Estimation of the outcome of a standing mental hospital population.

A review of surveys of mental hospital populations in Britain in the 1960s carried out for planning purposes reveals conflicting conclusions about the likely requirement for mental hospital beds over the next 15 to 20 years-the period over which estimates are needed for planning facilities. The estimate on which the Hospital Plan for England and Wales (National Health Service, 1962) was based assumed a fall from over three beds per thousand total population in 1961 to about 1 8 per thousand by 1975 (Tooth and Brooke, 1961). Cross and Yates (1961) reported broadly similar estimates based on the Birmingham region. Criticisms of the estimates in the Hospital Plan emphasized the regional variation in current bed provision and the self-fulfilling character of prophecies of this kind when they are acted upon (Baldwin, 1963; Rehin and Martin, 1963), and the low expectation of separation from hospital by death or discharge of the high proportion of relatively young long-stay patients (Gore and Jones, 1961). Earlier optimism about the possibilities of rehabilitation of long-stay patients and reduction of requirements for long-term beds (Cooper and Early, 1961; Norton, 1961) has been tempered by more recent studies which have expressed doubt as to the likelihood of fulfilment of the original estimates (Hassall and Hellon, 1964; Early and Magnus, 1966). It has also been shown that large differences exist in the behaviour of individual hospitals and of age and sex groups within hospitals, so that a uniform measure of bed needs could be misleading (Hassall, Spencer, and Cross, 1965). The problem of projecting the future size and structure of a mental hospital population on the basis of past and current use is usually subdivided into consideration of two interrelated processes: