ࡱ> BDA5@ /bjbj22 .BXX'8&4Z2zz(} } } $R`3a } } a a 3Hm m m a j m a m hm rTn @-mV Fm ^0{r 4rr} L 6m ,+ 6} } } 33dE (Exeter Partnership NHS Trust Records Fourth Project Report Dr Nicole Baur The Exeter Partnership NHS Trust Records project, which was originally scheduled for three months, has been extended for another four weeks. This fourth report covers the final stages of the project and relates to the time period 01 to 21 May 2007. It describes my activities during this period and outlines ideas for potential future activities and extensions of the project. Project phase 4 As we had decided in our last project meeting on 03 April 2007, I started by investigating the patient files for the years 1940 to 1944. We had scheduled one week for this activity whose purpose was to find out whether the files differ significantly from the earlier ones due to the impact of World War II. This is not the case as far as physical contents are concerned; a few, however, mention war-related impacts (shellshock; getting bombed out, etc.) as causes of the disorder requiring institutional treatment. Nevertheless, having a look at these files was worthwhile because I realised that several envelopes, which show admission dates before 1945 and the corresponding reference number on the front page, contain documentary evidence of earlier admissions. Further investigation revealed inconsistencies between the labels and contents for a considerable number of files, and several of these files matched records in our databases for which we were unable to find any files at earlier stages of this project. As this seemed a major breakthrough we decided that I would dedicate more time to the identification and retrieval of such files, and during the past two weeks I checked every patient file in the strongroom for previous admissions. Findings were encouraging: I retrieved a total of 177 files that were labelled inadequately. Not all of these files were already in our database, so I added 71 records to database I (admissions from 1870 to 1939), and 79 to database II (admissions from 1940 to 1944). The new findings increased the number of records in database I to 1,435, and in database II to 522. Of these, 273 files are available for database I relating to 260 patients; for database II we have 96 files for 96 patients. The record file relation has gone up from 12% to 18.1% (database I), and is 18.4% for database II. The fact that many of these files were missing from our databases (i.e. no Hospital Index Card existed for this particular admission) confirms Jos assumption that the HICs were filled in retrospectively only for patients who were considered (technically) alive at this particular point of time. The new findings also explain why I came across admission papers and entries in registers for which apparently no records existed in phases 2 and 3 of the project. There is, however, a downside to these new findings. Very few files still contain the documents of the first admission in most cases reference to the previous hospitalisation is only made by the dates of admission and leaving and reference number. Some more detailed files mention whether the individual was a voluntary or certified patient and the diagnosis as part of the personal history section. A total of 27 files have not been added to the database yet. In these cases reference to earlier admissions has only been made in the Statement of Particulars, a form that is part of the Reception Order and refers to the patients personal and social data. Although the form asks for dates and locations of previous treatment, information given cannot always be relied upon. The form does not make it clear who provided the information, and in several files dates given as previous admissions turned out to be either wrong or not very accurate (e.g. Devon Mental Hospital 1927 / 1929 / 1949). In some cases the information in question could be retrieved from the personal & family history of the patient which has been compiled much more accurately by a social worker in the more recent files than in the earlier ones. Files without accurate dates of treatment and/or reference numbers have been excluded from the databases so far. The impact of these new findings on the readmissions recorded in our database was considerable: by the end of the third stage of the project our database contained 194 patients who had been readmitted at least once. This number has now gone up to 268, with almost half of them readmitted a second time. Despite these shortcomings the recent findings add a new dimension to our project. Firstly, they give us a more accurate picture of the number of people hospitalised in the time period under consideration. Secondly, these files will prove even more important if we decide to carry out research on repeated admissions to the institution. A lot of patients who had been treated in the 1930s were readmitted in the 1950s often with a very long period in between for which no evidence of institutional treatment exists. This finding raises two questions: a) How could the patients manage for such a long time without hospitalisation, but then seemed to need it again? and b) Why are there so many readmissions in the 1950s? I dont have a satisfying answer, but two ideas crossed my mind. One assumption is that the conditions the patients were treated for were unrelated (e.g. several women were treated for puerperal psychosis / breakdown / melancholia or similar postnatal conditions during their first stay these might have cleared up entirely) diagnoses for previous hospitalisations are not always available, though. The other explanation is that there were more readmissions between the 1940s and 1950s, but they are a bit difficult to discover, as a lot of files refer only to the last readmission (we have to remember that patients were usually allocated a HIC and a file for each admission). This means, if a patient was first hospitalised from 1938 to 1940 and then readmitted from 1946 to 1947, the second file would refer to the first admission. If this person was readmitted again in 1952, this new file might only refer to the most recent previous admission, i.e. 1946. In this case, I would not have retrieved this file from the strongroom, as I was only looking for admissions up to 1944. It is therefore possible that we have missed some readmissions because they are not necessarily evident from the files. If financial and human resources became available for this project again, it would therefore make sense to create a database of all files (not necessarily with as many fields as we have now, but focus on the patients personal data & dates of admission and leaving) and check these names against the records in our database. Creating a database containing all patients names and addresses (including changes, if applicable) would be helpful in an additional way: a common problem with files that refer to previous admissions with dates and reference numbers but do not contain any previous records is that we cannot retrieve accurate information for social scientific research related to these earlier admissions. While the civil state at the time of the first admission can usually be found out through the date of marriage, and religion does not normally change, addresses pose an insolvable problem. This fact increases a particular problem related to files of female patients. Some female patients might already be recorded in our database but under their maiden names and with their previous addresses, i.e. they remain undetected, unless we can track them through their addresses. The other question is why there were so many readmissions in the early 1950s. It may be that the foundation of the NHS brought about a new trend of hospitalising people with mental health disorders. Another explanation could be that the war had an impact after all, but that more people were in need of treatment in its aftermath than during the war. Or, I might simply have fallen victim to a statistical trap: with more patient files available in our sample for the time from 1950 onwards, more readmissions could have been documented. Suggestions for future proceedings The current stage of the project suggests several potential activities (or a combination of several of them) for the remaining ten days. 1) Continuation work on the files One idea is to search some of the registers and other documents available at the DRO for the new entries in our database. This might produce the original case notes for some of the records and / or confirm some bits of information such as addresses. At the moment we have 207 records (120 from 1870 1939 and 87 from 1940 1944) for which we have the file as only source of information. Another potential option is to have a look at the Digby files (there is one shelf with 6 boards and 17 boxes) and include them into our database. Given that we have not worked at all with these, it might not be enough time, though. 2) Work on database Currently we have two databases (1870 1939 and 1940-1944). The question is whether we want to merge to two (if so, it should be done before we start cleansing them). As a final task the database will be checked again, burnt to a CD, and the table 2 in the previous progress report will be revised. 3) Dissemination of findings There are two possible ways of disseminating our findings. In our Centre Meeting on 17 May, Mark Jackson referred to a conference in Edinburgh on 12 14 December 2007, which deal with research resources and would provide an opportunity to discuss our outcomes and problems. A second opportunity would be to start preparing an article to be published, which deals with the archival aspect of the projects. 4) Application for funding Our results have shown that a continuation of the project in both the archival and research direction would be very desirable. The remaining time might therefore be used to start preparing a research application, i.e. develop a research question and, depending on kind of research, we might want to have another look at the files under consideration (e.g. admitted certified / voluntary, etc. when and how often readmitted). PAGE 3 PAGE 3 &+IK~   " / \ n w  & 8 G c s * 1 ; < = B G X ^ b c   1VTVjlmnhhO.h |IhTh hhOYh4Yh4l5 hA5 hmh4lh/zhmh4l h4l5 h5I%;JK FGpqx%y%''''A(B(d($a$gd$a$gdc=$a$$a$gd// "%'IX%8<IJ 2]x?iwx Ykr¾h/hCwh%=h5h  h5h4lhmZh hh4lhwh^(hazhh4lhTK !9JF[y +IPWZoKRYqt]sb14<INe &(EJ { !!!h8Vh8V5 h4l5\h8Vh <hUH h hc=hCwh/h4lR!!!! 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