Another Year’s Work, Report Of The Board Of Control, 1934
The Board of Control’s Report is an annual landmark recording the position reached by the community in dealing with the problem of the men- tally disordered and the mentally defective. As such, it is worthy of close attention by everyone concerned in that work, and the following summary of the position arrived at by the end of 1934 with regard to Mental Deficiency will be of interest to those who have not had an opportunity of reading the Report itself.
Ascertainment
The total number of defectives under the care of Local Authorities on 1st January, 1935, was 74,691 (in State Institutions, 1,268; in Certified In- stitutions, 26,782; in Public Assistance Institutions (Section 37 of the M.D. Act), 9,128; in Certified Houses, 219; in Approved Homes, 590; under Guardianship or Notified, 3,327; under Statutory Supervision, 33,377). To the uninitiated this figure may seem a large enough one, and it does represent an increase of 3,927 on the corresponding figure for 1933, but in the section of the Report dealing with ” Ascertainment,” the Board point out that Local Authorities have so far taken cognisance of only a little more than half the number of defectives in their areas for whom they may at any time become responsible. The total number of known defectives (including some who are not at the moment “subject to be dealt with under the Act”) represents a proportion of 2.69 of the population whereas the estimate given in the Wood Committee’s Report of the number likely to be found in the com- munity, is 4.52. The discrepancy is obvious and is no doubt in part due to inadequate methods of ascertainment by certain Authorities, for the propor- tion of defectives ascertained ranges from 0.68 per 1,000 to 7.05.
Feeble-Minded Children between 14 and 16 The position with regard to feeble-minded children in this age-group the Board view with ” much uneasiness,” for in their case a position has arisen which was not contemplated when the Mental Deficiency Act of 1914 was passed.
Under that Act, educable feeble-minded children can only be dealt with, except in special circumstances, if notified to the Local Authority when they are about to leave a Special School or Class, and despite the Education Act of 1921, making the establishment of such Special Schools or Classes com- pulsory, their development is completely at a standstill (and in rural areas and small towns recognised to be impracticable), so that only about one-seventh of the estimated number of feeble-minded children in the country are provided for. Consequently the number of feeble-minded children notified and thus ensured of the legal protection they need, was in 1934 only 3,488?a decrease of 55 on the 1933 figure.
*21st Annual Report of the Board of Control for the year 1934. Part I, H.M. Stationery Office. 1/6.
Until amending legislation is introduced enabling the feeble-minded child between 14 and 16 to be notified whether he is in attendance at a Special School or not, large numbers of these children?though definitely known to be mentally defective?
” are left at a most critical period in their lives without the supervision and control which the Legislature intended to give them. Even when they emerge from limbo at the age of sixteen, nothing can be done for them by the local mental deficiency authority unless they are neglected or unless their anti-social behaviour brings them into conflict with the law Legislation will be needed to fill this gap and the need for filling it is becoming more and more generally recognised.”
The difficulty which this anomalous position creates for Local Authorities with every desire to carry out their obligations, is further illustrated in the Report by a statement taken from the Annual Report of the Nottingham County Council: ?
” Again it is necessary to emphasise the very great handicap to the effective performance of their duties by the local authority as a result of the large number of educable defectives who evade notification because of the lack of Special School accommodation. Statistics show that in the next two years, more than 100 educable defectives will pass out of the jurisdiction of the Nottinghamshire Local Education Authority without having been to Special Schools and the majority of them will fail to become ‘ subject to be dealt with.’
By close and informal co-operation between Mental Deficiency Com- mittees, Education Committees and Voluntary Associations?the Board point out?the gap can be bridged to some extent, but nothing short of legislation can fill it effectively.
Institutional Accommodation
In reporting steady progress in this direction, the Board refer to the part played by the transfer of Public Assistance Institutions to County and County Borough Councils. This they suggest, has had the effect of bringing the urgency of the problem to the notice of Local Authorities, for formerly a considerable part of the expenditure on mental defectives was merged in general Poor Law expenditure.
During 1934, there has been an increase of 2,026 beds in Certified In- stitutions provided by Local Authorities, making the total number available, 17*452. Most of the increase is accounted for by extensions at already existing institutions, and several further schemes were being undertaken by Local Authorities at the end of the year under review. In addition, 9,053 beds are available in Institutions provided by other bodies, and 9978 in Public Assistance Institutions under Section 37.*
*In this connection it may be noted that in another section of the Report, the Board comment unfavourably on the practice of sending low-grade mentally defective children to mental institutions as voluntary patients under Section I of the Mental Treatment Act ?f which a certain number of instances have been noted. Such a proceeding is, they consider, an abuse of the provisions of the Mental Treatment Act and of doubtful legality.
Community Care
The development of an efficient system of Community Care for defectives for whom permanent institutional accommodation is not necessary, is recognised by the Board to be of great importance. Indeed, the care of defectives living in the community is stated in the Report to be ” perhaps one of the gravest responsibilities confronting those administering the M.D. Acts.”
In any effective programme for Community Care, the following are considered to be essential items: ? (a) Guardianship (b) Occupation Centres (c) Home Training (d) Statutory Supervision (with some provision for training or occupation) (e) Licensing from Institutions Hostels. (a) Guardianship
The number of cases under Guardianship on ist January, 1935, was 3,083, an increase of 274 on the 1933 figure. The Board urge Local Authorities to consider this alternative to institution care in all cases of defectives of amenable and harmless type who cannot be looked after in their own homes, but with the proviso that no such child should be placed with a Guardian unless an Occupation Centre is available, and that in placing high grade adults in private homes, care should be taken to ensure for them some sort of employment, paid or unpaid.
(b) Occupation Centres The rate of increase in the number of Occupation Centres, Industrial Centres and Clubs for defectives is regarded by the Board as disappointingly small, for there are still only 191 throughout the whole country, ana 42 towns with a population of over 50,000 have failed as yet to do anything in this direction.
That the Centres are appreciated by those whom they are designed to help is strikingly proved by the regularity of attendance. The average attend- ance in 1934 at the 52 whole-time Centres was 75.8% of the numbers on the registers?an achievement which the Board considers remarkable in view of the enfeebled condition of many of the children and of the fact that there is no legal compulsion. At the 9 whole-time industrial centres the average attendance was 88%.
(c) Home Training In cases where defectives are unfitted to attend Centres or where no Centre exists, the Board urge the provision of Home Teaching. This can, they consider, be best given by supervising officers of Local Authorities, as is done in Suffolk, Wiltshire and Kent, whereby overlapping of visiting is avoided, and they suggest one of the qualifications looked for in making such appointments should be some knowledge of handwork and training methods. (d) Statutory Supervision
Under statutory supervision?a method of care which should, wherever possible, be combined with some provision for occupation and training? there were on 1st January, 1935, 33,377 defectives this being an increase of r)456 on the 1933 number. In addition there were 23,544 cases under ” volun- tary supervision ” compared with 22,665 last year. There are still six areas m which no use at all is made of this provision of the Mental Deficiency Act.
Licence and Hostels
Discharge from institutions ” on licence ” is urged by the Board as being not only a means of testing capacity for complete discharge but in some cases as the most suitable form of prolonged care following on a period spent *n an institution. Stable low-grade patients may be licensed to foster-parents, and high-grade patients may be allowed to return home on licence or be placed with employers.
The Board consider that a Hostel from which selected patients go out to work daily, should be attached to every large institution and used as a pre- liminary to Licence, but at present only five of the larger institutions have such hostels attached to them. There are, in addition, 13 other Hostels functioning as separate establishments under the control of local authorities ?r of voluntary organisations.
Mental Defect and Crime
The Report for the year 1933 dealt with this question viewed from the standpoint of the triennial period, 1931-3, and when the figures for the further triennial period, 1934-6 have .been obtained, it is proposed to deal with the subject in greater detail.
During 1934, 334 persons found guilty of criminal offences were dealt With as mentally defective (compared with 278 in 1933). Of: this number, 48-4% were between the ages of 16 and 20; 18.3% were under 16, and 33-3% were over 20. 93% of the cases were dealt with by the Courts under Section 8 of the M.D. Act, and 7% by the Secretary of State under Section 9. The fact that 17.4% of these cases were sent to Public Assistance Institutions and 4% placed under Guardianship shows, observes the Board, that many Local Authorities when called upon to find a vacancy for an urgent case coming before the Courts, ” have to fall back upon these admittedly inadequate alternatives owing to lack of colony provision.”
It is regarded as significant that out of the 334 criminal defectives dealt With in 1934, only 32.4% had been previously ascertained by Local Authorities and of these only 28.8% had attended Special Schools. This throws another side-light on the present legislative position with regard to feeble-minded children between 14 and 16.
Nursing in Institutions for the Mentally Defective
During die past year, the Board record some inquiries made into the nursing in Institutions for Mental Defectives. Their returns are not yet com- plete, but they serve to show that considerably more than half the Matrons in the 67 Institutions where there are more than 100 patients, are either registered or certificated in Mental Nursing, or State registered in General Nursing, and of these, several are doubly qualified. A rather smaller propor- tion of Assistant Matrons in these Institutions possess similar qualifications.
Whilst stressing the importance of both general and mental training for Matrons and Superintendents, the Board urge also that additional experience in the training of low-grade defectives should be regarded as an essential qualification for those in charge of the smaller Homes. Those who take the certificate of the Royal Medico-Psychological Association in a Mental Hospital rarely receive such experience, and less than half of the larger Mental Deficiency Institutions are at present recognised as training schools. The Board therefore hope that Managers of unrecognised Institutions will consider the possibility of obtaining recognition through application to the General Nursing Council or to the Royal Medico-Psychological Association.
The Defective and Ourselves
The general attitude of the Board to the whole social problem of the mentally defective and an indication of what they expect from Local Authori- ties, may well form the concluding paragraph of this summary: ? ” The more complicated the social fabric becomes, the greater the need of the defective to have a place found in it for him. The tendency to think that defectives can only be properly looked after in an institution is due to the frequency with which they are found to be neglected at present. But segregation except for purposes of training, should be a last resort, only to be justified on the grounds of social incompetence or anti-social proclivities. There is all the difference in the world between a defective left to fend for himself, unprotected, and with his weaknesses unrecognised, and one who is given the special training, protection and control which enable him to meet social requirements. The double responsibility falls upon the local authority of seeing that’ every defective in the community has the training and occupation he needs and of showing the public how to protect mental defectives as they would do cripples or blind. The defective must be fitted for his environment and the environment adapted to the defective. The task is not an easy one and requires skilled and experienced workers to carry it out; otherwise it fails. But the ex- penditure which must be faced by the local authority is worth while economically and socially.”
Sir Leslie Scott
As we go to press, news reaches us that the Rt. Hon. Sir Leslie Scott, K.C., President of our Association, has been appointed a Lord Justice of Appeal. Readers of Mental Welfare will wish to join with the C.A.M.W. Council in congratulating Sir Leslie, who has given such invaluable service to the Association since its foundation, on this new honour which has been conferred on him.
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