'I have to-day seen all the 671 patients in residence in this institution': not listening to patients in the long 1920s.

In the 1920s, patients and former patients produced oral and written accounts of their mental hospital experiences. Many aimed to inform the public about the institutions and to improve standards of care, but their views were usually ignored. The assumption that mental disorders affected all aspects of a person's judgement, plus defensive and disparaging attitudes of hospital authorities and formal committees of inquiry, contributed to this. Various other public agendas, financial crises and rising unemployment detracted from the needs of mentally unwell people. Small improvements in care materialized, but lay, professional and institutional cultures generally preserved the status quo. Regarding learning from patients' feedback, some hurdles encountered in the 1920s resonate with challenges in today's National Health Service.