Changing Population of Mental Hospitals

A number of publications in recent years have pointed out that, as a result of alterations in the laws relating to the care of the insane, of new methods of treatment, and of the changing public attitude to mental illness, important changes have occurred during the last 25 years in the type of patient admitted to hospital, and in the average length of stay. Fitzgerald (1954), Norris (1952), and Harris and Norris (1954) dealt with different aspects of this phenomenon, and Shepherd (1954) analysed changes occurring in one circumscribed region after an interval of 15 years. Goldhamer and Marshall (1949) discussed age-specific hospitalization rates for 19th and 20th-century America. Their conclusions are expressed in hospitalization habits for different age groups in the areas and periods concerned. They suggest that increased hospital facilities for the aged rather than increased arteriosclerosis may account for recent upward trends. Most British medical superintendents in their annual reports have had occasion to comment on the accelerated changes in the numbers and composition of their hospital admissions during the past 5 years. In order to gain a clearer picture of the consequences which these tendencies have upon the composition of the mental hospital population it is necessary to carry out a census. Such a census was reported for hospitals in the Birmingham area by Cross (1954) in a survey which took especial note of the age distribution of patients, their length of stay, and the degree of ovei -crowding in male and female wards. The most comprehensive investigation of this kind to date has been the Registrar-General's statistical review (1953) which included a census of of all patients resident in mental hospitals at the end of 1949. This provides a valuable base-line for comparison with subsequent national and regional observations. In the present small-scale survey a census was taken, in four mental hospitals serving the London area, of all patients resident on July 12, 1954, patients' present age, length of stay, diagnosis on admission and, in the case of male patients, previous occupation being noted. These figures have been compared with the Registrar-General's findings for 1949. Th re has been a realtive increase in the proportion of older patients among the resident population (Table I). This fact is sufficiently well-known to hospital medical staffs, but an analysis of the sub-groups of patients in which the changes of ge-bias are most marked reveals some additional information.