Co-operation in Mental Health
- Author:
BUCK.
Mental Health Visitor, Oxford City Council.
As an effort has been made in Oxford City to co-ordinate all Mental Health services under the administrative control of the Medical Officer of Health it is thought that it may be of interest to the workers in other areas to hear of the results of this experiment.
The co-ordinating Committee set out with the idea of treating all forms of mental disability as questions of Public Health to be dealt with as far as possible in the same way as other physical disabilities. They have, therefore, endeavoured to provide the same services for the mentally ill as for the physically sick. On the preventive side there are two Clinics?the out-patient Neurological Clinic at the General Hospital for adults and the Educational Clinic for children. For observation of difficult children the Education Committee has provided a specialised school under the care of a teacher experienced in such cases. For the intellectually retarded there are backward classes in the ordinary schools, a small Special School and an Occupation Centre to which the children are sent on the advice of the doctor according to the degree of backwardness or mental defect from which they may be suffering. Hospital treatment for Voluntary and Temporary patients under the Mental Treatment Act and for Certified patients under the Lunacy Act is, of course, provided at the Mental Hospital, and for the mentally defective there are Borocourt and other Certified Institutions.
For each of these activities an appropriate Committee is responsible as in other areas but the co-ordination consists in the fact that each Committee has many members in common and employs for the most part the same officers. The Mental Health Committee is the original Mental Deficiency Committee which has also been approved as the Visiting Committee under the Mental Treatment Act 1930.
This Committee carries out all the duties of the Local Authority under the Mental Deficiency Act in the following manner :?
(1) It has appointed one full-time and one half-time Mental Health Visitor who are appointed as Petition Officers under the M.D. Act These officers are responsible for the ascertainment and supervision of all defectives in the area, for finding institutional accommodation and guardians for all cases requiring such treatment and for presenting petitions and conveying the defectives to the appropriate Institution or guardian. The Committee has also appointed a part-time worker to undertake the visiting of all cases under Statutory supervision in the area.
(2) The Committee is directly responsible for the Occupation Centre held in a building which is the property of the Council. There is accommodation at this Centre for 40 children. The staff consists of a supervisor, two assistants, a carpentry instructor, a lady gardener, a cook and an assistant cook. The Centre is held at the same times as the ordinary elementary schools and a mid-day meal is provided.
(3) Members of the Committee represent the Council on the Joint Board for Bucks, Oxon Reading and Oxford City for the provision of institutional accommodation. They have provided an institution at Borocourt, nr. Reading, which at present accommodates about 250 adult defectives and a scheme for extension has already been approved by the Authorities concerned.
Under the Mental Treatment Act 1930 it was not necessary for the Committee to provide an out-patient Clinic since such a Clinic had been in existance at the Radcliffe Infirmary for some years. It has, however, been made a duty of the Mental Health Visitors to act as social workers for this Clinic. The Clinic is held on two afternoons a week at the General Hospital under the direction of the Superintendent of the Mental Hospital, Dr Good, who is assisted by his Deputy officer and two general practitioners who have psychiatric experience. Cases are referred by private doctors, and appointments and other arrangements are made by the Almoner’s Department of the Hospital. The Mental Health Visitors attend each session and keep in touch as far as possible with all patients from the City area both during and after treatment. The Mental Health Visitors are also required to visit the Mental Hospital once a week and to visit any patients who are likely to be discharged so that they may follow them up when they return home.
The Education Clinic for difficult or mal-adjusted children was started in 1931 by the Education Committee. The reasons for organising such a Clinic were twofold:?
(1) A number of children presenting problems either in their behaviour or in the lack of educational attainments were attending the Out-Patient Clinic at the Radcliffe Infirmary and it was felt that they could be better dealt with in a separate Clinic where facilities could be provided for treatment suitable to their age.
(2) The number of ascertained mental defectives in the elementary schools was very much under the percentage given by the findings of the Wood report and the Committee desired to have an opportunity of making a more thorough survey of the school population.
The Education Committee were anxious that the Clinic which they proposed to start should fit in to the general Mental Health scheme for the City and thev, therefore, asked for the co-operation of the Mental Health Committee in organising and running it, and agreed to contribute to the salaries of the Mental Health Visitors in return for their services as social workers to the Clinic. The School Medical Service allowed a School Clinic to be used as premises for the new enterprise. The original premises, however, were soon found to be too small and the Clinic was moved to a new house which had recently been acquired by the Council to be used in part by the Public? Health Department.
The Medical staff of the Education Clinic is under the direction of Dr. Good assisted by the same doctors who work with him at the adult Clinic at the Radcliffe Infirmary with the addition of the Deputy School Medical Officer who acts as Secretary to the Clinic and is responsible for the physical examination of all children attending there. The clerical work is assured by two clerks, one from the school medical staff and one from the staff of the Education Offices.
In connection with the Clinic, the Education Committee have a small school for nervous and difficult children. Children are admitted to this school only on the recommendation of the Medical Staff of the Clinic and the Headmistress of this school works in close co-operation with the Clinic. Children referred to the Clinic who are found to be mentally defective are examined at the Education Offices by the Notifying Officer, Dr Good, and are recommended by him for degree of defect. If, on this examination, Dr Good wishes for a further period of observation before making his diagnosis, some children are also sent for a term to the specialised school mentioned above.
As had been expected the formation of the Clinic gave the teachers an opportunity of obtaining a medical opinion on many children who had been giving them anxiety through abnormal behaviour or lack of ability to respond to education. Some of these children were found to be mentally defective and the necessity of a Special School soon became apparent. The Mental Health Committee again agreed to co-operate with the Education Committee, and the approval of the Board of Education was obtained for a class of 20 children to be held on the same premises as the Occupation Centre. These premises consisted of a former Isolation Hospital which had been acquired by the Council. The building stands in a large garden at the edge of the City boundary and is surrounded by fields.
These premises had been approved by the Board of Control as an Occupation Centre for 40 children and it was therefore agreed that the expenses should be shared by the Education Committee and the Mental Health Committee in the proportion of J/3 to 2^ for all the services which could be shared between the Occupation Centre and the Special School. The teachers of the two departments are each appointed and paid by the appropriate Committee but the gardener, carpentry instructor and the cooks are paid by the two Committees in the above mentioned proportions. A large classroom is set apart for the use of the Special school and all the equipment for teaching is provided by the Education Committee. The meals for both departments are cooked in the common kitchen and instruction in carpentry and gardening are given on separate days. The general policy of this joint enterprise has to be approved by both Committees and any additional expense for staff or accommodation is met by them in the proportions of ^ to ^3.
The Special School has now been open for more than a year and the experiment appears to be quite satisfactory. It was at first feared that the parents of the Special School children would object to their being sent to the same school as the ” silly ” children but with few exceptions no such difficulty has been met with and both the Special School and the Occupation Centre are full and, in fact, both have waiting lists.
It will be seen from the above outline of the organisation of the Mental Health services in the City that the object aimed at is to have a general scheme which will provide for the needs of all patients, children or adults, requiring advice or treatment for any mental disability. At the same timq it has’ always been kept in mind that this scheme should be sufficiently elastic to allow of its extension whenever new legislation or advances in psychiatric medicine may make such extension advisable.
The Committees concerned each carry out their own duties under the various Acts and the co-operation consists rather in general policy and in personel than in the delegation of duties. The Chairman of the Mental Healtii Committee is ex-officio a member of the Visiting Committee of the Mental Hospital, and of the Joint Board for the Mental Deficiency Institution and she is also a member of the Education Committee. The Vice-Chairman of the Mental Health Committee and several other members also serve on one or more of the other three Committees.
The Mental Health Visitors in their capacity as Petition Officers under the M.D. Act were originally classed as part of the staff of the Town Clerk’s Department. They have now been transferred to the Public Health Department for administrative purposes so that the Mental Health Committee has the benefit of the advice of the Medical Officer of Health as in all other health services and has also the help of the Chief Clerk who has brought the general policy into line with that of other similar services.
This makes for close co-operation with the School Medical Services and avoids delay in dealing with any case which may be referred to the Medical Officer of Health. The Mental Health Visitors can have immediate access to any information already available on the case in the files of the Health Visitors, School Medical Department or any other of the Public Health services.
As Social workers to the Education Clinic the Mental Health Visitors are in close contact with the School Attendance Officers. All recommendations from the Medical staff of the Education Clinic are dealt with by the School Attendance Officers and the Social workers after consultation between them. Oxford City has a population of nearly 90,000 in an area of 8,428 acres so that it is a convenient area for the provision of a central service. It is easy for the officers of all the departments to co-operate and to divide the work between them with a minimum of overlapping. It will, however, be obvious that the staff is not sufficiently large nor sufficiently specialised to deal with all the sides of the work as thoroughly as we should wish. We do feel, however, that the co-ordination of the various departments does to a certain extent counterbalance this objection, and the general organisation does not rule out the possibility of the appointment of specially trained workers for each Clinic or for the Mental Hospital, in the future. In small areas of this kind it would not be possible to obtain the consent of the Council to the appointment of large specialised staffs such as would be required for a Child Guidance Clinic, but it is possible by the gradual development of each separate service to obtain additional help when and where required by co-operation between different Committees.
From the point of view of the patients there is also a distinct advantage in this unification of staff. A whole family may be treated when necessary by the same doctor and the same social worker. For example, a child may be referred to the Education Clinic by the teacher, owing to its lack of progress in class. When the home visit is paid the social worker may find another child in the family to be suffering from night terrors or some other trouble and possibly the mother or father to be in need of psychiatric treatment. The family can then be put in touch with the same doctor at the( Education Clinic and at the Radcliffe Infirmary for the necessary treatment and they will find the same social worker at each Clinic so that they will not have to repeat the history of their difficulties to several different people. In addition to the obvious advantage to the patients this system saves a great deal of time both in visiting and in clerical work. The files of all cases are kept in one office so that when any relevant fact is obtained at one Clinic it can immediately be added to the information on the case which is being treated at the other.
It is difficult in a short article to give an accurate description of a system which has grown by gradual alterations and additions, but it is hoped that the above description will be sufficient to show that it is possible by co-ordinating the work of all the Committees for small areas to have the essentials of a full Mental Health service and to provide in some measure for the needs of all the patients in their area.
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.