By the time James Fraser was formally appointed medical superintendent in August 1965 St Andrew's was earmarked for a reduced role within Norfolk Group 8 hospitals and the closure of the satellite St Nicholas’ hospital was under active consideration. Fraser was the last medical superintendent – the post was abolished in 1971 – and the closure of the hospital was a recurring issue over almost four decades. Care in the community proved to be a controversial subject and its development was slower and less extensive than originally envisaged. The national and county context, surveyed briefly below, involved the closure of psychiatric hospitals with gathering momentum: almost seventy had gone before the demise of St Andrew’s in 1998. Yet the local story was of a protracted and uneven decline which included a changed role from the mid-1980s and more than one glimpse of a very different future. Such possibilities depended upon a succession of plans for general NHS hospital services in and around Norwich and the emergence of a local strategy for relevant community care services, examined in a second section. This particular narrative can be traced from several sources and within the hospital there were differing interpretations and experiences of unfolding events, as is clear from interviews with staff personnel.

National and local developments

A national reorientation of mental health services away from large psychiatric hospitals was already envisaged and ostensibly under way by the mid-1960s. Beyond this broad objective, details on suitable forms of community care, the requisite resources and the timetable involved in this transformation remained unclear, however. The desirability of hostelstyle accommodation, day-hospitals, short- and longer-stay annexes to general hospitals and co-ordination with the social services had been expressed well in advance of the 1959 Mental Health Act and the preceding Royal Commission within the psychiatric profession. Most of Fraser’s colleagues acknowledged that new medications allowed forms of mental illness to be managed, rather than cured outright. The prospect of more people receiving treatment and living outside traditional mental hospitals was enhanced, but few considered such institutions to be wholly obsolete. Nor did the advent of new medications sufficiently explain the development of community care, as this was not the predominant influence in parallel proposals for care of the mentally handicapped, the very elderly and chronic mentally ill.