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75. It appeared that the average age of defectives on admission to institutional
care was 18 years. The cases maintained in institutions at the Council's charge had
been so maintained for an average term of three years. The statistics in the Council's
possession did not as yet justify an assumption of what might be expected to be the
total duration of stay of a defective who was admitted to institutional care. But it
appeared that, so far, the death rate had been low (between two and three per cent.
on average institution population), and the discharge rate (i.e., the number of cases
for whom detention orders had been discharged absolutely, omitting cases of long
leave of absence) was rather less. On the assumption that the average duration of
life of mentally defective patients in a large mixed institution would be 40 years,
it seemed probable that there was an expectation of continued detention of the
numbers resident in institutions at the Council's charge without substantial diminution
from death or discharge for at least another 16 years, and although after 1944
there might be an increase in the existing rate which would relieve the pressure for
further accommodation, no such relief was likely before that date.
76. During the six years, 1922-1928, the net annual increase in the number
of cases for whom institutional care had been afforded had been 285. Had the
Council possessed the accommodation to keep fully abreast of all demands, the number
of additional beds occupied each year would have been nearly 350. In the absence
of new legislation or a change of policy, it seemed unlikely that during the next few
years the rate of increase would diminish. During the next five years it seemed
probable that some 1,500 additional beds would be required. Upon the basis of an
anticipated annual increase of 300 cases to be dealt with by way of institutional care
and assuming that no relief worth speaking of would be available from contract
institutions, it appeared that the Council could now depend upon some 2,750 beds
being available for the cases for whom it had to provide, the total which would increase
in the course of 1929-30 to 2,997, and might thereafter further increase to perhaps
3,297. This assumed that contract accommodation to the extent then available
would continue to be available. Against this total had to be set responsibility to
provide at the present time for 2,950 patients, i.e., 200 more than the total beds
then available, with the anticipation that this number would increase at the rate
of 300 a year to, say, 4,600 by December, 1933. To meet this increased demand
it was possible to rely upon, at the outside, 547 additional beds in the Council's own
institutions, which meant that, at the end of 1933, accommodation would be short
of demands by 1,300 beds or thereabouts.
77. To meet this shortage it seemed obvious that the Council must contemplate
provision of a large new institution. Consideration was given to the possibility of
providing such an institution on the vacant land attached to Farmfield, not at
present occupied by the Council but let on an agricultural tenancy. This land,
however, proved not to be suitable for the purpose proposed. Enquiry, therefore, is
now being made for a site suitable for the erection of a specially designed
institution.
78. In this connection, it has not been forgotten that at 1st April, 1930, the
Council is to take over the whole of the accommodation at present allocated to
various uses for the poor law needs of London, and that this accommodation will have
to be reclassified. It seems highly improbable, however, that such a reclassification
will set free any substantial block of poor law accommodation which will be suitable,
either with or without material alteration, for use as institutional accommodation
for the mentally defective. It has to be remembered that the need is for an efficient
mixed institution for the mentally defective, and this calls for a specialised type
of accommodation. What is wanted is a vacant site upon which can be planned
a colony institution of the type required, which can be erected to some extent in
sections to keep pace with increasing requirements.
Poor law
accommodation—Possi
bility of
securing a
section
usable for
defectives.