No abstract

In recent years provision of care for psychiatrically disturbed adolescents has received increasing attention. The present situation was summarized in a leading article in the British Medical Journal (1971) which emphasized one aspect of this provision—the need for adolescent in-patient facilities based within the community. This paper describes the ideas and practices of an adolescent unit which was opened at Hill End Hospital, St. Albans, in September 1969 to take younger adolescents (up to 16) of both sexes, from the area of the North-West Metropolitan Regional Hospital Board. This area covers 13,000 square miles and has a population of 4½ million, which the Unit aims to serve with 11 available beds. Who should be admitted to these places is clearly a critical question.

separate acts of promotion and is, in money, worth more than four times as much as a C award. Similarly, pro rata, for A and B awards. An A-award is CJ18 100, an A award is £13 950, a B award is £8 350, and a C award is £3 720. DistributionThe four Thames Regions (4649 consultants) have 59-8 awards points per 100 consultants; the provinces (8594 consultants) have 50 9 points. In the-provinces 60°,) of consultants are in contract with regional health authorities (RHAs) compared with only 45°', in London and this pulls the average score down. Area health authority (teaching) (AHA(T)) consultants score much higher. Consultants with RHA contracts do a little better in the provinces (38 2 points per hundred) compared with London consultants with RHA contracts (36 7 points per hundred). No other figures are available this year for detailed regional comparisons but it is official policy to even things out geographically -an acknowledged influence on distribution of awards.Since 1979 more specialties are defined separately rather than being included in broader headings. At A + awards are held by 5 30% of men aged 60 to 64 or 3-5 O of men aged 55 to 64. Among men retiring over 60, well over one in 20 has an A + award, about one in ten in AHAs(T), and at least one in five at PGTHs. In RHAs only one consultant in 50 or 60 will have an A + award on retirement.Among men over 60, one in six has an A award or better. An A or A+ award is attained by about 6% of men at RHAs, by about 30% at AHAs(T), and by about 45% of men over 60 at PGTHs.The age scatter is wider for B and C awards. More than onethird of all consultants have at least a B award at retirement and three out of four men have at least a C award. At PGTHs, over 80%"I of consultants will reach at least a B award; in the AHAs(T), over 50%; in the RHAs, about 23%.

The decision admit a disturbed adolescent to a mental hospital is all too often made by a hard‐pressed duty psychiatrist, late in the day, but early in his training. The effects of this decision may well reverberate down the generations. At the Unit for younger adolescents at Hill End Hospital, St. Albans, Hertfordshire, England (5), the family, not the psychiatrist, makes the decision. This approach is based on the observation that when families eject their youngsters, parental authority is often disintegrating. Referral for admission provides a golden opportunity, not only for reversing the ejection process, but also for forging, on the anvil of a profoundly important decision, a more viable family authority structure. Therapeutic leverage is made available at the very heart of the family problem.

view of pathology is broader than that of one who studies pathology in the individual. The possibilities of interven tion are therefore broader and ramify into the 2 433 This One