Changing sociological and clinical patterns in mental handicap. The 1983 Blake Marsh lecture

The historical development of official provision for the care and training of the mentally handicapped--both adults and children--is outlined, to show the changes between Local Authority and Government. Changes in emphasis between compulsory and voluntary admissions to institutions are discussed with particular reference to changes in the law and the administration of the services. Demographic changes due to longer survival, falling birth rate, and prevention, diagnosis and treatment of individual causes of mental handicap are discussed. Particular reference is made to Down's syndrome and to the fragile X syndrome. The need for psychiatrists in mental handicap is mentioned along with the benefit of early intervention. The numbers of the mentally handicapped needing specialist care and training are not diminishing, but the manner of provision is changing, and partly reverting to ways tried long ago.