Community needs of elderly psychiatric patients.

Abstract

Treatment and care of psychiatric patients within the community rather than in the overcrowded wards of mental hospitals have been recommended by a Royal Commission (Report, 1957) and are about to become one of the corner-stones of the new Act of Parliament governing the legal aspects of mental illness. Recent accounts of out-patient, day-hospital, and domiciliary psychiatric treatments have gained so much attention that it is unnecessary to summarize them here. Few people would deny that these movements are in the right direction and are likely to benefit a large proportion of patients. But, to avoid imposing undue strain on their families, treatment of psychiatric patients within the community will have to be conducted in a spirit of flexibility and co-operation between hospital and community. We cannot overstress the paramount need for rapid and, if necessary, repeated interchanges between specialist treatment under the aegis of the hospital, and aftercare and support by the family, the general practitioner, and the services of the local authorities. Co-operation in passing the ball rather than the buck is a conditio sine qua non if patients who are both mentally disordered and elderly are to be treated outside hospitals ; and workers like Macmillan (1957) and DeLargy (1957) have pointed the way in which rapid changes between specialist treatment and community care can be achieved. Hospital costs can no doubt be greatly reduced by cutting down the time spent by people occupying hospital beds, but the public should be warned that adequate community services for the discharged patient are likely to be very expensive in terms of man-power (general practitioner and specialist time, home nursing, occupational and social therapy, etc.), of buildings, and of transport from home to treatment and occupation centres.