It will be remembered that the Department of Health and Social Security's Memorandum on the future of hospital services for the mentally ill specifically excluded all consideration of the problems of psychogeriatric care, and that this prompted the National Association for Mental Health to produce their ‘Mind Report’ No. 6, entitled ‘Now tell us how to solve the psychogeriatric problem of the psychiatric hospitals’. Fourteen questions were asked, covering divers areas such as the quality of information available for assessing the psychogeriatric problem, what the future admission policies were to be, what were acceptable standards of care, what practical alternatives existed to psychiatric hospital care for the elderly mentally impaired and what were the answers to the problems of provision and integration of local authority developments within the community.

From 1967 to 1970 there occurred a sharp decline in the number of British trainee psychiatrists (1). In 1967 there were 237 British-born or Irish-born registrars training in adult psychiatry in England and Wales; by 1970 this number had fallen to 165. Fortunately, more recent figures show that this downward trend has become arrested: in 1971 the number of British-born and Irish-born registrars was 187. There has not been an absolute reduction in the numbers of junior psychiatric staff because the decline in recruitment of ‘home-born’ psychiatrists has been offset by an influx of doctors from overseas. In 1966, 41 per cent of psychiatric registrars in England and Wales were born overseas; in 1971 this proportion was 62 per cent.

From Sir James Coxe's Presidential Address to the M.P.A., 1872 (J. Ment. Sci. 18, 311).

In twelve years the insane in proportion to the population has increased by more than a third. This is not proof of a real increase in lunacy: it is partly due to the operation of the statutes, and the opening of new asylums, partly to the tendency of patients to accumulate there. There must be taken into consideration the influences of modern society, such as the opportunities which asylums afford of getting quit of persons who from temper, disease, vice, intemperance or old age have become troublesome at home. Thus the definition of lunacy has expanded, and many a one is now treated as a lunatic who formerly would not have been so regarded.