Correspondence

ReWiHttItion oflong-stay patients 'The Rising Tide'

DEAR SIRS Dear SIRS
The psychological hazards of long-stay wards have long The Health Advisory Service has just issued a publica-
been realized. The helplessness and passive dependency tion, The Rising Tide, concerning the development of
engendered by such an environment, where food, clothes, services for mental illness in old age. I note that in para-
linen and even staff appear like magic through the door, is graph 83 of the document it lists various 'key staff' who
recognized as contrary to the desired aims of rehabilitation. should be involved in a comprehensive service for the elderly,
The drive towards community care got under way following but does not include senior trainees amongst the core group
the Royal Commission in 1957. After an initial flux of rapid of staff.
and successful rehabilitation of the best candidates from the In hospital practice the senior trainee often plays a vital
back-wards, we are all aware of a slowing-up. With the com- role in the day to day management of the unit and has the
bination of increasingly difficult clinical material and opportunity to bring with him fresh ideas learned from recent
decreasing resources, this is predictable. The chronic beha- experience in other branches of psychiatry. Furthermore, he
viour patterns of the remaining long-stay population, com- provides a back-up for the consultant at time of absence,
bined with the minimal staffing levels, are a recipe for despair. having first-hand knowledge of the methods of working in
Any move towards increased independence by these patients the unit, thereby improving continuity and benefiting both
is welcome, and we believe we have made one. staff and patients.
The long-stay wards, and various other units where Unfortunately, there are many psychogeriatric units
medical staff only visit intermittently, give Knowle Hospital which, as yet, do not have the services of a senior registrar to
a resident population approaching 500 patients. Their steady provide a link between consultant and junior staff. Many of
crop of physical ailments makes a high demand on the these units would provide good training experience towards a
psychiatric medical staff which can easily distract attention consultancy in the health care of the elderly. There are still
from the need for regular psychiatric review. In order that too few good training posts available in psychogeriatrics. If
the senior psychiatrists can apply themselves fully to the services for the elderly are to expand there will need to be
psychiatric management, we have established a 'Physical a steady supply of well trained senior registrars. The Rising
Treatment Unit' within the hospital, where a trainee psychia- Tide, by omitting to mention senior registrars in the docu-
trist holds a surgery each morning. Physical problems can be ment, has missed an opportunity to encourage develop-
brought to the surgery for consultation without appoint- ments in senior registrar training.
ment. The incapacity of the long-stay resident usually means A.N.CADE
a nurse escort is required, but even when this is the case, it is Exe Vale Hospital
still a good simulation of leaving home to visit the doctor, as Exminster, Exeter
is normal in the community. This makes a goal, needing
effort to get a reward, and so makes a good exercise in
rehabilitation, as well as getting the work done by those best
able to do it (the trainee with recent experience in physical 'Sciences Basic to Psychiatry'
specialties) in a place designed for this purpose. The most DEAR SIRS
outstanding benefit became apparent when preparing The AUTP Guidelines on 'Sciences Basic to Psychiatry'
patients for the recently opened hospital hostel; gaining (Bulletin, April 1982, 6, 54-56) were produced as an
experience in attending this surgery was one of the many attempt to inform trainees and those concerned with the
preparatory adjustments to their way of life, which made organization of training. A separate working group charged
their move to the community a success. In the first year of with the production of guidelines on dynamic and pheno-
the scheme about 700 consultations have been made, menological psychology was dogged by illness and other
averaging two or three per day. problems, but has now been reconstituted and hopes to
Situated near the pharmacy, the Physical Treatment Unit report by the end of this year.
also houses the optician, dentist, ECT unit and soon the X- Dr D. A. Black (Bulletin, April 1983, 7, 74) on behalf of
ray department, making a convenient centralization. of the Joint Standing Committee of the College with the British
demands for dressings, instruments and drugs. Psychological Society, also expressed a wish for some
We feel others may like to know of this scheme, which has amplification of the relationship between the basic sciences
been approved by providers and users alike. and their applications. This is a desirable objective and one
ANTHONY J. WHITE which motivates those who wish to see a broader representa-
Knowle Hospital tion of the basic sciences in the final Membership Examina-
Fareham, Hants tion.

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 The present guidelines take into consideration the fact that from the understanding of each other's difficulties (par-
the Preliminary Test (Part I) is largely, if not exclusively, ticularly the limited resources) arises the spirit of shared
non-elinical. In the future a more clinically orientated Part I adversity and a common determination to work together
may enable a closer examination of clinically relevant beha- towards the common end-the service to the elderly.
vioural science in Mth parts of the examination. Mistrust and suspicion can all too readily arise if each
Any changes will be reflected in future guidelines pro- specialty sees the other as a rival rather than a partner <as
duced by the AUTP. can occur between the Health and Social Services).
The Association represents those academic departments Such a department with a comprehensive oversight of the
providing undergraduate and postgraduate education in total service needs, can collect relevant statistics, monitor its
psychiatry, and as such is an interdisciplinary group pro- performance and argue with added strength for better
viding a forum for the discussion and dissemination of know- resources against other bids.
ledge relating to such teaching. At a clinical level the geriatrician and psychogeriatrician
I hope that psychologists, social workers, sociologists and hold a monthly out-patient clinic to which each can refer
other non-medical specialists active in medical teaching will patients for joint discussion on treatment and management.
join the Association and play an important part in its There is in addition a twelve-place Day Assessment Unit
deliberations. At present each academic department sends available to each consultant which allows a full social,
three representatives to the Standing Committee which meets psychological, domestic and physical assessment of patients,
regularly to formulate Association policy and exchange to be undertaken without the use of an in-patient bed.
information. Obviously having the Geriatric and Psychiatric Units on the
Anyone who is not a member of the Standing Committee one campus of a District General Hospital greatly facilitates
may, through their local representative or by writing to the clinical and administrative co-operation, yet ultimately a
Secretary (Professor A. C. P. Sims, Leeds), communicate good working relationship and the efficiency of the service
their views to the committee. A newsletter (Editor: Dr J. for the elderly must depend upon mutual goodwill at all
Connolly, Westminster) will publish letters or articles on levels. It needs the sense of purpose, belonging and direction
teaching and related matters. between all members of the consultants' teams, and in our
If anyone does wish to give us advice on the relationship view, this cohesion and drive can only be obtained within an
between the basic sciences and their application, on the administrative and clinical framework which unites the two
guidelines generally or, indeed, on any other matter, I or the disciplines in a common task.
other officers of the Association would be pleased to hear B. W. DURRANT
from them. B.C. KUNDU
SYDNEY BRANDON P. H. TALAVLIKAR
Chairman Oakwood Hospital
Association 0/ University Teachers 0/Psychiatry Maidstone, Kent
Leicester Royal I'ffirmary
Leicester

DEAR SIRS
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Collll1Jorlltloll ktwull Jlsyc1dtItrUts tDUl

Your correspondents, Drs Langley and Wilson (Bulletin,

DEAR SIRS
I share Little et ars concern about the Lundbeck Limited
method of advertising 'Depixol' in the context of art and
April 1983, 7, 73), draw attention to possible areas of con- psychosis <Bulletin, March 1983, 7, 55).
cern for psychiatrists and geriatricians in their endeavours to The question of creativity, whether in the arts or sciences,
work together. is a complex issue, recognized by most, questioned by some
To combat these difficulties, the geriatricians and psycho- and explained by few. Amongst the few, the late Arthur
geriatricians of the Medway Health Authority jointly formed Koestler's 'Act of Creation' is perhaps the most illuminating
a Department for the Care of the FJderly which has attempt at characterizing this basic human quality. To
admirably overcome the difficulties they itemize by the juxtapose men of great creative abilities alongside psycho-
solutions they propose. tropics belittles the achievement of both, or in Koestler's
Such a department engenders a sense of team work based words, it would dismiss 'The Ghost in the Machine'.
upon mutual trust and respect, and directed towards a GEORGE HALASZ
common goal. Problems previously seen as only affecting Maudsiey Hospital
one 'side' and not necessarily the other, are now shared, and LondonSE5
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