Social Psychiatry in the United Kingdom: The Approach to Schizophrenia

Abstract

British contributions to theoretical and applied social psychiatry have been determined in large part by a traditional empiricism and by developments in social welfare legislation over the past 70 years. The establishment of a national health service covering the whole population and the attempt to provide comprehensive social services have created special opportunities for epidemiological research and for practical community psychiatry. These developments have by no means been uniform throughout the country, and there has been plenty of scope for individual initiative. Open-door policies, domiciliary visiting, social and occupational rehabilitation, therapeutic communities, and long-term continuity of care were first introduced in pioneering centers and subsequently adopted elsewhere. The idea that disorders such as schizophrenia not only have the character of acute illnesses but can also take the form of chronic disabilities has led to recognition of the fact that services must be tailored to the needs of individuals, and to an emphasis on the importance of the family and other social environments. There is a readiness to capitalize on successes and to learn from mistakes, assisted by a wide range of evaluative studies, which promises well for the future.

Schizophrenia and brain dysfunction: An integration of recent neurodiagnostic findings.

“…Although it appears plausible to explain negative symptoms by frontal lobe dysfunction, it is unlikely that simple, localized frontal pathology can account for the presence of the admixture of symptoms usually found in schizophrenia (Wing etal., 1974;Wing, 1980). Moreover, the presence of neurologic soft signs and neuropsychological deficits, such as proprioceptive, gait, coordination, vestibular, eye tracking, and attentional (CPT) disturbances, suggest possible brain stem and cerebellar dysfunction (Holzman & Levy, 1977;King, 1974;Mirsky, 1969;Ornitz, 1970).…”

The metamorphosis of schizophrenia: from chronicity to vulnerability

“…Although the overall value of chi-square for the entire table is not statistically significant, the recovery rate alone shows a 10:1 advantage for the 'devotedly cared for' (x 2 for the row = 4-3, P < 005). Some of the 'devotedly cared for' may have received too much care which, according to Wing (1980), would militate against improvement. Leff(1978) has shown that patients exposed to a hostile critical environment relapse more frequently than those who returned to more favourable home situations.…”

Mental health care in Southern Italy: application of case–control methodology for the evaluation of the impact of the 1978 psychiatric reform

“…The awareness that custodial institutions per se could play a detrimental role with respect to the quality of care delivered to mental patients is part of the knowledge that for many years (Zubin et al 1983) and in most countries has led to reforms aimed at assuring a flexible interaction between ambulatory and in-hospital settings (Redlich & Kellert, 1978;Wing, 1980). In Italy the 1978 Mental Treatment Act has completely rearranged the public care sector.…”