National Health Service Bill
News and Notes
The Government’s scheme, embodied in the recently Published National Health Service Bill, for promoting a comprehensive Health Service in England and Wales, includes provisions for mental treatment and mental deficiency services which are to be part of the new hospital and specialist arrangements. Local health authorities, however, are given responsibility for all the ordinary local community care in the mental health service which covers also the initial procedure for placing under care those who require treatment under the Lunacy and Mental Treatment Acts. Certain sections of these Acts and also of the Mental Deficiency Acts, 1913 to 1938, are to be Repealed or amended in order to bring them Jnto conformity with the provisions of the new Act.
Certain functions of the Board of Control are to be transferred to the Minister of Health, including the ucencing of houses, registration of hospitals and the approval of nursing homes, the certification of institutions and houses and the approval of homes for the reception ?f mental defectives as private patients. The Officers ?f the Board, other than the Commissioners, the Secretary and Inspectors, are to be transferred to the Ministry. Extended powers in regard to the provision of mental health services are given to local health authorities who will be required to submit proposals to the Minister within a specified period for the carrying out of their new duties under the Act. While the Bill provides opportunities for mental health development, there is a danger of these not being implemented owing to the ambiguity and elasticity of the relevant clauses, the |;xtent of the mental health services to be provided being J?r the most part not clearly defined.
. A special Committee appointed by the Provisional National Council for Mental Health has forwarded recommendations to the Minister urging, in particular, lne need for making adequate provision for the care and aftercare not only of persons suffering from definite Cental illness or mental defectiveness, but also for Neurotics, psychopaths and psychotics, who cannot be uealt with under the Mental Treatment Act, epileptics, and mentally subnormal persons not certifiable under the Mental Deficiency Acts.
jThe need for a fuller representation of the Mental j^ealth Services on the Central Council and on the Regional Boards to be set up under the Act is strongly advocated, as is also the establishment of an Advisory ^ommittee on Mental Health as envisaged in the White l^aper. Of the present total number of hospital beds in lne country, some 40 per cent, are reserved for mental Patients and mental defectives and this figure is exclusive 01. accommodation for neurotics, psychopaths and ePileptics which is so urgently needed. Thus the 10 per S?nt. Mental Health representation provided for on the central Council under the First Schedule of the Bill is ?bviously quite inadequate.
The Council’s Memorandum to the Minister further raws attention to the paramount importance of setting UP machinery for ensuring that there is the closest possible co-ordination between the new Regional Hospital Boards Responsible for Hospitals and Clinics, and tfte Health ;r?nirnittees responsible for Community Services. In ms connection the following definite recommendations are made:
(i) That the Officers of Regional Hospital Boards should include psychiatrists whose services should be available for Health Committees when such Committees do not themselves employ psychiatrists.
(ii) That Psychiatric Social Workers and their teams employed by Regional Hospital Boards, should be available for carrying out work for Health Committees as and when needed, and conversely: (iii) That where Psychiatric Social Workers or teams of Mental Health Workers are employed by Health Committees, their services should be made available for Regional Hospital Boards as and when needed.
It is felt that unless the need for reciprocal arrangements of this kind is realized to be necessary, the administrative ” split ” created by the Bill as between the different types of mental health service may lead, on the one hand, to serious overlapping and, on the other, to inadequate provision in certain directions of the services required.
Finally, the Memorandum, stressing the deplorable lack of training facilities for all types of workers in the Mental Health field (psychologists, psychiatric social workers, mental health workers engaged in community care, Supervisors of Occupation Centres and staffs of ” School Departments ” of Certified Institutions and of Hostels for Difficult Children)?raises the possibility of provision being made in the Bill to empower the Ministry, Regional Hospital Boards, and Health Authorities, to establish training facilities, or to contribute to their establishment by other approved bodies.
Copies of this Memorandum have been sent by the Council to a number of Members of Parliament of all political parties, and, at the time of going to press, offers of help and support had been received in introducing or supporting amendments on some of the points raised.
Institute of Labour Management
The establishment of an Institute of Labour Management to provide a centre for the study of management, and generally to assist in raising the standards of management in this country, is the outcome of the recommendations of the Committee appointed in November last by the President of the Board of Trade and presided over by Sir Clive Baillieu, President of the Federation of British Industries. The Committee, whose members included heads of some of the large industrial groups of the country, was charged with the duty of formulating detailed proposals for the setting up of a central institute for all questions in connection with management.
In the Committee’s recently published Report, reference is made to the important part wlych the Institute will be called upon to play in promoting facilities for training and education whereby those engaged in management may equip themselves to discharge their functions more effectively, and in this connection tle Committee recommend the establishment of propaganda and training and education divisions of the Institute.., While there are many existing bodies in this country concerned with questions of management which have done valuable pioneer work, it is recognized that they cannot individually provide the comprehensive facilities which a central institute would offer. One of its primary purposes will be to strengthen existing effective organizations in every possible way, and to act as a co-ordinating body.
The importance of the human factor in all kinds of employment, both as regards the workers themselves, and those in positions of authority, is now generally recognized, and the scheme to be set in motion is one which should command wide approval and support. In order to ensure a favourable start to the project, the Treasury will make a grant of not more than ?150,000 for the first five years, after which time the Institute should be self-supporting. It is also recommended that the Government should nominate the first Chairman and the first Council of the Institute, and that thereupon it should be left as an independent body responsible for its own affairs.
Training in Child Care
No doubt most of our readers have already seen the recommendations made by the Curtis Committee on the Care of Children which were published in its Interim Report on Training issued in March. It may, however, be useful to summarize them here, for the benefit of those who have not yet read the Report.
It is noted that a few large voluntary organizations responsible for Homes make their own provisions for training staff, but that otherwise:
” The men and women now employed in the posts in question, though sometimes very suitable in temperament and possessing the necessary practical skills, have only rarely had the opportunity for special study of the normal development of the child, his need of affection, the causes of any unusual developments of behaviour or personality, or the conditions, physical and social, which can best compensate him for the deprivation of the more stable background of a family home.”
It is therefore urged that child care should be raised to the status of a ” recognized calling for which definite qualifications are required To this end the following Recommendations are made which we are glad to note include proposals put forward by the Provisional National Council for Mental Health in evidence submitted to the Committee :
1. That a Central Council for Training in Child Care should be set up, to administer schemes of training. This Council should be representative of the various bodies interested in the subject, including the Government Departments concerned, the Association of Municipal Corporations, the County Councils Association, the Association of Education Committees and the L.C.C.
Voluntary Bodies represented should include, the Council of Associated Children’s Homes, the British Paediatric Association, the National Council of Social Service, the Provisional National Council for Mental Health, the National Council for Maternity and Child Welfare, together with educational bodies such as the Joint University Council for Social Studies, and the Association of Teachers in Training Colleges and Departments . of Education.
2. That a Course in Child Care should be instituted for House Mothers, Assistant Matrons or Masters, Foster Mothers or Fathers, consisting of two parts ?Part I, leading to a Certificate in Child Care, after two years’ training?Part II, comprising a third year’s training in employment and leading to a second Certificate indicating suitability for more senior work.
3. That the Course should begin with a trial period of not less than 3 months in a selected Home, as a test for suitability and aptitude for the work. Thereafter, theoretical instruction would be added to practical work, the two being preferably carried on concurrently.
4. That the theoretical work should include (i) Household Management, (ii) Care of Health, (iii) Study of Child Development, (iv) Playing with Children, (v) Elementary lectures in social conditions and the social services, (v) Courses for improving general standard of culture, e.g. literature, music, art and dramatics, (vii) Record Keeping, accounts, etc., (viii) Religious Education if desired. 5. That provision should be made for bursaries for candidates who are unable to take the Course without financial assistance.
6. That the theoretical training should be given at existing educational institutions such as Teachers’ Training Colleges, Polytechnics, Technical Colleges, County Colleges (when established), existing Training Schools such as those attached to Dr. Barnardo’s Homes, and the National Children’s Home. The Central Training Council would, in addition, employ Supervising Tutors to keep in touch with the Training Centres and the students’ progress.
Under Section 23 of the Report it is recommended that encouragement be given to any suitable scheme for immediate intensive theoretical training of a few Heads and Senior members of the staffs of those Homes which may be selected for residential training. Mention is made of the proposal that the Provisional National Council for Mental Health is prepared to institute such a course in Child Development.
The Report contains a useful Appendix on qualifications and present facilities for the training of Nursery Nurses, Staffs of Homes, and Social Workers in Child Care.
Developments in Provision for Maladjusted Children St. Francis School, Hook The Society of St. Francis (Anglican) is opening, with the approval of the Ministry of Education, a Residential School in Dorset for Maladjusted Boys, between the ages of 12 and 16.
A large country house a few miles from the sea has been secured, and there will be ample opportunities for outdoor activities in addition to school-room education. There will ultimately be accommodation for 30 boys, but owing to delay in the completion of building operations, it will not be possible in the immediate future to admit more than 10.
Further particulars can be obtained from Father Owen, S.S.F.,St. Francis School, Hook, nearBeaminster, Dorset.
Reception Hostel, Salford
The Salford Education Committee is about to open a Hostel for the reception of children committed to them by the Courts for ” Care and Protection “, but too maladjusted to be placed in foster-homes without preliminary psychiatric treatment and habit training. The children will remain in the Hostel for as long a period as is necessary, and they will be under the supervision of a carefully selected staff working in close touch with the Authority’s Child Guidance Clinic.
Provision of this type, though urgently needed all over the country, is all too rare and Salford’s enterprise should encourage other Authorities to take similar action.
Hay brook House Residential Nursery ,
In December, 1942, the Provisional National Council for Mental Health, with the approval of the Ministry oi Training in Child Care. Interim Report of the Care of Children Committee. H.M. Stationery Office. 3d. Health and in co-operation with the Church of England Waifs and Strays’ Society, opened this Nursery for maladjusted children from the age of 2 years. The Nursery was specially designed to meet the needs of children evacuated to ordinary Nurseries who were unable to make a satisfactory adjustment, and of the 45 children received, all were ultimately able to return to their own homes or to be passed on to billets or hostels.
With the ending of the Evacuation Scheme, the Nursery has been approved by the Ministry of Education for the reception of maladjusted children, and the Provisional Council invites applications for admission from Local Education Authorities, Public Assistance Committees and other interested bodies. The fees are Three Guineas weekly. Particulars may be obtained from the General Secretary, Provisional National Council for Mental Health, 39 Queen Anne Street, London, W.l. Tavistock Institute of Human Relations A pioneer venture of outstanding importance has recently been inaugurated by the Council of the Tavistock Clinic, London, who, with the aid of an initial grant of ?22,000 from the Rockefeller Foundation, have formed an Institute of Human Relations. Its primary object is to undertake and to co-ordinate practical work in relation to the clinical and social needs of the individual. The experience in this direction gained with the Forces during the war and the successful results achieved have afforded convincing proof of the desirability for extending such work to the civilian population. The individual’s psychological well-being depends not only on medical treatment, but on a satisfactory adjustment to environmental conditions and community life. This in its turn involves the development of harmonious relationships in all spheres of human activity, and the linking up of the clinical with the wider aspect of social work on such problems as industrial relations, rehabilitation and the current difficulties of families and communities.
The work will be undertaken by a co-ordinated team of psychiatrists and psychologists, most of whom have served with the Forces and who will be able to bring to it the valuable experience in the field of social psychology which they gained during the war.
It is proposed that the Institute shall also become a Training Centre, and plans for this are expected to be completed by next autumn.
The generous grant made by the Rockefeller Foundation will enable the Institute of Human Relations to carry on their activities for a very limited period only, but the promoters of the scheme are confident that the value of the work will be conclusively demonstrated during that time and they are hopeful that it will command a wide measure of public support which will ensure its continuance on a permanent basis.
University Appointments
Dr Aubrey J. Lewis, who for a number of years has been Director of Clinical Psychiatry at the Maudsley Hospital and is also Director of Clinical Psychiatry at Mill Hill Emergency Hospital, has recently been appointed Professor of Psychiatry at London University. Prof. Lewis is also Consultant in Psychological Medicine at the British Post-Graduate Hospital, Hammersmith, and in the course of a distinguished career he has undertaken research in Europe having been awarded a Rockefeller Medical Fellowship in 1926. He was at one time on the staff of the Johns Hopkins Hospital, Baltimore. Prof. Lewis is closely associated with the work of the Provisional National Council for Mental Health, being also Chairman of its Clinical Services Committee. It is announced that Aberdeen University have appointed Dr Douglas R. MacCalman to the CrombieRoss Chair of Mental Health.
A unique feature of the appointment is that it was made in co-operation between the University, Voluntary Teaching Hospitals and Local Authorities. The teaching will be centred mainly in the General Hospitals rather than be oriented to the Mental Hospitals.
Dr MacCalman, who has been Lecturer in Psychopathology at the University since 1938, was formerly Medical Director of the Child Guidance Council, London. Prior to this he was for some time Medical Director of the Notre Dame Child Guidance Clinic in Glasgow, which he helped to organize and to develop, and for over a year he studied in America at the Boston Psychopathic Hospital and the Johns Hopkins Hospital, Baltimore.
Regional Work of the Provisional Council
In addition to the work in connection with the aftercare of discharged Service psychiatric casualties, and clinical and advisory services for children and adults, the Regional Representatives of the Provisional National Council for Mental Health undertake a large amount of liaison work with local authorities, organizations and individuals with a view to promoting mental health in their areas and a recognition of its fundamental importance in every sphere of human activity. This personal approach has been found to be of the greatest value and help as is evidenced by the increasing demand on the services of the Regional Representatives.
Lectures are also given by the Regional Representatives, and during the past few months they have addressed such groups as Red Cross Home Visitors, service women about to be demobilized, children’s Welfare Officers and Moral Welfare students, teachers, and Club Leaders, etc. Lectures in the areas have also been arranged by the Provisional Council for Townswomen’s Guilds, Women’s Institutes and other women’s organizations, clubs, groups connected with Maternity and Child Welfare Centres, parents and teachers. On May 21st, Dr Soddy, Medical Director of the Provisional Council, addressed a drawing room meeting held at Eversley, Hants, on the subject of ” Mental Health and the Community “.
This introductory talk has brought requests for further lectures on mental health in the area and has been the means of stimulating a fresh increase of interest in the subject.
Defectives and the Disabled Persons (Employment) Act The Board of Control have recently issued a Circular on the position of mental defectives in connection with Registration as Disabled Persons.
It is pointed out that mental defect is a recognized disablement under the Act, provided that it causes a substantial handicap to obtaining or retaining employment or work, and that there is nothing to prevent a defective on licence, under Guardianship or under Statutory or voluntary Supervision from applying for registration. If, however, there appears to be no reasonable prospect of obtaining or keeping any form of employment, registration should not be suggested. ?
Advisory Service on Handicraft and Play Activities The Provisional National Council for Mental Health is prepared to offer, and invites applications for the services of its Advisers on educational handicrafts and recreational activities. The Advisers are prepared to visit Institutions and Occupation Centres for mentally defective children, and Childrens’Homes of various types. Advice is given on the planning of time-tables, the teaching of handicrafts with improvised and home-made materials, play activities suitable for children of various ages and aptitudes, group work, etc.
Further information regarding fees, etc., may be obtained from the General Secretary, 39 Queen Anne Street, London, W.l.
Birthday Honours
We are happy to announce that among the recipients of Birthday Honours this year are the Rt. Hon. Lord Alness, P.C., K.C., who is created G.B.E., Prof. Cyril Burt, designated Knight Bachelor, Miss D. Keeling (O.B.E.), Alderman William Pashby (O.B.E.), Dr J. R. Rees (C.B.E.).
Lord Alness was until recently Chairman of the Scottish Savings Committee, and for a number of years has been Chairman of the Child Guidance Council and also of the National Council for Mental Hygiene. Dr Cyril Burt, who is Professor of Psychology at University College, London, is also a member of one of the Standing Committees of the Provisional National Council for Mental Health, and Miss Keeling is Chairman of its Social Services Committee. Dr Rees, who attained the rank of Brigadier in the late war, carried out valuable pioneer work as Consulting Psychiatrist to the Army. He is Medical Director of the Tavistock Clinic, London, and also a member of the Committee of the National Council for Mental Hygiene. Since his demobilization he has become actively associated with the work of the Provisional Council. Alderman Pashby represents Hull City Council on the C.A.M.W. Executive Council.
General Board of Control for Scotland
It is announced that during the past year the following changes have occurred among the Members of the Board of Control for Scotland: Sir John Jeffrey, K.C.B., C.B.E., retired from the Chair on December 31st, 1945, and was succeeded by Dr John Jardine, O.B.E., Principal Assistant Secretary Scottish Education Department. Dr Aidan Thomson, Medical Commissioner retired in July, 1945, for health reasons and was succeeded by Dr T. Ferguson Rodger.
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