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24. New Chronicity 329 This is the third paper in the series dealing with Psychiatric Services in the Eastern Health Board Region. The first paper is entitled ‘Guided Evolution of a Community Mental Health Service’, followed by ‘Community Care or Independence’. This was a talk given at a seminar run by the organization ‘GROW’ IAM pleased and honoured to be here because I have admired GROW’s work for a good few years and I have had a number of dialogues with Con Keogh whom I have great respect for. This, of course, means I am a deviant like the rest of you, because the orthodox people do not even ask me to talk anymore. Anyway, the reason I wanted to look at this question is because I think it has been something of an assumption that everything is developing nicely and that mental hospitals are going down in number and we are getting all the mentally ill back to a healthy community life. I have spent a great part of my life struggling with mental hospitals; they are definitely closing and that is a very good thing. Nevertheless, it does not follow that everything is right. There is the hidden problem of the people who would in the old days have gone into mental hospitals and probably stayed there – the whole question of where are they now and what is happening to them. That is what I really want to look at. If we look at what we call the ‘new longstay’, these would be people who are under thirty-five years of age and have been in hospital for one to five years – that is the usual definition of the new chronics rather than the old ones, who have been there for twenty/thirty years. Below thirty-five years of age, the people we call schizophrenic comprise 88% of the total number. What I mainly want to talk about is this group aged under thirty- five, who are becoming the new chronics or the new longstay (the names are not very nice), people who are still continuing to be a problem. As you can see, the majority of them are schizophrenic. A small number of cases that we call ‘organic syndromes’ are probably the truly new chronics, in the sense that they won’t ever be able to be dealt with purely in the community, but these are a small number and it could be asked whether they should be included in the psychiatric field at all. Although these may show behavioural disturbances, the problems they are suffering from are mainly neurological, like brain damage from motorbike accidents, or those who damage their brains from drink. So there will be a small number like these who will need full institutional care of some kind but probably only fifty to a hundred beds in a whole area like the Eastern Health Board region. It is important to realize that they are there and that they do need care. Nowadays, a better term for them is the young chronic sick, like those in the late stages of multiple sclerosis and, as I say, it is questionable that we should be considering them to be psychiatrically ill, although some of them will show severe behavioural disturbances. The bulk of the problems I want to consider fall under the heading of what we call ‘schizophrenia’ or allied conditions in the younger age group; also some of the very chronically neurotic people and particularly people who have been chronically depressed, whose moods swing. Some of these can be equally chronic. In the government policy document ‘Planning for the Future’, which is the nearest thing we have to an official document, it was suggested that for people like this we were going to need 0.27 beds per thousand. I know it doesn’t sound very much but that would be 2.7 beds per ten thousand or twenty-seven beds per hundred thousand. In the area in which I have been working in the Eastern Health Board region, we have about twelve areas of roughly 100,000. Once you look at it, then you realize that you are looking at roughly 300 places – which is really a mental hospital again. Hopefully we won’t be talking about a mental hospital but, whatever we are talking about, if these people are going to become chronic and unable to live an independent life (which is really what orthodox psychiatry is saying), then they...


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