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109
At observation ward A, there are considerable facilities for treatment and this
possibly explains the high discharge rate and low admission rate to mental hospital of
which over half were certified. Group F, on the other hand, show the highest rate of
admission to the main sections of the mental hospitals and as at observation ward B,
a low proportion of certified patients. As there is no special selection of cases for different
observation wards so far as mental state is concerned, other factors must play their role
in producing the variations shown.
Analysis of disposals from observation wards, sub-divided according to initial source
of referral, continues to show, as in 1956, that the greatest discharge rates occur among
referrals from general hospitals, 46.3 per cent of casualty department cases and 40.6 per
cent. of general ward cases compared with a range of 29.0 to 33.9 per cent., with
average of 30.9 per cent. for all other cases. In both 1957 and 1956, the highest proportion
of certified cases amongst those transferred to mental hospitals applied to cases referred
originally to mental welfare officers by non-medical sources, 42.9 per cent. in 1957,
compared with a range of 24.9 per cent. to 31.6 per cent. medical referrals.

The proportions (70-72 per cent.) entering mental hospitals is similar in the two
years, but somewhat higher than for observation ward cases except where such
(section 20) accommodation is based at a mental hospital. The percentage of these
cases who were certified was, however, much higher in comparison, and although
there was a reduction from 67.7 per cent. in 1956 to 63.3 per cent. in 1957, the reduction
was not so marked as in the observation wards.
Initial action and age—It was mentioned earlier that removal to observation wards was
used, when appropriate, in preference to referral to a Justice of the Peace. Younger
patients, however, receive preference in the use of beds because the elderly tend to block
them whilst awaiting vacancies for other accommodation. Within this general policy
framework, however, each case is individually considered and some older patients are
removed to observation wards where the mental welfare officer considers that this is
without doubt in the best interests of the patient. In fact, in 1957, 88 per cent, of
observation ward patients were under the age of 65.
The table below shows the major types of initial action taken by the mental welfare
officer for age groups of under 65 and 65 and over.