When Robert Hayward and Andrew Heenan first entered the corridors of St Augustine’s Hospital for the mentally ill in the early 1970s, it was still often nicknamed the nuthouse, funny farm or loony bin.

The pair were aged just 18 and 20 and admit they were ill-prepared to start work at the former East Kent Lunatic Asylum near Canterbury, which at the time housed almost 1,200 patients across 36 wards.

Many of those ‘inmates’ had been incarcerated for several decades - the initial reasons often becoming blurred or past recall - where little to no contact with the outside world meant society had all but forgotten about the men and women condemned to spending a lifetime locked behind the institution’s walls.

On its wards, mistreatment and malpractice were “rife”, and while the use of straitjackets as a means to restrain people had been all but phased out a few years before, Robert and Andrew say physical violence from both staff and patients was notorious in some sections of the hospital.

Inmates were routinely over-medicated, sedated or sometimes left unsupervised in locked wards or rooms at night and new employees had little choice but to fall in line with the historic regimes and practices instilled by older, senior staff - all issues that would eventually come to be challenged by younger generations, whistleblowers and subsequent inquiries into the inner workings of many mental hospitals, including St Augustine’s.

These glimpses into institution life half a century ago - 30 years before the closure of most mental hospitals - and a desire to better document some of the many hundreds of patients Robert and Andrew encountered, prompted conversations in lockdown about collating a more personal account of the asylum and its inmates - a story now being published by the pair this spring.

“We were very young,” explains Robert, who was employed as a nursing assistant in January 1972.

“Almost anyone who came from the outside would be ill prepared. It was, as an 18-year-old, a shock to the system.

“It was my first real job. It was an eye-opener.”

Built in 1875 on a hilltop outside the village of Chartham, when Kent needed a second mental asylum to support its existing Maidstone facility, there were more than 400 workers - the majority nursing staff - when Robert and Andrew arrived almost a century later.

It was a time when controversial treatment practices were commonplace, and demeaning descriptions like “normal for Folkestone” or “normal for Thanet” were - somewhat unbelievably - still adopted as a means by which to refer to patients.

Robert, now aged 72, says there was little choice for new staff but to be subservient and admits, as trainees, you probably either “adapted or you left”.

The latter perhaps not an unlikely scenario when you listen to the graphic accounts of young workers like Robert, who on just his second day was instructed to help a third-year student nurse prepare for the electro-shock treatment of a dozen patients and then solely take charge of their recovery despite few qualifications to justify such immense responsibility.

The procedure - usually now referred to as electroconvulsive therapy - involves sending electric currents through a patient’s brain to induce a seizure.

A divisive treatment even today, guidance around its use is now more specific thanks to a greater understanding of the success of other treatments for conditions like depression.

However, 50 years ago, it was often routine treatment for all asylum patients, many of whom it may never have been suitable for.

Administered using mouth gags and sedation, Robert describes what he witnessed less than 48 hours into his new job.

“The patient was then told to lie on the bed, had her shoes removed and placed under the mattress at the bed end, and the rubber mouth gag inserted, the patient instructed to bite down upon it and then she was given the anaesthetic intravenously,” he wrote.

“Almost simultaneously, the doctor in a harsh guttural accent demanded the muscle relaxant that was handed to him by the SEN, and it was administered. After a brief pause the trolley with the ECT machine was edged forward, the two electrodes attached and, after further short pause, the voltage applied.

“On receiving the shock, the patient’s back arched, her visage turned to a grimace and her face went a deep red as she began a short series of convulsions lasting a few seconds.

“The twitching gradually subsided into a series of deep gasps and gurgling.”

With qualifications eventually under his belt, Robert left Chartham in 1975 to take up a nursing position at the Royal Free Hospital in London.

Andrew qualified as a mental health nurse in 1973, leaving the same year as Robert and initially going on to work as a registered general student nurse at the Kent and Canterbury Hospital.

Of the 21 staff who entered St Augustine’s at a roughly similar time to Robert, only four, he believes, ever completed their qualifications.

While the sights and sounds of the job no doubt bore down on those numbers, Robert says other societal issues such as the 1972 miners’ strike may have contributed to some absences as workers took the chance to abandon their hospital posts prematurely in favour of a return to the pits.

‘Certified lunatics’

In their early days, only ‘certified lunatics’ could ever be admitted to asylums for mental health treatment under the conditions of the 1890 Lunacy Act.

A status that usually served as a life sentence, it wasn’t until reform under the 1930 Mental Treatment Act that lunatics became patients, an asylum a hospital, and patients were able to be admitted on a more temporary basis.

However, when Andrew and Robert first took up their positions, there were inmates who had been brought to St Augustine’s under that now-outdated Victorian legislation.

This, combined with inpatients with more serious conditions, made for a varied cohort including some, suggests Robert, who actually “didn’t appear that unwell”.

There were women and girls on female-only wards who had conceived out of wedlock, where a charge of promiscuity had justified their incarceration.

They could be joined by the mistresses of once seemingly powerful people - locked up as a means to hide a problem alongside others similarly deemed a threat to “public order”.

Some characters, the pair recall, were simply of “low intelligence” or had learning disabilities, where next-to-no community care at that time condemned those deemed “too simple” for life on the outside to serving time alongside patients with more severe or aggressive symptoms.

Petty criminals, too, could be shipped from prison cells to St Augustine’s corridors if a fiery temper, aggressive incident or some other erratic behaviour meant an indefinite psychiatric diagnosis was handed down with their sentence.

And then there were the shell-shocked and nervous soldiers who also came to endure lengthy, if not near-permanent, stays on St Augustine’s geriatric wards as a result of service in one of the two world wars.

The admission of a former Japanese prisoner of war, whose depression was triggered several decades later when he failed in older age to pay the £46 in rates he owed Herne Bay Council, is among the tragic tales contributors highlight in Andrew and Robert’s book.

They also tell of the prolonged incarceration of six Polish soldiers, who more than 25 years after the war ended remained locked up on the outskirts of Canterbury “among some of the purportedly most disturbed or dangerous men in East Kent”.

Forgotten about, unclaimed or simply institutionalised hundreds of miles from home, accounts question why these men were never repatriated to their homeland and how they came to remain within the corridors of the asylum.

Robert, who went on to graduate with a BA in social psychology and social policy from the University of Kent in 1984, wrote: “Far from home and family, what did they make of this? Conversely, how did we allow this to happen and not rectify the situation in the quarter of a century since the war had ended?

“It didn’t make sense to me at the time, particularly as I felt that I had little to offer them in terms of the ‘therapeutic practice’ I was being taught in the school of nursing.

“If I had nothing to offer, (and I was not alone in this), then what was the point of it all? It was only at this juncture did I begin to really comprehend the primary functions of the institution – segregation and containment.”

‘A faceless collective dismissed by society’

Most inmates who saw out their lives in the institution in the 19th and 20th century would ultimately be buried on-site - often in unmarked graves - interred up to three in each plot.

After years of discussion, St Augustine’s was eventually scheduled for closure in 1993, when only about 200 patients remained at the facility.

Most of its buildings, although not the chapel, were demolished, and in the late 1990s, work began on redeveloping the area as a housing estate, which is still known as St Augustine's.

With few contemporaneous records of asylum life, and those in existence tending to focus on official documents usually unavailable to the public, Robert and Andrew feel such accounts seldom acknowledge those who spent their lives in the asylum.

Staff generally, they say, had little concern for the background of these patients.

But it is the part they played that has driven Robert and Andrew’s desire to “resurrect” those ghosts and place what little they, or others connected with the asylum, could remember of them and their experiences on record.

It’s something they’ve attempted to do alongside detailed discussion in their book about the legacy of the asylum system, how it continues to underpin health policies today and whether, ultimately, much has changed in society’s attitude towards those with long-term mental health problems.

“These people were a faceless collective who had been dismissed by society,” says Robert.

“We were the last people to see them and they shouldn’t be forgotten.

“We want to turn these people into human beings and reflect and ask have things changed that much?

“The sad thing is that the voices of the patients are not there. These people were largely anonymous.

“What we tried to do in the book is to present a human face to these people.

“It’s the voice that has been ignored by everyone.”

Asylum Years: Back to the Future? Glimpses of Institutional Life in the 1970s is published by Free Association Books and is available in paperback and as an e-book.