London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1957
[Report of the Medical Officer of Health for London County Council]
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It will be noted that just over half the cases referred to mental welfare officers were admitted to mental hospitals and of these just under two-thirds entered as voluntary or non-statutory patients. There were, however, considerable variations in these two proportions dependent upon the nature of the original source of referral as may be seen from the succeeding table.
| Source of referral | Total | |||||
|---|---|---|---|---|---|---|
| Psychiatrist | G.P. | General Ward | Casualty Dept. | Nonmedical | ||
| Percentage admitted to mental hospital | 59.2 | 53.2 | 54.0 | 40.9 | 46.7 | 51.1 |
| Percentage of these certified (Section 14/16) | 41.2 | 33.1 | 39.7 | 23.7 | 45.9 | 37.2 |
It will be noted that proportionately fewer of the casualty department referrals were
admitted to mental hospital and that these few also gave rise to the smallest certification
rate. An overall comparison with the disposal of cases investigated in 1956 reveals a
reduction in certifications from 23 per cent. to 19 per cent., an increase in voluntary
patients and non-statutory admissions from 27.4 per cent. to 30.8 per cent. and an
increase in no action cases from 21.7 per cent. to 26.8 per cent.
The following table shows the final disposal of cases investigated by age group :
| Under 65 | 65 and over | Total | ||||
|---|---|---|---|---|---|---|
| No. | % | No. | % | No. | % | |
| No action possible or necessary | 1,346 | 24.2 | 637 | 34.5 | 1,983* | 26.8 |
| Admitted to mental hospital— | ||||||
| (a) as voluntary patient | 1,658 | 29.8 | 269 | 14.6 | l,927† | 25.9 |
| (b) non-statutory patient | 80 | 1.4 | 282 | 15.2 | 362 | 4.9 |
| 41 | 0.7 | 7 | 0.4 | 48 | 0.6 | |
| 38 | 0.7 | 4 | 0.2 | 42 | 0.6 | |
| Certified | 1,061 | 19.0 | 352 | 19.0 | l,413† | 19.0 |
| Miscellaneous (discharge, etc.) | 1,359 | 24.2 | 297 | 16.1 | l,656† | 22.2 |
| 5,583 | 100.0 | 1,848 | 100.0 | 7,431 | 100.0 | |
* Age not stated in five cases.
t Age not stated in one case.
Conclusion—The aim of the department is increasing liaison with individual mental
hospitals and psychiatrists both with respect to cases referred to mental welfare officers
and in the field of preventive care and after care by the Council's psychiatric social
workers. Some progress has been made. Co-operation with the hospitals takes different
forms according to their individual circumstances such as their distance from their catchment
areas. The assistance of psychiatrists not directly connected with the mental hospitals
concerned is also, and will continue to be, sought on an increasing scale, in particular
for elderly patients referred to mental welfare officers and of whom so comparatively
small a proportion received psychiatric assessment before entering mental hospital.
There is still scope for a continued reduction in the certification rate irrespective of new
legislation. Mental welfare officers are not in a position to assess the finer clinical aspects
of cases referred to them but they show a very high standard of good judgement in the
actions they take after considering the known alternative facilities at any given time.