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70
Of the three, schizophrenia is the most serious in terms of
suffering and economic loss for even if re-employment becomes
possible it is usually at a level well below that expected from the
patient's abilities and education.
One in every hundred children born will develop schizophrenia
and its prevalence in society is estimated at 4 per 1,000 of the
adult population. Although, like epilepsy, some cases of schizophrenia
are due to definable causes such as trauma, infection,
tumours, etc., most are not and these must be presumed to be
precipitated by genetic influences. Present views are that probably
75% of cases are due to genetic causes and only 25% to environmental.
Fortunately, over the last 40 years, this disease has
become progressively milder (for reasons which are unknown) but
patients are now more likely to be discharged from hospital than
hitherto.
Most mental patients, including depressives and schizophrenics,
benefit from drug therapy and in the former case an eventual
return to normality is usual although elderly persons, who are more
averse to medication, need careful supervision. It is in these cases
and those of discharged schizophrenics that local authority services
should provide the complementary but very necessary after-care
to hospital diagnosis and treatment.
In recent months many of our special hospitals have been
shown to be old, ill-equipped, intolerably overcrowded and understaffed
and, in such conditions, it is no small wonder that staff
morale is as high as it is. Understandably, the immediate reaction
to this revelation has been a nation-wide campaign which has
received almost universal support, to "phase out" subnormality
hospitals and replace them with small units or family care. Nevertheless,
however compassionate such views may be, very careful
consideration of the situation is needed before such a violent and
headlong change of policy is implemented. Undoubtedly improvement
in subnormal hospitals is essential but their complete elimination
is not only impractical but would be a serious error of
judgement.
Surgical intervention in cases of spina bifida and the increasing
life expectancy already apparent in the mentally subnormal can
lead only to an increase in their numbers. Furthermore, projections
show higher proportions of the population in the older age groups
which will result in the presentation of more geriatric disabilities.
Many of these problems will not be amenable to treatment in the
community and attempts to do so may well prejudice a local
authority's ability adequately to fulfil its obligations to other
underprivileged or handicapped groups.