London's Pulse: Medical Officer of Health reports 1848-1972

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Lewisham 1971

[Report of the Medical Officer of Health for Lewisham Borough]

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SPECIAL REPORTS
It is a pleasure to include in this report the following items from consultants in
two important fields of medicine.
PSYCHIATRY
Dr. A. Norton, Consultant Psychiatrist, Bexley Hospital
The chief event in the psychiatric field in 1971 was without doubt the implementation
of the Social Services Act on 1st April.
Next in importance was the memorandum from the Department of Health and
Social Security on Hospital Services for the Mentally 111 published in December
1971. This memorandum continues and extends the policy laid down many years
ago of transferring many of the major functions of psychiatric hospitals to facilities
nearer to where the patients liveā€”to psychiatric units in general hospitals, to day
hospitals and to out-patient departments. Lewisham is not, unfortunately, very
high on the list of areas likely to acquire a psychiatric unit in the near future, but
the establishment of a psychiatric day hospital may not be so far off.
Meanwhile, the out-patient services at Lewisham Hospital remain fully stretched,
as they have been for many years, their growth limited only by the staff and
accommodation available. In 1971, for example, there were over 5,000 out-patient
attendances of which 10% were new cases. Since 1970 the out-patient work at St.
John's has also expanded.
The increase in self-poisoning since the war is a nation-wide phenomenon and
the Borough of Lewisham provides no exception to this trend. This increase in
self-poisoning contrasts with the national fall in suicide rates. Britain is the exception
in Western Europe for showing this decline consistently in the past decade. The
reasons are uncertain but may well include more effective methods of resuscitation
carried out in intensive care units, the efforts of the Samaritans and the investigation,
treatment, help and care given to those who have already attempted suicide, for it
is well known that such people carry a higher risk of repeating the attempt, sometimes
successfully. There has been a steady increase in the numbers admitted to
Lewisham Hospital in the past few years for this cause and the investigation and
treatment of such people forms a substantial part of the work of the Psychiatric
Department there.
No great step forward has been made in 1971 in the treatment of psychiatric
illnesses, but it has become more and more clear that the introduction earlier of
long-acting phenothiazine drugs, given by injection, to prevent relapses in schizophrenic
patients was a major advance. Most drugs used in psychiatry have some
unpleasant side-effects, and this may lead patients on essential maintenance treatment
to stop taking these drugs, to take them only intermittently or to take them
only in reduced dosage. The advantage of the long-acting phenothiazine drugs is
that one knows that patients are actually getting the medication that they are
supposed to be having. More than 100 patients now attend the psychiatric out-patient
department monthly, or more often, for their injections. The giving of these drugs
and the pursuit of patients who default from the clinic is an important part of the
work of the two psychiatric nurses who have recently been appointed to the staff
of the Health Department. They began work in December 1971. These nurses also
perform a valuable function in continuing the nursing care of patients recently
discharged from psychiatric hospitals back to the community. They may well also
be able to employ their nursing skill to avert the admission of a few elderly patients
to a psychiatric hospital. It is too early yet to fully evaluate the work that psychiatric
nurses can do in the community, but this is a field that may well expand in the
future and already a useful beginning has been made.
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