Papers and Originals Institutional Care of the Mentally Subnormal

The trend of progressive opinion concerning the hospital care of the mentally subnormal is well expressed in a Ministry of Health Memorandum [(65)104] on Improving the Effectiveness of the Hospital Service for the Mentally Subnormal. It states: "In the absence of complicating conditions, such as severe physical disability or disturbed behaviour, the severely subnormal patient who has been adequately investigated and treated ought not to be primarily the responsibility of the hospital services for long-term care. Ultimately, when facilities outside hospitals are fully developed, continued hospital care will be necessary only for patients who require special or continuous nursing and for those who, because of unstable behaviour, need the kind of supervision and control provided by a hospital." Our object in this paper is to estimate the proportion of patients now in hospital who, according to these criteria, require hospital care and to consider the future organization of institutional care of the mentally subnormal in the light of the findings. In 1965 an investigation was made of the needs of all (1,652) Birmingham patients (874 male and 778 female) in 13 hospitals for the subnormal in the Birmingham area. Each patient's requirements were assessed by a hospital doctor and nurse in charge of the ward. A previous report (Leck, Gordon, and McKeown, 1967) showed that in most respects Birmingham patients were similar to the subnormal in all hospitals in England and Wales. The exceptions were the lower proportion of young patients in Birmingham hospitals (accommodation for them in the area is deficient) and the higher proportion classified as " severely subnormal."