In 1978 the Section for Social and Community Psychiatry of the Royal College of Psychiatrists set up a working party to reconsider the DHSS guideline of 0.5 beds per 1,000 population for acute psychiatric units and to develop a new approach which would enable planners to adopt an appropriate bed provision figure according to the needs of different district psychiatric services. This followed the realisation that Health Authorities were beginning to set arbitrarily their own norms for bed provision, often based on one or two examples within their region, despite the fact that there is a two to three fold variation between districts in the number of beds provided for acute psychiatry. For example, in 1981 Worcester used 0.19 acute beds per 1,000 population and Camberwell used 0.76.

It was in 1961 at the Annual Conference of MIND that Enoch Powell first announced that the traditional mental hospitals were to be run down. Since then it has been government policy to emphasise the value of a transfer of care from hospital to the community. Concern was soon being widely expressed at the growing gap between statements of proposed government policy and their realisation. It has long been the intention to close Knowle Hospital, which originally served the city of Southampton, and over the last ten years there has been a gradual transfer of some of the services away from the main hospital site. A major problem in successfully implementing the closure of any mental hospital is the appropriate relocation of the long-stay population. The problems this involves have been much debated recently.

‘Community Care’ has become the psychiatric catch phrase of the eighties. With this burgeoning interest go the difficulties of working not just with a multi-disciplinary team but with Social Services and voluntary agencies, a move from our ‘ivory towers’ which not all psychiatrists will view with relish. Despite initial antipathy more psychiatrists are coming to accept the fact that moving patients out of long-stay facilities is a reality and new ways of working have to be found for these patients as well as acute patients.

Today the practice of psychiatry often involves a multi-disciplinary team comprising doctors, nurses, psychologists, social workers, occupational therapists, community psychiatric nurses and physiotherapists. Each discipline has its own contribution to make to the planning of care programmes for patients in the context of a team approach.

“No artist attains total excellence, but the strength of truth and justice is that it lasts and that man can say… this is the heritage of my father.”

When searching for a definition of mental handicap, I came across the following:

“Handicap is something imposed on a disability to make it more limiting than it need necessarily be.” (Shearer, quoted in O. Russell, 1985).

It is increasingly recognised that neither general medical nor specialist qualification marks the cessation of the need for continuing reinforcement and renewal of the well-known tripod of education, namely knowledge, skills and attitudes. It can be argued that experience is the great teacher and the day-to-day work of the graduate ensures a continuing updating. This is only partially correct since new knowledge and practices, together with changes in working relationships, may pass by the educationally isolated, leaving a person hidebound, prejudiced and reactionary on an island surrounded by a speeding torrent of change. Unthinking response to these pressures may not be the way to deal with the situation but an awareness of these changes, so that the choice of response is made from strength rather than weakness, is an essential aspect.