Group approach to inpatient adolescents.

Abstract

My purpose in this paper is to present our experience in developing inpatient units for the treatment of psychiatrically ill adolescents at the Bethlem Royal and Maudsley Hospitals during the past 3 years. I shall focus particularly on the therapeutic and administrative structure and the general dynamics of the wards rather than on specific problems of diagnosis, therapy, and outcome. I t will perhaps be expedient to give a brief history of the 2 hospitals integrated as one postgraduate teaching hospital and associated with the Institute of Psychiatry of the University of London. The Maudsley Hospital was established immediately after the first World War for the investigation and treatment of acute and recoverable cases of psychiatric disorders. I t was, from its inception, associated with the University of London. The Royal Bethlem Hospital has a history going back to 1247, when the Hospice of St. Mary of Bethlem in London formally initiated the care of the mentally ill. The Bethlem Hospital has been continuously in existence since that time and its history is a chapter in the history of psychiatry. The hospital was rebuilt for the fifth time in 1932 in wide and pleasantly wooded grounds 8 miles out of London. The 2 hospitals were united in 1948 with the Health Act, with a Board of Governors directly responsible to the Ministry of Health, and the staff is common to the combined hospital. At the same time the Institute of Psychiatry was established in the hospital as one of the Institutes of postgraduate medical training of the University of London. From its inception' the Maudsley Hospital dealt with children and a department was established in the charge of Dr. Mildred Creak in 1932. The present children's department was opened in 1939 but did not come into function till 1945 when the hospital was reopened after the war. The present outpatient organization was established in 1946(1) and the inpatient unit for children under 12 was opened in June 1947(2). Very shortly the problem of the adolescent requiring inpatient treatment became apparent. Our outpatient range in the children's department went up t o age 16 and we were able to admit only up to age 12. Patients above 12 were admitted to adult wards. In 1948 it was pointed out that: