Marcus Johns was the second clinical director of Gloucester House, following Margaret Collins. Marcus is well-spoken and considerate about what he says, but from the passion with which he speaks you’d scarcely imagine that it is 25 years since he retired.
He was at Gloucester House from 1975 to 1993 and is still angry about the impact of the savage cuts imposed by Mrs Thatcher, closing the ILEA and special schools across London, scattering the expertise of their staff to the wind.
Before becoming clinical director of Gloucester House Marcus was a clinician at the Child Guidance Training Centre, which at that time was based in the Tavistock Centre, but was a separate organisation to the Tavistock Clinic, with its own proud history. At that time the clinical work focused on child development from a number of perspectives: how the child grows in relation to its parents, how the child develops a social identity with other children, siblings and adults, and then going to school.
Marcus explained the theoretical background, saying, “There were a number of interlinked theoretical ideas: the growth of a child’s mind from a psychological and intellectual point of view, as outlined by Piaget, then the psychoanalytic background of Freud, Anna Freud, Melanie Klein, Donald Winnicott and, very important from the point of view of child development, John Bowlby and attachment theory.”
The referrals to the Day Unit came from schools, educational psychologists, social workers and of course other psychiatrists. Marcus explained, “Sometimes these were children who had been excluded from school, because of difficult behaviour, who couldn’t be contained in class, or the schools didn’t have the set up to look after them. Sometimes they came from a social worker who was looking after the family and thought the child was not flourishing or was becoming isolated, bullied, becoming withdrawn and depressed.
“The clinical work in those days was very varied. We had a wide range of children, some who were school-phobic through to children who were self-harming, sometimes were mute, sometimes were having psychotic delusions and some who were autistic. The education and clinical staff spanned this wide range. We enjoyed working together a great deal.”
The process at the school was to first see the children on an out-patient basis, and then, if suitable, the child would be invited for a visit to see how they would fit into the class and the Unit as a whole. The school had three classrooms, roughly split into age groups from five to eleven, with five or six children per class. Each class had a teacher and an assistant and their view of whether the child would do well was the most important part of whether or not the child the child was accepted. “Once a child had been accepted to the Unit we stayed with the child pretty much whatever the difficulties were. The staff were sometimes heroic in maintaining the child’s attendance at the Day Unit,” said Marcus.
“At that time we tried to maintain a very professional, but also a domestic attitude,” he went on. “We had a caretaker and his wife, who was the cook, and we prepared meals in the kitchen at the Day Unit. Some of the children hadn’t been used to sitting down with other people and having a meal, so every Friday all the staff, clinical, educational and the children ate together. This gave a very good feel to the place.”
Then, when the child improved, Marcus explained, “There would be reviews about the child and when we thought the child could go back to school at least part-time the educational psychologist, the social worker and the teachers would discuss with the receiving school how much they felt they could allow the child to attend. Then the child would start attending and might go back fulltime and leave the day unit.
“There were many moments at the Day Unit that were moving, because of the pleasure of some of the children when they felt they were getting better and found they weren’t having to do bits of behaviour that were compulsive actions.
“I remember one child, who as far as we could understand an elected mute, who came to the Day Unit and was probably there for 18 months and at the end of that time turned to me and said, ‘Thank you very much, I’m fine now. I want to go back to my ordinary school.’ And went back to their ordinary school and continued life in an ordinary way.
“Sometimes you never know what is quite going on a child’s mind, but having somewhere that is an environment that allows them to work things out in their own way is essential.”
Interview with Marcus Johns by Glenn Gossling, first published in In Mind magazine 2018