¹ The research on which this paper is based was carried out between 1970 and 1972 in collaboration with David Tidmarsh and Valerie Mooney. The project was supervised by J. K. Wing of the Institute of Psychiatry, London University, and financed by a grant from D.H.S.S.

² Minutes of L.C.C. Social Welfare Committee, 4 06 1935–15 05 1945.Google Scholar

³ Public Assistance Circular 136/46, Ministry of Health, 1946.Google Scholar

⁴ Changes in the general housing situation have intensified the pressure. In 1950, 45 per cent of all dwellings in the U.K. were rented from private owners. In 1973, this figure was 17 per cent (Social Trends No. 5, 1974, p. 161Google Scholar). In Greater London in 1973, however, the proportion of dwellings rented from a private owner was 27 per cent (Social Trends, op. cit., Table 132Google Scholar). This was the highest proportion in any region. Yet even in Greater London this represents a continuing shortage of appropriate accommodation to meet the needs of people living there, which results from the changing structure of the housing market. Similarly there has been a reduction in the supply of cheap accommodation in the form of lodging houses and hostels. Since 1965, the total number of available beds in such accommodation has reduced by 17 per cent in Great Britain as a whole (OPCS survey of hostels and lodging houses, forthcoming). This has been accompanied by changes in the kind of accommodation offered and there are indications that the reduction in London is most acute. At the same time, there has been an increase in the number of single person households from 11.9 per cent of total households in 1961 to 17.9 per cent in 1971. (Social Trends 1974, No. 5, Table 10.)Google Scholar

⁵ This paper uses data deriving mainly from two surveys conducted at Camberwell reception centre. Firstly, the case-paper survey which was an analysis of a 5 per cent random sample of the 16,022 case papers filed at the centre in April 1970. These case papers represent men coming to the centre within the preceding two years who may or may not have been attending since 1965 (when such case papers were established as the centre was transferred from local authority to central government control). 801 cases were selected and 797 were surveyed and four of these were discarded as unreliable. A stratified sample of 413 cases who attended in 1968 was compiled from this sample. These cases were surveyed for data on social characteristics (788 cases) and contact with other services and use of the reception centre (413 cases). Secondly, intensive interviews with a sample of men coming to the centre between October 1970 and April 1971 were conducted. The population of users was divided into new cases, casuals and residents: a sample of 210 new cases was collected, of whom 142 were interviewed (the remaining 68 were followed up through the case papers); the casuals' samples numbered 211, of whom 176 were interviewed, the remainder followed up through the case papers, and 61 of the 64 in the resident sample were interviewed. These interviews included a clinical assessment of each man's physical and mental condition (carried out by David Tidmarsh, a qualified psychiatrist), and a case history.

⁶ Source: C.R.C, annual returns.

⁷ There are a number of basic problems connected with discussion of the provision of services for men with alcoholism and personality disorders: (a) not all the alcoholics who attend C.R.C, are unsettled, thus consideration of their requirements for services should parallel that of the discussion of services for alcoholism in the community in general. However, the fact that these men are at least temporarily homeless and destitute indicates a need for some social support and medical treatment, (b) there are doubts about the efficacy of much of the treatment presently available but it is worth noting that large numbers of people are never afforded the opportunity of benefiting from even minimal medical treatment, (c) the question must be faced whether scarce resources should be directed to these categories: it could be argued that men bear a moral responsibility for their actions and must face the consequencies. (d) for a large proportion of these cases, the need is for supportive services in the form of sheltered accommodation and work. In competition for the very limited supply of such services presently available, the homeless, destitute man with no family support is clearly at a great disadvantage, (e) generally, these men are chronically handicapped rather than acutely ill, and it is the general lack of provision for the chronically handicapped and the lack of ideas about what to provide which lies at the root of the problem.

⁸ The reception centre at present is concentrating its resources on men it is ill equipped to serve and for whom other services should be provided. However, there is an overall lack of such services. For example, between 1960 and 1969, psychiatric hospitals have lost 24,000 beds while, even by 1972, there were only 2,016 hostel places. (D.H.S.S., 1972.)Google Scholar