The Mental Health Service in England and Wales
1939 to 1945
The publication of another Annual Report of the Board of Control is something of an event, for it is the first which has been made available to the general public since 1939, and the fact that it covers the war period makes it particularly interesting. The Report opens with a retrospect of the Board’s work and the major aspects of the administration of the Mental Health Service between 1939 and 1945, which is of special value in that it is only through knowledge of the facts recorded, that the contemporary situation can be fully appreciated. During these years a total of 252 doctors were called up for war service from Mental Hospitals and Mental Deficiency Institutions. By July 1st, 1940, 2,000 male nurses had left for service, 381 female nurses had joined other branches of nursing, and 109 had joined the A.T.S. During that year, staff shortage gradually increased, sometimes amounting to one third of the normal personnel. Six Mental Hospitals and Certified Institutions were completely surrendered to the Emergency Medical Service, and in a number of others, space had to be provided so that accommodation for a total of 40,000 casualties could be made available. In terms of actual beds released, this meant that by the end of 1941, 17,204 beds had been surrendered in Mental Hospitals and 5,926 in Mental Deficiency Institutions. In this latter number were included many new beds recently added as the result of the completion of enlargement schemes and at once diverted to other purposes.
Admissions to Mental Hospitals during the first part of the war were lower than the average, but by 1943 they had risen above it and during 1944 and 1945, the rise continued, due possibly to the effect of prolonged strain.
Section II of the Report surveys the situation in 1945, the first part dealing with Mental Disorders, the second with Mental Deficiency. Outstanding features noted are as follows:
Mental Disorders
The total number of patients under care in Mental Hospitals in England and Wales on December 31st, 1945, was 146,027, representing a decrease during the year of 241 (compared with a decrease of 1,289 during the preceding year). Of this total number, 10-7 per cent, were Voluntary patients under the Mental Treatment Act, and 3 per cent. Temporary patients.
Direct admissions during 1945 were 33,961? the highest on record. Of these, 50-7 per cent, were admitted as Voluntary patients and 4-1 per cent, as Temporary.
It should also be noted with satisfaction that there is a rising discharge rate, viz. 63 per cent. ” departed, recovered or relieved ” or, for recoveries only, 33-2 per cent, of the direct admissions. The total discharge rate was 71-7 per cent, as compared with an average of 66 ? 8 per cent, during the preceding quinquenium. To whatever causes this may be assigned, it has manifestly an important bearing on questions of future provision, in that a rising discharge rate means a decrease in the number of patients in hospital at any one time.
An interesting scheme has been initiated by the London County Council at two of their mental hospitals to enable certain patients who though recovering are not yet considered fit for leave on trial or discharge, to take paid employment in the locality, returning to the Hospital each night. At the end of the first year’s experiment, it was stated that undoubted success had been achieved, that it had proved a useful aid to rehabilitation and had induced self-respect in patients whose suitability for final discharge remained doubtful.
Mental Deficiency
The total number of defectives under care on January 1st, 1946, was 99,608 of whom 52,788 were in Institutions, Certified Houses and Approved Homes; 5,016 were under Guardianship or Notified, and 41,804 were under Statutory Supervision.
Ascertainment
The rate of defectives reported to Local Authorities during 1945 and found subject to be dealt with under the Mental Deficiency Acts, was 2-41 per 1,000 of the population as compared with 2 ? 33 the previous year. Comparative figures for the ascertainment rate of defectives reported, whether found subject to be dealt with or not, are 3-10 and 3-15 per thousand (including children between 14 and 16 notified informally for After-Care on leaving school)A table showing the Ascertainment Rates of all the Local Authorities throughout the country reveals, as heretofore, a diversity not due to any common factor such as type of population and area, and is presumably to be attributed mainly to the varying vigour with which the relevant Acts are administered or used by Authorities. Thus whilst in Walsall, defectives ascertained represent 8-48 per 1,000 of the population (of whom 4-32 were found subject to be dealt with) and in East and West Suffolk, 6-33 (3-41 “subject”), the figures for Merthyr Tydfil were 1 -37 and 0-39 respectively* and for Huntingdonshire, 1-17 in both cases. Of the new cases reported during the year, 420 were sent to Institutions, 17 were placed under Guardianship, 43 died, and 2,270 were left in the community under Statutory Supervision. * Thirty-Second Annual Report of the Board of Control for the Year, 1945. Part I. H.M. Stationery Office. Is’
Institution Care
The outstanding fact of the situation as regards accommodation, is a shortage of beds so acute that it is described by the Board as ” creating an unsatisfactory and at times dangerous situation At no time during the years preceding the war Period, was the need met, but whereas between 1932 and 1938, the annual increase was 2,148 beds, the subsequent rate of increase was only 174 over the whole seven-year period. The net increase during ‘945 was 10 beds, compared with a net decrease ?f 18 in the previous year.
On January 1st, 1946, the total number of beds available was 49,062 (including those for private Patients in Certified Houses and Approved Homes) and the difficulty of finding vacancies for all types ?f defectives except high-grade women, is ” more acute than everA considerable number of beds in the larger Certified Institutions are still allocated to the Emergency Medical Service, and new accommodation at others cannot be used because of the impossibility of recruiting staff. A further point of interest is that whereas on January 1st, 1939, the number of beds in Approved Homes Was 844, the number in 1945 dropped to 589. Discharges from Institutions in 1945 numbered j 33, and 38 Orders lapsed during absence without ‘eave. (Corresponding figures for 1939, were 603 and 95.)
hostels There are 3 Hostels under the management of “on-Statutory bodies, for patients On Licence from Institutions, and during the war, the Sheffield Cental Deficiency Committee opened a Hostel for w?men. In addition, 12 Institutions (as compared ^ith 8 in 1939) have separate Hostel Branches. The Agricultural Hostels established in 1942 by *he Central Association for Mental Welfare and afterwards carried on by the Provisional National Council for Mental Health, now number 9, and rePresent a new development which holds great Promise for the future.
Community Care
On January 1st, 1946, 51,768 defectives were under s?me form of Community Care, representing a ratio of 1-25 per 1,000 of the population, as compared with 1-14 in 1939. They were distributed as follows: ^ On Licence from Institutions .. 5,286 Under Guardianship .. .. 4,678 Under Statutory Supervision .. 41,804 In addition, 23,862 defectives were under Voluntary Supervision by arrangement with the Local Authority concerned, compared with 26,006 in 1939.
Occupation Centres
The situation disclosed in regard to Occupation Centres is a disheartening one, for whereas in 1939 there were 179 Centres and 8 Clubs, with a total number of 4,244 on their Registers, at the end of 1945 these numbers had decreased to 87 Centres and one Club, attended by 2,431 defectives. During the war, some Centres closed down altogether, others had to be evacuated to residential quarters in safe areas, and re-opening is made difficult owing to lack of available premises and of trained staff. All that can be said is that slow progress towards recovery is now beginning to be made, and that the demand for re-opening is coming not only from parents and the public, but from the defectives themselves to whom the deprivation of the training and happiness which Centres formerly brought to them, is a very grievous loss.
Since the ending of the war, the Board has sustained the loss of two outstanding officers. In March, 1945, Sir Laurence Brock, Chairman for 17 years, retired from the public service. Sir Laurence played an important part in re-organizing the Board after the passing of the Mental Treatment Act of 1930, and as Chairman of the Committee on Sterilization appointed by the Government in 1932, rendered distinguished service in another field. The last period of his time at the Board covered the war years and to him fell the task of guiding mental health administration through the maze of difficulties produced by the dislocation of normal routine.
The retirement of Sir Hubert Bond, Senior Commissioner since the creation of the Board in 1914, was also deeply regretted by his colleagues who record his death three weeks later, with profound sorrow. s Dr Adamson, Medical Commissioner since 1931, retired on March 31st, 1945. These officers were succeeded by Mr.- Percy Barter (Chairman), and the Hon. W. S. Maclay (Medical Senior Commissioner).
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