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of the total population although it must be conceded that this
figure may well be only two thirds of the true total. Despite the
fact that our mentally disordered cases occupy some 48% of all
N.H.S. hospital beds, psychiatrists form only 11% of the total
consultant strength.
In Greenwich, those under local authority care in 1970 numbered
1,138, equivalent to 0.5% of the Borough's total population and,
of these, some 441 were mentally handicapped, one third of whom
were under 16 years of age. Although the total number of persons
under our care remains fairly constant the actual content is subject
to substantial change and, as one would expect, this occurs mainly
in those classified as mentally ill. No statistics are available concerning
other mentally ill or handicapped residents who may be
receiving hospital or G.P. treatment for their disability.
It is, of course, a comparatively simple task to state in numerical
terms the mental casualties of our society and what facilities are
made available to them—the more difficult problem is that of
prevention. Our concern must not be limited to those already
so identified but must embrace methods by which we can reduce
or eliminate the effects of society's destructive elements which
impinge upon us all and to which some will eventually succumb.
Clearly prevention, if made possible, would bring in its train
enormous advantages not the least of which would be the release
of the great physical and financial burdens now being shouldered
by the hospital and local authority services alike.
Genetics figure largely in mental illness but, with the present
limited knowledge, prevention in this field will, for some time
yet, be restricted to the application of eugenics. Elimination of
brain damage in the new-born and the maintenance of observation/
handicap registers will eventually prove significant in our preventive
efforts.
After a century or more of treatment by isolation, modern
psychiatry is reverting to an age-old method of dealing with mental
illness, namely, in the patient's own home and it is here that the
local authority services will have their greatest impact.
It is generally agreed that mental illness may occur in three
forms: —
1. Dementia—a failure of memory usually occurring in old age.
2. Affective psychosis—characterised by depression and occasionally
mania arising primarily in the middle age groups.
3. Schizophrenia—principally a disease of young adults—manifests
itself by a change in behaviour and thought—recovery is
often incomplete leading to some permanent personality
damage such as loss of initiative and emotional warmth.