Mental Health Conference, 1948
The National Association’s Conference on Mental Health, held at Seymour Hall, W.l, on January 15th and 16th, attracted large attendances at all the sessions, and particularly at that dealing with the problem of the difficult child, which was presided over by Mr. C. P. Hill (Children’s Department, The Home Office), in the unavoidable absence of Professor Sir Cyril Burt. Approximately 1,150 persons attended, of whom some 550 were delegates of Local Authorities and voluntary organizations in all parts of the country.
The Conference was opened by the Rt. Hon. R. A. Butler, P.C., M.P., President of the Association, who made an earnest plea for a wider support of its valuable work and the enlistment of new members. The Conference was honoured by the presence of Mr. L. John Edwards, O.B.E., M.P., Parliamentary Secretary to the Ministry of Health, who expressed warm appreciation of the activities carried out by the Association. He urged that particular attention should be paid by local authorities to their after-care organization, upon which might depend, to a very large extent, the restoration to normal life of patients discharged from hospital.
Papers on re-adaptation to life and work of the neurotic patient in industry, were given by Dr G. R. Hargreaves, O.B.E. (Principal Medical Officer, Lever Bros. & Unilever, Ltd.) and Dr Donald Stewart (Medical Adviser, Austin Motor Company, Babcock & Wilcox, Ltd. and James Booth & Co.) who stated that neurosis accounted for well over 90 per cent, of psychiatric cases, and was probably a factor in 20 to 30 per cent, of all sickness.
Dr Kenneth Soddy (Medical Director of the National Association) gave an account of the Association’s aftercare scheme for psychiatric service casualties which, since 1946 had been extended to civilians and had dealt with between 13,000 to 14,000 men and women. He expressed the hope that local authorities might be able to carry on and develop or co-operate in this pioneer work which had proved of the greatest value. Dr. Doris Odium (a Vice-President of the National Association) gave a detailed survey of the opportunities presented to local authorities for the development of a Mental Health service under the National Health Service Act of 1946, both in regard to prevention and treatment. In response to many requests, these two latter papers are being printed separately for immediate circulation to local authorities for information and use in connection with the mental health schemes which they are at present formulating. These papers will also form part of the full report on the Conference proceedings which is to be published shortly and will be available at 5s. 3d., post free. The report will be sent automatically to all those who attended the Conference and paid an inclusive fee. The attention of our readers is also directed to proposals drawn up by the National Association for a suggested scheme for a Mental Health Service under a local authority. Copies of this leaflet, price 3d., post free, are now obtainable from the Association.
Miss E. M. Bartlett, psychologist to the Essex Education Committee, who spoke on methods of handling difficult children in primary and post-primary schools as required under the Education Act, 1944, commented on the wise shift of emphasis from medical to educational News and Notes
treatment. The problem of handling children of this type was linked with their whole educational environ- i ment, and she urged the need for training teachers to I recognize the principles upon which the attainment of mental health is based. Miss Clare Britton, Tutor, Child Care Course, London School of Economics, speaking on the selection and training of staffs for boarding homes for difficult children, referred to the need for having a complete family unit at the centre of each hostel or children’s home, and the therapeutic value to the children of having married couples in charge of these. The final session, which was presided over by the Earl of Feversham (Chairman of the National Association) was devoted to the subject of education for mental health as a national and international responsibility, the speakers being, Brigadier A. Torrie (Director of Army Psychiatry), and Miss S. Clement Brown, M.A., Programme Secretary, International Congress on Mental Health, who deputized for Dr J. R. Rees, C.B.E., owing to his unavoidable absence abroad in connection with the Congress arrangements. Brigadier Torrie, in the course of his address, stated that the need for information concerning the prevention and early treatment of mental ill-health, was as great as the need for information concerning tuberculosis and cancer. The greatest hope for the nation was to be found in the adequate handling of its children, and he advocated the institution of parent guidance clinics throughout the country. Editorial comment on the Conference is provided on page 58 of this issue.
Lunacy and Mental Deficiency in 1946 Mental Disorders
A striking fact brought out in the 33rd Annual Report of the Board of Control, Part I (H.M. Stationery Office. 9d.) is the steady rise in the number of voluntary patients admitted to mental hospitals and consequently in the total number of admissions. Whereas in 1938, out of a total of 27,437 patients admitted, only 9,651 were uncertified, in 1946, the relative figures were 35,585, and 18,059. More than half the direct admissions were, therefore, those of voluntary patients, and the rise in the total admissions may be taken as indicative of a greater readiness to apply for treatment rather than of an actual increase in the prevalence of mental disorder. In the Board’s opinion this upward tendency is likely to continue so that during the next decade it is possible that an additional 1,500 beds may be needed. The total number of patients under care on December 31st, 1946 was 146,444 (males, 42-8 per cent.; females, 57-2 per cent.) of whom 128,579 were in public mental hospitals. Of this number, 11-8 per cent, were voluntary patients, and 0-3 per cent, temporary: the remaining 87-9 per cent, were certified. Overcrowding inevitably continues and has now reached 13-1 per cent., estimated on a basis of recognized bed-space. Apart from the cessation of building, this state of things is largely due to the fact that 15,170 formerly available beds are unusable for the following reasons: 10,417 are still diverted to war-time services, 3,080 cannot be used because of shortage of staff, and 1,673 are awaiting restoration or re-equipment. The seriousness of this position, particularly in relation to the rising number of patients seeking admission, can hardly be over-estimated. Discharges?chiefly as a result of the large proportion of voluntary patients?show an increase of 4,519 over the figure for 1945 (viz. 25,326 compared with 20,807) and reached the highest level yet recorded, being now 71-2 percent, of direct admissions as compared with 67-1 per cent, the previous year. The recovery rate was 32-6 per cent., and the rate for ” recovered or relieved ” 62-9 per cent. The fact that ” many voluntary patients are quickly restored to health and leave hospital after a relatively short period of treatment ” is recorded by the Board with satisfaction.
Attention is drawn to the need for a greater awareness of the value of Occupation Therapy for chronic patients as well as for patients in the early stages of mental illness, and it is pointed out that by this means, deterioration of personality may be prevented. With regard to physical treatment, it is recorded that some form of this is now used in every mental hospital and that there is reason to hope that pre-frontal leucotomy?of which a special report was issued in February, 1947, by Dr Isabel Wilson?offers, in certain cases, ” a probability of relief and the possibility of recovery “.
Mental Deficiency
The position in regard to accommodation for mental defectives continues to be a desperate one, summed up by the Board in the statement that: ” We do not at present see any remedy for the partial breakdown in institutional provision which is already causing difficulties.’’’’
With 49,230 institution beds available on January 1st, 1947 (representing an increase of only 168) there was overcrowding to the extent of 4,131 beds, and a waiting list of 3,898 defectives urgently in need of removal. The total number of cases under all forms of care at the end of 1946 was 101,805, classified as follows: Increase on 1945 In Institutions .. .. 53,361 773 Under Guardianship or Notified .. .. 5,172 156 Under Statutory Supervision .. .. 43,272 1,468 Of the patients in institutions 5,571 were on licence, an increase of 285 on the previous year.
Occupation Centre provision is as deplorably inadequate , as it was during the war years, the increase being only eleven, and the total number only 98 (as compared with 178 in 1939). Moreover, Local Authorities are confronted by acute difficulties due to the shortage of trained personnel and of suitable premises, but that they are alive to the need is evident from the frequent mention of Occupation Centres in schemes under the National Health Service Act.
This Act will bring far reaching changes in the administration of the laws relating to Lunacy, Mental Treatment and Mental Deficiency, the most outstanding being the transfer of Mental Hospitals and Certified Institutions from Local Authorities to the new Regional Hospital Boards. In the transition period there must inevitably be many difficulties and complications, but the Board record their belief in the value of a Mental Health Service closely integrated with general medicine, and in the opportunities which it will bring for expanding its scope and increasing its efficiency.
Exchange Visit
An enquiry has been received from the Bureau Fran?ais d’Echange Internationaux, Paris, as to whether hospitality during the period of the International Congress on Mental Health (August 11th to 21st, 1948) could be offered to Dr Fretet of the Premontre Asylum (Aisne). Dr Fretet would like to stay either with an English doctor or medical student to whom he would be glad to offer hospitality in France, at a date which would suit his English host. Would any of our readers who are willing to help in this matter kindly communicate with the Congress Organizer, 19 Manchester Street, London, W.l.
Prisons in 1946
The Prison Commissioners’ Report for 1946 (price 2s. 6d.) is packed with information of general and special interest.
From it we learn of the complete re-organization of the Commissioners’ Office in order that it may effectively meet the growing demands made upon it. In addition to three Commissioners, the personnel includes the Director of Medical Services, the Director of Education and Welfare, two Directors of Industries and Works and a Vocational Training Officer. During the year, there was also set up a new class of Social Workers, including Psychiatric social workers, employed, to begin with, at the three Borstal Reception Centres (Wormwood Scrubbs, Latchmere and Holloway).
An interesting development recorded is the opening of Leyhill Prison (Falfield, Glos.) as a ” minimum security camp prison ” to accommodate up to 300 long-sentence convicts of the Star Class previously housed at Camp Hill, Isle of Wight. A Training Centre?foreshadowed in the ” Five Year Plan ” outlined in the 1945 Report? has been opened at Askham Grange, near York, for 60 to 70 selected women serving sentences of six months and over and a second Centre in the South will be opened when premises can be acquired. The first ” open ” Borstal institution for girls was inaugurated in October, 1946, at East Sutton Park. Here special stress is laid on the importance of linking up the life of this little community with that of the village, an enterprise in which considerable success has already been achieved. A further innovation, small in itself but of considerable psychological value, is the giving of facilities to women prisoners for the use of cosmetics which may be retained on admission and replenished out of earnings during sentence.
The chapter on ” Health and Hygiene” devotes considerable space to a report on the psychological and psychiatric services provided for prisoners in need of treatment. Dr W. H. de B. Hubert who contributed so substantially to the initiation and development of the Psychiatric Unit at Wormwood Scrubbs, left the Service during’ 1946, and Dr Jonathan Gould was appointed in his place. A non-medical psychologist (Mr. R. L. Morrison) was added to the Unit’s staff. It was decided to establish a second Unit at Wakefield Prison, where the medical staff is being increased by one more wholetime Medical Officer, a part-time psychotherapist and a non-medical psychologist. Reference is made to the men discharged from the Services during the war, with the label ” Psychopathic personalities “, some of whom found their way into prison and there frequently claimed privileges on the grounds of their particular disability. For this type attention is drawn to the need for prolonged observation with the fullest possible use of psychological tests and other diagnostic methods, e.g. the electro-encephalograph, if a correct opinion is to be reached, as some of these men respond ultimately to ordinary methods of rehabilitation despite their idea that they must be treated as mental invalids. In connection with epileptics, the difficulty of disposal on release is mentioned and the need for a state colony and clinic for epileptics with criminal records, suggested, even though the numbers are small. Considerable help has been obtained from the Psychological Unit at Holloway in the allocation of girls to the appropriate Borstal Institutions, now made easier by the opening of East Sutton Park, and the taking over of parts of the women’s prisons at Exeter and Durham. In July, 1946, a psychiatric social worker was appointed to assist in this work and to help the visiting psychiatrist.
The section concludes with a discussion of the Commission’s views as to the type of medical man best fitted to undertake psychiatric work in prisons, and refers to the imperative need for all-round experience and first-hand knowledge of the prison service if it is to be satisfactorily carried out. The recognition of certain prisons under the regulations governing the Diploma in Psychological Medicine, as being equivalent to mental hospitals and clinics, is placed on record. There has been a disquieting actual increase in the number of young offenders (aged 16 to 21) found guilty of indictable offences which for the year 1945 was (for males) 21,133 as compared with 20,438 the previous year. In the case of girls, however, the figures show a decrease from 3,273 in 1944 to 2,919 in 1945.
” The Health of the School Child “* During the war the publication of Annual Reports by the Chief Medical Officer of the Ministry of Education were suspended, and the appearance of this volume, covering the years 1939 to 1945, is therefore an event of special interest.
It contains material of particular value to Mental Health workers, notably in Chapter VI (Child Guidance and Hostels) and in Chapter VIII (Effects of War on Special Schools). The former chapter?contributed by Dr Gale?opens with a most useful summary of the history of Child Guidance in this country prior to the outbreak of war. It then proceeds to trace developments following on evacuation experiences, bringing to light ” the presence and problems of children who were psychologically maladjusted “. The opening of special emergency Hostels met a small part of the need’ but for the majority of children other methods had to be used, and more and more Local Education Authorities turned to the idea of instituting a Child Guidance Service, so that by 1945, the number of Clinics had risen from 68 in 1943 to 79, of which 57 were wholly maintained and 6 partly maintained by Local Education Authorities. A year later, the figures had risen again to 66 provided by Local Education Authorities and 49 by other authorities. Child Guidance had thus become a generally accepted necessity and an established service recognized by the Education Act of 1944. Turning from the past to the future, Dr Afford then discusses the Report on Child Guidance Services issued in 1946 by the Association of Education Committees, and the widening concept of Child Guidance. This includes not only psychiatric treatment for the few, but a psychological service in the schools for much greater numbers?a development intensified by the new duty laid upon Local Education Authorities to ascertain maladjusted children and to provide special educational treatment.
A concluding section in this chapter sums up the available evidence?substantially reassuring?as to the psychological effects of air raids on children. The chapter on the ” Effects of the War on Special Schools “, by Mr. J. Lumsden, H.M.I., describes the ups and downs of evacuation and re-evacuation, and of the intermittent periods when the cessation of bombing caused a drift back to the towns with the consequent necessity for some kind of makeshift educational provision. Day’ Special School children?except in the case of the delicate and partially sighted?were evacuated in groups with their teachers to large country houses or camps, and therefore problems connected with individual billeting did not arise in their case. But the premature return to the towns had a disastrous effect on special school education as a whole. Thus in the summer of 1941, the number of mentally defective London children attending schools?either in reception areas or in their home area?had decreased by 50 per cent, compared with 1938-39 figures. In Liverpool the decrease was 38 per cent, and in Manchester, 33 per cent. Attempts were made in evacuation areas to which the children had returned, to provide some sort of education in small groups, often in any room in any school which happened to be able to offer accommodation, sometimes even in private houses where a few children could be assembled. The Day Special Schools in particular, have not yet recovered from the upheaval* “//; many places they, in common with the ordinary schools, are in very makeshift premises: often, as in London, they have lost all thread of continuity in pupilsand staff and premises from the pre-war days and are really new entities striving to establish themselves in conditions of great difficulty. The tradition of regular attendance at school, built up over years, was rudely broken by air raids, fathers in the Forces, mothers at work, damaged housing and longer distances from school, and it takes time to re-establish tradition. In some places buildings have been so scarce that handicapped children, instead of being in large groups suitable for organization, have had to occupy two or three rooms here and there and be educated in classes with a very wide age range. These troubles will not speedily be remedied, but the production by local education authorities of their development plans will ensure that they are not forgotten.”
On the other hand, certain positive advantages are noted. Not the least of these was the knowledge acquired by teachers, as a result of the intimate day to day contact with their pupils in evacuated school premises, Children from residential schools, too, moved to emergency quarters, had perforce to do with less close supervision and be left more to their own devices, so that they developed a greater degree of self-reliance and independence. And the war-time necessity for granting more frequent leave during term-time (to correspond, e.g. with the periodic return of fathers from the Forces) has led to a less rigid attitude in this respect than formerly prevailed, and to the forging of a closer link between home and school.
South African Council for Mental Health It is announced that the name of the South African National Council for Mental Hygiene has been changed to the ” S.A. National Council for Mental Health “. The report of the Council for the year ended March 31st, 1947, shows a record of continued progress and expanding activities. Tn a foreword to the report, the President, * Report of the Chief Medical Officer, Ministry of Education for the years 1939-45. H.M. Stationery Office. 2s. 9d. post free.
Dr Gordon D. Laing, states that the contribution made by the Council towards the improvement of mental health is receiving greater recognition from the Department of Health, which has been reflected not only in the moral support given to the organization, but also in increased financial aid. It is noteworthy that the Council is one of the voluntary bodies represented on the National Health Council, for the establishment of which provision has been made by recent amending legislation in connection with the Public Health Act of 1919. The Scottish Association for Mental Hygiene The Scottish Association for Mental Hygiene, which was formed twenty-five years ago, started as a National Association of Care Committees dealing almost exclusively with the needs of the ex-Special School pupil and other ” mentally defective ” persons. The Association has since then extended its interests and it now covers, in some degree, almost all aspects of mental health work. Its offices are situated in Edinburgh, and enquiries and visits are welcomed from interested persons visiting Edinburgh, or needing information about mental health work in Scotland. International, national and local contacts are made from the office, but case work is as a rule immediately referred to a more appropriate agency. ? The Association has always worked as far as possible through local associations for mental welfare and local care committees. There are 21 local groups at present, and more are being instituted or re-formed each month. While working chiefly among the mentally handicapped in their areas, local associations have usually provided their own voluntary visitors in the past, but Edinburgh has had trained help in addition for some time. The aim for the immediate future is an extension of the voluntary work under experienced and/or trained social workers, and gradual extension of trained help as staff become available. The great work done on a voluntary basis in the Paisley area over many years is at present under scientific survey by Glasgow University Department of Social Medicine, and the Report of Professor T. Ferguson is eagerly awaited.
During the past year several local associations have been negotiating with their local education authorities for the taking over of the occupational centres as recognized special schools under the Education (Scotland) Act.
At a conference in January last of delegates from local associations, the implications and opportunities under the recent Scottish Education and Health Acts were discussed. Local health authorities have been offered the help of the Association, either directly or through its local bodies, on relevant details of Schemes for Mental Health Services. Particularly welcome have been invitations from local authorities to the National Office to form local associations for mental welfare. The Association receives a steady demand for training courses, and arrangements are being made to hold in the spring a course lasting three weeks for staff in Occupational Centres and Institution Classes, and for Home Teachers of handicapped children. During the summer a course will be held for workers of various kinds in mental deficiency who have no training, and the first of the revived courses for Medical Officers of Health and School Medical Officers will also take place. The Association has agreed to participate in the Mental Deficiency training of prospective psychiatric social workers at Edinburgh University.
The Association looks forward to greeting and meeting in London and in Scotland many delegates to the 1948’ International Congress from other countries, and will be glad to hear from ” international ” delegates able to visit Scotland who would like to see some special aspect of mental health work there.
All those interested in the work of the Association and who would like to receive notices, are asked to communicate with the Secretary and Organizer, Miss Isabel M. Laird, M.A., B.Ed., Scottish Association for Mental Hygiene, York Buildings, Queen Street. Edinburgh 2 (Tel. 21104 Ext. 17).
West Indian News
News has been received of good progress in the Mental Health movement in British Guiana?largely owing to the enthusiasm and initiative of two pioneers?Dr. Arthur Smith (Medical Superintendent of the Fort Canje Mental Hospital) and Mrs. K. Palmer?who between them started some 10 years ago, a Mental Welfare Association for. the Colony. The initial , difficulties confronting the Association were on a scale and of a kind unknown in this country but thanks to the sustained effort and faith of its promoters, it has now taken firm root and has received the encouragement of the Economic Adviser to Colonial Development and Welfare. The possibility of applying for a grant for the purpose of conducting a survey of handicapped children and adults with a view to the provision of care and treatment is at present under discussion, and a beginning has been made with the organization of a class for Backward Children in the Broad Street Government School, Georgetown, largely due to the enthusiasm and initiative of Dr C. C. Nicholson, School Medical Officer.
Following on the appointment of the Colony’s first Probation Officer (Mr. F. M. Briggs)?a Juvenile Court has been inaugurated?as well as a Home for Delinquent Girls. Finally, in August last year, as part of a reform project for which the Medical Superintendent, Dr. Smith has been working since his arrival in the Colony ten years ago, a self-contained ward was opened in the Mental Hospital and named after the founder of the Mental Welfare Association?the “Palmer Ward”. Various other innovations are being made in an effort to bring the Hospital up to date, but the new legislation for mental patients, drafted four years ago, has yet to come before the Legislative Council, and much remains to be done in the direction of stirring up public opinion. Events are beginning to move also in Trinidad which has decided that its wedding gift to Princess Flizabeth shall take the form of a Home for Defective Children.
Research in Industry
The decision of the Home Secretary to set up a new Committee on Industrial Productivity which will include a panel, under the chairmanship of Sir George Schuster, to investigate and report on the human factors affecting industry, will be widely welcomed. The startling facts concerning the incidence of neurosis in industry referred to at the National Association’s recent Conference and the research already undertaken, notably that dealt with in Dr Russell Fraser’s recent report published by the Medical Research Council (Industrial Health Research Board), can leave no room for doubt that serious consideration requires to be given by all concerned to the subject of psychological factors in attaining industrial efficiency.
The report and findings of the Committee will be awaited with keen interest.
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