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Salient. Victoria University of Wellington Students' Newspaper. Volume 31, Number 11 June 5, 1968

Mental illness increase

Mental illness increase

"Both the prevalence and incidence of psychiatric disorder in the community has increased substantially," said Dr S. W. P. Mirams, Director of the Division of Mental Health.

"Whether the increase in incidence is a true increase or simply a reflection of changing attitudes and improved diagnostic techniques is, as yet, undetermined. As Blacker pointed out some years ago, the descent of vast multitudes upon psychiatric clinics can be caused by nothing more than an alteration of standpoint among general practitioners."

Dr Mirams was speaking to the Social Sciences' Section of the Royal Society of New Zealand.

He discussed the dilemma encountered in planning changes to mental health services: "how to meet a rising demand when the true extent of that demand is difficult to assess and there is no general agreement as to the most suitable, or economic, design of service."

"The notion of an 'on call' type of mental health consultation freely available to everyone, is the basis of the 'community mental health centre' service acclaimed as 'the answer' in the USA." said Dr Mirams.

"I won't detail the socio-economic implications of this matter now, but it will be very obvious that the notion of a consulting service of this type, both freely available and free to all. will involve the community in considerable expense.

"And I don't question the potential value of the community-mental-health-centre concept. I see it fulfilling a most useful role.

"But I am unable to see it as providing more than a portion of 'the answer'," he continued.

"The notion of community care has very considerable attractions to administrators," said Dr Mirams. "It is undoubtedly true that many so called community care programmes are planned primarily in terms of expediency.

"This, in my view, is a crime only slightly less in magnitude than the unforgivable sin of attempting lo sell community care projects to politicians and the public, as cheap forms of psychiatric care.

"I cannot subscribe to the view that the only solution to the difficulties confronting us is to produce a vastly increased number of psychiatrists. In saying this. I am not implying that there is a satisfactory rate of supply at the moment or that I would not welcome the immediate addition of some psychiatrists to the medical staff of my division.

"But in considering the basic design of a future service I cannot see it as a sound plan except on the expectation that the general practitioner will continue to carry, as he does now, a substantial load of the services to those with psychiatric disabilities."

Dr Mirams suggested an increased number of postgraduate courses and training seminars for general practitioners on subjects of psychiatric concern.

"Training of psychiatrists must take account of this. If skills are to be used most effectively, the importance of their consultant role in their own profession, must be strengthened and their experience in this work increased.

"Uncritical advocates of community care frequently present their case as if there were a clear choice of alternatives —hospital care or community care. This is not so.

"It needs to be community stressed that hospital and community care are inter-related aspects of a total health service," said Dr Mirams.