Pints, Pits and Psychology: Developing an Alcohol Service in a Mining Community

Yorkshire, photography by Jamie Davies.

I reflect on my early years as a newly qualified clinical psychologist working in a former coal-mining area of West Yorkshire at a time of major social and industrial change. Strong community ties, heavy drinking and the miners’ strike formed the backdrop to my work and shaped both the problems people brought to therapy and the services we tried to develop. What began as my attempt, as an outsider, to understand local drinking habits led to the creation of a community-based alcohol service and an early experiment in computerised self-assessment that was ahead of its time.

In 1981, I qualified as a clinical psychologist and started work at Pontefract General Infirmary (PGI) in West Yorkshire. The psychiatric unit had been recently built on a greenfield site, and this was the first time that Pontefract had had its own service. Until then, psychiatrists and psychologists had travelled from nearby Wakefield. Pontefract district was a largely rural area with small towns dominated by the coal mining industry, agriculture and the Ferrybridge power station. The dominant culture was that of the “pit villages.” There was a strong community spirit centred on the miners’ working men’s clubs, pubs and welfare institutions. From my outsider’s perspective, heavy drinking appeared to be the norm and strongly linked to the working culture. Like many students, I had spent time in the subsidised bar of the students’ union, but regular heavy drinking was not something I was familiar with, and I looked for a way to make sense of it. I developed my own “folk” hypothesis.

Coal mining is hard, hot, thirsty work, as I found out for myself when I visited the Prince of Wales colliery with a group of community psychiatric nurses from the unit. After a morning underground, during which I accepted the invitation to crawl along a working coal face next to a heavy piece of machinery graphically called a “ripper”, I coughed and sneezed coal dust for several hours. When we returned to the surface, the only thing that seemed to slake my thirst was a pint of draught beer. These were times when there was a culture of drinking at lunchtime during the working week. This may appear to be extraordinary nowadays in the public sector, but at the time, it was not only acceptable but common.

I had applied for the job in Pontefract because of the opportunity to be involved in establishing a new service and the potential to explore my interest in, and commitment to, community approaches. There were only two psychologists in the entire Health District: myself, and my supervisor/manager, Steve. Although our office happened to be located in the day hospital of the psychiatric unit, we were responsible for seeing patients from all specialities across the entire range of ages and service groups (adults, children, primary care, psychiatry, older people, health and learning disability). Quite a range for two people. Steve was a supportive colleague and teacher. Alongside his expertise and skill, however, he also brought something equally valuable and useful – local knowledge. He was from the local area and the son of a miner. It was through his eyes that I came to understand something of the local culture, social history and the role of heavy drinking. The Pontefract area, although part of the former West Riding of Yorkshire, was culturally aligned with the coal mining areas of South Yorkshire, particularly Barnsley and Doncaster, and many families and communities were strongly associated with the activities of the National Union of Mineworkers (NUM).

My early work in Pontefract was in the period leading up to, during and after the year-long national miners’ strike (1984-1985). This was the background to my clinical work and interests. Many of the unit staff were from mining families, and during some unrelated industrial action by hospital workers, the NUM had unofficially supported picket lines and brought sandwiches (“snap” in the local dialect), and NUM members were often casual visitors to the hospital offices. The normal professional boundaries between staff, patients and visitors were looser than I was used to from my clinical training. This was all unsurprising to Steve. He told me that prior to the opening of the infirmary, the only medical facilities locally were those built by public subscription and attached to the pits. The local community felt that they owned the hospital and were grateful for the medical care it provided. This context was to play its role in the development of the alcohol treatment service based at PGI. My primary role was to assess and treat patients referred by GPs, psychiatrists, and hospital doctors for a range of mental health problems, but mostly anxiety and depression. I saw patients in the hospital outpatient department and in GP surgeries. The experience of heavy drinking was regularly present in the consulting room, either as part of a mental health problem or in the stories I heard of heavy drinking in a family member. These individuals were not “addicts” who required admission for detoxification under medical supervision, but heavy drinkers whose consumption was considered normal by people in the local culture. They drank frequently and heavily, had relatively low levels of alcohol dependence, experienced poor health, used general hospital services more than average and did not receive professional help for their drinking. Their drinking was socially embedded within family and social settings, which generally approved or accepted heavy drinking. The pub or club constituted for many participants a very significant setting in their lives, and provided, for many, a real feeling of community. The only available alcohol service in the area was a meeting of Alcoholics Anonymous, which was held in the Methodist church hall. This was for “addicts” and promoted only abstinence, so I decided to bring together a team of staff to discuss how we might develop our own alcohol service with a different approach.

The treatment model we adopted was to provide a one-off intense experience (the “Drinkers Check-Up) followed by a weekly evening “Problem Drinkers Group” for six weeks, facilitated by one of our team. This was a psycho-educational programme with plenty of time for socialising and chatting. Ironically, after one meeting, I dropped into a pub on the way home and came across a couple of the members having a quiet pint!

My first automated version of an alcohol assessment tool was created at this time. The occasion was an open day held for the local community in the psychiatric unit. As a gimmick, I wrote a simple programme in BASIC (Beginners All-purpose Symbolic Instruction Code) for our psychology department’s BBC Acorn computer. This presented the questionnaires to members of the public who wished to have a go and assess their own drinking. It had novelty value if not great sophistication. This was the first ever example of a computerised interactive alcohol self-help program, as far as I am aware.