A pioneer in the management of Australian psychiatric services: Dr Richard Greenup (1803–1866)

Abstract

Objectives

To provide a brief biography of Dr Richard Greenup and to explore the legacy he has left to one of Australia’s longest operating psychiatric services.

Methods

This history was obtained by consulting staff working within Cumberland Hospital, New South Wales and by examining primary and secondary sources.

Results

Greenup was the second surgeon superintendent of ‘The Parramatta Lunatic Asylum’ from 1852 until 1866 when he was fatally stabbed with a pair of scissors by a patient. Greenup was involved in establishing The University of Sydney and advocated for expanded and improved services for people diagnosed with mental disorders.

Conclusions

Greenup recognised the needs of the mentally ill and sought to address similar social and demographic determinants of health to those that we face today. The challenges he faced, and his tragic end remind us of the importance of delivering patient-centred care whilst being mindful of associated risks.

Dr Richard Greenup was the second surgeon superintendent of The Parramatta Lunatic Asylum from 1852 to 1866. This institution continues to operate today as a psychiatric hospital called Cumberland hospital and is now one of the oldest operating hospitals in Australia. Cumberland hospital is a large stand-alone psychiatric hospital of 96 acute beds and 134 rehabilitation beds at the centre of the Sydney basin and at the end of the Parramatta River. Together with its neighbouring large teaching and tertiary referral hospital, Westmead Hospital, it services the in-patient needs of a population of approximately 600,000 people. Cumberland hospital received its current name in 1983. Its previous names included: Asylum for invalid and lunatic convicts 1848–1849, Parramatta Lunatic Asylum 1850–1879, Hospital for the Insane 1879–1916, Mental Hospital Parramatta 1916–1960, and Parramatta Psychiatric Centre 1960–1983. The hospital is of historical significance as the site was initially established as a centre for female convicts commissioned by Governor Lachlan Macquarie in 1816 and completed in 1821. Although many superintendents have served the hospital over its 175-years history, only Greenup has a road on the campus named after him, that is, Greenup Drive.

In the context of changes in the direction of mental health care with leaders advocating for less restrictive practices and more patient-centred, recovery focused and trauma-informed models of care, ¹ it is important to look back to leaders of the past and to examine the principles that they advocated for. After 175 years, there are plans to build a new integrated ten-storey psychiatric facility at the neighbouring Westmead Hospital using consumer co-design principles to accommodate the psychiatric services currently provided on the park-like grounds of Cumberland Hospital. ² This is a time to remember why a psychiatric facility was built here and to understand the mindset of leaders at the time. This paper aims to present the life of Dr Richard Greenup and to understand how his story can help inform planning for future mental health care and the future leaders of such health care systems.

Methods

Information for this paper came from the Cumberland hospital museum collection, documents written by staff, interviewing staff within the hospital (some of whom had parents and grandparents who had also worked there as nurses), primary sources such as tomb stones, photographs, and internet searches. Mental Health Librarian and co-author TM and Clinical Nurse Consultant and co-author MB are viewed as local experts regarding the history of Cumberland Hospital. (Figure 1).

Figure 1.

Portrait of Dr Richard Greenup held on the grounds of Cumberland Hospital.

Results

Greenup was born on the 15 March 1803 in ‘Darcy Hay’, Sowerby Bridge, West Yorkshire, England. Greenup’s family life was one where he learnt to respect parental authority, religious teachings, and moral principles; he continued to practise and teach these attributes throughout his life. ³ At the age of 23, on 19 May 1826, Greenup entered Queens’ College, Cambridge and whilst studying for his medical qualification gained his Master of Arts degree in 1831. After gaining his medical qualifications in 1836, he practised in the town of Salisbury. In 1837, at the age of 33 he married Jane, born in 1815, in Salisbury, Wiltshire, England. She was the daughter of William Bird Brodie, a banker, and the niece of an eminent London surgeon, Sir Benjamin Brodie. ⁴

Greenup, his wife, and children left England and joined the John Knox emigrant passenger ship on the 6^th December 1849 with Greenup as the ship’s surgeon. This voyage would take almost five months commencing at Plymouth before arriving at Sydney Harbour, Australia, on 29^th April 1850. ⁴ These passenger ships were also named ‘orphan ships’. Orphaned girls ranging in age from 14 to 20 were selected from workhouses in Ireland and sent to Sydney. ⁵ A matron was appointed to supervise the girls. On this voyage of the John Knox 279 orphaned girls were also making the trip to Sydney. The schoolmaster of the girls wrote a letter of complaint regarding Greenup’s stance against punishment that was sent to the NSW Commissioner of Emigration. In his response, Greenup spoke approvingly of the girls and stated that the headmaster would ‘threaten grievous punishment for the slighted infraction’; he did not view these girls as impertinent, but as having ‘good-natured Irish readiness of repartee’. ⁵

Arriving at Sydney Harbour on 29 April 1850, Greenup and his family settled into residence in Sydney and almost immediately he opened a private practice. Greenup wasted no time in becoming familiar with his new colony and country, establishing himself as a respected and esteemed citizen. ³ After the first Senate to establish a University in Sydney (the first in the Southern Hemisphere) was elected in February 1851,^3,6 Greenup was appointed to the office of registrar and secretary. He played an active role in the establishment of this new university. On the 20 of March 1852, he was appointed surgeon superintendent of the Parramatta Lunatic Asylum after the death of the first surgeon superintendent of the hospital Dr Patrick Hill (born 1794; died 1852). ⁷ Greenup’s duties also included being the Medical Officer for the Protestant Orphan School, a visiting surgeon to the Parramatta Gaol, visiting surgeon for the Destitute Roman Catholic Children’s Institute, and an Official Visitor to the Tarban Creek Asylum (Gladesville Hospital).

Principles of care

Greenup is said to have encouraged staff to employ the virtues of kindness and empathy, and practices that encouraged patient freedom and recovery. He believed in humane treatment and ceased confinement of refractory patients in cells, reduced restraint with ‘leather belts and handcuffs’, and permitted patients to exercise. Patients were allowed to roam the grounds of the hospital and to eat their meals in a secluded corner of the grounds if they wished. ³ Greenup is said to have conducted Church of England services himself with large numbers of patients voluntarily attending. ⁴ Greenup reported on the numbers of patients that had been cured of their mental disorders and argued at Select Committees that some people had been wrongfully detained. ³

Despite Greenup’s apparent advocacy for better conditions for patients, his hospital attendants complained about their poor working conditions. Their complaints included: low wages, heavy fines if a patient was injured during shift, long shifts of up to 16 h, having to buy their own clothing (which was often damaged by patients whilst on duty and not replaced), poor rations (only given bread and tea for breakfast and supper), limited leave (only allowed to leave the asylum for two days every three months), and that Dr Greenup had his favourite staff that he treated preferentially. ⁸

Risks of care

On the morning of Tuesday 17 July 1866, Greenup was routinely inspecting the criminal lunatic yard when he commented to one of the patients by the name James Cameron ‘You look very pale this morning – rather greenish’ alluding to his hue. Cameron replied, ‘Do you see any green in my eye!’ Greenup replied ‘No’ and smiled. His master attendant (the most senior male nursing staff member in the asylum) by the name Michael Prior remarked to Cameron ‘There’s nothing green about you, Cameron’, trying to treat the matter jocosely. ⁹ Shortly afterwards, Cameron stabbed Greenup with a pair of scissors. Cameron was placed into a cell and when asked why he did this, he said ‘I did it for the purpose of being hung or burnt – I am tired of my life’. ¹⁰ Cameron had not been violent in hospital, but he had tried to hang himself three times and was ‘suicidally inclined’. Due to this risk, he was searched every night and not allowed to be given a bed, just a rug and a blanket. It was suspected that Cameron took the scissors from one of the attendant’s jackets. Greenup died two days later with post-mortem examination confirming that the scissors had perforated his omentum and small intestines leading to peritonitis. Greenup is reported to have said, ‘No one is to blame for it’. ¹¹ Although Edwards ¹² indicates that Cameron was an Aboriginal person, other sources report that he was a native of Scotland.^3,13

Greenup’s funeral notice ¹⁴ concluded that ‘those who knew him best testify to his considerate and humane disposition, which led him to be too trustful even of such men as those who are confined in the criminal division of the asylum – a confidence which has eventuated in his untimely decease’. Cameron was acquitted of Greenup’s murder on the grounds of insanity. ¹⁵ The medical testimony reported that Cameron ‘seemed to be under a delusion that poisons had been administered to him, and that the officers of the asylum were forcing gases into his body. He told me that the only way he could preserve life was by lying flat with his mouth on the ground. He also said that officers were continually torturing him, and that Dr Greenup was the chief actor in that torture, and that he had been recommended to get him out of the way’. ¹² The coroner also added that there was ‘an expression of opinion that there had been carelessness in the custody of the key to the lower attendants’ room’ from which the scissors were presumably taken. ¹⁰

Discussion

Greenup advocated for principles of care that appear very similar to concepts such as patient-centred care, least restrictive care, and recovery principles. It is important to note that ‘moral therapy’ was being promoted as a better approach to the care of the mentally ill at the time. The challenges Greenup faced are similar to those seen today regarding the safety of staff, balancing the advantages and disadvantages of restrictive practices, and requests to improve the working conditions of staff. Greenup’s tragic death is a timely reminder to us all of the fine balance between the need for restrictive care and the need for freedom within mental health facilities.

In planning the mental health services of the future, we need to aim for accurate diagnostic assessment and evaluation of risks, with appropriate plans for risk minimisation. Patients need to be treated in a respectful manner and the needs and sacrifices made by staff must be acknowledged. Access to open spaces and the ability to perform physical exercise and to engage in other freedoms were valued in Greenup’s era, but not at the expense of risks to staff or other patients. There are limitations to qualitative historical data that limit our ability to discern how the principles that Greenup advocated for at the time differed from other medical leaders of the time who advocated for moral treatment of the mentally ill. Prompt access to medical care may have assisted and perhaps saved Greenup’s life; certainly, that would be the case today.

Greenup was a pioneer in early mental health care in Australia. His respect and compassion for his patients is mirrored in the values that mental health services aspire to today. Greenup valued education, kindness, religion, and being involved in his community. The tragic stabbing of a pioneering leader in Australian mental health care by a patient reminds us of the delicate balance between restrictive care and freedom that remains central to the care of the mentally ill.