Board of Control Circular
News and Notes Education Act, 1944
An important Circular (No. 965) was issued by the Board of Control in September, 1945, drawing the attention of Local Authorities to changes in the Mental Deficiency Acts brought about by certain provisions of the Education Act, 1944.
Section 2(l)(b)(v) of the Mental Deficiency Act, 1913, has been amended, Section 2(2) and Section 31 have been repealed by the 8th and 9th Schedules of the Education Act, and a child between two and sixteen (previously the age group was seven to sixteen), is now subject to be dealt with if he is a person ” with respect to whom a report has been issued under the enactments relating to education that he has been found incapable of receiving education at school, or that by reason of a disability of mind he may require supervision after leaving school Section 57 of the Education Act imposes upon Local Education Authorities the duty of reporting to the Local Authorities under the Mental Deficiency Acts :? (a) Any child, between 2 and 16, who is suffering from a disability of mind of such a nature or to such an extent as to make him incapable of receiving education at school, or to make it inexpedient that he should be educated with other children either in his own interests or in theirs. (b) Any child who will by reason of a disability of mind require supervision after leaving school. Note :?This provision is no longer restricted to children leaving Special Schools.
Hitherto, it will be remembered, Local Authorities under the M.D. Act were unable to deal with defective children between 14 and 16 unless they had been notified by the Education Authority as about to leave a Special School. With the repeal of Section 30 (Proviso iv) of the Mental Deficiency Act this embargo no longer exists, and although it is contemplated that normally such children will have been ascertained by Education Authorities and reported under Section 57, it is now possible for them to be dealt with under the provisions of the M.D. Act applicable to adults. (This position arises out of the definition given in Section 114 of the Education Act, defining a “child ” as “a person not over compulsory school age Pupils registered as in attendance at special schools continue to be ” children ‘ until they reach the special school leaving age of 16, but those leaving ordinary schools on attaining the school leaving age are, for the purposes of the Act, no longer “children “.)
Children between the ages of 2 and 5, should, the Circular points out, be ascertained normally by the Education Authorities even though they may not be in attendance at a Nursery School, although co-operation between that Authority and the Mental Deficiency Committee is obviously desirable in the case of low grade children.
Defectives in Certified Institutions or under Guardianship together with those reported under Section 57(3) of the Education Act as being incapable of receiving education at school, are excluded from the provisions under Section 116 for Further Education. Defectives, however, who are under Statutory supervision under Section 30(b) of the Mental Deficiency Act, are not exempted and will be required to attend County Colleges under Section 44 of the Education Act, when these are opened. This provision should be of great value in helping the high grade defective on leaving school to make a satisfactory social adjustment, and in equipping him for work.
Handicapped Pupils (Certificate) Regulations* Section 34(5) of the Education Act, dealing with the ascertainment of children requiring special educational treatment lays it down that if, on receiving the advice ot a medical officer after the examination of a child, either the parent or the authority wish’for a certificate on the nature and extent of the disability diagnosed, one shall be given in the prescribed form.
This form (to be known as I.H.P.) has now been prescribed on the followi g lines:? 1. Name, date of birth, and address of child. 2. Nature and extent of disability of mind or body from which the child is suffering. . 3. Category of pupils requiring special educational treatment into which the child is considered to fa”’ Reports to Local Authorities Section 57(6) enacts that when an Education Authority reports a child to a local authority under the Mental * Statutory Rules and Orders, 1945. No. 1302. H.M. Stationery Office, Kingsway, W.C.2. Price Id. Deficiency Act, 1913, the report shall be accompanied by ” such records and other information relating to the child as may be prescribed Draft Regulations under this section were issued recently, consisting of two Schedules. Schedule I, gives the Form of Report to be used on a child examined for a disability of mind, (replacing the former Form 306 M. used under Part V of the Education Act, 19211.
Schedule II, gives the Form of Report to be used by a Head Teacher on an educationally sub-normal child. In addition to these two documents, it is prescribed that there shall also accompany every Report under Section 57(6) of the Act, a medical record and an educational record, and a report by an educational psychologist is also required unless ” in any particular case it appears to the Authority to be unreasonable to obtain such a report “.
With the publication of these Regulations, the Mental Deficiency (Notification of Children) Regulations, 1928, will be repealed.
Registration of Disabled Persons
The Registration of Disabled Persons under the Disabled Persons (Employment) Act 1944 is now proceeding, and applications are being invited by the Local Labour Exchanges from any person over statutory school-leaving age whether in work or seeking it who ” on account of injury, disease or congenital deformity is substantially handicapped” in finding or keeping suitable employment. In the case of school leavers a special form must be filled up by the School Medical Officer, and the consent of the parent must be obtained. It is through the Register that the machinery set up under the Act is put into operation, and therefore until a substantial part of it has been compiled, little progress can be made. Hence every effort is being made by the Ministry concerned, to draw attention to its institution. For Disabled Persons, registered as such, certain types ?f ” designated ” employment will be reserved. Moreover, the Act requires every employer with 20 or more Workers to employ a quota (a specified percentage of the total number of employees) of persons suffering from disablement of a type which makes them suitable for the work that can be offered, and an employer below his quota will only be allowed to engage a non-handicapped Worker if there is no one on the Register willing to fill the vacancy in question. The Act provides for priority to be given to ex-service candidates when inviting aPplications.
For persons too seriously disabled to stand up to the conditions of ordinary competitive employment, sheltered workshops may be provided, and for those who need training, special Vocational Training Courses are to be organized.
. At every Local Office of the Ministry of Labour there ls now a Disablement Rehabilitation Officer whose services are available for any disabled person seeking advice and help about suitable employment. He also ^isits Hospitals in the area to discuss the problem with disabled patients before discharge. Disablement Advisory Committees are being set up throughout the country, composed of an equal number employers’ and workers’ representatives together ^th one or more doctors and other persons with a special knowledge of, or interest in, the problem of disablement. As a rule, Registration questions will be dealt with by the Committees through a Panel before which the person concerned will be entitled to appear. It should be noted that under the Act, the expression ” disease ” is to be construed as ” including a physical or mental condition arising from imperfect development of any organ This brings within it, those who are handicapped by reason of mental defect, and defectives in the community who find difficulty in securing suitable employment should therefore be encouraged to register. This category includes defectives under Statutory Supervision and those who are On Licence from Certified Institutions.*
Delinquent Defectives
In a paper read at the Annual General Meeting of the Mental Hospitals Association in July last, Dr R. G. Blake Marsh, Medical Superintendent of Bromham House Colony, Bedfordshire, drew attention to the increasingly urgent problem presented by high-grade defectives sent to Certified Institutions by the Courts under Section 8 and Section 9 of the M.D. Act, 1913. For defectives in this group who are ” dangerous or violent ” special provision is made by the Board of Control at the Rampton and Moss-side State Institutions, but in the vast majority of cases it is the ordinary Certified Institutions who are called upon to deal with them? and their number is steadily growing owing to an extended use by magistrates of their powers under the Act.
The problems involved in the training of such a defective are made apparent by the description which Dr Marsh gives of his characteristics, viz.: ” He is really more a Mental Inefficient rather than a Mental Defective, and he merges into a very large group of persons who form the lower fringes of our social scale. He is a person endowed with much cunning, his offences show evidence of planning and foresight, he realizes the possible consequences if detected, but punishment and fear of punishment has little or no effect on him. He commits crimes because he gains prestige, notoriety and publicity from them, and he often has sufficient powers of leadership to induce others of equivalent or lower mentality to commit them on his behalf.”
He arrives at the Institution often having been told it is only for a period of one year, and when he discovers that the chances of his being discharged in so short a time are small, he feels that he has been ” let down ” and becomes acutely resentful. His parents, themselves frequently subnormal, share his resentment, are completely unco-operative and often incite him to defiance ; he quickly joins with other patients of the same type as himself and they form a closed coterie which defies authority, evades rules, is abusive and truculent and, does all it can to spoil the pleasure of others. The behaviour of this group is so different from that of the vast majority of non-delinquent patients, who are childish, docile, friendly and amenable, that the Colony becomes divided into two sections with all the resulting difficulties of smooth administration. Earlier ascertainment, increased accommodation in Special Schools, more effective supervision, a greater use of Social Workers able to give advise on the treatment of delinquent, difficult and defective children^ would all help to reduce the size of this problem, and it * For further details, see Disabled Persons (Registration) Regulations. Statutory Rules and Orders, 1945. No. 938. Disabled Persons (District Advisory Committees and Panels Procedure) Regulations. Statutory Rules and Orders l9*5. No. 939.
could be dealt with more effectively in the Colonies themselves if the standard of skill on the part of nursing staff could be raised. But Dr Marsh considers that the real solution is along the lines of more specialized Institutions for such cases, provided possibly?under the new Mental Health Service?on a Regional basis.
Mental Defectives in Industry
Hostels from which defective girls go out to daily domestic work have for many years been provided by progressive Local Authorities and Certified Institutions, and the C.A.M.W.’s wartime Agricultural Hostels are also well-known.
An enterprise which has had less publicity is that carried on by the West Riding County Council in connection with a small certified institution for 54 medium to high grade women at Wakefield, opened in 1940. From the Institution a number of the girls were placed in domestic service, often with very satisfactory results. It was found, however, that some girls though industrious and reliable in the Institution, failed in this type of work, and it seemed likely that they would do better in group employment of a different kind. Within a reasonable distance of the Institution, at the time the problem was being considered, a Biscuit Factory was advertising for staff, and the Manager agreed to give some of the girls a trial. This proved so successful that ever since, from 8 to 16 girls at a time have worked there, at wages beginning at 25s. a week and rising, after 12 months service, to 36s. Other patients work at a Commercial Laundry, and others again in the packing department of a firm of wholesale grocers, in each case being paid the usual Trade Union rate of wages. A prefect system has been instituted whereby certain selected girls are made responsible to the Matron for the conduct and supervision of the others, whilst at work on their way there and back, and on parole, This has helped to develop in them a sense of responsibility, and girls who were inclined to be refractory have been found to make excellent prefects, gaining in poise and stability.
Every effort has been made to free them from any disability as compared with their fellow workers, and they have been given facilities for choosing their own clothes, paid for out of their earnings.
The experience gained by this experiment goes to show that defectives in industry are able to make wider social contacts than is possible for those in domestic service, leading in turn, to a broadening in outlook and the development of a social sense.
A Danish Institution under German Occupation Readers of Mental Health who know something of the splendid work done by Dr Wildenskov at the Keller Institution for Mental Defectives, Denmark, may be interested to know that a letter was received from him (dated August 12th) in which he tells something of his wartime experiences. He writes :?
” In May 1940, the Germans took possession of our branch on the island of Sprogo. We had to take all the women away in 48 hours in an easterly gale. We also took all the furniture, food and cattle at the same time. When the Germans arrived at the island, they were very angry. They had to live on gulls’ eggs for a week, and they had expected to come to comfortable and well furnished quarters. They did not behave well and spoiled a lot, but by now we have returned and got the whole colony repaired and painted. But the agricultural part of it is still a jungle, and gives the women a lot of work to do.”
” In February 1944, the Germans occupied our branch institution, ‘ Solund We resisted the occupation, but they said they needed the Institution with all its furniture and equipment and had been ordered to take it. We told them in that case they must keep the patients, as we could not remove them if we were not allowed to remove the equipment too. The discussion continued for 3 days, and we used the respite to prepare for evacuation. Seven small bombs, placed by the Danish Free Movement, exploded in the Institution one night which infuriated the Germans who threatened us with the Gestapo. Then we evacuated, taking all our things with us, leaving the patients to the last as hostages for furniture and food. The Germans did not really want them to be left, and they were rather afraid of the idiots. I myself was the last of all to leave, taking with me two hams which had been forgotten.”
” The Germans converted Solund into a fortress for their Air Force stationed in Denmark. Later they tried to take away our Inspector Botker, but we managed to get him off by boat and to conceal him in North Jutland. But they took his wife as hostage and she was detained for 5 weeks. I myself had then to take precautions to avoid arrest, as I was on the Gestapo’s black list and might have been murdered by them . .
Members of the Association of Mental Health Workers who in 1938 had the privilege of meeting Dr. Wildenskov and of visiting the Keller Institute will be relieved to know that the ordeal through which he and his staff have passed, is now over and that none of them has come to any serious harm.
Lasker Award in Mental Hygiene, 1945 This Award, instituted last year to be given annually through the National Committee for Mental Hygiene, New York, for outstanding service in the mental hygiene field, has this year been awarded jointly to . Major General G. Brock Chisholm, Deputy Minister of Health for Canada and to Dr J. R. Rees, Medical Director of the Tavistock Clinic, London and lately Consulting Psychiatrist to the British Army.
In the Citation accompanying the Award, reference is made to Dr Rees’ ” aggressive and shrewd leadership and genial encouragement ” of the group of ” brilliant, energetic and resourceful ” psychiatrists working under him during the War, to the effectiveness with which the group functioned in applying scientific knowledge to help the Army in its use of man power, and to the enlightenment spread by his Salmon lectures in November, 1944, subsequently published as a book under the title The Shaping of Psychiatry by War.
Readers of this journal will join us in congratulating Dr Rees on being the recipient of this Award, and in expressing pleasure at this token of American appreciation of British Army psychiatrists.
Mental Health in Northern Ireland
The Northern Ireland Minister of Health and Local Government has appointed a Mental Health Services Committee, under the Chairmanship of Lieut-Col. A. R. G. Gordon, D.S.O., D.L., M.P., to advise on questions of a specialized nature in connection with Mental Health Services.
The Committee is representative of Mental Health Services throughout Northern Ireland and will work in close co-operation with the Health Advisory Council. Any recommendations made by the Committee will be considered by the Council in the first instance so that they can be fitted into the general plan now being worked out for Health Services of Northern Ireland as a whole.
In particular, the Committee will be asked to give its views on the steps to be taken to make provision for the care and supervision of mental defectives, especially children.
Report of Committee on the Juvenile Employment Service This Committee, appointed in January, 1945, under the Chairmanship of Sir Godfrey Ince, to consider the establishment of a comprehensive Juvenile Employment Service, has made a strong recommendation in favour of a system of Vocational Guidance for every school leaver, in whatever type of school he has been educated.
The term is used in a wide sense to cover:
1. The keeping of a School Record throughout the whole of a child’s life, to be made available to officers of the Juvenile Employment Service. In connection with this it is the teacher who is chiefly concerned and upon his or her ” skill in methods of assessment of intelligence and aptitude and in estimating general qualities and character “, its value will depend. It is therefore urged that the teaching staff responsible for making the records and the Juvenile Employment staff using them, should be fully instructed in their preparation and purpose. Suggestions as to the data required are given in detail. 2. The possession on the part of the Service of full and adequate information on industries and professions both locally and nationally, their conditions of work, and the individual qualities required for the various types of employment they offer.
The setting up by every major industry of a National Joint Council to deal with the recruitment and training of young persons is urged in this connection. 3. The preparation of the child’s mind for the change from school to work, first indirectly, then by School Talks, to be given preferably by a Juvenile Employment Officer with special training for the purpose. Films and pamphlets are also valuable at this stage. 4. The School-Leaver’s Interview, to be conducted by the guidance officer in the presence of the parent and the teacher but of no one else. This, it should be recognized is work for an expert and the practice of the Perfunctory methods sometimes used is deplored. Throughout the Report the highly skilled nature of the Work of placing children in employment is stressed, and it is considered that for senior posts in the Service, candidates should have (a) Knowledge of industrial requirements of jobs and of industry generally, (b) Interest, experience and knowledge of social service, Particularly in relation to youth, (c) Experience and training in public speaking, particularly to young People, (d) Knowledge and experience of all other Matters involved in an adequate vocational guidance service.
The Report contains a most useful historical summary ?f the activities of the State in regard to Juvenile Employment, beginning with the setting up of Juvenile Departments in Labour Exchanges in 1909 and the empowering ?f Local Education Authorities (under the Education (Choice of Employment) Act, 1910) to provide bureaux f?r children under 17.
It recommends that the dual system then started should continue and that Education Authorities should oe required, within 6 months of the relevant legislation, to decide whether or not they will exercise their powers. It is proposed, however, to ensure greater uniformity, that Schemes submitted by them must be approved by a Central Juvenile Employment Executive, staffed by officers of the Ministry of Labour and National Service, |he Ministry of Education and the Scottish Education department. It is further suggested that the present National Advisory Councils appointed in 1928 by the Minister of Labour should be replaced by a National Advisory Council on Juvenile Employment with Advisory Committees for Scotland and Wales.
This Report is throughout of great interest and some of its recommendations have an obvious bearing on Child Guidance and Mental Health problems.
Speech Therapists
In a Circular recently issued to Local Education Authorities*, the Ministry of Education deals with the position of Speech Therapists which has recently been reviewed.
In the past, their work has been regarded as primarily educational and the majority employed by Local Education Authorities have been recognized or approved as specialist teachers under Schedule I (6) or II (5) of the Code of Regulations for Public Elementary Schools. Recently, however, there has been a change both in the training provided and in the work itself. The four Training Schools are maintained by or conducted in close association with hospitals, and the instruction given comprising anatomy, physiology, neurology, pathology of the ear, nose and throat, phonetics and speech therapy?does not include training in the teaching of children in classes. Consequently, the work of Speech Therapists is becoming more curative and less educational and is carried out, in part at least, under medical supervision, whilst the condition of employment is approved by the Minister of Health for admission to the Register of Medical Auxiliaries.
It is therefore proposed that as from November 1st, 1945, Speech Therapists employed by Education Authorities shall be treated as members of the staff of the School Health Service and shall not be regarded as teachers except in special circumstances.
The Circular deals further with Superannuation arrangements, and salary scales, and concludes with the suggestion that Education Authorities in whose areas there are Ministry of Pensions and Emergency Medical Services Hospitals, should release their Speech Therapists for part-time service at such Hospitals in order to help to relieve the present shortage of supply.
French Guests of English School-girls Through the enterprise of the Allies Wing of the British War Relief Society of the United States, 50 selected French children were recently invited to spend three months in this country to recuperate after painful experiences in occupied France.
On arrival the children were placed in Hostels or Convents and as family billets could not be secured for them all, it was decided to try to find hospitality for 15 of them, between the ages of 12 and 16, in a country town able to provide good educational facilities and where the services of a Psychiatric Social Worker to select billets and give subsequent supervision and help, were available. The town chosen was Tunbridge Wells, (though three of the children were placed in Ashford), and the girls attending the County School were asked for offers of hospitality so that the French guests could share the education of their hosts. There was an enthusiastic response. The girls received settled down quickly and in their visit of 5 weeks put on weight and became gay and affectionate. They left, with the sound of the School’s cheers in their ears, and having forged links with English families which may be of long duration. Further offers have been received should another batch of children be brought over by the Allies Wing and it should be possible again to organize, with the School’s co-operation, an equally successful scheme.
(26.10.45). 18 MENTAL HEALTH The Regional Representative of the Provisional Council in the area (Miss R. S. Addis) had the privilege of helping in this enterprise and her skilled services, as a Psychiatric Social Worker, were appreciatively received.
The Problem of Spastic Paralysis
We are glad to record the appointment?made jointly by the Ministry of Education and the Foundation for Educational Research (University of London)?of Miss M. E. Dunsdon, M.A. (Educational Psychologist, Bristol Education Committee), as Director of Research into the problem of educating children suffering from spastic paralysis and allied conditions.
The research is planned to cover at least 5 years, and will include a visit to the United States where pioneer work in the subject investigated was initiated a number of years ago by Dr Winthrop Morgan Phelps of Baltimore.
Readers of this journal will be interested to know that in our next issue we hope to publish an article contributed by Mrs. Collis and Dr Buck on the work of a small experimental Unit in this country, which has been working on the subject since 1943.
The Psychology of Tuberculosis
The National Association for the Prevention of Tuberculosis has appointed Major Eric Wittkower, R.A.M.C., to conduct a research investigation into the psychology of tuberculosis on his release from military service.
Before the war, Major Wittkower was a Halley Stewart Research Fellow and Physician at the Tavistock Clinic, London, and for the last five years has been engaged as a Psychiatric Specialist in the R.A.M.C. He has also been responsible for inquiries into the Psychological Aspect of Severe Physical Disablements, and has published a number of papers during the last ten years.
The present research will be begun by investigating case histories and making personality studies on a number of tuberculous patients.
Provisional National Council for Mental Health Two important appointments to the Council’s staff have been made recently:?
Medical Director. Col. K. Soddy, M.D., D.P.M., at present serving overseas as Deputy Director of Selection of Personnel and Chief Technical Officer, India Command, has been appointed as Medical Director on his release from the Army early in the New Year. Col. Soddy held in 1939 one of the Fellowships in Child Psychiatry awarded by the Child Guidance Council, and has also had Mental Hospital experience. General Secretary. Mr. Conrad Ormond, formerly Administrative Secretary of the Tavistock Clinic and during the War on the staff of the Air Ministry, took up, in September, his duties as General Secretary of the Council.
Amalgamation. Legal formalities in connection with amalgamation are now nearing completion, and it is expected that the Licence from the Board of Trade for the new incorporated body to be known as the National Association for Mental Health, will be received during the next few weeks.
Child Guidance News
Since the new system of Committees was established in June the Child Guidance work of the Provisional Council has been divided between the Child Guidance Interclinic Committee whose members are actually engaged in clinical work, and the Child Guidance Services Committee which will consider wider problems connected with Child Guidance. It was agreed that someone representing, so to speak, the “consumers ” of Child Guidance should be co-opted to the latter Committee and it was suggested that a member of the Women’s Co-operative Guild might fulfil this function. The Committee is delighted that Mrs. Bamber who is President of the Guild has accepted an invitation to serve. The Interclinic Committee has been trying to obtain an assessment of the cost of Child Guidance treatment. A detailed and careful calculation was prepared by the Child Guidance Training Centre and other Clinics were asked to submit estimates. It was not an easy task, particularly for some of the Clinics maintained by Local Authorities where premises are shared with other departments of the School Medical Service which made it difficult to assess overheads. Miss Fildes is now analysing the reports received. Dr Winnicott was invited to one of the Meetings of the Interclinic Committee to initiate a discussion on the working of the Clinic team. This proved both valuable and interesting and the Committee agreed that time should be set aside at future meetings for professional discussion of particular topics.
A systematic introductory course of lectures for Child Guidance Fellows has been asked for and discussed for some time. Such a course has now been planned and is to begin in January. It is to take three weeks and is to consist of lecture-discussions and visits of observation to a number of institutions concerned with children. Fellows who have completed their training are being invited to attend either the whole course or any particular lectures which interest them.
We are glad to welcome back Dr William Moodie who has resumed the Medical Directorship of the Child Guidance Training Centre. It is most satisfactory to have him, and also Dr Emanuel Miller and Dr Mildred Creak serving on our committees once more. In August the Tavistock Clinic moved from Westfield College to new quarters in Beaumont Street, W.l> which is more central and conveniently close to the office of the Provisional Council. Two new Clinics have been officially recognized during the quarter, the Nuneaton and the Bangor Child Guidance Clinics. There is no doubt that this number would have been larger if there had been more trained staff available. ” Lord ” Memorial Competition
The National Council for Mental Hygiene announce that the subject chosen by their Selection Committee for the 1945 Essay is ” What are the essential personal qualities required for success in Mental Nursing ? ‘ The competition, which is administered by the Council on behalf of the Society of the Crown of Our Lord, is open to all certificated mental nurses, of the rank ot staff, charge or chief charge employed in Mental Hospitals of the United Kingdom and Northern Ireland. Essays should be of approximately 2,000 words in length, and the following prizes are offered : First Prize, ?3 3s. and a medal ; Second Prize, ?1 Is. The latest date for the reception of essays is February 28th, 1946. Further particulars may be obtained from the Secretary, National Council for Mental Hygiene, 39 Queen Anne Street, London, W.l.
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