Neurosis and the Mental Health Services
- Type:
Reviews
- Author:
Blacker, M.A., M.D., F.R.C.P. With a Foreword
by Sir Wilson Jameson, K.C.B., M.D., LL.D., F.R.C.P. Pp. 200. Oxford Medical Publications. 20s. net.
This is the most valuable survey in relation to outpatient mental health services in the country that has been made so far. It was prepared with the object of finding out what psychiatric out-patient facilities existed in England and Wales, whether these were adequate, and also whether there had been an increase in neurosis among the civilian population as a result of war conditions. The work was begun in October of 1942 and its ulterior purpose was related to the integration of the country’s Health Services after the war.
The survey, which was officially sponsored by the Ministry of Health, was carried out in each of the eleven Civil Defence Regions of England and Wales by Regional Investigators who were assisted in their task by the Regional Representatives of the Provisional National Council for Mental Health, by two Inspectors loaned by the Board of Control, and by the Psychiatric Social Worker of Cefn Coed Hospital, Swansea. A questionnaire was circulated to 216 clinics ; of these 186 responded, and 145 gave information on all the questions asked. The survey revealed not only the need for a greater number of out-patient psychiatric clinics, but also considerable inequalities in the distribution of facilities throughout-the country. The south of England was better served than the north: the aggregate number of clinics per million of population in the two regions in the North, i.e. Region I (comprising Northumberland, Durham, and the North Riding of Yorkshire) and Region X (comprising Cheshire, Cumberland, Lancashire and Westmorland) was 3-74; the corresponding figure for the three regions which form the south coast was 7-75. Of a total of 101 Mental Hospitals, 25 had not established psychiatric clinics.
It was possible to classify 45,201 new patients in terms of diagnosis?neurosis, psychosis and ” other The figures showed that in 1942 the London clinics dealt with the largest proportion of neurotics and the smallest proportion of psychotics; the reverse was the case in the provinces. Figures of clinics outside London for 1942, when compared with those for 1938, showed a rise in the proportion of neurotics and a fall in those for psychotics, which suggested that clinics were increasingly dealing with mild or early cases, and that general practitioners are as a whole gaining confidence in the services provided by such clinics and are recognizing their usefulness.
The neurosis survey produced figures for four years, of which the last was 1942. No comparable data are available for later years, so there is no means of knowing if the trends described in the survey have been continued or reversed. The majority of the Directors of clinics who expressed definite views on the subject, held that there existed in the civilian population latent neurosis likely to disclose itself after the war. Dr Blacker is of the opinion that ” well-grounded generalizations about . real trends of neurosis will not be possible until diagnostic and therapeutic standards are clearer and also more widely understood ” than they are at the present time.
Not only does the book give a complete picture of existing out-patient facilities, but Dr Blacker also submits proposals for the organization of mental health services dealing with the kind of provision that we want and the scale on which it needs to be supplied. One of the most valuable chapters contains suggestions for dealing with a population of a million treated as an administrative unit. A hundred beds per million population should, for a start, it is suggested, be provided outside Mental Hospitals for psychiatric cases, either in Teaching Psychiatric Units which form part of Teaching Hospitals of University Medical Schools, or in non-teaching units located in key towns. Over and above this provision, additional psychiatric beds should be made available in whatever ways are deemed appropriate in view of local conditions and impending changes in procedure for cases now admitted into observation wards. Child Guidance Centres, established by Education Authorities, at the minimum rate of one for every 20,000 children are advocated and also three or four Child Psychiatric Clinics per million population to form part of a central psychiatric clinic under the Mental Health Services. Other recommendations include a hostel for about fifty unstable or difficult children in close association with the most active child psychiatric clinic, and a children’s reception centre for the sorting and appropriate disposal of homeless or destitute children. Accommodation in Mental Hospitals should be suited to needs and staffs increased, and colonies for mental defectives should be provided on an adequate scale. Provision should also be made for some 4,000 persons who will need community care.
There is a section dealing with neurosis in industry with suggestions for facilitating adjustment to industrial life and recommendations regarding the continuance of the Rest-Break Service, started as an emergency measure during the war, and a careful system of selection of foremen, heads of offices, works’ managers, welfare workers, and others in order to lessen avoidable stresses among workers.
The factual results of the survey and a discussion of their implications are to be found in Parts 1 and 4. Part 2 contains the long term proposals for post-war psychiatric services. These are particularly timely in view of the fact that the National Health Services Bill is now before the House.
The book is a model of arrangement and is written in Dr Blacker’s own inimitable style. It is most lucid and clearly set out, and contains a wealth of information. It should certainly be read by every psychiatrist and every psychiatric social worker and by all who are interested in the future of the Mental Health Services of this
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.