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.

The development of a creative work rehabilitation organisation

“…However, such an account should not understate the role of local actors and local contingencies. The paper by Millard et al (2023) in this issue describes how alternatives to hospital care are more loosely related to central governmental initiatives than might appear at first glance. In Oxford, Bertram Mandelbrote created a humane environment within the hospital, and forged links with external organisations.…”

“…The conditions for the creation of Restore 1 (an acronym for Rehabilitation Services Trust for Oxfordshire Reemployment) had their origins in the changes initiated at Littlemore Hospital by Dr Bertram Mandelbrote, who in 1959 had been appointed Physician Superintendent there. His contribution to innovative developments in hospital and community psychiatry in the late twentieth century in Oxfordshire is extensively covered by an article in this issue by Millard et al (2023).…”

“…Following Mandelbrote’s arrival at Littlemore in 1959, the post of Work Rehabilitation Officer was created. This was initially filled by Helmut Leopoldt, a senior nurse, thus continuing a role he had fulfilled when working with Mandelbrote at the Horton Road Hospital in Gloucester (see Hall, 2023; Millard et al, 2023). As Leopoldt increasingly turned his attention to developing group homes, this post was filled by Oliver Carton, another nursing officer; links were made with specialist officers at the local employment exchange, and directly with local employers such as at the car factories in Cowley, with subsequent support for patients in their work settings.…”

The development of supported mental health accommodation and community psychiatric nursing in Oxfordshire

“…While at Gloucester, he had encouraged the formation of an active League of Friends, and he replicated this on moving to Oxford. In 1960 he promoted the establishment of a League of Friends for Littlemore Hospital, which was later to be the main vehicle for funding non-NHS accommodation (see Millard et al, 2023 ). The next step was to open two hospital hostels, Thorncliffe House in 1961 and Stapleton House in 1962, which enabled hospital staff to gain experience in rehousing long-stay patients.…”

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

“…The institutions created as a consequence of this environment were a result of a shared culture and of happenstance, as much as a result of service planning, as conventionally understood. The nature of his influence is the subject of the first of these articles (Millard et al, 2023). 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).…”