THE ST. JAMES' JOURNAL

St. James' Hospital 2000 A.D.
 
In this space age it is becoming increasingly popular to attempt to look into the future. Dr. Who and the Daleks are national figures and What the stars foretell' is told in most newspapers. Scientists frequently make intelligent guesses as to what the future holds. Let us then look at the possible future of St. James' and mental illness in the year 2000 and beyond.
 
First the buildings themselves; the main building cannot be upgraded indefinitely and must be eventually demolished. Before this comes about it will be surrounded by individual units, each unit with its own specific purpose. These units will be connected by a network of pleasant service roads and the whole set in a series of landscaped gardens. No walls will separate it from the community. Many areas will be set aside for outdoor activities and no doubt a swimming pool will have been built.
 
The units which house the patients, or residents, will be of the villa type and be luxurious by present standards. There will be a gymnasium and a well-equipped centre for social gatherings. There will be classrooms of a sort which will enable the residents to continue with adult education and so broaden their outlook; a centre for occupational pursuits will also be provided. I think, however, that the emphasis will be on filling one's leisure hours rather than on occupation. We can assume that automation reduces working hours to a minimum and produces a state where most of the increased population will be unable to work. This is happening in America now at an ever increasing rate.
 
Who then will be the residents of this apparent Utopia?
 
I think by the year 2000 the psychosis will have been controlled by chemical means. The illness will be recognised at an earlier age, and corrected before it reaches serious proportions. The Psycho-geriatric will remain a problem, but will be nursed in a General Hospital atmosphere as will the many organic states. The subnormals will continue to be cared for in special hospitals. This leaves us with mainly the neurosis, which will increase as the need for drive for survival decreases, and time has to be filled constructively. The stresses of life will no doubt increase.
 
Assuming then that we have long and short stay neurotics in our care what part will the hospital play in helping them? As today our main asset will be to provide an alternative environment to the one in which they find themselves, and to provide specialised care. Much work will be done in the community to prevent neurosis and prevent recurrence. Much can be done by rehousing, changing occupation and pointing out the possible causes for the breakdown.
 
If it is decided that a person would benefit by becoming a resident, then they may be admitted on a day basis or as a full-time resident. During their stay it will be the task of the staff to correct disturbed thoughts, and to build their confidence in themselves, broaden their outlook, and give them the means to live a full and happy life to the limits of their capabilities. This by present standards is a tall order and an impossible task with the facilities available. But we have made a start in many ways.
 
What of the staff who we hope will combine to bring about this ideal? The ratio of residents to staff will be much improved; each Psychiatrist will care for not more than 20 residents ; to assist will be highly trained equivalents to the present day Nurse. Their title yet to be created, but certainly not Nurse. In collaboration with the Psychiatrist they will integrate the services available, and lead the residents through a web of neurosis, and probably continue to help when the resident returns to the community.
 
This will all be possible as physical disease is reduced and the problem of mental illness becomes apparent. It will be interesting to hear the comments of the twenty-first century therapists, on our early efforts, and to look with them into their future.
J. B. E. C.
 
Summer 1965
 

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