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MENTAL HEALTH

Editorial PREVENTION AND EARLY TREATMENT There has been much comment on the gap created by the National Health Service Act between two large bodies, the Regional Hospital Boards and the Local Health Authorities, and certain dangers which result from this are particularly obvious. The difficulties, for instance, which arise in the after care of mental patients were described in this column in our last number (p. 62). A less obvious question is perhaps more important?who is responsible for the prevention of mental ill-health or, to put it in more positive terms, for the maintenance of mental health ? Under the Act, it would seem that the responsibility is that of the Local Health Authorities and that the specialist psychiatrists employed by the Regional Hospital Board are to be occupied in serving out-patient clinics. It is true, of course, that the latter's aim is to treat cases as early as possible, and the further this goes, the nearer does it approach to prevention, so that any specialist in charge of a clinic must inevitably be asked to advise on factors which affect the maintenance of mental health. In so far as the understanding of these factors is gained in a large part from the study of examples of mental ill-health, this is very proper: and it would seem as ridiculous to make plans for maintaining mental health without the advice of the practising psychiatrist, as it would be to plan a general health service without a doctor. Nevertheless, plans for mental health, of necessity are made and put into execution by the Local Health Authorities, and unfortunately, as things are at present, there are few who employ full-time psyand it is not suggested here chiatrists; that the time is ripe for them to do so. Consequently there is a grave danger that some

may not take enough account of the clinicians' point of view. Although the case of the psychiatrist has been

discussed here, there are, of course, other members of both Local Health Authority and Regional Hospital Board services whose help is essential, for instance, the psychiatric social workers, and health workers. At present, the majority of the former are on the staffs of mental hospitals (or teaching hospitals), but, in so far as their work inevitably takes them into contact with their colleagues employed either by voluntary bodies or by the local health authorities, there is not everywhere such a rift between the work of the- two sides; and there are signs that where there is one, it is narrowing, as has been discussed before. All these, and in particular, the psychiatrist, must be brought in. How this should happen must obviously vary with local situations; it is in fact taking excellent shape in some areas, where the psychiatrist in charge of an out-patient clinic, and perhaps on the staff of a mental hospital, has been asked by the health committee to act as their adviser on a mental health programme; in other areas, a less formal, but equally close contact is maintained between two sides. In other areas, however, the gap created by the introduction of the Act yawns wide. Bridges are best built from both sides at once; and sometimes a few piers in midstream (in the shape perhaps, of voluntary associations) are necessary if the river is wide and turbulent enough. There is a real need on the part of both sides to approach the other if we are to advance from the purely curative aspect of psychiatry to plan how to maintain and improve mental health.