Studies of Social Attitudes and Values in Relation to Psychiatric Epidemiology.

FOR MANY years the annual rate of first admissions to psychiatric hospitals in England and Wales has shown a steady rise (Registrar General 1964). Changes in the legal and administrative arrangements for the care and treatment of mental disorders are probably accountable for the greater part of this rising influx. The Mental Treatment Act 1930 established voluntary admission and enabled local authorities to set up out-patient clinics. The development of the National Health Service brought a substantial enlargement of the specialist establishment in psychiatry. More recently the Mental Health Act 1959 has abolished the special status of psychiatric hospitals and has removed all formality from the admission procedure for all except a minority of patients. These changes in social policy towards the mentally ill may arise in part out of rather widespread changes in attitudes towards mental illness among the general population. Implementation of the policies must, in turn, serve to generate modifications in social attitudes. The passage of patients into and out of the specialist mental health services and the factors which play upon and determine this movement represent one stage of a cycle which begins with the earliest recognition by the individual patient (or by his relatives) that something is wrong. The process continues when the abnormality is reckoned by the patient, or by his family, to have medical significance, and when a decision is made to seek advice, usually from the general practitioner. A further stage is encountered in the appraisal of the case by the G.P. and in his diagnosis and treatment, and in his decision whether to handle the case himself or to refer the patient for a psychiatric opinion. Part of the work of the M.R.C. Social Psychiatry Research Unit (S. Wales detachment) has been to examine certain aspects of the elaborate social process whereby psychiatric cases are defined in the community, recognised by community members and by medical and social agencies, and dealt with by one means or other. Studies of this kind are very relevant to the epidemiology of mental disorder since, by the nature of such illness, the detection and enumeration of cases is intimately linked with prevailing social "yardsticks" pertaining to the acceptable bounds of "normal' behaviour and experience and also to the categorisation of deviant behaviour as falling within the doctors' province.