Psychiatric Treatment Outside Mental Hospitals

Extract

In this discussion of psychiatry outside mental hospitals, it is proposed to deal mainly with the field of psychiatry inside general hospitals. The idea of in-patient psychiatric beds in the general hospitals is certainly not new, and was tried out between the last two wars. One of the factors responsible for failure was a lack of effective therapeutics. Thus the comparatively small number of beds available were occupied for periods too long for ordinary general hospital practice, and facilities to ease long-term admission in occupational and social directions were usually lacking. The situation has not substantially changed from that described by Weir Mitchell, who caustically remarked that psychiatrists pleaded for opportunity to treat the early case, but when the plea was granted there was little that could be done. In the last few years advances in both psychological and physical methods have reached a point where certain categories at least of mental illness can be considerably helped by admission to a general hospital psychiatric unit, and be discharged in a period comparable to that usual in general medical wards. A report made in 1943 by the author at Sutton Emergency Hospital, and later, social studies by Brown and Carling, 1945, at the Radcliff Infirmary, Oxford, showed that the six weeks' average stay of the psychiatric in-patients was less than the average for medical patients of a general ward. It was not just a matter of performing a little diagnostic investigation and then transferring the patient elsewhere. In fact less than 8 per cent. of these psychiatric patients were sent to other hospitals. The full figures for a year's admissions are available in the 1943 report.