250 years ago today (20/05/2024), the Madhouse Act of 1774 received royal assent, marking a significant milestone in the history of mental health care and legislation. Understanding of mental illness was severely limited in Georgian England, often hindered by stigma and superstition. While private asylums, colloquially known as ‘madhouses’, had been operating in the country since the early 1600s, their exact legal status and authority remained undefined up until 1774. Ran as commercial enterprises with little to no medical involvement, madhouses were basically private residences where the proprietor was paid to detain residents who had been declared insane.
Lacking regulation, many residents were subjected to deplorable conditions in madhouses, where they often faced neglect, abuse, and mistreatment. There were also few legal safeguards in place to protect individuals from arbitrary confinement in madhouses. As a result, many individuals, including those deemed insane or simply perceived as troublesome by their families or communities, could be confined to madhouses against their will and without due process. Indeed, a parliamentary committee investigating the issue in 1763 found that a disturbingly high number of sane people had been locked away in private asylums for the financial or social benefit of their 'friends' and relatives.
The most notable case of wrongful confinement occurred in 1762 when a young woman named Mrs Hawley vanished after dining with a friend in London. Suspecting Hawley’s family may have confined her in a madhouse against her will, Hawley’s friend applied to the High Court for a writ of habeas corpus, a legal principle that protects against unlawful detention by requiring a person under arrest to be brought before a judge or into court. Initially refusing the request due to Hawley’s friend not being a relative, the High Court subsequently ordered a doctor to be sent to the madhouse to investigate. Having been refused entry, the doctor managed to speak to Mrs Hawley through a window and the writ was then granted. She was later discharged.
Following the Hawley affair, a select committee of the House of Commons was established by the Whig politician, Thomas Townshend, in 1763. Its aim was to investigate the problem of unlawful detention in private madhouses. The committee found that Hawley had been committed to the house solely on the word of her husband and that she had been unable to leave. The madhouse’s proprietor also freely admitted to investigators that he had not committed a single insane person in over six years. Finding that this situation was a common occurrence, the committee recognised that legislative regulation was needed.
While parliament ordered the committee to prepare a reformatory bill, it would not be brought forward for another ten years. Finally, in 1774, Thomas Townshend’s son (also called Thomas Townshend), reintroduced the Madhouses Bill, presenting it to the Commons on the 2 March. The bill was amended several times, eventually receiving royal assent on the 20 May.
The Madhouse Act featured several beneficial provisions, the primary one being the requirement that all madhouses now had to obtain a licence from the Royal College of Physicians, or a local magistrate, to operate legally. This licensing process aimed to provide oversight and accountability for the treatment of mentally ill individuals by empowering local authorities. It likewise sought to ensure adherence to specified standards of care. The act also established procedures for regular inspections of these facilities by appointed inspectors. Another key aspect of the legislation was that it prohibited the admission of patients without written consent provided by a magistrate or physician, thereby preventing arbitrary detention.
While progressive in theory, in practice the act was severely limited. One major issue was that the certification needed from a magistrate or a physician did not apply to individuals deemed ‘Paupers’—those who received relief from the government under the English Poor Laws. Importantly, paupers made up the majority of madhouse residents. Thus, their exclusion from medical certification restricted the act’s effectiveness. Furthermore, a parliamentary committee established in 1815 found that the licenses that madhouses needed to obtain were treated as little more than a formality and were not taken seriously. The committee also criticised the superficial nature of madhouse inspections and recommended that further legislation should be introduced. This came during the first half of the nineteenth century, which saw the passing of the Madhouse Act of 1828 and the Lunatics Act of 1845.
Despite its limitations, the Madhouse Act of 1774 represented a crucial first step towards recognising the rights of mentally ill individuals and regulating the institutions responsible for their care. It laid the groundwork for future reforms in mental health legislation and contributed to a gradual shift towards more humane and compassionate treatment of the mentally ill in Britain.
If you want to find out more about how mental illness was diagnosed and treated during the seventeenth and eighteenth centuries, please check out one of our fascinating collections of digital primary sources, namely Records from Bethlem Royal Hospital, 1559–1932. This features over 130,000 document images drawn from the records of this longstanding psychiatric facility. Sources include voluntary and criminal admission registers, discharge and death registers, male and female patient casebooks, minutes of the Court of Governors, and staff salary books.