The dynamics of a long-stay mental hospital population.

THE census of all patients in psychiatric hospitals and units in England and Wales (Brooke, 1967) showed that the rundown of this inpatient population, as forecast by Tooth and Brooke (1961), was being maintained in 1963. Since then other studies (Lancet leading article, 1969) have confirmed this continuing trend, although the rate of decline obviously varies from area to area. In the Birmingham Region, for example, the number of patients in residence per 10,000 population of the region was 21 at the end of 1968 as compared to 28 per 10,000 population at the end of 1958. These reductions are mainly due to the falling numbers of long-stay patients (those continuously in residence for at least two years), and for any such long-stay population it is important to study separately (1) the changing pattern of a standing population selected at a given time; and (2) the extent to which new patients are accumulating. In a previous paper (Hassall, Spencer, and Cross, 1965) the authors considered in some detail the composition of the inpatient populations of Powick Hospital at the end of each of the years 1952, 1957, and 1960. These patients were followed up until the end of 1962 and annual rates of discharge and death for the three populations were compared. The purpose of the present contribution is to study the subsequent experience of patients admitted to the hospital over the 10 years 1956-65 and to estimate the annual rates of accumulation of 'new' long-stay patients and their contribution to bed occupancy. By combining results from the two enquiries, forecasts of long-stay hospital populations can be made. Important differences exist between localities in respect of the needs for inpatient psychiatric care, and it is important to conduct local studies which take account of as much relevant data as possible regarding the changing patterns of admission and discharge of patients.