Moral Management in Mental Health Institutions in the British Colonial West Indies

Moral management with its three main elements – classification of patients according to the nature of their mental disorder, elimination of mechanical restraint, and employment and occupation of patients – was the basis of mental healthcare in Britain in the nineteenth century. Despite consistent doubts about its effectiveness, moral management was implemented throughout the British West Indies following a scandal in Jamaica. Based on annual reports submitted by British West Indies colonies, we created a cross-colony time-varying dataset of mental healthcare practices and patient outcomes from 1869 to 1942 to study the implementation of moral management and its success in the West Indies. Regression analyses reveal the importance of employment, religious services, and female attendants in reducing deaths and increasing cures among patients. Physical restraint, which was still used despite being discouraged, had positive effects on survival and cures among patients.