Medical and social needs of patients in hospitals for the mentally subnormal.

In a series of investigations between 1949 and 1958 an assessment was made of the medical, nursing, and social needs of Birmingham hospital patients (Lowe and McKeown, 1949; Garratt, Lowe, and McKeown, 1957, 1958a, b; McKeown, Mackintosh, and Lowe, 1961). The most significant finding was the heterogeneity of patients in each type of hospital-acute, mental, and chronic -and it was suggested that patients should be regrouped to bring together those with similar needs. This idea led to the concept of a balanced hospital community: a hospital centre designed to accommodate all classes of patients from a defined population in multiple buildings on a common site (McKeown, 1958). The only patients not included in these proposals were the mentally subnormal. There were two reasons for this omission: there had been no investigation of the needs of the mentally subnormal in hospital; and it was thought advisable to allow a little time for appraisal of the idea of comprehensive responsibility for all other types of patients before considering the possibility of this addition. At the same time it was recognized that the case for classification of the mentally subnormal according to their medical, nursing, and social needs, and for reappraisal of services in the light of such a classification, was particularly strong. There is wide variation in the care required by patients in the same hospital. Moreover, institutional provision for the mentally subnormal is deficient in quantity and quality, and raises staffing difficulties at least as serious as those in mental and chronic hospitals. This paper presents the results of an assessment of the type of care-medical, nursing, and socialrequired by all (1,652) Birmingham patients in local hospitals for the mentally subnormal. A