Home Aspects of Mental Health Work
In view of the great public interest aroused in the Mental Treatment Bill, which passed its Third Reading in the House of Commons on the 14th May, it seems opportune to place before our readers in this issue the following composite article in which workers of specialised knowledge and experience deal with certain branches of mental health work which will, it is hoped, be further developed and extended when the Mental Treatment Bill becomes law.
EDITOR. Training for Occupational Therapy Nature of the Work
The kind of training needed for a trade or profession depends on the kind of work to be done and the result it is required to produce. In Occupational Therapy the work usually consists of some form of art or craft: the result required is the education or re-education of an individual with special needs. With mentally deficient children our aim is education: for adolescents or adults with discordant nervous systems, re-education. In either case, the art or craft most suitable to the person at the moment is a means to an end: whilst using this means our end is to establish his nervous harmony.
The method or technique consists in helping the individual to focus his or her nervous energy upon a suitable form of creative effort, the suitability being a matter for the patient to decide. This is fundamentally important, since the effort to choose is the first practice in focussing a dispersed energy; it is the first step away from discord and toward harmony.
Thus the nature of the task, the result desired, and the technique employed, determine the nature of the training, the type of student, and the professional status of the work. Occupational therapy is plainly a branch of education: the students will become teachers. The training will aim at an introduction to as many forms of art and craft as possible: the more the merrier, since these are the links with which we establish connection with the widely differing minds of the patients. But training in craft alone may be worse than useless: there must be a mastery of the method, the technique, of therapy. Such technique can only be based on a general knowledge of the nervous system and a particular acquaintance with the special needs of the case. Take an example. An individual with a sluggish digestion and a poor circulation may do much better work after playing ball for a few minutes, since conscious thought depends directly on the supply of blood to the brain.
But, if he or she has a weak heart, some other method of helping the circulation must be found. Or again, an irritable and depressed person who is incapable of prolonged effort, who cannot work for more than five minutes at a time, may find weaving unsuitable, yet be benefited by sawing wood and hammering together a rough box. Another may like a long slow job on one day and prefer a short quick one on the next. These very simple instances show how essential it is for the teacher to know at least the outlines of the history of each case, if technique and method are to be satisfactory. They also indicate the type of student needed to make a successful teacher. Valuable though it is to have a wide range of crafts from which to choose, and to know the processes of each, it is even more necessary to be able to adapt them skilfully to the individual need. It is through this adaptation that the education or re-education must be obtained. No mere craftsman can do the work: what is required is a teacher working in close co-operation with the doctor.
Its Status
This concept of Educational Therapy as a branch of education cuts right across existing conditions. Doctors are accustomed to prescribe a treatment and nurses to carry it out, but few doctors are teachers, and most nurses are not craftsmen. In any case, it is impossible to prescribe a dose of leatherwork as one would a tonic. And though nurses or attendants might, and often do, wish to do something new for those in their charge, they are not expected to make suggestions. The doctors do not know; the nurses are afraid to try.
The water-tight-compartment system in some Mental Hospitals means that an occupational therapist, instead of having opportunities for discussing patients freely with doctors and nurses, is working in the dark. Where a number of specialists are gathered together to help a person, knowledge must be pooled; the military system of ranks and orders is out of date. The type of student and the training for occupational therapy must be such that the teacher may become a colleague, not a subordinate. This is a basic principle which no organization for training such teachers can afford to neglect. The result will not be arrived at quickly, but a start can be made by a careful choice of the students.
Type of Student
The main qualification for a student of occupational therapy is a certain attitude towards life, rather than a remarkable ability in art and crafts. The manner of approach to patients is of vital importance, since the object to be made is merely a centre upon which all the curative processes taking place in the patient, and between teacher and patient, are focussed. Those students who are sympathetic, sensitive and tactful, have the making of the best teachers. An inelastic, overbearing person may produce showy articles, but will never help to heal disordered minds. Those in the hospitals who, so often, have been broken by shock and trouble, greatly appreciate teachers who themselves have had a varied experience of life, and for this work the teacher who is not young may prove of even more value than the twenty year old who charms by freshness and youth. The age limits for students might well be as wide apart as 18?40 years.
Conditions of Work
In view of the great drain upon their vitality, students should pass a preliminary medical examination. To conserve this vitality, training colleges should expect teachers not to take posts of more than 5 days per week. The length of holidays in mental hospitals will be a question of much discussion. One month yearly for rest and re-creation is at present supposed to be ample. Actually, eleven months is too long to do really good work at a stretch patients go back, not forward, with a jaded teacher. Everyone who has worked amongst the insane knows of the inertia which creeps over attendants, adding dullness to dullness, making chronic patients of those who should be temporary residents. As to numbers?when a medical officer tells me that the thousand odd patients under his charge are known to him ” inside out,” it is no wonder that teachers are expected to teach dozens, or even hundreds without help from nurses. Apparently, in some hospitals, it is sufficient to hand any patient some raffia and to return hours later to find it a lovely basket. practice, the majority of patients need help every few minutes, many of them all the time. There is a need for those working amongst non-normals to associate frequently with normals, so as to keep their eyes fixed on health rather than disease.
The Teacher
In character, the occupational therapist of to-day needs to be a pioneer, a research worker, an experimentalist, who is not entering into a standardized profession, but is making new history in the study of human minds under very difficult and disheartening conditions. Possibly those who have been altogether trained outside mental hospitals bring into them as teachers a less hampered personality than the nurse who slips into such a post with little or no training.
Particular Training
At present we have in England no training college for occupational therapists?they are gathered haphazard. Such a college, both for residential and non-residential students, might well be founded near London. It is an educational project: the aim is to cure, but to cure by education, not by medicine or surgery. The Head of such a college should therefore be an experienced teacher in art and craft, with knowledge of the conditions of mental hospitals.
Intending students should be able to produce evidence of having benefited by their previous education. A slow mind sometimes makes a better teacher than a brilliant one, and the lack of Senior School or Matriculation certificates might be waived after a personal interview. Training should extend over a period of three years. These years are not too long for the end in view.
Students might take somewhat varied courses, but each needs at least an elementary knowledge of six crafts, with a specialized training in three of them, and a study of what is generally called ” art,” or Drawing and Painting in its varied branches. Pottery, Carpentry, Weaving, Basketry, Rhythmic Movement, Bookbinding, Leatherwork, Metalwork, Gardening, Embroidery, are some only of the many branches from which a student might select his or her subjects. In addition to courses of lectures, there must be practice in learning to express their observations by essays and discussions. Teachers are practising psychologists, but at the moment they are rather dumb before the ” theoretical psychologist.” These teachers must be able to do, and then to explain what they are doing, when they take their place in the hospitals. Vitally important is the necessity for understanding the anatomy and physiology of a human body, particularly of the nervous system. It is suggested that instead of any lectures upon psychology the students, until the last year, should learn to know the structure and function of the nervous system and gather their own impressions in regard to normal and abnormal conduct from their own observations. To help them, second and third year students should have first one, and then two or three mental defectives and insane persons to teach. They will have studied, under an enthusiastic and experienced college staff, primitive and modern methods, but they will need preliminary and unhurried practice in adapting both the apparatus and the presentation of the subject to their patient. During the third year students should attend lectures in psychology and modern medical treatments.
Students would pay their own fees. The college would possibly be an individual organization recognized by the Board of Education. Such a scheme, the details of which would arrange themselves quite simply, demands a fuller recognition for the work, a higher standard of training and an increased remuneration for the teacher. It will seem more than justified when we remember the material with which we have to deal, not looms, nor clay or raffia, but that most delicate, most complicated of all organisms?the nervous system of a living human being.
Ruth Vaughan Roper.
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