Mental Hygiene ASSOCIATION WITH GENERAL HOSPITALS

Press, Volume C, Issue 29509, 10 May 1961, Page 14

Mental Hygiene ASSOCIATION WITH GENERAL HOSPITALS

(From a Medical Correspondent J

Unbeknown as yet to most people, one of the most exciting advances in modern medicine is now gaining speed overseas. The mental hospital, one of the few safe and solid permanancies left from the Victorians, is reaching the end of its days. This prospect is no longer invisible to all but a handful of visionaries in the field of psychiatry, but has come clearly into focus for hardened administrators in Britain and America, whose task is to plan ahead for the health services. In New Zealand, meanwhile, a building programme in mental hospitals still continues along lines decided years ago; it is a way of spending millions which the citizen must surely begin to question. It has already been questioned tn the medical profession for some time, and in open fashion in 1959 when the B.MA published the Burns Report, criticising some of these wasteful and out-of-date schemes. So far. neither a Labour nor a National Government has shown any sign of altering the course to which the taxpayer has been perforce subscribing, nor will they dp so unless the voter (or

the Finance Minister) acquires an interest in it A few weeks ago in London. the Minister of Health disclosed that an official target was to reduce mental hospital accommodation by one half in 16 years. His expert advisers indicate that, with the promotion of alternative psychiatric services which is now firmly in hand as well, the Government has chosen a dramatic target which really it cannot miss. In 20 years’ time, whatever is left of mental hospitals in Britain’s provisions for the mentally sick will be so diminished and altered as to be unrecognisable. In the post-war period, a new optimism in psychiatry began to overtake the traditionally stagnant lunatic asylum. It underwent reforms which changed it (in more than name) from a custodial institution to a psychiatric hospital. In fact, the transformation in a few short years which the pioneers achieved was so remarkable that the World Health Organisation in 1953 endorsed their methods and experience for the benefit of hospital planners everywhere. But the change has not stopped there, and the modern mental hospital, as described by W.H.O. in 1953, and still by no means fully realised in New Zealand in spite of praiseworthy efforts, will soon itself be out of date. The turn of the tide was first seen in Britain in 1955. In that year, the everincreasing resident population of mental hospitals came to a halt and declined for the first time. By 1959, this population had fallen by 15.000 from the peak of 149,000 reached in 1954. Tn the United States, there is parallel if perhaps slower progress, and in 1956 there was a similar drop of 7400 to which every year since is adding. The president of the American Psychiatric Association in 1958 declared that all mental hospital building should “cease forthwith.” Now, in April, 1961. Dr. Geoffrey Tooth, principal medical officer of the Min. istry of Health in London, has made public the startling calculations for the future which are plainly guiding health service plans and policies there. The size of mental hospitals, he shows, has been determined in the past by the number of the sick who become chronic and were never discharged, and who constituted a mass of long-stay residents. Nowadays in Britain, he points out, admissions are steadily proving briefer in duration so that this long-stay institutional population is running down at a rate which will eliminate it in 18 years. By that time, the number of hospital beds of all types needed for the mentally sick will have fallen to 1800 per million, and in New Zealand.- this would mean a drop in mental hospital patients from their present number of about 11,000 on the registers to under 5000. However, this is only part of the picture. The 1959 Mental Health Act in Britain completely scrapped the time-honoured laws relating to mental illness, abolished the legal separateness of mental hospitals, and drastically restricted certification and other procedures based on compulsion. Professor Curran, a London psychiatrist who visited this country recently, reported that the plan which this now makes possible in Britain, is to reserve one bed m every 10 in ordinary hospitals, where sick people in general are treated, for the treatment of psychiatric patients as well This means that the reouirement of 1800 beds per million now anticipated for the mentally ill will, to a considerable extent. be met in general hospitals with psychiatric de. oartments. and not in the form of mental hospital accommodation at all A similar policy tn New Zealand would end tn a few years the segregation which by custom is tolerated too easily between people w‘h sick bodies and their neighbours with sick minds.