Administrative Psychiatry
- Author:
William A. Bryan, M.D-, Superintendent, Worcester State Hospital, Mass, London. George
Allen and Unwin, Ltd., 1937. 15/-.
There is, indeed, a dearth of literature dealing with mental hospital administration and the author of this book is to be congratulated on fulfilling a want in a field so long left barren. While the book is necessarily written from an American viewpoint, essential problems of administration vary but little from country to country. Dr. Bryan’s opinions, based on long experience, are worth while, practical and ably presented, and his book should be of the greatest benefit to all psychiatrists engaged in institutional practice.
After an historical survey he goes on to deal with the problems of hospital organization and he deplores the tendency, unfortunately common, to emphasize certain material aspects of administration, whilst relegating to the background more important considerations directly affecting the treatment of the patients. ” The custom of judging the administration of hospitals exclusively on the basis of per capita cost is a vicious practice. They can be operated at such low cost that the essential purpose for which they are built is defeated. Excessively low per capita costs are invariably gained by sacrificing many things that would contribute to the recovery of patients. They are accompanied by poor service, which is expensive at any price.” Preventive measures and organised research at whatever cost will produce increasing dividends in the restoration of patients to sound health and economically adjusted life, whereas short-sightedness and parsimony mean custodial care and bigger and bigger institutions. ” Fine buildings, good equipment, adequate records, and all the things we associate with well-managed hospitals are essential, but unless they eventually lead to an increase in the discharge rate, shortening the hospital residence, and lengthening the time the patient spends in the community, the increased cost to the taxpayer is not justified.”
It may be of interest to note that Dr. Bryan is a firm advocate of the one-man type of administration traditional in mental hospitals and he castigates as an administrative absurdity the placing of a medical director in charge of the treatment of patients and a business manager in control of the economic side of the hospital. ” A medical education should be a requirement for any hospital administrator. It is only through this background that he can apply the true principle of mental hospital administration, which is the cure of patients and the study and prevention of disease The leadership of the institution must be professional if the atmosphere of the hospital is to be one of healing, research and teaching.
Special attention is given to the way staff should be built up and selected, and the nursing problem, acutely to the foreground in this country at the present time, is considered in some detail. The author is of the opinion that it would be an economy of time and money if nurses already trained could be attracted to the Mental Hospital service; he suggests that as a result the standard of care would be raised from the custodial to the nursing level. The ideal of staffing a mental hospital with already trained staff, except in the senior posts, is not feasible in this country nor is it necessary in view of the high standard of training already available in most mental hospitals. He wisely states that eight hours is a sufficiently long period for anyone to spend in a ward with psychotic patients. In analysing accidents, he found that there were two peaks in the twenty-four hours; one between 6?7 a.m. and one between 3?5 p.m., times at which nurses shewed fatique, irritibilitv and lack of care. It is considered advantageous that staff off duty should live away from the hospital.
We are glad to note that most American mental hospitals have barber’s shops, hairdressing saloons and beauty parlours. A number of hospitals in this country are now equipped in this fashion and anyone having experience of the heightened morale and ensuing self-respect of patients, especially female, having their hair skillfully attended to, cannot but wonder why such an essential innovation was so long delayed. Calisthenics, recreation and organised occupational therapy are all fully discussed. No hospital that pretends to be in keeping with the times can afford to neglect utilizing each of thesemeasures to the full.
Social service work, teaching, clinic organisation and research have each a chapter that is full of sound advice.
Research into the causation of mental disease and deficiency is still shockingly neglected in this, as in other countries. It is gratifying to realise that responsible bodies are becoming increasingly aware of the gravity of the psychiatric problem and that efforts are now being made to plan future research cn a co-operative and co-ordinated basis. The book concludes with an interesting chapter on the relationships of the mental hospital with the public.
This, the first book of its kind, is well deserving of study. It should be in every mental hospital library. T. J. Hennelly.
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