Obituary: Ronald Arthur ‘Sam’ Robinson, pioneer in old age psychiatry

Born: 18 April, 1924, in Holywood, Co Down. Died: 28 March, 2014, in Edinburgh, aged 89

Ronald Arthur Sam Robinson: Psychiatrist who revolutionised approach to the care of elderly patients

RONALD Arthur Robinson became affectionately known to all his colleagues and friends as “Sam” in the Fifties because his thick moustache looked like that of the bandleader Sam Costa. His family roots were in Lancashire, but his parents moved to Northern Ireland, and he was born in Holywood, County Down, where he formed lifelong enthusiasms for sailing and golf.

Sam attended Sullivan Upper School, Holywood where he developed another lifelong interest, rugby. His medical education at Queen’s University Belfast was interrupted when he volunteered for training as an RAF pilot, and was not completed until 1949. He later joked that his interest in medicine was fostered by believing doctors might be infallible, and when he found this was not the case he turned towards psychiatry, initially spending six months at Purdysburn Mental Hospital outside Belfast.

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He trained at the Crichton Royal Hospital in Dumfries, at the time a centre of excellence that had attracted leading psychiatrists, including Willy Mayer-Gross. Sam said Mayer-Gross directed his interests towards the care of older patients.

As a trainee he attended a conference on gerontology in London and was impressed by an Wisconsin psychiatrist Raphael Ginzberg who was advocating an eclectic approach to mental illness in old age, incorporating psychological and environmental approaches as well as physical treatments in what he called “attitude therapy”. His other stimulus came from a trainee research project on using electroencephalography examination (EEG) to distinguish dementia and other “organic” disorders in older patients from “functional” disorders such as depression and psychosis.

Sam had high hopes this would lead to more refined diagnostic tests. At the time the Crichton was trying out the idea of assessing older patients in the general admission wards, but this had only led to bed-blocking, so other solutions were being sought.

Sam formulated the idea of a specialist assessment and treatment ward for older patients, paralleling developments in geriatric medicine. He was given the chance to try this out as a new consultant, the ward opening in 1958. It was judged a success and he was allowed to continue to develop the service, opening a day hospital in 1964.

Sam made connections with those psychiatrists in England researching mental disorders in old age, such as Felix Post. The Crichton unit became the place to visit for those planning geriatric psychiatric services. He was an important member of the group of enthusiasts who developed what would become the Old Age Specialist Section (now Faculty) of the Royal College of Psychiatrists, eventually becoming its chair from 1978 to 1981. He spoke about his service around the UK and abroad, and published accounts in various journals and books including an influential World Health ­Organisation publication.

However, he was not a natural self-publicist and the ground-breaking nature of the Crichton unit did not achieve the recognition it deserved; it was the world’s first comprehensive psychogeriatric service. Another lasting element was Sam’s Crichton Behaviour Rating Scale which became used worldwide as a measure of the severity of psychiatric disability in older people. He maintained an interest in the field throughout his retirement and took a leading part in a Witness Seminar on the beginnings of Old Age Psychiatry in Glasgow in 2008.

Sam had more innovations in mind. When the late Jimmy Williamson was creating a specialist geriatric hospital in Edinburgh at the former Royal Victoria tuberculosis hospital, Jimmy wanted a psychiatric component to the service. Sam was appointed – some of his psychiatric colleagues were sceptical about joining forces with physicians – and he moved to Edinburgh in 1971 to a hospital still only half built. He was faced with an assessment ward, a day hospital in the old rec hall and four leaky wards in Bangour Village Hospital, 15 miles away, the old North Edinburgh asylum. Each ward had 75 older “back ward” patients, nursed in bed. But the plans for the rest of the RVH were in place, due to be completed in 1975.

From Sam’s point of view his ten years at the Royal Victoria were not all easy going. The health board planners were fully behind the new developments, but progress was slow and they didn’t seem to understand that a psychiatric patient might wish to be up and about during the day, so every inch of day space in the planned new buildings had to be fought for. As a “peripheral” unit it was sometimes difficult for the RVH to get high priority in the Edinburgh psychiatric world.

General hospitals sometimes seemed to treat both geriatric medicine and psychiatry as potential dumping grounds for the elderly unwanted; and his medical colleagues didn’t always see liaison between the two services in the way he did. The psychiatric section of the Royal Victoria buildings was not completed till 1984, three years after Sam retired; and it was many years later when the last older North Edinburgh patient returned from Bangour to Edinburgh.

But despite these frustrations the Royal Victoria Old Age Psychiatry unit was a major success. Sam was a respected leader, a fine trainer and teacher and a first-rate clinician.

And his great sense of humour always shone through his sometimes gruff exterior. The joint service worked for the great benefit of patients and was envied as a model other areas found difficult to emulate. It was an idea of co-ordinated and comprehensive care joining the specialties and the community together for the benefit of the patient. The joint hospital service at the Royal Victoria survived for about 30 years after Sam retired.

He retired in 1981, but did several locum jobs, including two years at St Brendan’s Hospital, Bermuda, where he found the problems of “sex, drugs and alcohol” a bewildering experience at first.

Sam married Freda McDowell shortly before moving to Dumfries in 1951 and they had two daughters, Geraldine and Susan, and one son, Peter. Family holidays involved sailing off the Dumfries coast, and Sam kept a chalet in Cardoness, which he was last able to visit in 2010.

In retirement he bought a house in Port Grimaud near Saint-Tropez, two doors from Joan Collins, but was never able to afford the larger boat he dreamed of. He indulged his passions of crosswords and fast driving. He became deeply involved in genealogical research, which formed the basis of Always Turn the Page, a family history compiled by his nephew, David Robinson.

Always a keen golfer he won the Lockerbie Senior Open in 1996, and continued to play, mainly at Dalmahoy near Edinburgh, till declining mobility led him to give up in 2007.

He and his wife had a rather up and down relationship and he lived the last 20 years on his own. But they kept in very regular touch and ended their days in the same block of flats in Morningside. Freda died in 2012. In 2009 Sam had developed shingles and became frail thereafter, suffering a number of falls. He spent considerable time in Astley Ainslie Hospital where his old colleague Jimmy Williamson was also a patient, so geriatrician and psychogeriatrician got together in the end.

Sam received excellent care at home and died in the Edinburgh Royal Infirmary. He is survived by his children and six grandchildren.