The End of an Experiment in Community Care
April 30th, 1949, was an important date in the history of the National Association for Mental Health. It marked the end of a period of five years during which the Association acted as agent for the Ministry of Health for the after-care of ex-Service psychiatric casualties, and, ‘latterly, for civilian cases in increasing numbers.
This important aspect of social medicine and Preventive psychiatry was incorporated in the new National Health Service Act under Section 28. The After-Care scheme, as it has been known, has led very often to the prevention of relapses and the saving of much hospital bed space and medical and nursing time. It was hoped to continue the scheme for a year or two on the same lines, until local authorities had gathered together mental health teams with the right training and qualifications, but this was not to be. Under Circular 146/48, local authorities could either undertake this work themselves or ask the National Association for Mental Health to act as their agents until they had adequate resources available. The bulk of local authorities decided to make their own plans, so that on April 30th, 1949, seven of the Association’s eleven regional offices were closed down.
The work has been conducted on the team method of the child guidance movement; that is to say, the team consists of a senior psychiatric social worker, assistant social workers, and a consultant psychiatrist for case conferences. Regular meetings of senior psychiatric social workers, who acted also as Regional Representatives of the National Association for Mental Health, were held at Headquarters, and regular residential conferences of all the workers were a feature of the scheme. There was ample opportunity for the pooling of experiences and the discussion of developments.
The Association’s regional workers were very reluctant to leave its service, and it was felt that they had done such a first-class piece of work that they were written to on their departure in the following terms:
” The Executive Committee wish to express their whole-hearted appreciation of the excellent services you have given the Association, both in promoting and supervising the Community Care work of your Region, and in the performance of your own casework. We are particularly grateful for your loyal support during these last months, as it is only too well realized how heartbreaking this state of uncertainity has been for the Regional Representatives.” Even more important was the regret of the patients under this scheme of community care. They had developed a trust and faith in our workers, and one of the Regional Representatives has written to us as follows:
“Many do not realize the intricacies of the patient’s environment and the difficulties which are due to the friction between the personalities in his background. This has been our particular field and if, as I hope, the Association produces a memorandum from our work, I hope that this will be stressed. There is really no one else working in this field. It has been a gruelling experience trying to hand over our cases. We have all been haunted by the feeling that we are deserting our cases, and some of our patients have actually said this to us. Knowing that we can do nothing else and that it was a Government decision has not removed any of the bitterness from the experience.” We have had many expressions of appreciation, among which is one from the Ministry of Labour and National Service who write:
” After five years of happy association during which your officers have given very valuable service, not only to our Disablement Resettlement Officers, but to the disabled men and women in need of assistance, whether ex-Service or civilian, I wish to express to your Association the thanks of my Minister for this fine piece of work so ably carried out in spite of many difficulties and often at great personal self-sacrifice.”
Voluntary agencies and others who have referred cases to us during the period of the full scheme have been circularized. In case any agencies may have missed seeing the circular, a copy of this is printed below.
Regional After-Care Scheme
As you know, this scheme has been run by this Association for the last five years at the request of the Ministry of Health. It was started originally for psychiatric war casualties, men and women, and has been extended to civilians recovering from psychiatric illness and for those in need of social therapy as a preventive measure.
With the inception of the new Health Service, Local Authorities were asked (under the provisions of Section 28 of the National Health Service Act, 1946) to continue this scheme on similar lines. Authorities could either undertake the work themselves, or use our services until they had an adequate scheme of their own.
The majority of Authorities have decided to make their own arrangements. Certain others asked the Association to do the work for them, but we have not been able to accept in all cases owing to the difficulty of re-planning our regional work geographically.
As from May 1st of this year our teams of workers therefore will be available only from the regional offices based on:
London 39 Queen Anne Street, W.l. Birmingham 29a Frederick Road, Edgbaston. Newcastle 129 Clayton Street West, Newcastle upon Tyne.
108 MENTAL HEALTH Tunbridge Wells 31 Upper Grosvenor Road, Tunbridge Wells.
In all other areas, cases referred by local branches of your Department or Organization must be dealt with by the Mental Health Services of the Local Authority. The central advisory services and other activities of the Association are, of course, continuing as before.
A. Torrie, Medical Director. National Association for Mental Health. April, 1949.
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