Psychiatric Community Care
News and Notes
In the Lancet of February 4th, there appeared an informative article on ” The Future of Community Caredealing with the Scheme so successfully carried on by the National Association and brought to an end with the withdrawal of the Ministry of Health grant on the coming into force of the National Health Service Act in July, 1948. To emphasize the effect of the cessation of this Scheme before Local Health Authorities are themselves in a position adequately to undertake the work, the writer quotes a statement made by Dr. Louis Minski in the annual report of the Belmont Neurosis Hospital, Sutton, for 1948-49 :
” One great difficulty which social workers have found since July 5th, 1948, is the obtaining of social histories in respect of patients living in distant parts of the country. This work was formerly undertaken by psychiatric social workers from the National Association for Mental Health and in most cases they have now ceased to function. Nowadays there is often no psychiatric social worker available in the district where the patient lives and the local M.O.H. has to be approached. He may have no one on his staff with experience of psychiatric work and the report is often of little or no value. Similar difficulty is also being encountered in arranging after-care for patients because of the lack of psychiatric social workers. In some districts, after-care consists in referring patients to a psychiatric clinic which may be the last thing which is required. I am afraid after-care as understood by us in the hospital has almost ceased to exist.”
In conclusion, it is suggested that the Service might again be made possible through the help of ” one of the rich voluntary funds “?at least until there is something else which can take its place. Social Workers in the Mental Health Service The Committee on this subject set up in July, 1948, under the Chairmanship of Professor J. M. Mackintosh, M.D., F.R.C.P., issued, in April 1949, an Interim Report, which it was hoped might have been made generally available. It has, however, been decided to publish only the Final Report, and meantime the Ministry of Health has sent to Regional Hospital Boards, Hospital Management Committees and Local Health Authorities, a circular giving the Committee’s short-term suggestions on methods of dealing with the present situation arising from the acute shortage of trained workers.
The recommendations are as follows : 1. Fuller and better use should be made of married psychiatric social workers in part-time appointments. 2. The recruitment of men into the Mental Health Services should be encouraged. 3. The term ” psychiatric social worker ” should be restricted to those persons who hold a University Mental Health Certificate.
4. Efforts should be made to economise in the use of the services of fully qualified workers. It is noted, for instance, that they could be freed from a good deal of clerical and office routine work, which could be assigned to clerical assistants, which could be done by clerical assistants.
5. Efforts should be made to develop the joint use of senior qualified workers by agreement between Regional Hospital Boards, Hospital Management Committees and Local Health Authorities.
We understand that the Ministry is not drawing attention to other recommendations made in the Interim Report dealing with the possibility of helping to meet the shortage by instituting an emergency scheme of training, by reason of the fact that they would entail some expenditure which at the present time cannot be sanctioned. In view of the desperate need, and the fact that lack of workers seriously militates against the efficiency of the Mental Health Service in its social aspects, this is surely to be regretted.
World Federation for Mental Health
A generous donation is being made towards the budget of the World Federation by the Josiah Macy, Junior, Foundation of New York. The donation will be ?15,000 a year for the next three years, though for the second and third year it is conditional upon the Federation raising from other sources at least ?60,000 annually. An anonymous British donor has given ?7,500 to be used during the next three years in meeting the salary of a Director.
Generosity on this scale is enabling the Federation to make a start with its work, but the question of how to place it on a permanently satisfactoty financial foundation, with an adequate office in Geneva, is causing considerable anxiety : it is estimated that a sum of approximately ?30,000 per annum is needed if the organization is to pull its weight in world affairs. At present thirty-three countries are represented in the Federation and there are sixty-two member societies from whom some help may be expected. Individuals wishing to be kept in touch with the Federation’s activities, are recommended to subscribe to its Bulletin (5s. per year) to be obtained from its London office, 19 Manchester Street, W.l.
On February 17th, the British Standing Committee of the Federation arranged in London, an ” International Symposium ” on ” Mental Health within the Family and the School ” when the speakers were : Dr A. Repond (Switzerland), Professor W. Line (Canada), Professor Fr. H. C. Rumke (Holland) and Dr J. R. Rees (Director of the Federation) with Professor J. M. Mackintosh in the chair.
Third Annual Meeting, Paris Attention is drawn to the Third Annual Meeting of the Federation to be held in Paris, by kind invitation of the Ligue d’ Hygiene Mentale) from Thursday, August 31st to Thursday, September 7th, 1950. The main topics to be considered (mostly *n small working groups) are : ” Mental Health in Education ” Occupational and Industrial Mental Health”, “Mental Health Problems of Transplanted and Homeless Persons ” Problems of Leadership and Authority in Local Communities.”
The meetings are open to members of memberassociations of the Federation and full particulars jflay be obtained from the Secretary, 19 Manchester Street, London, W.l.
Leeds Regional Psychiatric Association Professor T. Ferguson Rodger, Department of Psychological Medicine, Glasgow University, addressed a meeting of this Association held in Leeds General Infirmary, in November.
Professor Rodger described his experiences as a Member of the Sub-Committee on Mental Health of the World Health Organization and discussed the Principles for mental health organization which this Sub-Committee had formulated. The Committee J^as representative of psychiatry in Britain, U.S., China, Czechoslovakia, Brazil and India. The facilities for psychiatric treatment throughout the ^’?rld were generally inadequate to meet the demand?grossly so in Asiatic countries. The need for preventive measures was paramount ; yet even ln the advanced countries prevention was a relatively new field. The most suitable field of development ?f preventive services is the Public Health Service Which must establish an organization equivalent to that which it has provided for dealing with the Problems of communal physical health. Such Mental Hygiene Departments would require the distance of research workers in sociological and Psychological aspects of the work. The International Sub-Committee regard mental health work among University students as of great importance as these individuals would in the majority undertake responsible positions in the community. In discussion members emphasized the importance oi instruction in the aims and methods of psychiatry tor influential laymen such as industrialists, trade union officials and teachers. The importance of the Health Visitor, and her part in imparting to Parents knowledge on the management of children Was also urged.
Scottish Association for Mental Health c At the Annual Meeting of this Association, held in Edinburgh on October 15th, 1949, it was decided to substitute for ” Mental Hygiene ” in its title, the term ” Mental Health and a new Constitution was approved. The crowded public meeting which followed was addressed by Dr J. R. Rees, who took as his subject ” World Mental Health Begins at Home In the summer of 1949, a resident week-end Conference was held at St. Andrew’s University on the work of Local Voluntary Associations for Mental Health, attended by forty-five men and women in key positions. In October, the Association arranged, in Glasgow, an eleven-day Training Course for workers in the mental deficiency field, and several members took an active part in the Post Graduate Course for Medical Officers held at Glasgow University in the same month.
At the request of the Scottish Council for Social Service, the Association submitted a memorandum on the welfare of the mentally handicapped, for incorporation in a joint memorandum presented by the Council to the Secretary of State’s Advisory Council on Disabled Persons. The Advisory Council subsequently requested the Association to submit another memorandum dealing with the welfare needs of the mentally handicapped and on ways of meeting them by voluntary effort. At the Assembly of the World Federation for Mental Health in Geneva, the Association was represented by Professor T. Ferguson Rodger, Chair of Psychological Medicine, Glasgow University.
A new Local Voluntary Association for Dumfries has been formed following on the holding of a very successful meeting in November, 1949. Miss Isabel Laird resigned her post as Organizing Secretary of the Association during the year, and an Interim Secretary (Miss Mary Baker) was appointed, The address of the Edinburgh office is now, 41 Charlotte Square, Edinburgh 2.
Mental Health in South Africa
In the current Annual Report of the South African National Council for Mental Hygiene, some interesting developments are recorded. The Special Schools Act, 1948, is now in operation, and under it, grants-in-aid may be awarded to Clinics run by Mental Health Societies, which opens up a new range of possibilities.
The training of Social Workers, particularly those engaged in mental health work, is being actively considered by the Council who have made representations to the Joint Universities Advisory Board and the Committee of Enquiry into the Training and Employment of Social Workers. All the Mental Health Societies affiliated to the National Council now employ qualified social workers, as a result of which marked progress has been noted.
Shortage of institutional accommodation for mental defectives and for mental patients continues to be acute, but the opening of the Howick Institution for European defectives will bring some relief. It is intended ultimately that this institution shall provide for 1,500 patients, but at present only 400 males can be accommodated.
The Cape Mental Health Society, at the request of the Council, is considering the possibility of opening a Home for coloured mental defectives, as a ” pilot demonstrationThe need for establishing standardized mental tests for assessing the intelligence of non-Europeans, has been brought to the notice of the Education Department. A non-European Child Guidance Clinic has been started in Cape Town, serviced by five psychologists, two social workers, and several playroom assistants. Connected with the National Council, there are now seven local Mental Health Societies?in Bloemfontein, The Cape, Durban, East London, The Witwatersrand (Johannesburg), Pietermaritzburg and Port Elizabeth. A record of their activities includes responsibility for Mental Treatment Clinics and Child Guidance Clinics, After-Care of psychiatric patients and mental defectives, Occupation Centres and classes for defectives.
This Report is indeed a record of solid achievements in many directions, and the appreciation of the South African Ministry of Health (Dr the Hon. A. J. Stals) is expressed in a message conveying his good wishes to the Council of which he is Hon. President.
The Council’s address is : 426 Empire Buildings, Kruiz Street, Johannesburg (P.O. Box 2587).
Child Care Courses
The University of London Institute of Education and Child Health has recently organized a Senior Child Care Course for the training of workers for senior posts in the field of Child Care. This Course is designed to equip men and women for Junior Inspectorships, for supervisory and tutorial posts in connections with workers in Children’s Homes, for supervisory or tutorial posts in connection with Day Nurseries and similar work. The course includes lectures and seminars on physical and psychological aspects of child care, on educational aspects and recreational activities, on homecraft and domestic aspects of child care and on social services. Special attention is paid to the needs of the deprived child and of the delinquent child and seminars are held on religious education and on tutorial methods. Visits to clinics, schools, children’s homes, approved schools and other institutions are. arranged throughout the year. Two months residential work in a Children’s Home and Reception Centre is undertaken during the Course. Special observations and special studies are made by the students and a careful balance is kept between medical and psychological aspects of child care and between practical and theoretical work.
The purpose of the Course is to give those, who are already qualified and experienced in some aspects of the care of children a broader and more balanced knowledge of the whole field of child care and to deepen and widen their understanding of the physical and psychological needs of children. Applications may now be made to the Secretary, Institute of Education, Malet Street, London, W.C.I, for admission to next session’s Course commencing October, 1950 and finishing July, 1951.
Applicants should have had not less than five years experience in the care of children and be either certificated nurses, teachers or social workers or possessing a University degree or similar qualifications. Candidates will be selected by interview.
Epilepsy and its Problems
In the Report on the Health of the School Child 1946 and 1947, there is an informative chapter on Epilepsy which could well stand by itself as a pamphlet on the subject.
In outlining the development of educational provision since the passing of the Elementary Education (Defective and Epileptic Children) Act, 1899, it is noted that since the opening of Lingfield in 1905, Chalfont St. Peter in 1909, and Sass Moss, Cheshire, in 1910, only one day special school (for twenty-nine pupils) has been added to the list and there are at the present time only seven boarding schools in the whole country, with accommodation for 696 children. Complete information as to incidence is not yet available, but the probability is that in the school population the proportion of educable epileptics is 0.3 per 1,000, and residential provision is needed for at least 1,500 of these. . The great majority of epileptic children do well in ordinary schools, and the fact that 80 per cent, of those in Lingfield and Chalfont were reported in 1946-47 to be below average intelligence, shows that the main need is for more schools for those who are educationally subnormal.
In a discussion on the curriculum and organization of residential schools, emphasis is laid on the importance of providing facilities for activities out of school hours?sometimes omitted owing to shortage of staff?and on the value of sending the children home for holidays, a practice not invariably encouraged by medical superintendents. The Report is uncompromisingly dogmatic on this point : “… the one massive, overwhelming argument in favour of sending a child home for holidays is that he ought to maintain as close a relationship as possible with his family and so experience the intimacies and the ups and downs of family life.”
a plea which is equally valid for every other type of handicapped child in a residential home or school. The association of ” behaviour problems ” with epilepsy has, in the past, been the subject of over-statement, and it is noted that the inevitable linking of the two was always deplored by Dr Tylor Fox who used to express the opinion that he doubted whether one in ten of epileptics living outside institutions possessed the epileptic temperament. One of the smaller special schools, it is true, has said that 25 per cent, of its pupils were ” difficult to handle ” but the writer of the chapter under review, refers to the part played by “boredom in too mstitutional an environment” in producing Problems of the kind. The establishment of a unit *n one of the schools for maladjusted epileptic children is, however, a future project. In addition to the educational aspect of this Problem, this chapter of the Report gives a clear summary of the different types of epilepsy on Prognosis and on treatment, and it concludes with a section on ” Public Opinion and Community Care touching on the question of employment and on the community’s attitude towards the ePileptic.
There is thus an urgent need for a representative National organization ” to champion the cause of toe epileptic “?the chapter concludes ; and we are ?lad to be able to state that plans for such a scheme are now under active consideration. In them, the Rational Association is co-operating and it is h?ped that a preliminary conference may be called shortly, to which further reference will be made in ?ur next issue.
Ascertainment of Educationally Subnormal Children . In the Report referred to above, there is an interesting chapter, written for the guidance of Education Authorities and School Medical Officers, ?n this all-important question. Stress is laid on the imperative need for a proper selection of medical officers upon whom falls the responsibility of deciding whether a child’s ” disability of mind ” is such that he needs special education or whether he must be pronounced as ineducable within the school system. This work, lt stated :
” calls for judgment founded on deep understanding and knowledge, reinforced by extensive experience of children, both normal and abnormal. It requires very special aptitudes and attributes, particularly patience and a capacity for friendliness with children.” ^fpreover, to carry it out efficiently, a medical ?jncer should be acquainted with the various types o* schools now provided so that he may fully Understand the import of the recommendations he make.
A warning is given against exclusive reliance on the results of intelligence tests, and the need for allowing sufficient time during the examination for gaining llle child’s confidence is pointed out. The confidence of the parent must also be gained : ” … it is their child who is being examined. Therefore they have a right to be given sympathetic and friendly attention, partly in order to obtain their co-operation but chiefly to give them an understanding and appreciation of the Problem which causes them much anxiety… . Much unhappiness can be dispelled by a straightforward and human approach with a sympathetic understanding of the parents’ difficulties.”
In a borderline case, where diagnosis is difficult, the examining officer is urged to give the child the benefit of the doubt, by postponing the making of a decision until after a further period of observation, or of trial in a special school, and the fact that no special school exists in the area must never be allowed to influence the final decision. Another important point is stressed at the conclusion of this chapter?in the paragraphs headed ” Ineducable Children If a diagnosis of ineducability is made, Section 57 (3) of the Education Act requires the Local Education Authority to inform the parent in writing of this decision. It is, however, urged that such a notification should not merely be sent through the post but should be delivered personally by a social worker, health visitor, school nurse or some other experienced welfare officer of the Authority, in order that the matter may be sympathetically explained and questions answered.
“On examining children “, we are told, ‘’ whose parents have appealed to the Minister against the issue of a report, it has been found over and over again that the parents do not really contest the view of the Authority as to the educability of the child, but owing to the notice having been phrased in official and sometimes terse language, they fear that it presages immediate and permanent removal from his home and their care. This fear naturally causes much distress and unhappiness.” This chapter is primarily concerned with ” human relations ” and we welcome its warmth of tone and sympathetic understanding.
Amending Regulations In connection with this question of ” ascertainment we draw attention to the recent issue of Amending Regulations (Statutory Instruments, 1949, No. 1970) on procedure in cases of children referred for examination by reason of educational subnormality.
The original Form of Report (H.P.2) received some criticism in that it had to be filled in exclusively by the School Medical Officer and no provision was made in it for the statutory services of an educational psychologist (where one is employed) in assessing intelligence.
The revised Form now gives to psychologists due professional status and Part II comprising not only a record of the results of Intelligence Tests (including performance tests) but also ” general observations ” may be filled in and signed either by a psychologist or by the School Medical Officer.
Cerebral Palsied Children
Those who are interested in cerebral palsied children will be glad to know that in The Health of the School Child (1946 and 1947), a whole chapter is devoted to the subject.
Some information is given about experimental research work now being carried on in this field (e.g. at St. Margaret’s, Croydon, and Queen Mary’s Hospital, Carshalton) and reference is made to enquiries as to incidence which have been undertaken in Sheffield, Bristol and in Wiltshire, as well as to American experience. It is emphasized, however, that the study of the subject is still in its infancy and that ” we are only at the beginning of a tremendous task the implications of which are sympathetically outlined in this very human presentation of the cerebral palsied child’s urgent needs.
These needs are also revealed in’a note that has reached us from a mental health worker who is employed by the Education Authority of a small County Borough as a home teacher of six cerebral palsied children all seriously crippled. Growing out of this work is a social club for less handicapped older children and a class to help them in subjects in which they are backward at school. A Parent’s Association, affiliated to the British Council for the Welfare of Spastics has been launched. The interest of the local Scouts has been enlisted, and it is hoped in time to start a special troop. It is particularly interesting to know that these activities grew out of an enterprising piece of pioneer voluntary service, consisting of efforts made to help an individual child, followed by a Saturday morning experimental class sponsored by the children’s parents with the help of the Red Cross car service.
Art and Music Therapy
Readers who are interested in the use of art and music in the treatment of mental patients, may like to know that a report of a one-day conference on ” Art and Music Therapy ” held by the British Council for Rehabilitation in the spring of last year, appeared in the October issue of the Council’s magazine Rehabilitation (32 Shaftesbury Avenue, W. 1. Price 2s.). It includes contributions from Dr E. Cunningham Dax (Netherne Hospital, Coulsdon), on ” Music Therapy Mrs. H. I. Champernowne, on ” Painting and Modelling as an Inner Process “, Miss J. Guy on ” Modelling and Pottery “, and Miss N. Godfrey on ” Painting ” ; Dr W. J. T. Kimber (Hill End Hospital, St. Albans) gave an address on ” The Patient with the Paint Brush “, and an account of the Arthur Segal Method in Art Therapy was given by Miss Elsie Davies, (Art Therapist, City Sanatorium, Birmingham). Mr. Adrian Hill, referred to the ” giant strides ” made by Art Therapy since he first launched it as an experiment at the King Edward VII Sanatorium in 1942.
Forthcoming Conferences
The following Conferences?all of which have a bearing on mental health?are amongst those taking place during the next few months : British National Conference on Social Work, Harrogate, April 19th to 23rd. Subject : ” Social Services in 1950, the Respective Roles of Statutory Authorities and Voluntary Organizations.” Particulars from Conference Secretary, 26 Bedford Square, W.C.I. Royal Sanitary Institute. Health Congress at Eastbourne, April, 24th-28th. Subjects include ” The Administration of Care and AfterCare Schemes “, ” The Role of the Family in National Life “, ” Administrative Problems due to Vague or Complicated Legislation “. National Marriage Guidance Council Annual Conference, Rustington, near Littlehampton, Sussex, May 6th-13th. Particulars from Marriage Guidance Council, 78 Duke Street, London, W.l.
International Conference on Social Work, Paris, July 23rd-28th. Subject : ” Social Work in 1950. Its Boundary and Content.” At this Conference, the conclusions reached at Harrogate will be presented.
British Social Hygiene Council’s Summer Schools. July 31st to August 14th, Seale-Hayne Agricultural College, Newton Abbot, Devon ; August 16th-30th, College Franco-Britannique, Cite Universitaire, Paris. Subjects ” Biology and Rural Life” (Devon School) and ” The Welfare of the Family” (Paris School).
Particulars from British Social Hygiene Council, Tavistock House North, Tavistock Square, London, W.C.I. Twelfth International Penal and Penitentiary Congress, August 14th-19th at The Hague. Particulars from John Ross, Esq., Assistant Under-Secretary of State, Department of Probation and Juvenile Delinquency, Home Office, London, S.W.I. Second International Congress on Criminology, Paris, September 10th-19th. Particulars from the Organizing Secretary in the United Kingdom, c/o Institute for Scientific Treatment of Delinquency, 8 Bourdon Street, London, W.l. Psychodrama The Theatre of Psychodrama, New York, is holding weekly performances every Sunday evening until the end of May. The productions are spontaneous and unrehearsed and result from the interaction between the stage and the audience, and they are regarded as a social experiment to demonstrate the possibilities of mass therapy. Further information may be obtained from The Theatre of Psychodrama, 101 Park Avenue, New York 17, U.S.A. 1
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.