Hostels for Children in need of Psychiatric Attention
- Author:
Lucy G. Fildes, B.A., Ph.D.
Chairman of Ad Hoc Committee on Hostels, Provisional National Council for Mental Health During the past few months the Provisional National Council for Mental Health has had under consideration the question of the provision of hostel Accommodation in post-war planning for children ln need of psychiatric attention. The main results ?f these considerations are outlined below:?
The Need for and Function of the Hostels While it is accepted that, as a general rule, Psychiatric investigation and treatment of children should be carried on while the children are resident ln their own homes, a certain proportion of such cases cannot so be dealt with, e.g. where the home conditions are grossly unsuitable, where distance from a clinic militates against treatment, etc., etc. Foster home placement might provide a solution for some of these cases, but, in view of the often seriously disturbing behaviour of the children, this cannot always be found. For the same reason, and because of the particular needs in the handling the children themselves, they do not fit into a hostel or home for normal children. It seems inevitable, therefore, that all Authorities planning for the psychiatric treatment of children under their care, must also plan some provision for residence in special hostels during treatment for a Proportion of these children.
The function of these special hostels would therefore be to provide care and a suitable environment for the full development of a child who, for his own welfare, has to” be removed for a period his own home or his normal place of residence. Either some problem in the child or factors in his environment may make this transfer advisable. far as is possible the hostel should provide normal family conditions, the child should go out to school, mix with other children and be prepared to take his place in the community. He should be discharged when he is fit to return to life in the community.
Administrative Controls. Admission and Discharge It is clear that the Authority or Authorities Responsible for the setting up of such a hostel must nave full administrative control, but, owing to its specialized nature, it appears essential that arrangements should be made whereby all admissions and discharges should be directly recommended by the psychiatrist to whom the case is referred for investigation or who is conducting treatment. Furthermore, opportunity for consultation and discussions between the staff of the hostel and that of the clinic conducting treatment should be made readily available.
The Hostels Themselves The Committee felt strongly that no attempt should be made to set up any fixed or rigid standards for the hostels themselves. Flexibility and freedom to experiment were most essential at this stage. They did, however, agree that our present knowledge of the problems involved justified us in laying down certain broad general principles which should be taken into consideration in making plans for the starting and running of such hostels.
1. Size of Hostels. It is best that a hostel designed for the accommodation of maladjusted children should be small in size, taking about 8-10 children. In this way the close personal relationships with adults which most of the children need, can then more easily be achieved. If for any reason the hostel must be for larger numbers, arrangements should be made whereby groups within the whole number of children are each made the particular care of one adult.
2. Age Range. In a small hostel (8-10 children) all ages could and should be catered for since this arrangement the more nearly simulates a family group. Age differentiation is probably essential in larger hostels.
3. Sex Differentiation. So far as evidence could be gained by the Committee it is preferable that boys and girls be together in one hostel, and that a reasonable equality of numbers be aimed at between them.
Definite decisions with regard to this matter must, however, be made after our consideration of the nature and ability of the staff, the type of child receiving treatment, and the nature of the house. 4. Facilities for Play and Occupation. It is important for the development of the children that adequate play space (both outdoor and indoor) and play material be provided so that both destructive and constructive impulses may be worked out. A small room or rooms for quieter forms of play and recreation is also desirable, these rooms should be pleasant and homelike, giving the children a sense of ownership coupled with responsibility for their care and maintenance. Separate lockers should be provided for each child’s individual possessions.
5. Sleeping Accommodation. On this matter the Committee felt that information which they had so far received was not adequate for any definite opinion. However, with regard to the special group of children under consideration, information and experience indicated that preferably not more than two or three, with a possible maximum of four, should sleep in one room. This policy would certainly be practicable in a small hostel.
6. Meals. Suggestions were made as to the desirability of communal provision of meals (with children in other hostels, in schools or special centres, etc.). On this point the Committee felt strongly that mealtimes were so essential a part of the children’s education and training that all meals should be served in the individual hostels.
Staffing
Since success or failure in the hostel’s purpose depends ultimately on the staff, selection of staff is of the highest importance. Points to be borne in mind are:?
Personal suitability.
Adequate training and knowledge.
(c) Adaptability and initiative, together with the power to co-operate with others.
Small hostels are necessarily expensive in staff, while maladjusted children certainly require a proportionately larger staff than normal children. Preferably the staff should be mixed. A man and wife, if suitably qualified, might be the ideal arrangement as people to take charge. The number of assistants would depend on the size of the hostel, type and numbers of children, etc.
Classification of Cases
1. There should be no classification of cases for particular hostels on the basis of symptoms only. This point is of special importance because of a tendency, unfortunately still prevalent, to group together children who show the same symptoms whatever be their cause (eneuresis is the most obvious example). It is clearly recognized that any special symptoms may be the result of widely differing causative factors, while the same fundamental disorders may reveal themselves in a variety of ways in different individuals. Classification by symptoms alone tends almost inevitably to attempt to cure the symptoms without further analysis. This, even if successful, may in itself be dangerous in obscuring yet further the fundamental trouble. Such classification is psychologically bad for the children concerned?its only defence is convenience which can in no sense be set against the child’s well-being.
2. Separate hostels should be provided if possible for the following two groups of children i. Those constitutionally inferior, whether their inferiority is intellectual or emotional or both. ii. The neurotic, i.e. the child of essentially normal personality make-up distorted by environmental circumstances.
This need for separation rests on the fundamental differences in make-up between the two groups of children?those who are by nature inferior, either intellectually or emotionally, need above all things adult guidance and support to a degree above what is usually considered normal. Neurotic children, on the other hand, require maximum freedom.
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