72 Mental Health
Three Bills, all with important mental health aspects and all giving opportunities for the development of mental health service to the community, are now before Parliament, viz. the National Assistance Bill, the Children’s Bill and the Criminal Justice Bill. The two former link up at several points with each other and preceding legislation, particularly the National Health Service Act, the Disabled Persons (Employment Act), and the Education Act, and for efficient administration will involve a large measure of co-operation between the various Central and Local Authorities concerned.
The National Assistance Bill
This Bill, introduced in October, 1947, and referred to Standing Committee C. in December, finally brings to an end the old Poor Law and the mixed workhouse. Whilst County and County Borough Councils are to continue to be responsible for providing residential accommodation for persons in need of it (other than the sick who will be dealt with under the National Health Service), financial assistance is to be the responsibility of the National Assistance Board, acting through local officers, with local Appeal Tribunals to which dissatisfied applicants may appeal.
For ” persons in need- of re-establishment through lack of instruction or training the Board is empowered to provide Re-Establishment Centres, and in certain circumstances maintenance in such a Centre may be laid down as a condition of help. The National Association for Mental Health enlisted the help of sympathetic members of Parliament in bringing before the Standing Committee, when considering this clause, the importance of recognizing that persons dealt with in these Centres are likely to fall into three categories: (1) the ” workshy (2) the mentally disabled, e.g. psychopaths and neurotics, (3) the mentally subnormal?and that any attempt to apply to all three groups the same methods of training and handling will be, as experience has amply shown, doomed to failure from the outset. This point was ably made by Colonel Elliott, and it is hoped that when the time comes for issuing Regulations in connection with Re-Establishment Centres due regard will be paid to it.
Clause 28, empowering local authorities: to make arrangements for promoting the welfare of persons … who are substantially and permanently handicapped by illness, injury or congenital deformity or such other disabilities as may be prescribed by the Minister, makes no specific mention of the mentally disabled or subnormal, and this point was also raised by the Association. It is understood, however, that the phrase is considered to be sufficiently all-inclusive as it stands, and that no further elaboration is required. Under this clause, much constructive work can be carried out by means of home teaching, hostels, the provision of recreational facilities, etc., and voluntary organizations, if suitable, may be employed by local authorities as their agents?a proviso of which advantage may well be taken in many areas.
A serious defect in this part of the Bill is, that no mention is made of requiring that personnel used in carrying out the new community care services shall be required to have any specific qualifications or training.
In bringing this matter before members of the Standing Notes on Recent Legislation Committee, the Association drew attention to Section 66 of the National Health Service Act, which empowers regulations to be made in regard to qualifications of the workers engaged in the Service, as being a useful precedent, and urged’ its importance. During the debate on the clause in question, a promise was made by the Parliamentary Secretary to the Ministry, that the matter would be duly considered.
The Children’s Bill
This Bill, introduced in the House of Lords in January, implements the main recommendations of the Curtis Report and must be read in conjunction with the Assistance Bill, in that it provides for children formerly in the care of the Public Assistance Authorities (of whom no mention is made in that Bill) and for other children who are orphans, deserted or homeless or whose parents are unable to look after them, either temporarily or permanently by reason of ” mental or bodily disease or infirmity or other incapacity err any other circumstances “. It is to be the duty of Local Authorities in respect of such children (if under the age of 17), to receive them under their care by a definite resolution and to keep them under care ” so long as the welfare of the child appears to them to require it and the child has not attained the age of 18 Children may be dealt with by local authorities in the following ways:
(a) By being boarded out. Ib) By being placed in a Home provided either by the Local Authority itself or by a voluntary organization. (c) In the case of a child over compulsory school age, by being placed in a Hostel (which may or may not be provided by the Local Authority ? itself), catering for young people under 21 in employment or undergoing further education or training.
Local Authorities are further required to provide After-Care for a child formerly in their care, up to the age of 18 (unless satisfied that it is unnecessary) or to see that it is provided by any voluntary organization responsible for such a child.
The Bill contains provisions dealing with the registration and regulation of Voluntary Children’s Homes and empowers Treasury grants to be made to voluntary organizations responsible for such Homes. Local Authorities also may, with the consent of the Secretary of State, make contributions to voluntary organizations in their areas whose primary object is to ” promote the welfare of children “.
Attention may also be drawn to Part V of the Bill extending the measures in regard to Child Life Protection, hitherto applicable only to children under the age of 9 years, to all children of compulsory school age and, in the case of those still with foster-parents after leaving school, until the age of 18. Clause 5 makes it obligatory upon Local Authorities to act as “fit persons” under the Children and Young Persons Acts, if the Court makes an order to that effect.
To carry out their duties, Local Authorities are required?either separately or in conjunction with neighbouring Authorities?to establish Children’s Committees and to appoint Children’s Officers. For this purpose, the names, ages, experience and qualifications of the selected candidates, must be submitted to the Secretary of State, and if he is of opinion that any such candidate is unsuitable he may prohibit the appointment. In the case of Officers already employed, however, the Secretary of State, may dispense with this requirement. The necessity of training for persons employed in connection with the care of homeless children also receives recognition in Clause 43 of the Bill, which empowers the Secretary of State to make grants to students undergoing training and to any organization providing training courses.
The provisions of the Bill undoubtedly constitute a great step forward in social legislation and the speed with which action has been taken on the Curtis Report is a notable achievement. From those who have supported the view that the Ministry of Education, rather than the Home Office, should be the Government Department responsible for all children, and that their care locally should be undertaken by Education Authorities rather than by new ad hoc Children’s Committees, some criticism may justifiably be forthcoming on the scanty references to education that are to be found in the Bill, particularly in regard to the special needs of the handicapped children, who will inevitably be amongst those coming under care. Presumably Clause 12(2) (which enacts that a local authority shall make such use of ” facilities and services available for children in the care of their own parents ” as appears to be reasonable) will include special educational treatment, and the supposition is that children in Homes are to be educated in the schools of the area. There is, further, Clause 21, authorizing the Secretary of State and the Minister of Education to make regulations for providing (where a local authority under the Children’s Act and a local Education Authority ” have concurrent functions”) by which authority these functions are to be exercised, but there is a somewhat disquieting vagueness and absence of precision about such phraseology. In this Bill?as in other contemporary legislation? the scaffolding erected is to be filled in by subsequent Regulations. Those provided for, as the Bill stands at the time of writing, are on the following subjects: Boarding Out, by Local Authorities and Voluntary Organizations, Conduct of Homes and Hostels run by Local Authorities, Conduct of Voluntary Homes, Emigration arrangements of Voluntary Organizations, and the allocation of functions between the Local Education Authorities and Children’s Committees referred to above. The National Association is therefore making a close examination of the Bill with a view to submitting points which should find a place in such Regulations.
Criminal Justice Bill
The introduction of this Bill?substantially on the lines of its predecessor which was one of the earliest war casualties?fills an urgent need, and, from the mental health point of view, no serious criticism appears to be necessary.
The amendments proposed by the National Association are designed principally to ensure that the “duly qualified medical practitioner”, on whose evidence an offender may be required to submit to treatment for his mental condition, or by whom a report as to suitability for Borstal sentence is made, shall have had special experience in psychiatry. It is further recommended that Detention Centres should be in buildings which are not parts of a prison, and that they should be staffed by trained personnel?also that the age groups, 14 to 17 and 17 to 21, should be segregated. The Bill assumes that mental treatment will be obtained free, but it is suggested that Local Authorities should be empowered to pay for patients attending Voluntary Clinics in view of the present shortage of facilities, and that where possible part of the payment should be recovered from the patient. Finally, where young offenders released from prison on licence are placed under the supervision of a voluntary society, it is submitted that the use of such societies should be limited to those which employ trained Social Workers. Education (Miscellaneous Provisions) Bill, 1948 This short Bill contains two provisions of importance relating to mental health.
First, it will now be possible for the report made by an Education Authority to a Local Health Authority, that a child is incapable of receiving education at school by reason of mental disability, to be cancelled, if it appears that, as the result of, e.g. training in an Occupation Centre, he should be returned to school.
Secondly, maladjusted children undergoing treatment as voluntary patients under the Mental Treatment Act, are no longer to be withdrawn from the aegis of the Education Authority, but may, if considered desirable, continue to attend school.
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