Reflections on the Current Psychiatric Consultation and Referral Pattern and on the State of the Art, at Oxford Regional Centre, An Adult Mental Retardation Facility

This paper investigates the utilization pattern of the psychiatric consultation and referral service provided by the author in an Adult Mental Retardation Facility over a three-year period. The services, their history and locale are described against a background of changes in attitudes towards the problems of the retarded. Rising interest by psychiatrists in the field is placed in context. A spectrum of variables is used for a statistical analysis of factors (Chi2) influencing psychiatric referrals or non-referrals of all new admissions over the period indicated (N = 98). Against a background of increasing normalization and de-institutionalization, the character and composition of the shrinking institutional population has changed. Administration and direct-care staff are now confronted with management and care problems of lower functioning retardates, presenting difficult-to-manage behaviours and severe, often multiple, handicaps. Several factors with resource and care implications are considered, affecting institutionalized as well as community placed retardates, especially in hard economic times. Findings are discussed; recommendations are made concerning the application of scarce psychiatric resources to meet changing psychiatric needs of the population, maximize services and continue community directed normalization efforts. Some caveats are sounded and further research suggested.