Nottingham Hospitals History


Duncan Macmillan

1902 - 1969

O.B.E., B.S.C., M.D., F.R.C.S. ED

Obituary, British Medical Journal, 10th January 1970

Duncan Macmillan was born on 20 March 1902, and was educated at the University of Edinburgh, graduating B.Sc with distinction in 1922 and M.B., Ch.B. in 1925. He proceeded M.D. in 1926 and took the M.R.C.P. Ed and the diploma in psychology in 1930. He was elected Fellow of the Royal College of Physicians (Edinburgh) in 1944. From the outset his main interest lay in psychiatry, and having worked for a time in Scotland he was appointed deputy superintendent of Mapperley Hospital in 1930 and later, in 1940, its physician superintendent. Here he remained until his retirement in 1966 and here he fulfilled his life's work. He was appointed O.B.E. in 1960.

The transformation of the traditional mental hospital into a community-centred health-centred, comprehensive psychiatric service, and the extension of the frontiers of psychiatry deep into the life of society, which Duncan Macmillan achieved at Mapperley, are too well-known to require description and have stimulated similar developments throughout the world. Less well-known are his great personal qualities. Those who have had the privilege of working with him have seen his utter and selfless devotion to the tasks he set himself, his unlimited desire to help, his infinite respect for the human personality. Although an outstanding administrator he was never detached from personal relationships. The centre of his thoughts was not just "the hospital," but each individual patient or member of the staff. He never spared himself and was always available when ever his help was sought by anybody – patient, friend, nurse, or colleague.


Personal reflections of Duncan Macmillan

Dr Alfred Minto

In the early 1950s, working in another mental hospital I often heard sceptical reference to what was going on at Mapperley in Nottingham. Duncan Macmillan had opened the doors of his hospital and was claiming that being mentally ill did not mean that patients should be locked up forever. Scathing reference to "revolving door" psychiatry paid little heed to his views that several short admissions are preferable to one long spell in hospital which breaks down all the ties with family and job.

If the community in Nottingham did not care about mental health in 1950 Duncan Macmillan made it care by pushing the problem into the full glare of every kind of publicity he could raise. Opening up the hospital, taking psychiatry into the home, the school, even the Industrial Rehabilitation Unit at Long Eaton – all these initiatives were his.

These were the ideas but what about the man? Clearly he must have had great personal courage and integrity to tackle the social pressures against the mentally ill as they existed twenty-five years ago. But what about the man – what was he like? Despite his achievements he was not personally well-known and meeting him for the first time in 1959 was a complete surprise. I had a picture in my mind of a driving bustling extrovert leading a revolution in mental hospital practice. In fact I found him slightly built, dark-suited, bespectacled with a meticulously trimmed moustache – neat, punctilious, precise in every way. His soft Highland accent and his very intent way of looking directly at me when he was speaking gave an impression of a detached, maybe even chilly, personality who could be difficult to get close to. That first impressions stayed with me for a long time and his reserved manner halted any real chance of knowing what lay behind this very polite, self-contained demeanour which virtually precluded any rapport.

To add to this problem colleagues appeared to stand in awe of him so that he was almost forced to remain a single-minded loner because he was so seldom challenged. His natural reserve was made more noticeable by the curious way he was isolated by these responses from other people. He was well aware of this and, when I got to know him better, he would often let slip a typical very dry shaft of humour about it. On one occasion I had to ask him why he had issued a particular order about drug dispensing after being told by nursing staff "Dr Macmillan has said so." He smiled in an almost expansive way and said this was an example of his name being used to support something he had never been asked about. Perhaps the special investment to power given to him by his staff was a help to them in developing lesser powers!

Beneath the reserved lay a very sharp mind, listening, sifting, judging and storing up ideas even when their application might be years away. He had real doggedness of purpose, and ability to bide his time in the working out of a lifelong plan to improve the lives of his patients. And they were "HIS" patients. He had a commitment to the care of mentally ill people that never wavered. If sometimes he seemed reluctant to let go of even small details I never felt that this was the autocrat ruling with a rod of iron – much more his conviction that it was his duty to see through whatever he had initiated. This strength of purpose after made him curiously remote from his staff perhaps because we were thinking of "today" whereas he was way ahead. His "action now" had been worked out in relation to many actions planned for five or six years ahead and sometimes it was difficult for the rest of us to keep up with the long-term plan.

My own recollection is of an elusive private man who only let us see inside him when we saw his personal vision in action – to restore mentally ill people to rightful place in society. I could always sends his steely purpose, occasionally see the flash of dry humour and just now and again be given a fascinating glimpse of his hopes for the future. Not, of course, the easiest people to work with because his own output and application were daunting to lesser mortals, but he was also keen to encourage those around him who wanted to try out new ideas. If these went wrong he never condemned but tried to sort out what had happened so that anything good in a scheme might be developed and expanded. At these times he was kindness itself and I have good cause to remember him for that.

Not many people leave a living monument to their drive and integrity and fewer still live to see a vision translated into working reality. Duncan Macmillan did all that. Mentally ill people throughout the world who have never even heard of him and his beloved Mapperley have benefited from his foresight and respect for the rights of the mentally ill. The quiet, reserved Scot was a genuine revolutionary who achieved so much, so quietly that I doubt we will see his like again. That is his true measure – a uniquely gifted psychiatrist who worked out a dream that has improved life immeasurably for mentally ill people and who gave his staff and inspiration that will last all our working lives. It was a great privilege to have known and worked with him.


Personal reflections of Duncan Macmillan

J. D. Smith, Sector Administrator (Psychiatric)

After six years in the Army during the Second World War, I felt the need to settle down in some useful occupation. By pure chance that occupation turned out to be at Mapperley Hospital. I consider myself fortunate in that I was privileged to be involved at Mapperley Hospital during the time that the greatest strides were being made not only in the treatment of mental illness but in the attitude to mental illness.

The one person, of course, who was responsible more than any other for an enlightened approach to mental illness at Mapperley Hospital was Dr Duncan Macmillan who used to ring me up on the 1st January each year and say: "Are the figures ready Mr Smith?" in a dark brown sugar voice followed by a chuckle.

He knew very well that these annual statistics could not possibly ready but it was his way of indicating firstly how much importance he placed on the statistics as a way of proving to the world that his policies were working and secondly emphasising how anxious he was to have them as soon as possible.

In a lecture tour to America in the 1950s he astonished his contemporaries thereby his explanations of 50 per cent reduction in beds, 100 per cent increases in short-term admissions and his development of care in the community. Many came to see for themselves! 20 years ago he said in an article in the Lancet "Evaluation of the benefits offered to the psychiatric patient by Community treatment must wait scientific appraisal, but its advantages are already sufficiently clear to justify a critical attitude towards rigid measures of long-term hospital treatment."

From that point onward everything possible was done to find alternatives to long-term hospital treatment in order to avoid two great dangers, (a) people becoming institutionalised and (b) losing their place in the Community.

Dr Macmillan was a stern man but a man with a sense of humour, a man whose whole life was dedicated to his work; the fair man but a firm man whose mind once made up, seldom changed. But one thing is certain: he made his mark at Mapperley as, 14 years after his retirement, few weeks pass without the name being heard.

Since the days when the hospital was a close-knit community, almost a village with its own farm, laundry, bakery, stores, shoemaker, upholsterer, tailor, plumbers, engineers, etc., there has always been evidence of a family spirit, all working together for the benefit of the patients – in modern terminology, multi-disciplinary management, but self-motivated. This is evident in the production of this history;-no one gave instructions, a body of interested people got together, researched it and produced the booklet. The staff are proud of their hospital and the progress that has been made over the last 100 years. I think it's true to say that the hospital is no longer the subject of local jokes and certainly no longer a place of fear. Many changes are still taking place and phasing out of the old mental hospitals is still under consideration, but let us hope that when those less fortunate than ourselves feel they cannot cope with the increasing pressures of our civilisation and all that can be done, has been done then there will be a secluded place where sympathetic people will understand and treat them as individuals in a place such as Mapperley Hospital.