Mental Deficiency in Northern Ireland
The task of the Mental Health Services Committee ^ppointed in October, 1945, by the Minister of Health and Local Government in Northern Ireland, to give the problem of mental deficiency urgent c?nsideration “, was?as is stated in their Report Just issuedf?a formidable one.
“In Northern Ireland there is no Mental Deficiency Act, no institution, no community supervision and there is only one special school (in Belfast) which is unable to meet even local needs. Apart from the inadequate provision made by the Education Acts and the Poor Relief Acts, the responsibility for dealing with mental defectives has not been placed by statute on any authority and, for the most part, these unfortunate people lead a hopeless existence at home, in poor law institutions or in mental hospitals. The problem of Rental deficiency has, by years of neglect, developed into a grave social evil and we cannot over-emphasize the need for early action to deal with it.” These words will have a familiar ring for the generation of social workers concerned with the ^ePort of the Royal Commission on the Care and ^-ontrol of the Feeble-minded, published nearly 7” years ago, and Northern Ireland, as a late-comer jnto the field, has at least this advantage?that she s able to benefit by British experience. Of this 116 Committee is not unmindful and they have utlined a Mental Deficiency Act which, though fected within substantially the same type of cafTolding, seeks to avoid the demerits inherent ‘thin its English counterpart and to meet the P^ial needs of a much smaller territory. r We would particularly draw attention to the Commendations which diverge most widely from our own legislation on the subject as embodied in the Mental Deficiency Acts, 1913-27.
Definitions
The Committee, whilst adopting in the main the definitions of the English Acts, suggest a revision of that relating to the feeble-minded group in order explicitly to emphasize the basic conception of Mental Deficiency as a social rather than an educational defect, viz.: (the italics are ours) : ” … . persons in whose case there exists mental defectiveness which … renders them socially inefficient to such a degree that they require care, supervision and control for their own protection or for the protection of others, and in the case of children special training also.’’’’
Further, to avoid ” unpleasant apd undesirable associations in the minds of the public it is proposed that the various groups shall be referred to by numbers, and that the terms idiot, imbecile, feeble-minded and morally defective?though adopted by implication?shall not be explicitly formulated.
Ascertainment
Although under the Education Act (Northern Ireland) 1923, it is the duty of Education Authorities to ascertain mentally defective children and to report those considered ineducable to the appropriate authorities, the Committee point out the ” futility of the present system ” as revealed by statistical tables showing that, e.g., in the twelve year period, 1932-44, only two children were so H.M. Stationery Office, Belfast. Is.
notified in Co. Londonderry and three in Co. Tyrone. (During the same period the figures for Belfast and Co. Down were 302 and 232 respectively.) It is not proposed, however, that the English system should be adopted in toto, but that on the Mental Deficiency Authority should be laid the duty of ascertaining all defectives, whether or not they are in need of immediate help and whether or not they are attending school. Thus it is recommended that Education Authorities should be required to report any child considered to be defective, to whatever degree, for examination and diagnosis by the Mental Deficiency Authority’s psychiatrist. Further, in order to supplement ascertainment through other authorities, voluntary bodies and individual social workers, it is proposed that it shall be made incumbent on all medical practitioners to notify any patient whom they suspect to be a mental defective.
Certification
Taking its stand on the principle that the final determination of mental defect is a medical rather than a legal question, the Committee recommend that judicial certification shall be dispensed with, and that a certificate by a specialist medical officer of the Mental Deficiency Authority shall be all that is necessary as a preliminary to removal to Institutional care.
Institution Accommodation
It is suggested that, as Northern Ireland’s population is not more than 1| million, one Colony to accommodate in the first instance, 500 patients (and ultimately 1,000) should be adequate to meet the need. Priority in the selection of cases for admission should be given to trainable patients, and the lowgrade untrainables should be housed in a separate building of a simpler type within easy range of the main Colony.
An interesting proposal is also made for the establishment of an Observation Unit to receive, for a temporary period, cases in which further observation is needed prior to an accurate diagnosis.
Administration
The Central Authority for the administration of the new Act would obviously be the Ministry of Health and Local Government, but it is suggested that here another departure from the English set-up should be made. To ensure uniformity in standards of administration and the pooling of the services of the necessary experts, it is proposed to institute a special Regional Authority composed of representatives from all the statutory bodies dealing with defectives. To act in an advisory capacity to this body, Local Mental Health Committees would be formed, co-ordinating the activities of interested local organizations and individuals. Ultimately it is envisaged that the Service should be linked up with the other Mental Health Services of the Province.
In concluding their Report, the Committee, whilst recognizing that the programme outlined must inevitably take a considerable time to put into operation in its entirety, urge that as early as possible plans should be drafted for the proposed Colony and that a Medical Superintendent should be appointed.
This is emphatically a document which should be studied by all who are interested in social trends and particularly by those concerned with mental deficiency administration in other countries. * Iii this connection, the Committee have perhaps tended to overlook the need of even low-grade defectives for skilki training and the response which may be got from them, as shown by the experience of Bridge Home> Witham (Ro)’a Eastern Counties Institution.) 1
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