Much has been written about the dangers of Cartesian dichotomy for psychiatry, with its equally perilous errors of ‘mindless’ or ‘brainless’ psychiatry (Eisenberg, 1986), as well as the nonsense of talking about disease as either ‘mental’ or ‘physical’, or with ‘somatic’ or ‘psychological’ symptoms. Kendell (1993) has made this point eloquently; this paper further extends the theme. We psychiatrists complain when our medical colleagues cannot get beyond the physical, even when evidence for psychosocial aetiology is quite blatant, but we may be guilty of an equivalent error in almost totally excluding spiritual considerations from the way we understand our patients. This was alluded to in the address to the Royal College of Psychiatrists by our patron (HRH the Prince of Wales, 1991). We ask patients to which religion they ascribe, but we neglect the much more important question of “what does your religion and your faith mean to you?”

This is a study of one mode of inception into psychiatric care in Birmingham. Mentally disturbed people coming to the attention of the police are referred to a mental welfare officer and assessed by him, usually in a police station. The mental welfare officer may then refer for a psychiatric decision with regard to further management, and the patient is examined by the doctor in the police station. The annual frequency of use of this referral system was studied from 1962-73 inclusive. It is shown that there was an increase in referral over the years and that such referral from the police became an increasing proportion of new referrals to the Mental Health Department (Social Services Department). The sample of referrals from the police for 12 months is studied in greater detail (252 cases), surveying social characteristics of individual patients, the relationships between such police intervention and areas of the city, the nature of situation requiring intervention and the management and treatment which these patients received. The referrals were traced from contact with the mental welfare officer to hospital where the case notes of those admitted were studied for details of legal status and mental state on admission, diagnosis, duration of stay and disposal. The effectiveness of this method of entering treatment is discussed and some recommendations are made.

No abstract

No abstract

No abstract

Is there an increased relative risk of death in severe neurosis? 1,482 patients from three psychiatric units in different hospitals in Birmingham were followed-up after a mean of 10.9 years. 91 per cent of the sample were traced and 139 patients were found to have died; a highly significant increased mortality for both sexes for all causes of death. Although suicide and accidents contributed disproportionately, particularly in early follow-up, there was still a markedly increased mortality from the combined categories of nervous respiratory and cardiovascular disease, more evenly distributed in time.

This is a descriptive account of 22 psychiatric patients who precipitated themselves out of high buildings, usually the window of a psychiatric ward. The clinical characteristics of these subjects and the circumstances of the jump are studied. Some recommendations are made to try and prevent the severe consequences of this behaviour.

No abstract