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108
Mental welfare officers are free to select cases for possible attendance at out-patient
clinics or, if the patient is unfit for such attendance, for a domiciliary visit by a psychiatrist
in any area. Such action is in all cases subject to the consent of the general practitioner
concerned who may choose the consultant if he so desires ; otherwise the mental welfare
officer will make arrangements on his behalf.
In practice, reference to psychiatrists is largely confined to those parts of London
that fall within the catchment areas of Bexley and Cane Hill Hospitals. Special arrangements
were made with the former in 1956 and extended to the latter in 1957. Basically
the scheme is that if the patient had previously been known to the hospital concerned
or there is no observation ward vacancy, the mental welfare officer contacts the hospital
for advice with a view to out-patient attendance or urgent domiciliary visit. In practice
a knowledge of the existence of the scheme has sometimes led the general practitioner
to refer the case initially to the psychiatrist instead of to the mental welfare officer.
Although as a group these cases are unlikely to contain the normal proportion who
are potentially certifiable there is little doubt that reference to a psychiatrist under the
scheme has contributed to a lower certification rate ; of the 138 cases referred to
psychiatrists 72 were given out-patient appointments—none of the 23 who failed to
attend were so seriously disturbed as to be referred back to the mental welfare officer
for other action and it is interesting to note that another 23 were considered to merit
only out-patient attendance.
It is intended to expand the arrangements for referral of suitable cases to psychiatrists
but the problem of providing coverage for the whole of the county is by no means a
simple one.

* Including 4 cases referred by mental welfare officer to psychiatrist.
† Including 4 cases referred by mental welfare officer to psychiatrist.
The proportion of observation ward cases subsequently entering mental hospitals
was almost exactly the same in 1957 as in 1956, i.e., 63.2 per cent. and 63.5 per cent.
respectively. The percentage of these cases who were certified under sections 14/16
fell, however, from 40.7 in 1956 to 33.3 in 1957.