Mental After Care
Mental Welfare
The return to normal life and the resumption of work after a prolonged illness is always associated with considerable difficulty and personal distress. This is especially true in the case of those who have suffered from any form of mental or even nervous breakdown.
Unfortunately, such forms of illness are still regarded by many people with superstitious dread and are held to be in some way disgraceful. Thus, recovering or recovered patients are apt to find themselves looked upon both by their families and by their employers with considerable fear and distrust.
It often happens, moreover, that the environmental conditions of home or work have played a large part in precipitating the breakdown, so that there are many reasons why discharge from a mental hospital and the return home of a patient who has suffered from any mental illness tend to be a very critical procedure.
There can be no doubt that in a considerable proportion of cases the feeling of ” alienation ” from the social circle and the difficulty of obtaining work cause extreme depression and a sense of hopelessness that may lead to a serious relapse or even to suicide.
Not infrequently also, it occurs that patients who recover after a number of years find themselves homeless and friendless, without clothes, money, or prospects of any kind; long residence in an institution has caused them to lose touch with the outside world and the protected environment has unfitted them for the economic struggle necessary in order to maintain an independent and self-supporting existence. It is not surprising that such people almost inevitably drift back into institutional care of some kind and become a permanent burden on the community. The case of the poorer professional or middle-class patient is particularly hard, and presents some of the greatest problems.
Obviously, the whole position is extremely difficult and unsatisfactory, both from the point of view of national economy and from that of the human suffering involved.
There can, therefore, be no question of the great need for the work of Mental After Care, whose business it is to deal with problems of this nature. This was started by the Mental After Care Association, which was founded over fifty years ago, and which has carried on without intermission ever since, constantly extending the scope and value of its work, until today it is dealing with patients from mental hospitals in nearly every part of the Country.
The first necessity for adequate After Care is the Social Worker, who can keep in close touch with the patients, the patients’ friends and the Medical Superintendents of mental hospitals.
In order to have a complete knowledge of the patients under his care, the Medical Superintendent must be aware of the conditions under which they have lived and worked before their illness, so that he can accurately assess the importance of those factors. This is most necessary, both from the point ?f view of treatment and of the patients’ future prospects. It is obvious that a patient who has broken down under apparently quite favourable circum- stances, does not present so hopeful an outlook, other things being equal, as one who has only broken down after prolonged stress and anxiety. Again, their knowledge of the home circumstances?whether there are sensible relatives willing and able to receive a patient on discharge, whether here are good prospects of his obtaining employment, etc greatly influence the doctor’s decision to recommend the patient for discharge or for a period of leave ” on trial.” Without the aid of the Social Worker this information would be unobtainable.
Another aspect of the Social Worker’s function is that of establishing a happy and sympathetic relationship between the patient and his family. The attitude of fear and distrust on the part of the relatives, to which reference has already been made, frequently makes the patient extremely unhappy and militates seriously against his future well-being.
The welfare worker who has inspired the patient with confidence and is on good terms with the family can do a great deal to avert this. Both parties turn to her for advice and sympathy and she can explain to the relatives the nature of the illness from which the patient has suffered and suggest to them the best method of helping him. It is definitely accepted, however, that the Social Worker, though she must be in close touch with the mental hospital, should not have any official connection with it if she is to obtain the full con- fidence of either the patient or the relatives.
The second important aspect of After Care Work is the provision of suitable ” convalescent homes,” where patients ” on trial ” or newly dis- charged from mental hospitals can go for a time before returning home and taking up work. There are numerous cases in which it is desirable that the patient should spend some time in a place of an intermediate or ” neutral ” character as a preliminary to taking up the threads of normal life. The ordin- ary convalescent homes are, of course, out of the question, as they will not receive these patients, and even if they were willing to do so, they have no one with the special knowledge and experience which is essential for the wise and sympathetic handling of this type of case.
The Mental After Care Association has numerous homes of this character with trained matrons in charge and a large number of patients are constantly passing through their hands. Thirdly, there is the great necessity for the existence of facilities for helping those unfortunate people who have no home and no relations willing to receive them: often they are faced with the prospect of sheer starvation on being discharged. Their homes having been sold up to help to pay for their keep while in the institution? an iniquitous system which urgently needs revision? work is naturally extremely difficult to obtain.
The Medical Superintendent cannot permit them to remain in the institution when they have recovered, nor is it desirable that they should do so. On the other hand, it is a terrible thing for them to have to drift into the poor law institution. The After Care work can, and largely does, prevent this by finding temporary homes where they can stay while looking for work; by advertising for posts for them; by fitting them out with clothes and tools, and again by giving them small grants of money or food to tide them over. This work is perhaps even more valuable in the case of the father with a family to support. Many a little home has been saved, many a man has been estab- lished as a self-respecting and self-supporting member of the community by
the provision of adequate after care of this kind. The Mental Treatment Bill will give more power to the Local Author- ities to spend money on the provision of After Care and we may therefore look for a great development of the movement throughout the Country. There is no doubt as to its value and importance; an enquiry recently circulated by the National Council for Mental Hygiene has elicited from the Medical Superintendents of nearly all the Mental Hospitals in the Country, expressions of the warmest appreciation of the value of Mental After Care work and of the need for its extension.
The principle of keeping the work on a semi-voluntary basis?that is to say, of having it carried out by a voluntary organisation assisted by local grants ?has been supported by the Royal Commission and by all other expert bodies dealing with this subject, and it is to be hoped that it will be adhered to in the future.
It is a system which works extremely well in this Country in relation to many of the social services and, as has already been stated, it makes for a much happier relationship between the workers and the patients and their relatives in this particular field than would be the case if the work were carried out directly under the aegis of any official body or institution.
Mental After Care is furthermore doing valuable educational work through its Social Field workers; not very obviously or dramatically, it is true, but rather in the manner of the leaven which leavens the whole lump. By going into the houses of the people and getting into touch with them, they have good opportunities of urging them to a realisation of the truth about mental illness.
Thus they are beginning to discard their old superstitious fears and to accept it as a form of illness which is capable of prevention, treatment and, in many cases, of permanent cure. They are coming, though very slowly, to realise that there is no stigma or disgrace attaching to it and that infact the people who suffer from mental breakdown are commonly those who have worked conscientiously and lived temperately.
The results of After Care work are most encouraging, the large majority of patients are only too eager to co-operate in the efforts that are made to set them on their feet and establish them again as self-supporting and valuable members of the community.
DM Odlum, Vice-Chairman, The Mental After Care Association.
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