American Journal of Public Health 62(1): 91–94.

23.

Haigh

Harrison

Johnson

Paget

Williams

(2012) Psychologically informed environments and the “Enabling Environments” initiative. Housing, Care and Support 15: 34–42.

24.

Hall

(2023) The development of supported mental health accommodation and community psychiatric nursing in Oxfordshire. History of Psychiatry 34(1): xx–yy.

25.

Hall

, et al. (2023) The processes and context of innovation in mental healthcare: Oxfordshire as a case study. History of Psychiatry 34(1): aa–bb.

26.

Hollingsbee

IMC

(2002) Gloucester’s Asylums 1794–2002: An Account of Gloucester’s Two Public Mental Health Hospitals at Horton Road and Coney Hill. Gloucester: Author.

27.

Ingold

(2013) Making: Anthropology, Archaeology, Art and Architecture. London: Taylor & Francis Group.

28.

Jones

(1968) Social Psychiatry in Practice: The Idea of the Therapeutic Community. Harmondsworth: Penguin.

29.

Kennard

(1983) An Introduction to Therapeutic Communities. London: Routledge and Kegan Paul.

30.

Kennard

(1998) An Introduction to Therapeutic Communities, 2nd edn. London: Jessica Kingsley.

31.

Leach

Agulnik

Armstrong

(2023) The development of a creative work rehabilitation organisation. History of Psychiatry 34(1): rr–ss.

32.

Leach

JSR

(2019) Madness and chaos in the culture of a therapeutic community. International Journal of Therapeutic Communities 40(1): 16–24.

33.

Letemendia

FJJ

Harris

Willems

PJA

(1967) The clinical effects on a population of chronic schizophrenic patients of administrative changes in hospital. British Journal of Psychiatry 113: 959–971.

34.

Mandelbrote

(1958) An experiment in the rapid conversion of a closed mental hospital into an open door hospital. Mental Hygiene 42: 3–16.

35.

Mandelbrote

(1965) Factors associated with the rapid conversion of a custodial institution into a therapeutic community. In: Freeman

(ed.) Psychiatric Hospital Care – A Symposium. London: Baillière, Tindall and Cassell, 102–111.

36.

Mandelbrote

(1983) Benn Alton Pomryn: Obituary. Bulletin of the Royal College of Psychiatrists 7(7): 135.

37.

Manning

(1989) The Therapeutic Community Movement: Charisma and Routinization. London: Routledge.

38.

Marshall

(1989) Collected and neglected: are Oxford hostels for the homeless filling up with disabled psychiatric patients? British Medical Journal 299: 706.

39.

Martin

(1962) Adventure in Psychiatry. Oxford: Bruno Casirer.

40.

Micheli

(2019) Not just a one-man revolution: the multifaceted anti-asylum watershed in Italy. History of Psychiatry 30(2): 133–149.

41.

Millard

(1996) Maxwell Jones and the Therapeutic Community. In: Freeman

Berrios

(eds) 50 Years of British Psychiatry, Vol II: The Aftermath. London: Athlone, 585–586.

42.

Mosley

Marwell

Ybarra

(2019) How the “what works” movement is failing human service organisations and what social work can do to fix it. Human Service Organisations: Management, Leadership and Governance 43(4): 326–335.

43.

Oldfield

(1983) The Counselling Relationship. London: Routledge Kegan Paul.

44.

Overeem

Tholen

(2011) After managerialism: MacIntyre’s lessons for the study of public administration. Administration and Society 43(7): 722–748.

45.

Pearce

Haigh

(2017) The Theory and Practice of Democratic Therapeutic Community Treatment. London: Jessica Kingsley Publishers.

46.

Pomryn

(1952) Techniques of group formation. In: M

Jones

(ed.) Social Psychiatry: a Study of Therapeutic Communities. London: Tavistock Publications, 85–95; reprinted in 2001, Abingdon: Routledge.

47.

Pomryn

Jones

Skellern

(1956) Work therapy. The Lancet 276: 343–344.

48.

Powell

(1988) In conversation with Enoch Powell (Minister of Health, July 1960–October 1963). Bulletin of the Royal College of Psychiatrists 12(10): 402–406.

49.

Pullen

(1999) The therapeutic community and schizophrenia. In: Schermer

Pines

(eds) Group Psychotherapy of the Psychoses. London: Jessica Kingsley, 359–387.

50.

Robinson

(2012) O, to be a Doctor: Seminal Moments and Their Consequences in the Life of an Oxford Psychiatrist. Norwich: Frontier Publishing.

51.

Tansey

(2008) The witness seminar technique in modern medical history. In: Cook

Hardy

Bhattacharya

(eds) Social Determinants of Disease. London: Orient Press, 279–295.

52.

Turner

Hayward

Angel

, et al. (2015) The history of mental health services in modern England: practitioner memories and the direction of future research. Medical History 59(4): 599–724.

53.

Vagg

(1987) Support for Difficult to Place People in Oxford. Oxford: Elmore Committee.

54.

Vagg

(1992) A little local difficulty: the management of difficult-to-place people in Oxford. International Journal of Law and Psychiatry 15: 129–138.

55.

Wilson

(2012) Therapeutic communities in mental hospitals. International Journal of Therapeutic Communities 33(1): 55–70.