Mental Health Emergency Committee
News and Notes
Children under Five. The work of the Sub-committee on Children under Five is rapidly developing and requests for loan workers to help the staffs of the new War Nurseries in establishing them on a sound educational basis are steadily coming in,- neeessitating the appointment of further full-time or part-time workers to assist Miss Ruth Thomas (C.A.M.W. Educational Psychologist) in these visits. Nurseries in the following areas have already been visited: Bedford, Berkshire, Darlington, Herts, Kingston-on-Thames, Lees, London (Islington and St. Pancras), Redditch, Tottenham Stockton-on-Tees. It would appear, from the experience so far gained, that the majority of Nurseries are urgently in need of educational equipment and play material, and that the staff welcome information as to the type of material which is suitable and suggestions on the right way of using it. A list of recommended equipment has been prepared and is available on application.
Training Courses. A Week-end Course for Welfare Workers employed by Local Authorities in Reception Areas is being held in London from February 13th to 16th. f* is hoped that the Course will help such workers to meet the many problems confront- lng them in dealing with cases of mental disorder, mental subnormality and mental deficiency which they find in the course of their work amongst evacuees, or in Rest Centres and Air Raid Shelters.
A second Course for Hostel Workers is to be held at Bingley in April. Hostels for Mentally Subnormal ” Difficult ” Children. The problems created ln Hostels for Difficult Children by the presence of children who, by reason of mental snbnormality, are found to need different methods of treatment and a much longer Period for adaptation, have been repeatedly brought to the attention of the Committee bY its Regional Representatives and by other workers concerned.
It would seem that one possible solution of the problem might be the allocation ?f certain Hostels in each Region for this group of children, and the possibility vyas discussed at an exploratory Conference called by the Committee at which representatives of the Ministry of Health and of the Board of Education were present ln a consultative capacity. The members of the Conference were generally in favour ?f the suggestion, provided that care was taken to ensure that such special Hostels should only be placed in areas in which local schools were large enough to enable them to absorb a number of ” dull ” children and which could offer facilities for Providing them with the special type of education required. It was further suggested that such a Hostel should not accmmodate more than 15 children. The necessity ?f ensuring that before transfer to a Special Hostel, a child should be examined hy an expert in order that his degree of intelligence might be accurately ascertained, was emphasized by all the members of the Conference.
A further consideration brought to the notice of the Conference was that the ?r?up under discussion would inevitably include some children who were certifiably mentally defective, within the meaning of the 1921 Education Act (Part V), and to meet the needs of this group it was proposed that the Mental Health Emergency Committee should endeavour to ascertain whether Education Authorities with evacuated Special School Parties in residential schools or camps had vacancies, would be willing to allot to feeble-minded children from other areas, if this informa- tion were then made known to Hostels and Billeting Officers, it was thought that there would be a greater readiness to draw the attention of the Education Authority in the Reception Area concerned to the need for examination in the case of a child in a Hostel who appeared to be mentally defective.
Pamphlet on Hostels for Difficult Children. The Committee has recently published a small pamphlet on Hostels for Difficult Children, containing suggestions on methods of selection, classification, re-billeting, educational facilities, staffing, etc. Copies of the pamphlet may be obtained from the Hon. Secretary, 24 Bucking- ham Palace Road, S.W.I, on application.
Central Association for Mental Welfare
Hostel for Agricultural Workers. This Hostel?at Hatherley Court, Down Hatherley, Gloucestershire?was opened in November 1941, and at the time of writing, 35 youths on Licence from Certified Institutions, are in residence. Excellent reports of their behaviour and capacity have been received from the Gloucestershire War Agricultural Committee which is responsible for their work, and farmers to whom they have been allocated speak highly of them, finding that they compare very favourably with normal workers from other Hostels opened by the Committee. The boys themselves are exceedingly happy and fit, and are quite content with the arrangements made. Their wages vary between 42s. and 53s. 6d. weekly; 25s. is paid direct to the C.A.M.W. for board, and Is. 6d. for laundry; 10s. may be kept for pocket money and the balance is then banked in the boy’s name, or put into National Savings.
So successful has been this initial experiment that the War Agricultural Com- mittee has asked the Association to be responsible for a second Hostel run on similar lines, in the same district, and it is hoped that this may be opened at the end of March in premises which are being acquired by the Committee.
Note.?Gifts of ” football shorts ” and shirts, would be gratefully received for the Hostels, to enable football teams to be organized.
Hostel for Industrial Workers. The Council is hoping to initiate a further development in this work by opening a Hostel for youths on Licence from Certified Institutions, who are not robust enough for heavy farm work but would be likely to make efficient workers in some industrial occupation not involving exceptional strain and pressure. This would exclude any form of ” Munitions “, but it is envisaged that there are a number of factories still engaged on some form of civilian production which have difficulty in securing labour.
The Ministry of Labour and National Service, with whom negotiations are in Progress, welcome the scheme, and it is thought that it will be particularly acceptable !? Certified Institutions at the present time owing to the difficulty of providing industrial occupation which arises from the shortage of raw material.
Social Case Work Department. An analysis of the cases dealt with during 941 shows a total of 1,871, made up as follows : General (including Mental Health Emergency Cases) .. 1,170 Licence and Guardianship .. .… .. .. 269 Epileptics .. .. .. .. .. .. .. 276 Joint Register of Foster-Homes .. .. .. .. 156
These cases were referred by Local Authorities, Societies of various kinds, hospitals, Schools, psychiatric social workers, relatives and friends,etc., and 111 were received .lrect from doctors. They fall, roughly, into the following types : Mentally Defec- tlVe> 596 ; Mentally Disordered, 25 ; Senile, 25; unbalanced and borderline (in- c uding psychoneurotics) and psychopathic personalities, 524.
It is, perhaps, of interest to record that the number of cases received from ^dical practitioners is continually increasing. In other cases, efforts are always rfiade to obtain a medical report before further action is taken or advice given except in the cases of obvious low-grade defectives and of unstable or unbalanced applicants who cannot at the moment be induced to consult a psychiatrist. In regard to this group, the policy of the Department is to befriend the family in the hope ?f effecting such easement of the situation as is possible until the patient can be Persuaded to seek the expert medical aid which is his chief need.
The total number of cases dealt with has more than doubled in the last twelve jrionths, and machinery has been devised to ensure that there is close co-operation etween the various workers concerned. The body of information as to schools, 0rnes, foster-parents, etc., which has been collectively acquired, is now a considerable ?ne, and constructive advice and suggestions can be given on a wide variety of Mental Health ” problems.
The Department works under a Committee whose members are engaged in yarious forms of social administration and have expert knowledge of many divergent s?cial problems.
Educational Psychologists. To meet the increasing demand for the Association’s service of Educational Psychologists, the Council has appointed, as from March 1st, 42, a second full-time psychologist (Miss N. Gibbs, M.A.) who holds one of the ellowships awarded by the C.A.M.W. and the Child Guidance Council under the J0lnt scheme for providing psychologists with clinical experience. A psychologist ls a^So being engaged, on a temporary basis, to work in Grimsby for three months, under the Local Education Authority.
The Council has agreed to continue to contribute towards the provision of ellowships under the joint scheme, and hopes to be able to increase its contribution to meet the increasing demand for psychologists with educational and child guidance . experience.
Middlesex Home Teaching Scheme. It is with much regret that the Association has to record the ending of the Home Teaching Scheme which it has carried on for the Middlesex Mental Deficiency Committee during the past 12 years.
In 1941, the staff of Home Teachers (reduced to three, to meet the exigencies of war conditions), visited at regular intervals 160 to 170 children excluded from school by reason of mental defect and unable to attend Occupation Centres, all of which were closed down in September 1939. A successful experiment had also been carried on in Group Teaching, and of the 170 children on the register, 70 were being taught in groups.
It is therefore particularly disappointing that, for reasons of economy, the Middlesex County Council have brought this work to an end, despite urgent represen- tations as to its value made both by the C.A.M.W. Council and by the parents themselves, on behalf of children for whom the periodical visits of ” their teacher ” have been for so long the high light of uneventful and isolated lives.
Pamphlet on Mental Deficiency Acts. The Association’s pamphlet briefly setting out the chief provisions of these Acts, and the procedure enacted by them, has been re-printed, with a supplement on the position of defectives in regard to certain emergency regulations concerning Registration, fire-watching, etc. The pamphlet can be obtained from the Offices of the Association, 24 Buckingham Palace Road, London, price 3d. post free.
Child Guidance Council
The Council finds itself in a position to award a third Fellowship in Psychiatry of the value of ?150 for one year half-time work. The successful candidate will be trained at the Tavistock Clinic.
The Salford Education Committee Child Guidance Clinic which is classified as a Group I Clinic, is now functioning with the following staff: Dr Muriel Hughes (Psychiatrist), Miss E. A. Bonniface (Educational Psychologist) and Miss B. Joseph (Psychiatric Social Worker). The address of the new clinic in 49 The Crescent, Salford 5. The social worker reports that a good start has been made and excellent co-operation obtained.
The new Education Committee Clinic at Cambridge, which is not under medical direction, has been classified in Group lib. The Psychologist is Mr. H. Bannister, Ph.D., and the Psychiatric Social Worker, Miss D. Hutchinson. The clinic is housed at the Municipal Health Centre, Coleridge Road, Cambridge.
Reigate Child Guidance Clinic has just issued a report on its second year of work. In February 1941 the Clinic became part of the general School Medical Services of the Borough, a consummation on which the clinic staff is to be congratu- lated. The clinic is concerned with psychological work in two types of evacuation areas and the Report is a valuable record of wartime problems.
Though the rush of work diminished in the second year of war, certain difficulties ^creased, e.g. decrease in number of billets for various reasons making it impossible to deal with minor problems through a change of billet. Discharged cases had to change billets for various unavoidable causes and in some instances breakdown occurred again. The second winter of billeting proved more of a strain than the first-?many wives were left to cope with evacuated children single-handed and the second black-out often proved the last straw. In the summer, out-of-door recreation had been possible.
The clinic staff has inaugurated a new social service?the after-care of evacuees leaving their school group. Intelligence and performance tests have been helpful as a guide to a child’s future?whether training should be undertaken, or paid employ- ment. An endeavour has been made to keep children in the evacuation area in work of a suitable nature.
Preventive Work. In pursuance of its policy of stressing the need for prevention ?f behaviour problems, the Council has sought and obtained representation on the Mothercraft Training Sub-committee of the National Association of Maternity and Child Welfare Centres. Dr Grace Calver had kindly consented to serve on this Committee and also represented the Council at a Conference called by the National Baby Welfare Council to discuss a new British Maternity and Child Welfare film. Dr. Calver suggested that the film might begin with the ante-natal period and the mother’s n?ht emotional attitude towards both childbirth itself and the child in particular. Tl-i ? .
ine importance of breast-feeding in relation to good emotional development was stressed because, in actual fact, from the purely physical point of view, artificial feeding can very well be substituted for breast-feeding, though breast-feeding ensures the best foundation for the child’s adaptation to life, and to the overcoming of early anxieties. On these in turn depend future love relationships and social relationships general.
The Conference expressed its gratitude for this contribution and the Chairman, ln particular, said how extremely pleased they were to be given such a definite explanation of psychological needs as the background of physical and mental health.
Hostel School for Evacuated Boys?A Scottish Experiment
A Hostel School for boys has been instituted in Peebleshire under the Warden- ship of Mr. W. David Wills to meet the needs of the group of wild, neglected and undisciplined boys who seem to be unbilletable.
Members of the Society of Friends took the initiative in establishing the Hostel; Provision for staff and for school equipment was made by the Education Authority and the Peebleshire County Council, sanction being given by the Department of health; while private subscriptions provided the salary of the Warden and running expenses for a year. The Hostel was opened in July 1940 and 38 boys received. The boys’ histories were studied and showed a high incidence of truancy, stealing, disciplinary problems and police records, while each boy’s progress and idiosyn- crasies were followed at regular staff meetings. The resulting treatment soon showed the establishment of a sense of security and affection which came as an entirely new experience to many of the boys.
Consciously, the community life aimed at showing the boys, in a practical way, the need of discipline in the framework of an ordered society. Their response later led to the institution of a regular house meeting, which opened for discussion all the activities of the Hostel including practical administration, and which is attended by everyone, including the domestic staff.
School curriculum was difficult as age groups and types of boys varied widely, while free time has not been overmuch organized but aimed to give opportunity for free expression. During the experimental year these children gained a sense of inner security and happiness previously denied them and this feeling of well-being has become part of the school, while there is considerable lessening of the constant fighting and quarrelling and other symptoms of instability and unhappiness which were evident in the early days.
The National Council for Mental Hygiene
Mental Health Lecture Course. The Council is holding a course of eight lectures for students and also the general public on Fridays at 8 p.m. at University College of the South West, Exeter. The first meeting took place on January 23rd and was presided’over by the Principal of the College. There was a large attendance and a keen discussion during which the lecturer, Major J. A. Hadfield, R.A.M.C., answered a number of questions. The subjects being discussed deal with the developmental stages of childhood and adolescence, mental health and the war, and an explanation of the psychological theories of Freud, Jung and Adler. The speakers include Dr Culver Barker, Major R. F. Barbour, Dr H. Crichton-Miller, Major A. McLeod Fraser, Major Alan Maberly, Dr H. C. Squires, and Major Geoffrey Thompson.
The course will end on March 13th. Full particulars may be obtained on application to the Secretary of the National Council for Mental Hygiene.
Lectures for Civil Defence personnel. A series of eight lectures on nervous manifestations under air raid conditions was given in December and January on behalf of the Council by Major Wyndham Pearce, Northern Command Specialist in Psychological Medicine, to members of the Leeds Civil Defence Casualty Service and also to medical personnel. The audiences were composed of both men and women whole-time and part-time Civil Defence workers employed in the City’s various First Aid Depots.
Similar lectures have been held or are being arranged in other parts of the country, including Lancashire, Lincolnshire, Cheshire, Oxfordshire, Nottinghamshire (where it is also hoped to arrange short courses for Rest Centre workers). A lecture on ” Nervous reactions in War-time ” was given by Dr H. Crichton-Miller on January 7th in a special course arranged by the Royal College of Nursing for those working in the River Emergency Service, shelters, and first aid posts.
Early Treatment Facilities. The Council’s Joint Committee of the Standing Committees has given attention to the question of extending early treatment facilities for both children and adults and the need for placing this important subject in the forefront of post-war plans in relation to mental health. With the approval of the Executive Committee a recommendation urging that every Voluntary and Municipal General Hospital should itself or in conjunction with other agencies provide Clinics for cases of nervous disorders and for Child Guidance has been sent to the Medical Planning Committees of the British Medical Association and the Royal’ Medico- Psychological Association, to the British Hospitals Association, to the Committee Post-War Legislation of the Central Association for Mental Welfare, and also to ospitals with Medical Schools throughout the country. The Joint Committee has a!S0 stressed the need for extending the number of hospitals for functional nervous disorders in view of the extremely limited facilities in this direction which are at Present available.
New Occupation Centre, Slough
It is encouraging to record that the Buckingham Voluntary Association for the afe of the Mentally Defective has, despite the difficulties of the times, realized the urgent neecl of providing for its defective children excluded from ordinary elementary ^nd Special Schools, by establishing an Occupation Centre in the busy town of Slough, ?r which it is receiving a grant from the County Council.
The Centre (opened on February 9th) is a full-time one, and when fully organized, to 18 children will be in regular attendance. If necessary, provision may be made or a still larger number. A trained Supervisor has been appointed, and provision as been made for the appointment of an Assistant Supervisor and Guide. Cheap travelling facilities have been granted by the London Passenger Transport Board. ls hoped later to provide a mid-day meal, and arrangements are being made with Milk Marketing Board for the supply of milk under the ” Milk in Schools ” Scheme.
Edinburgh’s Provision for M.D. Children
It is encouraging to record that despite the difficult conditions described in a note ?n Scottish Special Schools, in our last issue, educational facilities for mentally etective children in Edinburgh now approximate to normal standards. The Special ehools are functioning as in pre-war days and adequately meet the needs of the nildren left in the city, and of the returning evacuees.
During the early period of the war, the premises used for an Occupation Centre 0r imbecile children were commandeered, and when the Special Schools re-opened 111 April 1940, provision was made for these children in three of such Schools and attendance was made compulsory. As, however, ascertainment steadily proceeded and more children were referred for special school education, new arrangements ecame necessary and a house was recently acquired to serve as an Occupation Centre or between 80 and 90 children. The responsibility for the Centre is divided between * e Public Health Committee who finance it, and the Education Committee who SuPPly the staff and arrange transport, dinners, etc.
Visit of Canadian Investigators
By arrangement with the Ministry of Health, three investigators from the Canadian National Committee for Mental Hygiene recently spent some weeks in this country engaged in surveying the provision made for children from bombed areas and other mental health activities arising out of war conditions.
The’delegation consisted of Dr C. M. Hincks, Director of the National Com- mittee, Dr William E. Blatz, Director of the Institute for Child Study and Professor of Psychology, University of Toronto, and Dr Stuart K. Jaffary, Director of the School for Social Work, Toronto.
Mrs. Montagu Norman (Chairman of the Mental Health Emergency Committee) and Miss Evelyn Fox had the opportunity of discussing with Dr Hincks and his colleagues the serious position arising out of the shortage of trained Mental Health workers at the present time, and it is very much hoped that by the loan of such workers Canada may be able to offer substantial help.
Mental Health Course, 1942-3
An advertisement of the Mental Health Course appears in this Journal, and it is hoped that suitable candidates will be encouraged to consider entering the training course which begins in September 1942. The details of the course are set out in the advertisement.
In this war, as in the last, the demand for psychiatric social workers has again become manifest and, in fact, demand now threatens to exceed supply. The normal channels of work are expanding as new child guidance clinics continue to be opened both in evacuation and reception areas. E.M.S. Psychiatric Hospitals are recognizing that such workers are a necessary addition to their staffs, workers have been appointed to special positions in the W.R.N.S., and, what is perhaps the greatest expansion of all, the Ministry of Health has sanctioned the appointment of psychiatric social workers in reception areas to help and advise with the difficult evacuated children. At the present time there are twenty of these last appointments with the possibility that they will continue to increase as the value of the work becomes more and more appreciated. In addition the Mental Health Emergency Committee has appointed four psychiatric social workers as its Regional Representatives in certain of the Civil Defence Regions together with a Regional Worker, who also has taken the psychiatric training, in each case. It is expected that more of these appointments will be made.
Institute for Scientific Treatment of Delinquency
It is interesting to learn that the LTniversity Extension Courses of lectures arranged J the Institute are being well attended, despite the fact that the lectures have to be ?!ven on Sundays. Last term, the course on Criminal Law (Sunday mornings) was attended by 30 to 35 students, and the course on Social Psychology (Sunday afternoons) y between 50 and 60. Twelve lectures on the Psychology of Delinquency are being S^en during the present term.
The Broadcast Appeal on behalf of the Institute given by Mr. Donald McCullough ?n December 7th resulted in the gratifying total of ?1,706, so that anxiety about the immediate future hitherto so acute has been delayed and a drive is being made 0r new members.
The Institute’s Annual Report for 1940, just issued, gives a record of work j*CCornplished under the most difficult conditions and despite serious damage sustained y enemy action necessitating a move to new premises.
Enquiries in regard to its work will be welcomed by the Institute whose address is: ^ Manchester Street, London, W.l.
The \ar an(| pSyChosis In a letter received from Dr L. J. Bendit, he expresses the opinion that as a result ? the war, the number of cases of psychosis has increased, especially in the case of eniales, by 25 per cent, to 30 per cent. He does not give detailed figures and controls, and his opinion is not shared by many authorities who do. For example, in the lscussion on war strain at the Tavistock Clinic (1940), it was stated that out of cases admitted as psychotics during the London blitz, only in 9 was there any trace 0 effects of air raids, while in a general practice in North London, about 5 per cent. developed mild anxiety which cleared quickly. Stalker (1940) quoted 7 acute breakdowns, but all these occurred in previously unstable persons. Twenty-one persons out of 179 psychoneurotics admitted the effects of sirens; most of these were women over 60 (Bodman, 1941).
It is probably true, as Dr Bendit says, that war conditions ” toppled over ” patients who were previously disposed to mental breakdown. Thus Brown (1941) states that psychoses only develops where there has been some previous abnormality or predisposing conflict which leaves the patient emotionally insecure. Some psychoses, especially depressions, may develop in persons who would not have developed a psychosis but for the bombing. Psychotic incidents may be precipitated by bombing, especially senile dementia.
On the other hand Harris (1941) remarks that out of 46 cases in a series of 300 consecutive admissions to a mental hospital supposed to be due to air raids, in only 4 were these regarded as causative, and in 6 as contributory. Again, in only 23 out of 435 cases were air raids in any way causative.
Admissions to one mental hospital increased from about 350 to 435, but these were mostly senile dements who could no longer be looked after at home, and it is noteworthy that the socially unfit tend to gravitate towards institutions during wartime.
On the other hand, in another mental hospital the admissions for 1940 (354) were the lowest for five years, and in only 17 men and 14 women did war seem to have any aetiological significance, and of these 21 gave a history of previous breakdown or strong family taint (Hemphill, 1941).
REFERENCES
Bodman, F. ” Reactions to Air Raid Warnings.” Lancet, August 10th, 1940. Brown, F. ” Civilian Psychiatric Air Raid Casualties.” Lancet, May 31st, 1941. Harris, A. ” Psychiatric Reactions of Civilians in Wartime.” Lancet, August 9th, 1941. Hemphill, R. E. “The Influence of the War on Mental Disease.” J. Ment. Sc., April 1941, Vol. LXXXVII, 367, p. 170. Stalker, H. ” Panic States in Civilians.” B.M.J., June 1st, 1940. Tavistock Clinic. ” War Strain.” Lancet, December 28th, 1940.
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