Tom Main became the medical director of the Cassel Hospital in the 1940s. He brought from his experience as an army psychiatrist the belief that the hospital itself could be a powerful therapeutic tool for helping patients who had neurotic difficulties.

Tom Main pointed out that the usual concept of a “hospital as a refuge too often means that patients are robbed of their status as responsible human beings.” (Main, Tom, in Barnes E 1968 Psychosocial Nursing) Instead, patients at the Cassel Hospital were encouraged to be active members of a community, and staff played a mainly supportive role helping patients to have real jobs and responsibilities. These responsibilities covered the areas of emotional care, housekeeping, childcare and leisure activities.

For most of its history, the hospital was divided into three units, offering in-patient treatment for families, single adults and adolescents, each unit having its own staff of nurses and psychotherapists. The Cassel Hospital gained a reputation for helping troubled families to parent their children, as well as for treating individuals through life in the community.

Much of the daily support, challenge and care of patients was provided by other patients. Daily community meetings could be focused on both sorting out rotas for the community and providing emotional support. If a patient was very troubled in the evening, a patient representative might call a meeting and together with the night nurse and the troubled patient, work out a way of providing support through the night.

Since domestic staff were not employed to clean bedrooms, dining room and kitchen and there was no professional cook after lunchtime, the patients and nurses took joint responsibility to plan for and cook suppers and to keep patient areas clean.

Relationships based in work responsibilities are likely to be different from those that form in less active contexts. Nurses were trained to work alongside patients, helping them with the practical tasks necessary for the life of the community, as well as collaborating with the clinicians who provided individual psychotherapy in thinking about their emotional problems.

The Cassel Hospital in-house training and qualification in Psychosocial Nursing was developed by Doreen Waddell and Tom Main in the late 1940s, and provided modules in experiential learning, theoretical understanding and research.

The Cassel Nursing Approach is further illustrated in “Face to Face with Distress” Edited by E.Barnes,P. Griffiths,J. Ord and D. Wells: Butterworth Heinemann 1998