Mental Disorders
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Book Reviews
Twenty-fifth Annual Report of the Board of Control for 1938. Parti. H.M. Stationery Office. Is. 6d.
The Report of the Board of Control for 1938 is a fine record of achievement. After years of struggle, great improvements in conditions and treatment, both in mental hospitals and mental deficiency institutions have taken place. It was chiefly due to the Board that the Act of 1930 became law and this revolutionized the official outlook on mental illness so that early treatment came into the forefront of policy. The voluntary organizations such as the National Council for Mental Hygiene who have worked for nearly twenty years to educate public opinion to demand early and preventive treatment have also con- tributed much to the desired end, for as Sir Laurence Brock has said a Government Depart- ment cannot act in advance of public opinion, though without its backing no Act can come into being. It is very regrettable that the extension of these hardly won advances will tend to be shelved during the war and some of the already existing facilities may even have to be curtailed. Out-patient Centres. Only three public mental hospitals in England have no centre associated with them for out-patient treatment. Existing centres now number 177, most of which have sessions at least once weekly. The total number of patients seen exceeded 19,000 with an aggregate of 74,000 attendances during the year. This suggests that a real attempt at treatment is replacing the merely diagnostic service which was formerly the rule rather than the exception. It is to be hoped that the war will not reduce the activity of out-patient centres since the need for them among the civilian population even if not greatly increased is not likely to be reduced. Part-time Psycho-therapists. The appointment of a part-time medical Psycho-therapist on a sessional basis to the staff” of St. Bernard’s Hospital (formerly Hanwell) to treat patients likely to benefit is an important precedent. The existing staff of most mental hospitals have neither the time nor the training to give this specialized and intensive form of treatment. The National Council for Mental Hygiene has long advocated this policy.
Nurses’1 Homes. The provision of Nurses’ Homes goes forward surely though slowly, and the Board’s hope that demands for emergency work at night will be reduced to a minimum is very important. The part that the nurse plays in the treatment of patients in mental hospitals cannot be over estimated, and only if the nurst health and happiness are safeguarded can she b expected to carry out her duties with the efficient, and tranquillity that mean so much to th- patients under her charge.
Voluntary Treatment. The increase of volun- tary admissions is encouraging, but the numbers are not so high in many hospitals as they ought to be. For this, Public Assistance Officers, Medical Superintendents, and Visiting Com- mittees may all be to blame. As the Board points out, it does make a real difference to the patient and his relatives if certification can be avoided. It is to be hoped that public opinion will bring pressure to bear on those who through lack of human understanding or indifference to the feelings of others prefer a course which is easier for themselves although more damaging to the patient. A specious excuse is sometimes put forward that voluntary patients discharge themselves too soon, even a few days after admission. But when patients do this, it is usually a reflection on the conditions or treat- ment in the mental hospital. This is proved by the fact that those hospitals which have the highest proportion of voluntary admissions do not necessarily show the highest proportion of voluntary patients discharging themselves against medical advice.
Storage of Patients’ Clothing. The insanitary habit of tying patients’ clothes in a bundle at night is rapidly disappearing. Nothing could be more damaging to a patient’s morale than to have to wear creased and messy clothes; indeed the superior type of patient strongly resents being deprived of his personal belongings and having to wear ugly and clumsy garments. The trouble and expense of providing suitable hangers for clothes is abundantly repaid by the improvement in the patient’s outlook. An interest in his personal appearance is an impor- tant factor in restoring the patient’s social adaptation.
Physical Training is still very limited in mental hospitals, but it awakens the patient’s interest and reality and should certainly take a more prominent place. It must, however, be carried out by properly trained instructors or nurses, and the ex-army sergeant is quite an unsuitable person.
Libraries. It is strange that there has been so much apathy and in some cases active opposition to the introduction of adequate library facilities in mental hospitals. Many medical superin- tendents seem to resent the introduction of voluntary visiting librarians as if they feared that would in some way have an unfavourable effect upon the hospital; but where the experiment has been tried the happiness of the patients has manifestly been increased. The National Council for Mental Hygiene has strongly advocated the establishment of a well organized library in every mental hospital, and it is hoped that even in wartime the project will not be neglected.
Mental Deficiency
The total number of defectives under care, either in institutions or in the community was, at the end of 1938, 89,904 (as compared with 86,510 at the end of 1937). Of these 46,054 were in Institutions or Homes, and 43,850 were under some form of community care.
Ascertainment. The number of defectives reported to Local Authorities, whether subject to be dealt with or not, was 125,859 representing a proportion to the population of 3-07 per 1,000 as against 2- 99 a year ago.
In addition, 3,536 feeble-minded children between 1 and 16 were informally notified for After-Care on leaving school, and if these are added to the number given above, the total number of cases known to Local Authorities ?n January 1st, 1939, was 129,395, or 3-15 per 1,000 (as against 3-07 the previous year). The number of defectives ascertained to be subject to be dealt with, was 95,418, viz. 2- 33 per 1,000, as against 2-26 last year.
The number of children between the ages of 7 and 16 notified by Education Authorities during the year was 3,425, and it is discouraging to note that this represents a decrease of 485 on the number notified during 1937.
The Board regret that the number of defectives ‘ subject to be dealt with ” and in receipt of Poor Relief (8,506) has remained almost stationary for the last four years, after the initial drop due to the passing of the Local Government Act in 1929, and they draw attention to the provision by which such defectives can be Placed under Guardianship under the Mental Peficiency Act and continue to receive a grant ln aid. They urge that this procedure should be adopted in order that training and special care can be provided in addition to monetary relief.
The Table of Ascertainment Rates provides, as always, much illuminating information as to the varying standards of administration which are to be found throughout the country. Thus, ln Cardigan, whilst the proportion of defectives reported is given as 8-03 per 1,000, only 1 -46 are subject to be dealt with and only ? 23 under some form of care; in West Hartlepool, on the other band, out of 1-18 per 1,000 reported all were subject to be dealt with, and -92 were placed under care. In Ipswich?to take another example?4-13 were reported, 3-76 were subject to be dealt with, and 3-67 were placed under care.
Institutional Accommodation. During 1938, the total number of beds increased from 43,552 to 45,717, and practically all the larger Authori- ties in England had sufficient beds to meet at least their most pressing needs, though in Wales no progress has been made. In Institutions approved under Section 37, there was a net decrease of 410 beds, and no new approval was given during the year to such premises unless the scheme provided for the complete separation of the defectives from the other inmates and the patients were restricted to a type for whose requirements it was within the capacity of the institution to provide.
Community Care. Of the 36 per cent, of defectives subject to be dealt with, who were under statutory care in the community on January 1st, 1939, 3,107 were on Licence, 4,531 under Guardianship, and 39,009 under Statutory Supervision. For the first time for many years there was a decrease in the number of Licence cases (3,155 in 1937) which the Board attribute in part to the effect of their Circular No. 850, issued in June 1938, as a result of which there was a review of the position of all defectives who had completed their second year of Licence after leaving an institution. Of the cases considered, approximately 350 were discharged, being those in which it was clear that Licence had ceased to fulfil a purpose which could not equally well be served by some measure of friendly supervision.
Occupation Centres and Home Training. The number of Occupation Centres remained the same (191) as in the previous year, but there was an increase of 101 defectives in attendance, and more Centres were open for whole-time sessions. Three Centres were housed in their own premises and in five other areas plans ‘for building were under consideration. The growing recognition by Local Authorities of the need for expert physical training is noted with satisfaction. Twenty-two Home Training schemes of varying types and scope were brought to the notice of the Board during the year.
Attention is drawn to the urgent need for some recognized standard of training and salaries for Occupation Centre workers. Until, it is pointed out, ” there is more general agreement as to the proper scale for supervisors, and until it offers a living commensurate with other careers calling for the same personal qualities and the same kind of experience, it will be difficult to establish a satisfactory scheme of training or to secure an adequate supply of candidates of the right type
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