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the opportunity to avoid acceptance of difficult cases. Under arrangements made by
the Regional Hospital Boards, each mental hospital serving London is responsible for
receiving all patients needing mental hospital treatment from a given area, known as
the hospital's catchment area. These arrangements have obvious practical advantages,
but if the Royal Commission's proposal is implemented, and the appropriate hospital
should refuse to admit a patient in respect of whom the necessary medical certificate or
certificates had been given, the intolerable situation might arise that local health
authorities would have to seek accommodation in other hospitals having no specific
responsibility to take the patient.
(b) Severely sub-normal patients and feeble-minded psychopaths—The admission arrangements
proposed by the Royal Commission as regards sub-normal persons or feebleminded
psychopaths would not create any difficulty so far as the Council is concerned
and a good deal of work would be saved. The overwhelming majority of these cases
would be admitted informally as opposition to admission is raised in only a small
proportion of cases. The removal of the necessity for formal ascertainment and for
proof of the existence of defect before the age of 18, as proposed by the Royal Commission,
would obviate the need for the completion of the elaborate case history, at
present prepared in every case. The practice of completing these histories no doubt
arose bccause of the information required for the completion of the formidable legal
documents necessary in cases sent to institutions or placed under guardianship. A case
history would still be necessary but not in the present comprehensive form. If informal
admissions are agreed to, it would seem that, after the appropriate form of care has been
decided, all the arrangements could be left to the Council's existing local offices of the
mental deficiency service, except that, while the present bed shortage persists, a central
system of bed finding and allocation would be necessary.*
Guardianship—The powers proposed for voluntary admission to local authority and
voluntary residential homes are such, it is thought, that the need for formal guardianship
would seldom arise.
Community care—The clarification by the Royal Commission of the respective functions
of the hospitals and the local authorities in the field of after-care of patients discharged
from hospitals is welcomed.
(a) Mentally ill patients—Notwithstanding the terms of section 28 of the
National Health Service Act, 1946, mental hospitals in the main have regarded it as
their function to keep in touch with their own discharged patients. In its evidence to
the Royal Commission the Council suggested that owing to the distances of the catchment
areas from the hospitals and the limited amount of after-care which can be provided
by hospital staff having many other commitments it would be expedient for the local
authorities to carry out this work in many cases. If the view of the Royal Commission
in this matter is accepted, a considerable enlargement of the Council's after-care service
for the mentally ill may be expected and more psychiatric social workers will be needed
although the shortage of these workers may make it difficult to secure their services.
If, as suggested earlier, the mental hospitals were associated with units in general
hospitals in their catchment areas for observation, etc., these units would provide
useful media for liaison between the psychiatric social workers (as well as the mental
welfare officers) and the mental hospitals. It would, of course, be necessary for the
Council's officers to visit the mental hospitals as well.
(b) Severely sub-normal and psychopathic patients—As regards social work for the
severely sub-normal and psychopathic patients this will take the place of the existing
service of statutory and voluntary supervision of the mentally defective. The fact that
this has been a statutory duty has no doubt caused local authorities to endeavour to
supervise some defectives in the face of opposition from parents and perhaps to continue
to supervise some defectives beyond the time when it is useful.
*Note.—In January, 1958, the Minister of Health authorised the informal admission of patients to mental deficiency
hospitals and institutions—Ministry of Health Circular, 2/58.
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