Scheme for Rural Health Education
112 MENTAL HEALTH News and Notes
We have pleasure in announcing that the Central Council for Health Education has awarded jointly to the Central Association for Mental Welfare, Child Guidance Council, and the National Council for Mental Hygiene, the prize of ?250 which they offered to Affiliated Societies for the best programme of work submitted and to be undertaken during the period ending June 30th, 1942. The Scheme submitted by the three societies, to which reference was made in the July number of the Journal, was considered to be of special merit, and its object is to provide in rural and small urban districts, where services of the kind have not been previously offered, talks dealing with the needs of the child through succeeding stages of development, and with the attitude of adults towards their responsibilities as parents and citizens.
A Committee, consisting of representatives of the three societies concerned, has now been set up in order to carry out the work, and a series of four talks entitled Understanding Ourselves and Our Children is being offered to local organizations which have already been approached and many of whom have offered to co-operate ^in the Scheme, such as Women’s Institutes, Townswomen’s Guilds, Youth and Church organizations, Rotary Clubs, British Legion, etc.
Scottish Special School Children and Evacuation A note received from the Scottish Association for Mental Hygiene draws attention to the special difficulties under war conditions connected with feeble-minded children of school age. Under the general evacuation scheme, numbers of children known to be feeble-minded were placed individually in billets, and the variety of problems occasioned by this lack of specialized treatment were apparently quite unexpected by the authorities. At the same time provision was made for the reception of groups of such children in country houses taken over for the purpose, but from the outset the voluntary principle brought down the numbers to such an extent that the cost became prohibitive, and at the present time only one or two such residential homes are in existence.
A second stage of the problem has now been reached, following the drift back of evacuees to their homes. With inadequate air raid shelters, and accommodation still reserved for the Civil Defence services, many of the city schools are attempting the almost impossible task of educating a far larger number of children than it is possible to deal with efficiently. The policy which has been adopted is to begin with educational provision for the older, brighter children and gradually to work down to the younger and duller. Thus whilst most of the normal children now have more or less adequate schooling with compulsory attendance, the Special Schools are still trying to carry on with voluntary attendance and inadequate or no provision for transport, feeding, nursing and other auxiliary services. An attempt is being made to keep up to date with ascertainment, but headmasters are naturally discouraged from embarking on this somewhat elaborate procedure because they know that even if proved to be mentally defective a child may have to be retained in the ordinary elementary school where attendance at least can be enforced, in order to prevent his running wild. At the same time ascertainment, even without subsequent adminis- trative action, should, it is felt, be urged in that it at least will prevent the future evacuation of defectives along with normals, as well as enabling them to be weeded out of the ordinary schools with the return of normal conditions.
In some areas, where Special School premises were requisitioned by the Civil Defence or military authorities, their classes were scattered over the ordinary schools in the neighbourhood, but this proved so unsatisfactory that in several instances the children were grouped together again as a school unit in some other building. As parents have so widely chosen to bring their children back even to the most dangerous areas, it would seem that there is an urgent need for educational facilities for Special School pupils on lines approximating to those of normal times. Mean- while a tribute is due to those teachers who have carried on so valiantly under conditions which too often have been ones of utmost discouragement and difficulty.
Mental Health Emergency Committee
Regional Representatives. Mrs. Montagu Norman (Chairman of the Committee) has very kindly consented to become. Regional Representative?-jointly with Miss Fox?for the L-ondon area. The full list of Representatives is now as follows:? Region 1 (Northumberland, Durham, North Riding): Alderman Wm. Locke, 47 Red Hall Drive, Newcastle-on-Tyne, 1. Region 2 (East and West Ridings): Miss M. E. Cullen, 35 Wellington Street, Leeds.
Region 3 (Derbyshire, Leicestershire, Lincolnshire, Northamptonshire, Notting- hamshire, Rutland, Soke of Peterborough): Miss M. Dyson, 1 Alpha Terrace, North Sherwood Street, Nottingham. Region 5 (London, Middlesex, Essex, East and West Ham, parts of Kent, Croydon, parts of Surrey, parts of Hertfordshire): Mrs. Montagu Norman and Miss Evelyn Fox, 24 Buckingham Palace Road, S.W.I. Region 6 (Berkshire, Buckinghamshire, Dorset, Hampshire, Oxfordshire, Isle of Wight): Miss Findlay, Room 3, Watlington House, Reading. Region 7 (Cornwall, Devon, Gloucestershire, Somerset, Wiltshire): Miss H. E. Howarth, 2 Elton House, Rodney Place, Bristol, 8. Region 10 (Cheshire, Cumberland, Lancashire, Westmorland): Miss Martland, Lyndhurst, Queen’s Road, Oldham.
Assistants to Regional Representatives have also been appointed in order that by their work for individual cases they may demonstrate to Local Authorities, inclined to be sceptical, the value of such work for evacuated children in Reception Areas, or for children and adults in areas which have suffered from heavy bombing. A very successful Conference convened by Miss Howarth, Regional Representa- tive for Region 7, was held in Exeter on September 6th, attended by psychiatrists, psychologists and psychiatric social workers in the area. Dr Frank Bodman (Acting Medical Director, Bristol Child Guidance Clinic) was in the chair. A paper was read by Dr Sylvia Davies (Psychiatrist to the Devon County Council) in which she described the arrangements made in the county for dealing with mental health problems resulting from war conditions. Dr Barbour (formerly Medical Director of the Bristol Child Guidance Clinic, now on war service) spoke on the importance of the preventive side of mental health work. There was a good discussion which was felt to be so stimulating that the desire was unanimously expressed for further opportunities of a similar kind, and the conference has been followed up by a request to workers present, for notes on their special individual experience of mental health problems under war conditions with suggestions for lines of research. It is hoped later to call a larger and more representative conference to include representatives of the health and education services in the Region.
It is encouraging to note the increasing number of appointments of psychiatric social workers made by Local Authorities who have taken advantage of the power given to them to include the salaries of such workers in the Government Evacuation Account. Recent appointments have been made in Lancashire, Westmorland, Northamptonshire (second worker) and Somerset, and in Tunbridge Wells, Caer^ narvonshire and Nidderdale the loan of workers by the Mental Health Emergency Committee has led to permanent appointments. In addition, appointments are pending in Cumberland and the West and North Ridings. The recent appointment of a worker to the staff of the Shotley Bridge Hospital (Emergency Medical Service) is an interesting precedent.
Children under Fixe. The Joint Board of the Ministry of Health and the Board of Education, which is responsible for Wartime Nurseries, has approved a plan submitted by the Committee for a loan service of workers with psychological training and special experience of young children, for the purpose of visiting Nurseries to give informal talks to staff and voluntary helpers on the handling of groups of children, planning of recreative occupations, individual activities for special types of children, difficulties of discipline, etc. Notice of the scheme is being sent by the Ministry of Health to Regional Officers, and by the Board of Education to their Inspectors throughout the country, and both Government Departments are giving it their whole-hearted support.
At the time of going to press, Miss Ruth Thomas (C.A.M.W. Educational Psychologist) is giving a series of talks to the staffs of five Nursery Centres in the Saffron Walden district, at the request of the Principal of the Training College. Course for Staffs of Hostels for Difficult Children. This Course was organized by the Committee, with the approval of the Ministry of Health (who allowed Local Authorities to charge students’ fees and expenses to the Government Evacuation Account), at St. Luke’s College, Exeter, from September 1st to 6th, 1941. Seventeen students attended, the majority of whom were in charge of Hostels; four were assistant workers. They came mainly from Hostels in Civil Defence Regions 6 and 7, with the exception of two from Wales, two from Yorkshire and one from Westmorland. The Course was directed by Miss Ruth Thomas, and lectures were given by Dr Frank Bodman and Dr Sylvia Davies (Child Psychiatry), Miss Lucy G. Fildes and Mrs. Highfield (Child Psychology), Miss Rendel (Caldecott Community), Miss Geere (Handwork), Miss Winifred Houghton (Rhythmics and Percussion Band), and Miss Howarth (Social Work). By the courtesy of the Devon County Council all the students visited the Holne Cross Hostel, Ashburton, where they received valuable practical information from the Matron. The syllabus included consideration of all the problems of hostel routine and child management raised by the students them- selves, e.g. punishment, sex training, handling of subnormal children, behaviour problems of various kinds, general aspects of organization, etc.
The Course undoubtedly met an urgent need amongst Hostel workers, and all the students agreed that they had received strong reassurance and a new sense of direction as a result of the ideas which had been put before them and of the interchange of experiences amongst themselves. This result was achieved despite the fact that their work was so arduous and exacting, allowing so little free time or opportunity for holidays that they arrived at the Course in a state of fatigue which inevitably tended to lessen their receptivity. If, therefore, as it is greatly hoped, the Ministry of Health will sanction the organization of further Courses, the Committee recommend that a fortnight instead of a week should be allowed. This is regarded as the minimum period necessary, particularly in view of the fact that the majority of Hostel workers have had no special training and it is therefore not easy for them quickly to adapt themselves to the group life of a Residential Course.
It is planned to discuss with the appropriate Ministry of Health officials a ” follow-up ” scheme, involving visits from the Director to students in their own Hostels,, which is designed to supplement the lectures and talks given at Exeter.
The National Council for Mental Hygiene
Through the generous renewal of the Exchequer grant for the continuance and development of the Council’s work, it has been made possible to extend the offer of free lectures to Civil Defence personnel, and as a result a further large number of applications are being received from Scheme-making Authorities in different parts of the country. Lectures have already been arranged at Birkenhead, Bootle, Burnley, Salford, Stockport, Trafford Park, and Wallasey. Plans are also being made for similar lectures to be given in Leeds and in other parts of the East and West Ridings of Yorkshire. The Council’s special pamphlets addressed respectively to those in charge of First Aid Posts, Rest Centres and Air Raid Shelters, continue to be in great demand, and applications for copies have been received from Local Authorities throughout England and Wales. The Department of Health for Scotland propose to bring the pamphlet relating to Rest Centres to the notice of supervisors of such centres in a memorandum on the subject which they will shortly be issuing.
Luncheon Meeting. A Luncheon Meeting of the Eugenics Society will be held at the Eccleston Hotel, Eccleston Square, S.W.I, on Tuesday, November 25th, at 1 p.m., at which Dr H. Crichton-Miller will give an address on behalf of the National Council for Mental Hygiene on ” Nature and Nurture in Mental Health”. Invitation cards for the Lunch (price 3s. 6d., including tips, payable at the meeting) may be obtained on application to the Secretary, N.C.M.H., 76-77 Chandos House, Palmer Street, London, S.W.I.
Central Association for Mental Welfare
Hostel for Agricultural Workers. The search for premises has now been successful, and satisfactory arrangements have been made with the Gloucestershire Agricultural War Committee for the opening of a Hostel for thirty-five workers at Hatherley Court, Down Hatherley. The Hostel will open as soon as the necessary equipment can be obtained, with the admission of about twenty boys and men on Licence from Certified Institutions. Applications for the remaining vacancies are invited from Local Authorities, but it is pointed out that applicants must be physically strong enough to undertake the rather heavy winter work of land drainage, and should be of stable temperament. At present, admissions are limited to patients who have already received training in an Institution, and have had some experience of outdoor work.
Course for Teachers of Retarded Children. This Course, held at St. Luke’s College, Exeter, from August 29th to September 12th, was attended by thirty-three teachers, coming from schools in all types of areas. The Course was under the direction of the Association’s Educational Psychologist, Miss Ruth Thomas, and lectures and classes were given by Miss Lucy G. Fildes, Dr Mildred Creak, Miss Winifred Houghton and Miss Geere. Several talks were given by teachers in attendance, on their educational experiences under wartime conditions. By the courtesy of the Devon County Education Committee, and of the Exeter Education Committee, visits of observation were arranged to various types of schools, and the students spent a helpful afternoon at the Royal Western Counties Institution, Starcross.
The Course was much appreciated by the students, who asked that it should be followed up by a Week-end Conference at a not too distant date.
Educational Psychologists. Under the scheme organized jointly with the Child Guidance Council, four Bursaries have been awarded to candidates wishing to gain practical clinical experience in Educational Psychology, and two of these have begun their training at the Oxford Child Guidance Unit.
Miss Ruth Thomas (C.A.M.W. Educational Psychologist) is giving a course of lectures for parents at Morley College and one to midwives at the College of Nursing, and she is also working for the Mental Health Emergency Committee as Secretary of the Sub-committee on Children under Five.
Mrs. Bathurst (part-time Educational Psychologist) is working in Kettering and Northampton, and has been loaned, through the Child Guidance Council, to the York Child Guidance Clinic for sessional work for a further period.
A scheme is being considered by the Shropshire Education Committee, following on three sets of lectures on the Education of Backward Children given to teachers in the area, under the auspices of the C.A.M.W., by Mrs. Highfield (formerly Educational Psychologist at Southend-on-Sea). Under this scheme it is proposed that the teachers who attended the lectures should work out (under her guidance) the methods suggested and, if they so desired, should institute a short investigation to provide data for future lines of approach in the teaching of reading and number to backward children.
Social Case Work Department. The work of this Department?which includes Mental Health Emergency Cases, Epileptics, and the Joint Register of Foster Homes for Nervous and Difficult Children?continues to increase, and it is hoped that in the next issue of Mental Health some account of its growth and development may be published.
School for Difficult Boys. At the suggestion of the Board of Education, plans are now under consideration for the opening of a Residential School for Difficult Boys, to be received from Local Education Authorities under Section 80 of the Education Act, 1921. The search for premises has been begun and it is hoped that a house large enough to accommodate thirty children, preferably in the Home Counties, may ultimately be found.
Committee on Post-War Legislation. In view of the fact that Government Departments have begun to plan proposals for legislative reform to meet post-war conditions, the Executive Council has appointed a Committee to consider questions concerned with Mental Health legislation, in all its various branches. Representa- tives of the Child Guidance Council and the National Council for Mental Hygiene are serving on the Committee and will report back its recommendations to their executive bodies for approval. The Committee’s first task will be to consider the various proposals for reform which have already been made by the Wood Committee, the Feversham Committee, the Special Committee on Education and Notification of Defective Children, and in connection with the Criminal Justice Bill. These proposals will be examined in the light of the new experience gained under war conditions with a view to deciding whether modifications or further amendments appear to be necessary.
Child Guidance Council
Conference. ” The Future of Child Guidance in Relation to War Experience ” was the subject of the Council’s One-Day Conference held on August 16th. About 100 people were present, and a lively discussion followed four excellent papers. Proceedings will be published at a cost of 2s. 6d. per copy or 15s. per dozen, obtainable from the Council’s offices, 23 Queen Square, Bath.
New Clinics. The new Child Guidance Clinic which is to serve Oldham and Rochdale opened on September 1st with Dr Muriel Hughes as Psychiatrist, Mrs. Henshaw, Psychologist and Miss Bavin, Psychiatric Social Worker. Salford Education Committee is establishing a part-time clinic.
It is learnt with regret that Liverpool Child Guidance Clinic has had to close, it is hoped temporarily, as from August 1st.
Fellowships in Psychiatry. Two Fellowships in Psychiatry have been awarded by the Council, one to Dr Kathleen Cobb, for training under Dr D. R. MacCalman at Aberdeen, and the second to Dr Ella Ward who will train at the Child Guidance Training Centre at Oxford, under Dr Kathleen Todd.
The Pre-School Child. The need for work among pre-school children is receiving more and more attention. The Corporation of Glasgow Clinics Report for the period 1939-41 states that there has ” been a definite increase within the last year in the number of pre-school children referred. Many of the five-year-olds had not attended school when they first came to the Clinic. Some of these children were referred by private doctors, but the majority were sent from Corporation Child Welfare Clinics. This again is a highly desirable development. The younger the child the more effective and lasting is the treatment, and early treatment not only saves time but is probably an insurance for the future. Nurses taking the Health Visitors’ Course now attend the Child Guidance Clinics as part of their training and, it is hoped, carry its principles into their work with young children. During the past year three Nursery School teachers have each spent six months in the Clinics and have made valuable contributions from their own sphere.”
Juvenile Delinquency. A conference of Surrey and Sussex Magistrates was convened at Brighton by the Magistrates’ Association on the afternoon of Monday, September 29th, the Mayor of Brighton taking the Chair. Subject: “Juvenile Delinquency and the Powers of the Court in dealing with it.”
Mr. Blake Odgers, a Home Office official, addressed the meeting and prefaced his remarks by saying that he had nothing to add to the joint circular entitled ” Juvenile Offences ” sent out by the Home Office and Board of Education in June 1941. He stressed paragraph 23 of the circular and dwelt on the benefits to Juvenile Courts of obtaining the services of mental specialists who are willing to advise. He also spoke with approval of Child Guidance Clinics.
The speaker dwelt on the question of probation or binding over, and pointed out that the Court could not impose probation and a fine except in the case of two offences.
The importance of co-operation between Probation Officers and Local Education Authorities was dwelt on for the purpose of getting good reports to lay before the Court at the trial.
Dealing with the difficulty of finding accommodation in Approved Schools, Mr. Blake Odgers stated that the Home Office had no power to start Approved Schools, but that it could give financial help to voluntary bodies providing them. He stated that 3,000 new places were required and that 400 of these had been provided to date. It was hoped that many more would be available next summer. In the discussion which followed, one Justice stated that weekly talks in schools on ” Good Citizenship given by someone who was not a member of the staff, would be useful. Mr. Blake Odgers said that this was a matter for the Board of Education, not the Home Office.
The question was raised by a Sussex Justice of adding schoolmasters and Educa- tion Officers to. Juvenile Panels, thus ensuring their attendance in Court. There seemed to be some confusion in the matter, Mr. Blake Odgers taking it for granted that they would be appointed to the Bench, but this did not seem to be the idea of the speaker.
These Conferences seem useful to revive interest in Home Office circulars, but do not add much to the knowledge which can be obtained through books and circulars.
Epileptics and Air Raids
In interesting contributions to The Lancet of May 17th, 1941, Dr Tylor Fox, Medical Superintendent of Lingfield Epileptic Colony, and Dr J. Shafar, Medical Registrar, West End Hospital for Nervous Diseases and Willesden General Hospital,” testify to the rather surprising fact that air raid disturbances and war conditions do not increase the incidence of epileptic attacks.
Dr Tylor Fox has based his conclusions on the observation of 250 epileptic children and 200 adults during exposure to the ” alarms and excursions ” attendant upon air activity in the neighbourhood of their Colony, both by day and by night, involving ” sirens, a hasty exit from school or workshop, or an unwelcome routing out of bed; on occasion a rush to a rather overcrowded protected room “?in short, a complete upheaval in the orderly routine life considered to be so essential to the welfare of the epileptic patient under normal conditions. And yet, to quote Dr Fox’s conclusions:
” … nothing happened. There was no general increase of attacks on days or nights of air activity, nor has any evidence been found of increased fits in individuals. At least 95 per cent, of our patients have to all appearances been unperturbed, and the resultant mental upset in the remainder has not been striking.”
Dr Shafar records a study of 77 cases of epilepsy under observation between March 1939 and March 1941, most of them being adults in middle life. His findings were as follows:
” There was little difference in the incidence of attacks before the war, during the first year of war and during the six months of heavy raids… . It is fair to conclude that neither the first year of war nor six months of aerial bombardment affected the incidence of epileptic attacks.
” The emotional response to danger was also studied with a view to noting the development of nervous disorders. In most patients, fear was almost completely absent during raids and anxiety symptoms were few and mild. No hysterical attacks were reported, and no other manifestations of hysteria were encountered.”
This experience is borne out by the C.A.M.W.’s Social Case Work Department which has a considerable number of epileptics discharged from Colonies, under its supervision. Many of these patients have had experiences of bombing, but in none of them has this been followed by an increase of fits.
Association of Mental Health Workers
During the past quarter there has been some revival of regional activity, and meetings of the South Wales Group and the Eastern Counties Group have been held. The Executive Committee met at Oxford on October 18th and discussed, amongst other subjects, the contribution which the Association hopes to make to the Con- ference to be held next spring by the British Federation of Social Workers on ” Social Changes due to the War “?a subject on which, it will be remembered, the Nuffield College Social Reconstruction Survey is now engaged. The problems raised by the recruiting of mentally defective men into the Forces was also discussed. Sugges- tions for the 1942 Conference will be circulated to members shortly, and another issue of the ” News Letter ” is in course of preparation.
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