Whatever its flaws as an institution, my time in Whitchurch Hospital was a good place to learn what should be done—and even more importantly not done—in mental health care. I joined the academic unit on Ward E1 and moved with it, as a lecturer in the School of Medicine, when the new ward on A4 was opened at the University Hospital of Wales. By this time, around 1972, my marriage to Roger had ended and I was working with Professor Ken Rawnsley, with whom I later had my two wonderful children. When our son Rupert was born in 1973, it became apparent that there was no way I could continue working for Ken in the academic department and would have to find another job.

I thought a lot about my mother’s experiences as a psychoanalyst. My mother and I had not talked much about her work, something I greatly regretted as she had lived through interesting times and even worked for a while at the Maudsley Hospital in the late 1930s before WW2. From what I remembered, I felt that she had mixed her insights with a good deal of common sense and full medical knowledge as a doctor, unusual for those early times. Back then, the rift valley between the various (quarrelling) schools of psychoanalysis and the NHS ‘working’ psychiatrists was often impassable. Being under-confident, my mother never rated her eclectic, sensible approach as highly as she should have, being disowned by both sides.

To a minor extent, this happened to me too. Looking back to my time as a junior psychiatrist, before I met Ken, I realise that I should have been treated as something of a catch at work; bright, very interested in the specialty, caring of patients and extremely hardworking. Mind you, the standards overall were not high, but I know from Ken—though from nobody else—that I shone like a star. I don’t remember any effort to keep me in the specialty and although sexism was far less obvious than in general medicine and surgery, I suspect it played a part. I never felt like a star!

Looking back, I also realise that it would have been difficult for me to give up work altogether, even though I always felt bad about leaving my children’s care to others. I was still, of course, very sensitive about the loss of my firstborn. Going back to work and psychiatric training after his loss had not only filled a void but restored and healed me. I did not dare trust myself to look after him without being a smotheringly anxious mother. Thanks to a knowledgeable contact, I found a carer I could trust in Pam, later known as ‘Mummy Pam’, and I could relax at work in the day, then come back to collect Rupert after work.

Ken was—as he always proved to be—wonderfully supportive of whatever I wanted. “Why don’t you go and see Andy Wills?” he suggested. Andy was the consultant in child and family psychiatry in Gwent, and Ken and he had been involved in some NHS problems a few years earlier. They thought highly of each other and I found that Andy and I got on famously. He enthusiastically wangled some funding to take me on as a clinical assistant for two days a week. I later also got two sessions as a consultant child psychiatrist at the education department in Cardiff, working at the North Road Clinic and then one day a fortnight as a consultant to social services at Ty Mawr, a ‘special school for delinquents’ near Abergavenny. Later on, I added another fortnightly day with a charity school for children with cerebral palsy, then known as the Spastics Society.

I was therefore regarded and paid as an ‘expert’ in child mental health in some of my posts, but really I knew little and had to hit the ground running. So in my time with Andy I was getting a speedy and marvellously useful apprenticeship type of training, although it was in a post in which I was not meant to have either training or expertise! Such were the oddities of the system in those days.

Andy Wills had been a GP in the Aberfan area during the tragedy there and had changed to train in psychiatry afterwards, partly as a result of seeing the effects of the long-term trauma. I watched him work with the new and ragged team of nurses, occupational therapists, social workers, psychologists and others in trying to set up a completely new inpatient service for children and adolescents in the grounds of St Cadoc’s Psychiatric Hospital in Caerleon. He had a facility for younger children in an old house called Pollards Well with a brand new build, Ty Bryn, as a residential unit, both with full-time teachers as well as nursing and other staff.

This necessitated a huge cultural change of outlook for the adult services in St Cadocs, in which we were mostly lucky to have good support from our psychiatric colleagues, as well as some very enlightened nursing and management staff. But this was all against the huge inertia of the institutional attitudes of the majority at that time—often a nightmare to deal with.

In my sessions with Andy Wills, as his assistant, I was drinking in his tales of children and families he had worked with. I knew I was getting first-class training and a far more compassionate look at the world than even I had felt up till now. He involved me in building up the new adolescent unit from 1974. I was to stick with Caerleon, with short gaps after Amanda’s birth and for my first year of retirement, for the next 30 years.

Two little anecdotes about Andy can best describe his approach. Very early on, just as we were developing the inpatient service, the agitated and upset staff told him that a boy who had run away from our unit had been picked up by the police and just returned to us. It was—I regret to say—then and for many years after, common for such children to be punished severely, even beaten if in social care. Andy sat back and drew on his pipe.

“Has he had any breakfast?” he said. The nurse sputtered a negative. “Well, when you’ve fed him, perhaps you, Dr Kapp, would have a word with him and see what the problem is?” he said.

He knew he could rely on me to take a kindly approach and the nurses soon learnt. Those who didn’t like it were gradually weeded out until we had a really good service. But I too needed lessons. Another early case was a young girl he had visited at her home. She had shut herself in the bathroom and wouldn’t speak to him. I thought I was doing well when I persisted in visiting for three weeks running, sitting on the floor in the corridor and talking gently to the locked door before telling Andy Wills, my boss, that I was not getting anywhere.

He made no comment other than to tell me to leave it with him. Some months later I found that he had patiently gone back every week until eventually she had opened the door and listened to him, but with her hair down over her face, never saying a word. It took many more weeks before she—literally—began to show her face, to reply to him and then start attending our unit daily. She made a very good recovery.

“I gave up much too soon, didn’t I?” I said, very chastened. He sucked on his pipe for a moment. “Maybe,” was all he said, eyes twinkling. You never forget a lesson so slowly and kindly given.

Oh, how I envied that pipe smoking as a ploy! He was noted for quietly drawing at it in ward meetings, buying time, then coming out with something so deep and with such a kind understanding of the problems of troubled teenagers that his leadership was unquestionable.

Of course, I read the textbooks and followed the child psychiatry research in the journals. Most of all though, I learnt from each family who came into my orbit. My rather hit-and-miss collection of posts provided a very good range in practice.

The clinic in North Road, though paid for by the education department, was very traditional. Each of the three teams had a medically trained doctor/psychiatrist, a social worker and a psychologist. We would usually see two or three children in each session, with an hour each and some time for discussion; usually the social worker would see the parents while I did a play session with the child. The clinics were bright, spacious and very well equipped with toys, particularly sand and water. I learnt how to play and observe, something I missed when working in small NHS hospital clinics with no toys.

In Pollards Well, the children’s unit in Caerleon, the nurses and occupational therapists did most of the hands-on playing, but at least I had the basis for discussing what they did and helping to train some of them.

I cannot overestimate the amount you can learn from taking the most disturbed teenagers in your county into a psychiatric unit and running a full-time psychiatric residential and day service for them for a few years. You learn amazingly ingenious methods of avoidance, delinquency, disruption and a whole new vocabulary from these youngsters. Things that your own average teenage children could only gasp at.

Never a dull moment, I assure you—and if I didn’t quite love every minute of it, I cannot think of anything that would give me more job satisfaction or was more rewarding and team-building for us all. Also the pleasure many, many years later when the local staff say to you “remember so-and-so? I ran into him/her the other day” and you hear that the troubled teenager is now educated, married, working, successful, happy or—at the very least—alive and functioning. Or maybe a smart young man fills your car with petrol or a smiling woman serves you in a posh shop, or someone with a car full of kids pulls up at the lights and they say “remember me?”.