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from III - Public Health Aspectsof Long-term Treatment
Problems of magnitude
In 1981, a group of World Health Organization (WHO) experts wrote in a booklet entitled Social Dimensions of Mental Health:
There is a pressing need to deal with the consequences of … falling death rates in early life and increasing expectancy of life at birth; these paradoxically contribute to an increase in the prevalence of certain health problems. Among the most important of these consequences is the rising pandemic of chronic ill health and disability. (WHO, 1981)
In fact, life expectancy at birth has been increasing in most European countries from about 40 to 50 years in 1900 to 70 and more in 1980. A rapidly increasing part of our population reaches old age. Morbidity in general and prevalence of chronic illness in particular considerably increase in old age.
Problems of incidence
In addition to the greater proportion of the elderly afflicted by chronic illnesses or among chronically ill people, other factors also contribute to the same kind of health problem. The main age at risk for the onset of functional psychosis (the most frequent and severe mental disorders in adults), is about 20-34 years for schizophrenia and 24-50 years for affective psychoses. Given stable, age-related incidence rates. the total number of onsets of these disorders reflects the number of people reaching the ages at risk.
In some European countries, e.g. in the Federal Republic of Germany, the annual birth figures nearly doubled between 1945 and 1965. Then the annual birth figures fell steeply within five years to approximately half the number reached in 1964 and have been maintained at this level. As a consequence of these demographic changes, the Federal Republic is being confronted with a proportional increase in onsets of schizophrenia during the period 1975-2000 and can expect a proportional decrease thereafter. The same will presumably happen (albeit with a small time lag) with the figures for the true incidence of affective psychoses. The question still remains unanswered, whether - in addition to the demographic influence on the morbidity risk - the age-related incidence rates for depression have also been increasing and will continue to do so. At the time when the demographically determined morbidity figures presumably reach their peak, we may have reduced the number of psychiatric beds considerably and thus will not be able to serve the increased need.
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