Journal of Mental Science (1922) 68: 385-395. doi: 10.1192/bjp.68.283.385
© 1922 The Royal College of Psychiatrists
This Article
Right arrow Full Text (PDF)
Right arrow Submit an eLetter
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Bruce, A. N.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Bruce, A. N.

The Out-patient Treatment of Early Mental Disorder. The Neurological Clinic, and some of its Functions(1)

A. Ninian Bruce, D.Sc., M.D., F.R.C.P.Edin., Director

Neurological Clinic, etc., Ministry of Pensions, Edinburgh

(1) A paper read at the Annual Meeting held in Edinburgh, July 19, 1922.

ABSTRACT

  1. In all other branches of medicine facilities for dealing with disease in its initial stages are recognised as indispensable. In the case of borderline mental cases this has yet to come.
  2. The study of mental disorder requires a long apprenticeship, and the treatment of incipient cases is often a long and complicated process, for which the average general practitioner has seldom either the time or the special training necessary.
  3. It will permit of the recognition of dangerous and certifiable mental states at an earlier date than often occurs at present, and thus result in their removal to a mental hospital before, instead of after the tragedy.
  4. It will allow the general practitioner to obtain an expert opinion on all doubtful cases, and supply the early mental case with appropriate treatment at the beginning of the illness, thus tending to cut short the duration of the attack, and often prevent the necessity for certification and removal to a mental hospital; or, if this be ultimately necessary, shorten the duration of his time in hospital.
  5. It will help to relieve the overcrowding of asylums, and thus leave more time for the individual treatment of those who remain.
  6. It will assist, when necessary, in the after-care of the discharged patient.
  7. It will allow of the examination and segregation of mental defectives in institutions.
  8. It will allow of the examination of epileptics with a view to removal to epileptic colonies.
  9. It will form a useful adjunct to the treatment of offenders in the Law Courts.
  10. It will serve as a teaching centre.
  11. It will serve as a centre for investigation and research.
  12. It will allow surgical and other out-patient clinics to refer cases for examination whenever it is thought that nervous or mental factors are also present in the case.
  13. The clinic must work in close co-operation with the mental hospital, the mental defective institute, the epileptic colony, and the general hospital. The staff must be specialised in organic neurology, psychology, normal and abnormal, and psychiatry. Uncertified wards for the treatment of early cases requiring in-patient treatment, and for acute cases of short duration, should be attached to the clinic. A social service organisation to assist in the investigation of cases and their after-care should be also attached.

An out-patient clinic, organised on these lines, will bring the mental hospital into touch with the general public through the medium of the general hospital. It will help to expedite the removal of the vague fear of illegal detention, which has not yet passed away, and it will also help to remove the "stigma" which is still supposed by many to be attached to the legal certification of the person of unsound mind.