Occupational Therapy in Mental Hospitals
- Author:
Dorothy Hodgkins
Occupational Therapist at Maudsley Hospital, Denmark Hill, and at Camberwell House.
It is a fairly new idea for us in our hospitals to introduce Occupational Therapy as part of the curative treatment for mental patients. In America, I believe, it has been adopted extensively and on a much more elaborate scale than we can hope to achieve here for some time. Nevertheless, it is evident that it is being recognised now as one of the necessary factors in the treatment of mental patients and a great asset in helping towards the recovery of those in the early stages of mental breakdown, such as are treated at Maudsley Hospital.
I am dealing with this treatment primarily as for mental cases although it is also being used extensively for tuberculosis, mentally defective and disabled cases with splendid effect. Quite low grade defectives can produce marvellous work and the satisfaction they feel at being able to do something equally as well as their fellow men is enough justification for the long effort in training them. An unemployable boy of 17 had a glorious moment of pride when he won 2/6d. in a local open competition for his basket. However, that is another branch of the work that is not being dealt with here.
The patients who come to Maudsley Hospital are all considered recoverable; therefore their stay at the Hospital is only for a limited time. In the acute stage of their illness, capacity for work is almost non-existent but as they pass to con- valescence they can achieve quite an advanced stage in craft before they leave. There are other outlets for them as well, gardening, carpentry, office work, organised games and drill and sometimes singing classes are arranged for them, but the craft work is particularly beneficial for those who cannot leave the ward or who are not well enough to take part in the more strenuous sections. The idea of occupational treatment is to distract the patients’ thoughts from their real or imaginary illnesses, to assist them in regaining their self-confidence and to counteract any tendency towards habits of laziness; also to discover if there is any latent ability towards craft or artistic work and to develop this so that the patients may have a practical and absorbing hobby to hold their interest and help them over difficult times after they have left the Hospital. This part of the work is entirely constructive?a building up and creating?which is important in help- ing to steady the patient whose mental world is in a state of chaos.
With every possible kind of help and treatment being given it cannot be said that occupational therapy is directly responsible for any definite cures, but it has contributed largely to the recovery of many of the patients and has been useful to crippled cases. Some of them have taken up this branch of the work and adopted it as their means of livelihood. One man is now making tooled leather goods and has quite a profitable and ready sale for them. He is a man unable to do any hard physical work.
An elderly woman had to face the prospect of finding paid work to do when she left the Hospital. She had not had to work for her living before and the only possibility seemed to be a house-keeper’s job. She took up raffia work and now sells her work to various shops and has a standing order with a West End firm, and is also, of course, able to go on living at home.
At Maudsley Hospital the occupational work is done in the wards. It is done with the idea of interesting all patients whether directly concerned with it or not.
i his is quite desirable in many ways as it does tend to bring a fresh atmosphere and to create a little excitement and pleasant disorder into an otherwise immacu- late ward. This last opinion has no encouragement from the nursing stall of course.
There is a different arrangement at Camber well House. 1 wo workrooms have been allotted and the patients are sent to them from the various wards. There the cases arc often of long standing and those who can work are quite able to walk the short distance necessary to reach the workrooms. There is a mixed class of men and women which was tried as an experiment and has w orked very successfully.
As much variety as possible is made in the work, so that the patients may have a chance to choose a craft which will give most satisfaction to themselves, looled leather is one of the most popular crafts. It appeals to them as being artistic and is almost everlasting in wear. It needs great care both in the con” struction and decoration and is excellent for developing concentration and accuracy. There is always a ready sale for this work and usually more oiders than it is possible to cope with. Basket Weaving is useful for men patients in particular. It is fairly quick to do and its great quality is in the accuracy, neat- ness and shape construction which they find rather difficult to appreciate at first. Raffia is always useful and can be adapted in a variety of ways. A great deal of its value is in its colour which does help to create a cheerful atmosphere. The appreciation of colour is often unconscious, but it acts as a stimulant to the mind to handle bright colours and to harmonise them into one decorative whole. The worried and depressed patients usually choose red or warm shades to work with; green, cool and restful, is next in popularity. Mauves arc not appreciated until the patient is much stronger and able to enjoy the softer blendings of pastel shades. I had one student who had a preference for a combination of jade green and bluish mauve. About five patients in one ward were given these colours to use and the result was very depressing. None of them made any progress until the scheme was brightened.
Light pewter modelling is done, covering boxes and napkin rings and making brooches in conjunction with Ruskin stones. White wood articles are coloured and decorated with gesso and barbola work, which needs deft fingers to mould the clay into small and accurate shapes.
Innumerable articles are made out of suede leather; motor cushions, bedroom slippers, belts, etc. I his is an easy material to handle, light in weight, beauti- fully coloured and needing only accuracy and neatness to produce really useful and practical articles. Rush seated stools are woven by men patients, which includes the work of staining and polishing the wooden frames first. Table mats o moleuni and painted with cellulose enamel are attractive and saleable articles and popular with men who like to wield a paint brush. Lino cutting and print- ing is done in designs suitable for calendars or greeting cards. Figures and designs aie cut in wood with a fretsaw and afterwards coloured. The women patients are also making a number of fancy dresses which are used for the annual Christmas dance and for concerts. I his is a kind of work with which nearly all can help.
Whenevei it is possible the patients are encouraged to use their own ideas and to make designs for their own work. It is so much more fun than copying other peoples’ schemes and even if it is only part of the arrangement that the patients have suggested, they feel it is an idea born of themselves and they take a more vital interest in making its lasting form. It is important to try to make ? patients enjoy their work thoroughly, otherwise the best results will not be seen neither in the patients nor in the work they have done. This is why colour is so important and why the things they are given to make at the beginning must be easy to handle, attractive to look at and not too difficult to make.
The financial side is another problem of this work and although not all- important it adds to the already strenuous programme, as the work must be sold in order to cover the cost of providing the materials. The patients buy their own work if they wish, paying just the cost of the material used. Other work is sold outside to private buyers at a profit which helps to cover the loss on material worked by less competent workers. It has been realised by many of us engaged in this work that a place is needed to which we can send work for exhibition or to be sold. Many hospitals are in out of the way places and are only visited by friends of the staff and patients, which gradually limits the possibilities of sales. Sales of Work are another possibility but these again are usually limited to friends interested in the hospitals and who cannot be called on to buy continually. I think that there are trade difficulties about supplying shops, so that a depot seems to be the only means of reaching an outside public.
There are some patients who do work for us after they have left the Hospitals and this appreciation of the Hospitals’ efforts for them is very cheering. One woman comes to fetch materials and works at home making most attractive raffia trimmed hats and shopping bags. She does the work voluntarily. Several others have carried out orders in leather work in this way and besides the value of the work they do it creates a means of keeping in touch with them and knowing how they progress. One patient who did some excellent work in Hospital made about thirty-six pairs of mocassins. The first pair took her about three weeks to make, and that after much coaxing and persuasion. After they were done she saw that the result was good and that people wanted to buy them. She went ahead and averaged two pairs a week for the rest of the time she was at the Hospital.
There are awkward moments too. One old lady asked how much wool was needed to make a scarf and having no practical knowledge of knitting myself I had to make a wild guess and suggested that a pound would do. Her friend bought the wool for her?an expensive kind too?and after that I had to watch the scarf grow yard by yard. Nothing would induce her to stop until she had used up all the wool. Anyway, I am sure it was a warm scarf !
There is much to be done yet. Occupational work needs to be more fully appreciated and there is no recognised scheme of training for those who wish to take up this profession. Occupational workers would benefit by occasional meetings and exchange of ideas and mutual help. As yet we are isolated workers, unorganised and therefore unable to do anything as a whole to further materially this very necessary work.
In spite of these handicaps, however, most of the occupational instructors I have met have been capable people, full of enthusiasm and keen 011 their work and these, after all, are the mainsprings of successful work.
One of the first Mental Hospitals under the London County Council to employ an occupational therapist was the hospital at Horton. This was followed by the appointment of a part-time woman occupations officer at the Maudsley in 1924. The experiment was very successful and encouraged the L.C.C. in the next year to employ similar officers at each of their County Mental Hospitals for a trial period, and last year the Council definitely recognised an increase in every staff by one woman occupations officer. The Glasgow Mental Hospital has considerably developed occupational work and claims good results from it in a number of cases. The Royal Asylum has two pavilions devoted to this work under skilled instructors whose sole function is to occupy groups of patients. Organised occupation under special instructors forms a part of the regular treatment at the Ma “lesfield, Brentwood and other provincial mental hospitals.
As a *xsult of a meeting in 1925 of representatives of bodies interested in this subject, an Association was formed to help to stimulate and advance the work in this country bv promoting co-operation in the existing work and by aiding in the training and supply of suitable workers. As is stated in the above article, no course of training has been instituted as yet but details as to the work and possible openings, etc., can be obtained from Miss Gribble (Hon. Secretary, Occupational Therapy Association), Ridgelands College, The Ridgeway, Wimbledon, S.W.19.
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