MENTAL HEALTH
Dead to the world
LORD O'HAGAN
As medical care improves, there are many more elderly, confused patients in mental or subnormality hospitals. These psychogeria- tries now occupy 43 per cent of mental hos- pital beds. Sometimes they go there because there is nowhere else for them to go—and once inside, institutional torpor can soon overwhelm them.
WE are properly proud that nowadays there are fewer long-stay patients in mental hospitals. Between 1954 and 1968, those admitted for under one year increased from 17 per cent to 27 per cent of the total. Never- theless, many of these in fact return, and the 'yo-yo' patients are less likely to achieve successful independence as they grow older.
A visitor to a subnormality hospital should not expect to find an Ely; certainly the staff of those I have seen are some of the most selfless people I have met. They, too, have their long-stay inmates; today it is quite com- mon to find octogenarians in subnormality hospitals. More people seriously or multiply handicapped survive nowadays; and while everyone can feel sympathy for a handicap- ped child, who cares so much when he's sixty-five? The older subnormal person is not very likely to return to the community; parents and relations have often lost interest years before. Three quarters of subnormality patients stay inside for over five years—and the proportion of those who do so goes up all the time.
There is no obvious economic return to be had from helping those people to have' more to live for. Nor is their fate the subject of burning political controversy. But before the election manifestos are finally polished, it would be good for them to be remembered.
Of course, the present government has done quite a lot. After Ely, the regional hos- pital boards were asked to reallocate money to subnormality hospitals and they found £2 million; subnormality hospitals are to have an extra £3 million next year from central government. The creation of the new hospi- tal advisory service is a good omen. But more is needed. The ideal is to keep the old people out of hospitals. Although we do not know much about old age, isolation and bad food are very important undermining fac- tors: hence the great value of 'Meals on Wheels' and housing projects which keep old people in the community in special easy-to- run flats. If the social safety-nets were made better, many old people who would love to retain their independence could do so—with tactful help at hand if need be.
The person who is really subnormal (horrid word) probably needs to be in hospi- tal; but better social care could give earlier warning to parents and prevent mentally handicapped children from growing into dis- turbed adults. Social distress must be tackled at the roots to prevent the global village hav- ing its village idiots.
All mental and subnormality hospital patients would benefit from certain reforms. Wards should be small. In 1968 there were still fifty-five wards in mental hospitals, and twenty-two in subnormality hospitals, with over eighty beds: even half that size is too big. Could anyone give personal attention to forty', incontinent old ladies whom she had to 'top and tail'? The Victorian hospitals, like mausoleums, were built to last, and the nurs- ing staff have to struggle against conditions
imposed by another age. The steady move towards psycho-geriatric wards in general hospitals ought to continue.
Finally, those who do succeed in filtering through the system and returning to the community need to be helped to become in- dependent. The personal social services will provide an effective cushion if better co- ordinated. Hostels, half-way houses, are vitally important in this connection—and the less they resemble institutions the better.
Perhaps it should be compulsory to build hostels for former mental and subnormality hospital patients in New Towns, before local opposition can srop them being built. There is also a role here for some of the cottage hospitals under sentence of death.
The measure of success with a long-stay patient is that he or she is no longer in the hospital. How grotesque it is that the pay of those who work in subnormality and mental hospitals is governed by the number of beds in them! In good hospitals, patients are dis- charged and the staff suffer financially; in the less good hospitals some of the more capable handicapped patients are used as free labour and kept inside; more beds, more money for the staff. This is one extra ironic penalty upon a profession where mental and subnormality nurses are thought of as lower caste—by some other members of the pro- fession as well as by the public.
No nurse left Ely after the storm broke. No parent or relation withdrew a patient. -Dedication is not its own reward. As new techniques discharge many of those who would, in the past, have been long-stay pati- ents, those who are left need even more care.
Those who staff these hospitals must have a fair deal. Mr Crossman recently spoke about 'apartheid' inside the health service. He has found more money for the subnormality hos- pitals, for which much credit should go to him; he didn't smother the Ely report. But whether he will make a fundamental impact on the 'apartheid' remains to be seen; and without a fair deal for the mental and sub- normal patient, recruitment of their nurses will go on down and down. 'Dead to the world' could be more than a jab at the national conscience; it could be an accurate description.
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