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special services for adolescent and marital problems, and day centres
(with social clubs) in strategic areas associated with the planned
quadripartite division of the social services.
'Meanwhile I wish to refer to three further important matters:
general practitioner/social work attachments; psycho geriatrics; and
psychiatric case registers.
The General Practitioner/Social Worker
attachments
'The new emphasis on the teaching of behavioural sciences to
medical students will gradually result in an increasing number of
family practitioners taking a special interest in psychological medicine.
Such interest is being stimulated by post-graduate courses and also by
the activities of the Royal College of General Practitioners. In view
of the fact that a major part of psychiatric work is being done already
by general practitioners outside the hospital setting, and that a large
proportion of their patient load is with illness emotional in origin, it
will be seen that the Mental Health Service of the future should give
the family doctor every opportunity of becoming a member of the
psychiatric team itself. The attachment of selected social workers to
certain group practices has already been referred to, but I must here
mention the danger that with the removal of social workers from the
Health Department the general practitioner may be tempted to lose
his interest in the social side of his patients' problems, leaving it all to
" the other Department".
Psycho-Geriatrics
'With increased life expectancy the proportion of the population
aged 60 and over continues to rise. Mental and physical disease in
old people cannot be considered in isolation, and jointly absorb nearly
30% of expenditure on the National Health Service. No effort should
be spared to prevent deterioration arising from isolation, malnutrition
and similar remediable causes. Voluntary aid can augment the many
and varied provisions from the local authority. Regular medical
screening can aid early detection and so the provision of social, clinical
and psychiatric advice. That the numbers of elderly residents in our
psychiatric hospitals have increased in recent years is only too wellknown,
although these are but a small proportion of the total elderly
mentally infirm. For this reason I advocate special homes within the
community designed to meet their special needs, as well as short-term
hostel places to relieve families of their care in times of crises, as has
been done in the field of mental handicap. Day centres providing 100
places for 250,000 population, with companionship, purposeful occupation
and a good mid-day meal, can often help to avoid premature
and unnecessary admission to hospital.
'A psycho-geriatric assessment unit based on St. George's Hospital
is being developed and will enable joint consultation between
our Consultant Geriatrician (Dr. Peter Millard) and myself and my
colleague, Dr. Peter Storey. This will enable earlier and better
decisions to be taken as to management, especially as no patient will
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