NEUROSIS AND THE MENTAL HEALTH SERVICES OXFORD MEDICAL PUBLICATIONS BY C. P. BLACKER FOREWORD DR. BLACKER describes in the first chapter of this book the origin of the survey of psychiatric outpatient facilities of England and Wales. The matter was first raised in March 1942, and work was begun in October of that year. Changes were then in the air, and the time seemed ripe for a general stocktaking of our medical services. It seemed appropriate that the survey should be planned with an ulterior as well as an immediate objective. The immediate purpose of the survejr was to bring about a better coordination and distribution during the war of the countrys psychiatric resources which had been depleted by the demands of the fighting services and the E.M.S. The ulterior purpose it could be made to serve was related to the integration of the countrys health services after the war. At the beginning of Xovember 1942, I discussed his plans with Dr. Blacker, and I encouraged him to take the wider issues into account both in conducting the survey and in writing his report. The essential feature of the completed document is that it submits quantitative proposals for the organization of a mental health service in England and Wales. Scotland was separately surveyed. Three principles are embodied in these proposals. They relate to the future role of the eleven universities containing medical schools, to the incorporation of the mental in the general health service, and to the provision which might be made for a hypothetical population of a million, treated as an administrative unit. These proposals are, as far as Dr. Blacker is aware, in general consonance with the views expressed by those organizations concerned with mental health which have appointed planning committees and have published reports. But Dr. Blacker is in a position to take Ms suggestions a stage further than the others. He has attempted to embody in quantitative terms the generalized propositions of the planning committees. In the reorganization1 of any public service, two questions present themselves: what kind of provisions we want, and on what scale. In this volume will be found suggestions as to both. The numerical proposals therefore arise from the main finding of the surveythe wide disparities found to exist between the mental health services of diiferent regions of the country. SIR WILSON JAMESON RV OF HEALTH, WHITEHALL, S.W.I September 1945. CONTENTS FOREWORD SIR WILSON JAMESON, K.C.B., M.D., LL.D., PREFACE Acknowledgments Arrangement of Report Reckons Terminology INTRODUCTION I. ORIGINS, HISTORY AXD SCOPE OF THE SURVEY 1. Origins 2. History 3. Objects and Scope THE SURVEY: MAIN FINDINGS AND THEIR INTERPRETATION II. PRELIMINARY NOTES: CIRCUMSTANCES AFFECTING THE SURVEY: PRESENTATION OF FINDINGS 1. Questionnaire used In the Survey 2. Large Town, Small Town and London Clinics 3 The London Region 4. Partially filled Questionnaires 5. Number of Clinics included in the Survey 6. Case Sheets in use at Clinics 7. Statistical Significance III. MAIN FINDINGS IV, QUESTIONS ASKED FROM THE FINDINGS 1. Has there been a Real Increase of Neurosis 2. Would a Real Increase of Neurosis be detectable Today ? 3. Dual Origins of OutPatient Psychiatric Services 4. Central, Affiliated and Independent Clinics V. NEOROSIS IN INDUSTRY PART TWO POSTWAR PSYCHIATRIC SERVICES: LONGTERM CONSIDERATIONS VI. INTRODUCTION 1, Prefeative Psychiatry a Sociological Question 2. BifiB in Psychiatry: its Partial Insulation from Medicine 3. Prioritise ETC.