After Care or Treatment?
Editorial
It was not to be expected that the introduction of the National Health Service on July 5th, 1948, would occur without some teething troubles; many of these are now passing but one problem still remains as a cause for some anxiety, in particular to the workers of the National Association for Mental Health; this is the danger that a patient who requires help may fall into the gap created by the Act between treatment?the responsibility of the Regional Hospital Boards (aided where they exist by the Teaching Hospitals)?and after-care?that of the Local Health Authorities. Another danger which will, of course, seem the more grave to those who believe that patients are ” best left alone” is the converse; it is possible that representatives of two authorities may enter into a sort of “pull devil, pull baker ” tug-of-war for the possession of the patient’s mind. The presence of social workers of a third class?the voluntary organizations?further complicates the issue.
Naturally it is theoretically possible to decide from the interpretation of the Act whether any particular case is receiving, or is in need of, after-care or treatment. Unfortunately the practice is less easy than the theory, and many workers in the field are in fact in doubt; which can lead to a multiplication of their work, to friction between authorities, or to delay in dealing with the patient.
To meet this difficulty, several proposals can be suggested; first, that there should be a clearer definition of the matter, by those responsible for drafting the Act, in terms which the ordinary social worker can understand (and remember)?and perhaps this is already on the way. Secondly, even then it is still essential that there must be the closest possible co-operation between all workers in the field; its form must be worked out by those concerned in each area and modified to meet the local conditions; it should certainly not be imposed from any higher level as a rigid plan. The arrangements made will obviously vary according to the number of workers already employed, and the relative strength of the Regional Board representatives (that is the Hospital Management Committees of the mental hospitals), of the local health authorities and of the voluntary bodies. We publish in this issue excellent suggestions by Dr Ratcliffe and Miss Jones of the shape arrangements can take; this will be read with interest by all.
A problem which frequently arises is that of deciding which social worker shall visit a patient after discharge from a mental hospital. Even had there been no difficulty in understanding the Act on its ruling of the respective responsibilities here, close contact between all concerned would still be essential; for it is obvious that whatever the arrangements, exceptions must often be made on behalf of the welfare of the patient?for the benefit of whom it is to be remembered the Act was devised. Consequently, it may well happen that a social worker who has got into excellent touch with a patient in hospital will be required to continue to visit him after he has ceased to receive treatment, and when he is therefore theoretically no longer her responsibility. Conversely, a social worker who has done much for a patient before admission may reasonably expect to be allowed to visit him in hospital, and will take him over again at once on discharge.
Once the patient’s interests have been considered in this way, it must also be asked what particular skill is demanded of the individual worker. With the present shortage of fully trained psychiatric social workers we can afford no wastage of skill and if any work can be delegated to less highly trained workers, it surely must be done. This again indicates the need for the closest co-operation all round. It is therefore all the more unfortunate that in some places the contact between the various groups of social workers is not as close as it might be. There are, of course, notable ^nd honourable exceptions. It would help to have more joint meetings to discuss clinical and administrative problems and to find that on the other side of the fence people are working to the same end, and not merely for their own aggrandisement. It may be a sign of the times?when an Empire is changing its shape?that individuals and authorities are suspicious of any appearance of Empire building by each other; surely there is enough building of the Mental Health Services required for any would-be builder to add a few bricks, rather than to pull his neighbour’s buildings to pieces. J
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