Some will claim that the occurrence of the Chelmsford scandal happened only because a single psychiatrist was following a particular treatment philosophy. It this was true, then it would have been relatively easy for people close to Bailey, to report and put and end to these actions however. Therefore, the failure from both medical and governmental hierarchies to act appropriately upon received information, was one of the main reasons to why deep sleep therapy could go on. Overall, while individuals can be blamed for establishing the situation at Chelmsford, there were inadequate structures to prevent patient abuses, indicating that the problem was a concern for psychiatry as a whole.
Professional isolation was another important reason to why the Chelmsford scandal could happen. The doctors at Chelmsford were to a large degree isolated from the rest of psychiatry, which prevented criticism of the methods being used. As it was a private hospital, there was not anyone to question the practices except for nurses, which lacked such qualifications (Wilson 2003:126). There was further a lack of peer reviewing and scrutiny of the methods being used at Chelmsford, but those who disapproved of the methods could only protest through a meager withdrawal of support. On a larger scale it was not only Chelmsford that experienced isolation, psychiatry as a whole also suffered from being distanced from general medicine (Wilson 2003:122). Overall, this isolation allowed treatment that was both dangerous and outmoded to continue at Chelmsford.
Moreover, there was a lack of an enforceable code of psychiatric ethics at the time. So, even though some people were aware of problems and complained about the situation, there was not much that could be done about it. The Royal Australian and New Zealand College of Psychiatrists (RANZCP), which were supposed to be a regulatory instance, did not have any power to discipline its members. This meant that there was a lack of power to stop existing abuses within the profession. Additionally, the Health Department did not take any action, even though they had been made aware of problems and were in possession of evidence that doctors at Chelmsford were acting unethical and unprofessional (Wilson 2003:125). On the contrary, the Health Department actually failed to find any inadequacies of patient care during their regular visits.
A further problem with treatment of mental illness is that the causes are often not fully understood. This makes it easier for psychiatrists to get away with unproven methods, as it is hard for rivals to discredit this information. As psychiatrists treat problems with the brain, their authority over patients can be huge, often leaving them with few options but to trust the treatment they are offered. Additionally, complaints from patients at mental hospitals are less likely to be believed, due to their perceived lack of credibility (Foucault 1965). This often makes it difficult for a case to make it through the legal system. Overall, the strong hierarchy within mental institutions and the lack of patients’ credibility meant that the deep sleep treatment could continue.
Psychiatry as a whole was very wary of criticizing its own members at the time the scandal occurred, as the profession struggled with low credibility due to a series of scandals. The former inclusion of homosexuality as a mental illness was a case that led to great embarrassment for the profession and questioned its diagnostic reliability, as it showed that psychiatric diagnoses were wrapped up in social constructions of deviance. The Rosenhan study, where 19 normal people got admitted into mental institutions with a diagnosis of schizophrenia, brought further discredit to the profession. People from within were therefore discouraged from speaking up about complaints, as it could discredit psychiatry amongst the public (Wilson 1993:404). Overall, it therefore seemed like professionals were more concerned about protecting individual and psychiatry’s reputation, than with preventing abuses.
A further practice that allowed Chelmsford to continue deep sleep therapy, was the deliberate cover up of what was going on. Chelmsford’s failure to follow and enforce existing rules was concealed by falsification of papers (Geason 2007). Bailey did for example provide signatures on blank forms, which later could be used by nurses to prescribe drugs that should have been authorized by a doctor. Furthermore, death certificates were falsified and deaths were covered up, to prevent inquests from the coroner, which could have revealed patient abuse (Bromberger and Fife-Yeomans 1991). That Chelmsford was able to falsify papers on a large scale shows further evidence of the apparent inadequacies in psychiatry from preventing abuse from happening.
This lack of regulation and rules within psychiatry meant that the media and persistent individuals were necessary to uncover the story. This ultimately led to a Royal Commission, which later pointed to the failure of both peer reviewing and coronial inquests. Overall, both a faltering system and other individuals assisted Bailey. There was inadequate administration, laws and regulations on the treatment of mental illness and a poor policing of the system. The coronial system failed and the psychiatric profession was both unable and unwilling to criticize colleagues. The Chelmsford scandal was therefore possible due to a systemic failure in psychiatry, in combination with incompetence, apathy and collaboration of a handful of individuals.
