No place for the teenager Two and
a
half years ago the
regional hospital boards
to
Ministry
of Health asked the 15
expand their psychiatric facilities
for adolescents. The National Association for Mental Health then collected detailed information about the boards' expansion plans. But late last year a further NAMH survey revealed that in the 2\ years since the Ministry's call there had been a national increase of only 34 more beds for adolescents. Giustina
Ryan
traces this sorry
story.
By 1964 it had become clear to psychiatrists and Workers in the mental health field that psychiatric Provisions for adolescents were pitifully inadequate. Even if a few adolescents could be treated satisfactorily in adult wards it was felt that they were better cared for in units of their own age group. Acting on the advice of the Standing Mental Health Advisory Committee, the Ministry of Health, in January 1964 sent out a memorandum to regional hospital boards recommending that the number of hospital beds for seriously maladjusted or mentally ill adolescents be increased as soon as possible. The Ministry wanted to see a ratio of 20-25 beds per million home population, that is, about 1,100 beds for England and ^ales instead of the 180 then available. What happened? By July 1966, about 2\ years after the publication of the memorandum, all the hospital regions together were providing a grand total of only 34 more beds than in 1964, bringing the national average up to only 4-5 beds per million of the popu-
lation.
Following
the appearance of the memorandum in 1964 the NAMH had collected information from aU regional hospital boards about their plans for future expansion of facilities for mentally ill adolescents. This survey had revealed that seven regions already had some units specially reserved for adolescents: (Newcastle 16 beds, Leeds 6, Sheffield 12, South East Metropolitan 57, South West Metropolitan 46, Liverpool 18, Wessex 25, a total of 180 beds). All these boards, with the exception of Leeds,
^ere definitely planning
to add more beds, though did not say when. Two other regions (North Metropolitan and Manchester), which had n? units at all, were planning to open one each. Nine were therefore planning expansion. But, in *-act, during the 2\ years up to last July only one more hospital region had opened a new unit for adoascents. This was Birmingham. Against this, Newcastle region had turned its adolescents' unit over to children. The result is that there are still eight regions no special units for adolescents?apart from Newcastle they are East Anglia, North West Metro-
^ey East
politan, North East Metropolitan, Oxford, South Western, Welsh and Manchester. (Oxford has units for children and adolescents together.) Of these, the South Western and Welsh hospital regions have not even published plans for the future. Two regions have improved a great deal?Leeds, where growth has been from six to 26 places, and Birmingham, where, from no provision at all, there are now 22 beds. Sheffield, Liverpool and Wessex regions have the same number of beds as in 1964. The South East Metropolitan region, with 18-2 beds per million population, has come nearest to the Ministry's suggested minimum. In the summer of 1966 the position of other regions providing units was as
follows:
?e?ions
^*th
Leeds Sheffield S W Metropolitan
Birmingham Liverpool Wessex
Number of beds 26 12 48 22 18 25
Beds per million
population 8-2 2-6 14-7 4*4 8-2 13*3
Teenage tensions
What of the future? Only four regional hospital boards have definite plans to achieve the Ministry's 20-25 per million recommended ratio. The average planned total (i.e. the sum of existing and projected provisions for all regions throughout the country) comes to only 16-5 per million. And it must be stressed that here again no date has been given. Planning has not so far seemed to be necessarily related to achievement. For, of nine regions which in 1964 had definite plans for expansion only two actually increased the number of their beds reserved for mentally ill adolescents. The nearest we are likely to get to realistic figures is to look again at that record since 1964?a total of only 34 more beds throughout the country?a growth rate of only 0-7* beds per million of the population in 2{ years. At this rate it will take between 40-50 years before the Ministry requirements are met, by which time the adolescent population in this country ?and therefore, presumably, the number of mentally ill adolescents?will have increased substantially.
*
The Ministry of Health claims a growth rate of T2 beds 2\ years, based upon their own figures for 1964. per million in
a
half years ago the
regional hospital boards
to
Ministry
of Health asked the 15
expand their psychiatric facilities
for adolescents. The National Association for Mental Health then collected detailed information about the boards' expansion plans. But late last year a further NAMH survey revealed that in the 2\ years since the Ministry's call there had been a national increase of only 34 more beds for adolescents. Giustina
Ryan
traces this sorry
story.
By 1964 it had become clear to psychiatrists and Workers in the mental health field that psychiatric Provisions for adolescents were pitifully inadequate. Even if a few adolescents could be treated satisfactorily in adult wards it was felt that they were better cared for in units of their own age group. Acting on the advice of the Standing Mental Health Advisory Committee, the Ministry of Health, in January 1964 sent out a memorandum to regional hospital boards recommending that the number of hospital beds for seriously maladjusted or mentally ill adolescents be increased as soon as possible. The Ministry wanted to see a ratio of 20-25 beds per million home population, that is, about 1,100 beds for England and ^ales instead of the 180 then available. What happened? By July 1966, about 2\ years after the publication of the memorandum, all the hospital regions together were providing a grand total of only 34 more beds than in 1964, bringing the national average up to only 4-5 beds per million of the popu-
lation.
Following
the appearance of the memorandum in 1964 the NAMH had collected information from aU regional hospital boards about their plans for future expansion of facilities for mentally ill adolescents. This survey had revealed that seven regions already had some units specially reserved for adolescents: (Newcastle 16 beds, Leeds 6, Sheffield 12, South East Metropolitan 57, South West Metropolitan 46, Liverpool 18, Wessex 25, a total of 180 beds). All these boards, with the exception of Leeds,
^ere definitely planning
to add more beds, though did not say when. Two other regions (North Metropolitan and Manchester), which had n? units at all, were planning to open one each. Nine were therefore planning expansion. But, in *-act, during the 2\ years up to last July only one more hospital region had opened a new unit for adoascents. This was Birmingham. Against this, Newcastle region had turned its adolescents' unit over to children. The result is that there are still eight regions no special units for adolescents?apart from Newcastle they are East Anglia, North West Metro-
^ey East
politan, North East Metropolitan, Oxford, South Western, Welsh and Manchester. (Oxford has units for children and adolescents together.) Of these, the South Western and Welsh hospital regions have not even published plans for the future. Two regions have improved a great deal?Leeds, where growth has been from six to 26 places, and Birmingham, where, from no provision at all, there are now 22 beds. Sheffield, Liverpool and Wessex regions have the same number of beds as in 1964. The South East Metropolitan region, with 18-2 beds per million population, has come nearest to the Ministry's suggested minimum. In the summer of 1966 the position of other regions providing units was as
follows:
?e?ions
^*th
Leeds Sheffield S W Metropolitan
Birmingham Liverpool Wessex
Number of beds 26 12 48 22 18 25
Beds per million
population 8-2 2-6 14-7 4*4 8-2 13*3
Teenage tensions
What of the future? Only four regional hospital boards have definite plans to achieve the Ministry's 20-25 per million recommended ratio. The average planned total (i.e. the sum of existing and projected provisions for all regions throughout the country) comes to only 16-5 per million. And it must be stressed that here again no date has been given. Planning has not so far seemed to be necessarily related to achievement. For, of nine regions which in 1964 had definite plans for expansion only two actually increased the number of their beds reserved for mentally ill adolescents. The nearest we are likely to get to realistic figures is to look again at that record since 1964?a total of only 34 more beds throughout the country?a growth rate of only 0-7* beds per million of the population in 2{ years. At this rate it will take between 40-50 years before the Ministry requirements are met, by which time the adolescent population in this country ?and therefore, presumably, the number of mentally ill adolescents?will have increased substantially.
*
The Ministry of Health claims a growth rate of T2 beds 2\ years, based upon their own figures for 1964. per million in
