Implementing the 1913 Mental Deficiency Act:: Competing Priorities and Resource Constraint Evident in the South West of England before 1948

Abstract

Mental deficiency policy and practice remain controversial topics within the wider history of institutional and community care. While recent studies have highlighted emerging programmes of community care against a backdrop of fierce eugenic debates, this article focuses on the management of difficult cases within the mental deficiency sector. The Royal Western Counties Institution at Starcross, near Exeter, Devon, is used as a case study to draw attention to a serious conflict between new priorities for mental deficiency work following the 1913 Mental Deficiency Act and older traditions at one of the original five English voluntary idiot asylums. Controversial policies for selecting patients on the basis of class, gender, and grade of mental deficiency underline the importance ofboth continuity and change between nineteenth- and twentieth-century models of care. The often-difficult relationship that existed between the institution and the local authorities that financed it is explored in terms of guiding principles as well as exceptional cases. The control of women patients, especially their marriage and motherhood, emerges as a key concern for mental deficiency activists, but their care highlights diverging interests and real conflict over the management of mental deficiency as a legal, medical, social, moral, and eugenic problem.