A survey of mental hospitals and mental deficiency institutions in the Birmingham region. I. Mental hospitals.

The problem of providing adequate care and treatment for patients suffering from mental disorder has become more acute in recent years for many reasons, not least amongst them being the increased numbers and longevity of the population in conjunction with their greater willingness to seek early advice and treatment. As a result, mental hospitals are faced with the dilemma of increasing their admission rates and at the same time continuing to look after an increasing proportion of long-stay chronic patients who are living longer. Associated with an increasing psychiatric awareness in the general population, are other social agencies contributing to the increased numbers of patients, such as the unwillingness of families to accept responsibility, and provide a home, for parents too aged or too infirm to look after themselves. All too often therefore, a patient, who is otherwise fit for discharge, remains in hospital because he has nowhere else to go. The problem is a national one. Even before the last war there was a considerable shortage of beds for mental illness, and the inadequate provision of accommodation in the past has been accentuated by apparent deficiencies in planning since the 1946 Act. In August, 1951, regional boards were told by the Ministry of Health that their planning on the mental side was quite incommensurate with the needs of the situation. Furthermore, the problem of mental hospital accommodation is qualitative as well as quantitative. Most accommodation is extremely out-of-date; only a handful of mental hospitals have been built since 1918, and the majority were in existence before the Lunacy Act of 1890. Coincident with greater overcrowding at most hospitals, the general shortage of nursing staff has been aggravated by the loss of trained and experienced personnel; and the continuance of the service even at its present level is made possible only by employing less trained personnel and by using many part-time staff. Future staffing problems will be increased by falling recruitment and the high wastage rate of student mental nurses. The former is closely linked with the present financial situation, in that the hospital service cannot compete with industry in respect of salaries and hours of duty. The latter is largely due to overcrowding, and the vicious circle must be broken before improvements can be expected. The consequences of employing larger numbers of domestic staff call for special consideration, since this would lessen the wastage from employment of nursing staff on non-nursing duties.