The following Mmwrandum in reply to the Questionnaire from the Sub-Committee of the Standing Mental Health Advisory Committee on the ‘Role of Psychologists in the Health Service’ has been approved by Council and has been submitted lo the Sub-Committee. It was recognized thot the Specialist Sections might wish lo make additional comments and, if so, these will be submitted separately. (See under ‘Child Psychiatry Section’ below.)

The Royal College of Psychiatrists considers that there should be a statutory body or bodies concerned with the ethical and educational regulation of the medical profession and that a Register should be maintained. The body or bodies, quite independent of the State, should be mainly medical, but there should be increased representation of the public and possibly some representation of closely allied professions. At present the General Medical Council is answerable to the Privy Council, and consideration needs to be given to the question of the answerability of the new body or bodies. It is anticipated that in the future the profession will become increasingly involved in medico-social issues of public importance, many of them with psychiatric implications, (e.g. kidney machines, organ transplants, contraception, abortion, etc.).

Both Sweden and Denmark have systems of community care based upon the principle that the mentally handicapped should be able to live as independently as possible within the community and enjoy the experiences and opportunities available to the population as a whole. To what extent can this ideal be said to have been achieved?

In fact, the vast majority of individuals with uncomplicated mental handicap live in the community supported by a comprehensive range of sheltered facilities. Small residential homes (20-30 places) form the main living units, but a sheltered ftat system, utilizing ordinary council Rats for 4 to 5 individuals, is becoming increasingly popular. Highly industrialized workshops paying a realistic wage are provided for the more able, while the less able attend day centres for social training, education and simpler work. Leisure activity programmes are provided for both groups. Public attitudes are tolerant and accepting, and although the handicapped cannot be said to be fully integrated they are closely involved with the community and lead a nearly normal life with support provided at the minimal level necessary for effective functioning.

If the present provision of services for alcoholics is not improved as a result of all the efforts and stimulus of the Department of Health and Social Security, social, medical and voluntary agencies will need to start asking some questions about their own motivation rather than complain about how unmotivated alcoholics are. The latest move by the Department is a Circular, 21/73, entitled Community Services for Alcoholics. It is a tribute to the Department that funds are now available to assist alcoholics, who are not noted for being very popular; even the Circular admits “the reluctance of public opinion to recognize the scale and nature of the problem in their midst”. In essence, the circular makes clear the seriousness of the alcoholic problem for the whole community and the need to develop a “comprehensive treatment and rehabilitation service for all alcoholics”. Elements in this service include social workers and others able to assess the problem, particular attention being given to early diagnosis and prevention; hospital treatment facilities—a further six units are planned; special provision for vagrant alcoholics, including “shop fronts” and detoxification centres; hostels—where financial help is particularly forthcoming—information and advice centres. We shall be fortunate if within five years even some of these elements are in operation in all health authority areas.