Mental Health Treatment in York: A Historical Journey

In a fascinating conversation with Gary Brannan (Goodricke, 2004), Keeper of the Archives at York, we explore the city’s pivotal role in the history of mental health care. From the founding of York’s first asylum in 1777 to the groundbreaking work at the York Retreat, Gary sheds light on how York’s institutions shaped modern mental health treatment and the lives they touched.

“Many may not realise that mental health care has been one of York’s longest-standing contributions to public service. In fact, York’s history of mental health treatment stretches back over two centuries, making it one of the most significant locations for understanding the evolution of mental health services in Britain.

What makes York’s mental health history remarkable is not just the duration of its involvement but how it has both reflected and shaped broader societal attitudes and medical practices. From the establishment of the York County Asylum in the late 18th century to the groundbreaking work at the York Retreat, York has consistently played a role in influencing mental health care at both a local and national level. The story of mental health care in this city is one of gradual progress, marked by both setbacks and innovations, but always underscored by a dedication to understanding and improving the human condition.

The history of institutional mental health care in York began in 1777 with the admission of the first patients to  the York County Asylum. This establishment was part of a wider movement in England that sought to provide care for individuals deemed mentally ill – what would then have been referred to as “lunatics” under a harsh societal lens that stigmatised those who suffered from mental illness. However, it’s important to remember that mental health care has existed informally for much longer, both within family settings and through various forms of “indoor” and “outdoor” relief for the poor.

The founding of the York County Asylum came at a time when medical science had not yet reached the point where specific medical causes could be pinpointed; instead, the focus was on treating the symptoms. People were admitted for a range of conditions – what we might today recognise as postnatal depression, epilepsy, or mental breakdowns. Even more complicated cases like tertiary syphilis, dementia, or other congenital conditions found their way into York’s asylums.

For all its progressive intentions, the York County Asylum was not without its failings. By the 1790s, the institution had become notorious for providing preferential treatment to wealthier patients, while those without means often received subpar care. The death of Hannah Mills, a Quaker woman whose fellow Quakers were denied access to her before she died in Bootham, triggered a scandal that would reverberate throughout the city and lead to significant changes in the way mental health treatment was approached.

In 1796, out of the discontent with the state of mental health care in York, the Quaker community established the York Retreat. This institution was revolutionary for its time, offering a model of care that, rather than focusing on incarceration and control, sought to provide a peaceful and therapeutic environment where patients could recuperate away from the stresses of daily life.

The York Retreat became famous for its approach, which we might now describe as a precursor to modern-day mental health retreats. Patients were encouraged to engage in outdoor activities, and emphasis was placed on creating a calm, supportive atmosphere. The philosophy behind the Retreat was rooted in the Quaker belief in the “inner light” – the idea that all people, regardless of their circumstances, possess an inherent goodness that can be nurtured.

The contrast between the Retreat and the harsher realities of asylums like Bootham was stark. The Retreat took a gentler approach, and while it primarily catered to private patients, its methods would influence mental health care more broadly. It became known as a place where patients could receive treatment focused on their well-being rather than simply removing them from society. Though this model was seen as radical at the time, it is now celebrated as pioneering.

By the 19th century, York saw a further expansion of mental health services with the opening of Clifton Hospital in 1844, originally known as the North and East Riding Pauper Lunatic Asylum. This was followed by the establishment of the York City Asylum at Naburn in 1906. Both of these institutions were built to accommodate the growing number of people in need of mental health care, and both catered primarily to those who could not afford private care.

These new institutions were part of a broader trend in the Victorian era, which saw the creation of large public asylums to house the mentally ill. The rationale behind these asylums was to provide a space where people could be cared for away from the general population. However, as time went on, the sheer size and scale of these institutions became problematic, and many patients found themselves in long-term care with little hope of recovery.

This trend would eventually reverse in the mid-20th century, as mental health care shifted towards more community-based models. As medical science advanced and new treatments became available, the focus shifted from institutionalisation to rehabilitation and reintegration into society. York’s hospitals began to close, with Clifton Hospital shutting its doors in 1999, followed by the Retreat ceasing inpatient services in 2023. Today, only Foss Park Hospital remains, reflecting a new era of mental health care based on more modern principles.

“As I look back on the long history of mental health care in York, I’m struck by how far we have come – and how much more work remains to be done.”

The evolution of mental health care in York mirrors the broader changes in mental health treatment across the UK. Throughout the 20th century, new medical interventions were introduced, including the use of drugs and electroconvulsive therapy (ECT). Many of these treatments, while seen as groundbreaking at the time, are now viewed with scepticism or have been discarded altogether due to their severe and often irreversible side effects.

Yet, there were also significant advances during this period. Occupational therapy became an important part of mental health treatment, as did talking therapies, which provided patients with an outlet to discuss their problems in a safe and supportive environment. The goal of mental health care began to shift away from simply isolating patients to helping them recover and, when possible, reintegrate into society.

One of the most significant milestones in the history of mental health care was the move towards “care in the community” in the 1960s and 1970s. This policy shift recognised that many people with mental health conditions could live relatively normal lives with the right support and no longer needed to be confined to institutions. This was a turning point in mental health care, as it opened up new possibilities for treatment and allowed people to maintain their autonomy.

While this shift away from asylums was seen as progress, it also had unintended consequences. With the closure of large institutions, the visibility of mental health patients in society increased. This was a positive development for some, allowing them to live more independent lives. For others, however, the lack of institutional support led to increased isolation and difficulty accessing the care they needed. This remains a challenge in mental health care today.

Several key figures have played important roles in shaping mental health care in York. Among them are William and Samuel Tuke, the Quakers responsible for founding the York Retreat. Their work laid the groundwork for many of the advances in mental health care that followed, particularly their emphasis on humane treatment and respect for patients’ dignity.

Another important figure is Bedford Pierce, who served as the medical superintendent of the York Retreat from 1892 to 1922. Under his leadership, the Retreat introduced more formalised training for mental health nurses and helped to professionalise mental health care. Pierce was instrumental in bringing about many reforms defining 20th-century mental health care, including a greater emphasis on psychotherapy and patient-centred care.

The Retreat itself also played a role in the development of restraint methods. In the 18th century, for example, the Retreat introduced padded restraints made from horsehair, leather and canvas to prevent patients from harming themselves. This stood in stark contrast to the metal manacles used at other asylums, highlighting the more compassionate approach that the Retreat was known for.

As I look back on the long history of mental health care in York, I’m struck by how far we have come – and how much more work remains to be done. The city’s legacy in this field is both inspiring and sobering. On the one hand, York has been at the forefront of many positive changes in mental health care, from the early innovations of the Retreat to the modern-day focus on community-based treatment. On the other hand, the history of mental health care is also a reminder of the stigmas and challenges that people with mental health conditions have faced and continue to face.

Today, the archives here at York hold a wealth of information that sheds light on the experiences of those who lived through these systems. These records are more than just documents – they are the stories of real people, each with their own struggles, triumphs, and challenges. As we move forward in understanding mental health, it is crucial that we continue to learn from the past, recognising both the successes and the shortcomings of those who came before us.

The evolution of mental health care is ongoing, and while we have made great strides, there is still much work to be done to ensure that everyone has access to the care they need.

In preserving these stories, we are not just looking back; we are also looking forward with the hope that future generations will continue to build on the foundations laid by those who came before. York’s legacy in mental health care is one of resilience, compassion, and understanding, and it is a legacy that I am proud to be part of.”

Help support the Mentally Fit York fund by taking part in the Great York Walk Saturday 17th May 2025.  You can read more about the Mentally Fit York fund on the Mentally Fit York fund page. 

This article was first published in 2025. Mentally Fit York is now known as York Mental Health Research Fund.