Boarding-out the insane, 1857-1913 : a study of the Scottish system
The pioneering policy of boarding-out harmless, chronic insane patients in the community was implemented formally by the Scottish Board of Lunacy in 1858, following the passage of the Lunacy (Scotland) Act, 1857. Up to 25% of registered pauper and private patients were boarded-out under the terms of this Act. Despite the innovative nature of the system, the number of patients involved and its marked impact on Scottish lunacy administration, the policy has received little systematic attention this century. This study undertakes, therefore, a detailed assessment of the nature of boarding-out, the demographic and clinical characteristics of patients, the status, role and responsibilities of guardians, and the extent and effect of official supervision. The system was endorsed firmly by the Scottish Commissioners in Lunacy, who advocated its widespread adoption throughout the country. However, despite official encouragement, boarding-out came under sustained attack from certain medical and parish officials and from the general public. Facilitated by extensive recourse to contemporary medical journals, official lunacy reports and parish records, this study assesses the beneficial aspects of the system, and in addition offers a critique of prevailing shortcomings. Physicians from across the world came to see boarding-out in practice. The nature and success of international family care policies, and the extent to which the Scottish system was imitated overseas, therefore, are considered. Boarding-out continued to be utilised in the 20th century, albeit with a gradual transformation in its nature. The changing nature of boarding-out is examined, and its gradual decline, and replacement by the less closely organised policy of community care explored, thereby enabling tentative analogies to be drawn between the two systems.