Are Observation Wards Obsolete?

A Review of One Year's Experience in an Acute Male Psychiatric Admission Unit

¹ Senior Psychiatric Social Worker, Andrew Duncan Clinic, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh 10

A report on the first full year's working of the new 27-bed acute male admission unit in the Andrew Duncan Clinic, Royal Edinburgh Hospital. The unit which has a 12-bed lockable section, takes all psychiatric emergencies, including cases from the courts, police stations and prison.

One hundred and fourteen individual patients were admitted to Ward 6 during 1965. Schizophrenia was the principal diagnosis in 29, manic-depressive reaction in 26; the next two largest categories were alcoholism (23) and psychopathy (13). Three-quarters of the group had a previous psychiatric history. Analysis of their social background showed a preponderance of middle-aged isolates, drifters and unemployed. Thirty-one patients had a known criminal record: detail is presented on diagnosis and the nature of their offence.

Difficulties of therapeutic ward management are discussed, with particular relation to acting-out, episodes of indiscipline, and the many unsatisfactory discharges. It is suggested that a separate short-stay observation unit would be valuable in screening out the psychopath and social nuisance unamenable to and unsuitable for the treatment facilities available.