The inter-war years mark a period of contrasts in the treatment of mental illness, as in many other aspects of economic and social policy, between the best intentions of policy formulation and the delivery of services for large numbers of people. Although the 1890 Act remained on the statute book, it was considerably modified and partly supplanted by new legislation. Material provision for ‘idiots’ or ‘the feeble minded’, specified under the 1913 Mental Deficiency Act and the 1914 Elementary Education (Defective and Epileptic Children) Act, had barely begun. The 1913 Act also triggered administrative and legal changes, notably the replacement of the lunacy commissioners at the Lord Chancellor's department by the inspectors of a Board of Control, first under the Local Government Board and then from 1919 under the new Ministry of Health. Conventionally the onset of war is seen as masking the significance of these developments, although the experiences outlined in the previous chapter should warn against presentations of the new Board as the champion of the mentally ill.

Post-war planning featured a new emphasis upon appropriate forms of treatment rather than upon the proprieties of committal procedures, however. The Board sought to promote inpatient treatments, which bypassed the stigma of certification wherever possible, and also outpatient clinics, held in general as well as mental hospitals. Ministry concern with the poor reputation and the sheer scale of asylums, now typically accommodating over 1,000 inmates, produced attempts to reorient treatment in smaller mental hospitals. Ideally these were to have villa-style accommodation and smaller wards to facilitate an improved classification of patients, with specific admission/reception wards provided and the general promotion of face-toface relationships and treatment. These objectives were elaborated in Board inspectors’ reports following visits to Norfolk even before the 1924–6 Royal Commission on Certification, Detention and Care of Persons of Unsound Mind. The Commission also emphasised links between mental and physical illness in further justification of the need for an interactive approach to treatment, the adoption of the universal term ‘hospital’ and the abandonment of the stigmatised terminology of asylumdom.

Although the 1890 Act and its certification processes remained, the 1930 Mental Treatment Act set out alternative procedures and a future model. A patient willing to undergo treatment and making written application for it was seen as ‘voluntary’ and could then discharge himself or herself from a mental hospital at 72 hours’ notice.