News and Notes
Advisory Committee on Scientific and Ancillary Mental Health Services The Board of Control, with the approval of the Minister of Health, have appointed the following to be a Committee to advise upon questions arising in connection with scientific and ancillary mental health services :? The Rt. Hon. The Earl of Radnor (Chairman), Sir Laurence Brock, C.B., Sir Hubert Bond, K.B.E., D.Sc., M.D., F.R.C.P., Alderman J. W. Black, J.P., Alderman W. E. Lovsey, J.P., A. A. W. Petrie, Esq., M.D., F.R.C.P., F.R.C.S.E., D.P.M., Miss Adeline Roberts, O.B.E., J.P., M.B., B.S., Alderman J. C. Grime, O.B.E., J.P., C. J. Thomas, Esq., M.R.C.S., L.R.C.P., I).P.M., George Somerville, Esq., M.D., Cli.B., D.P.M., H. J. Clarke (Secretary).
A Committee was appointed in 1931, but owing to the financial crisis which occurred in that year, its work remained in abeyance.
The Mental Treatment Act, 1930, empowered local authorities to provide for out-patient treatment and for the after-care of mental patients, and, subject to the approval of the Board of Control, to undertake, or contribute towards the expenses of, research in relation to mental illness.
The primary function of the Advisory Committee will be to advise the Board of Control regarding organisation and encouragement of research, and other ancillary services will be within its purview. On technical questions relating to research, the Committee will have the expert assistance of members of the Committee on Mental Disorders of the Medical Research Council.
Royal Eastern Counties Institution
Dr F. Douglas Turner informs us that important developments are taking place in the Royal Eastern Counties’ Institution Research Department, under the direction of Dr Penrose, to which we are glad to call attention.
The Rockefeller Foundation has agreed to give a grant of ?700 towards the equipment of the new Laboratory, and an additional ?600 a year for five years towards the cost of the Research Department, in order that additional assistance may be employed. Increased grants are also being received from the Medical Research Council.
In future, the total annual expenditure on Research in connection with the Institution will be at the rate of nearly ?3,600 a year, made up by grants from the Medical Research Council, the Rockefeller Foundation, the Darwin Trustees, a Beit Memorial Fellowship, and a Pinsent-Darwin Studentship, added to which the Directors of the Institution pay about ?700 a year.
The Staff, under Dr Penrose, will in future consist of at least seven members, including Dr Munro, Dr Nevin (part time), Mr. Raven and Miss Newlyn.
New Laboratories and Offices are at present being built, at a cost of over ?4,000, towards which the Hon. Alexandrina Peckover has given ?2,200.
Mental Health Administration in Scotland
The General Board of Control for Scotland, in its 1936 Report, calls attention to the need for increased provision (other than that made in Observation Wards in such progressive areas as Glasgow, Dundee and the Burgh of Paisley) for the early treatment of mental illness and to the desirability of legislation enabling Local Authorities to provide Clinics with in-patient and out-patient departments. The Board agrees with those critics of the Scottish Lunacy Laws who urge their amendment and would particularly welcome the abolition of the use of the terms ” lunatic,” ” lunatic asylum” and “pauper lunatic.”
In a section of the Report dealing with the medical staffing of Asylums in Scotland, the need for reform is also indicated. The Board states that, generally speaking, the Asylums are medically understaffed ? the number of patients admitted per Assistant Medical Officer varies from 28 to 129?with the result that it is impossible for the necessary investigation into new cases to be undertaken and for full case records to be kept. The medical staff of the Asylums are too often overburdened with routine duties and the service offers little inducement to first-class recruits, however keen may be their interest in psychiatry. Moreover, it is pointed out, an additional burden is thrown on Medical Superintendents of Asylums where officials such as Clerks of Works, Stewards, Farm Managers and Dispensers?to whom responsibilities can be delegated?are not appointed. The need of trained psychiatric social workers is also indicated. Staffing adequate enough not only to allow proper individual treatment of patients?particularly of those newly admitted?but also to meet the needs of early cases of mental disorder coming for advice to Clinics, and Observation Wards in the vicinity of the Mental Hospitals, is regarded by the Board as the ideal to be attained if the Mental Health Services in Scotland are to take their rightful position in Public Health.
Every mental patient and mental defective in Scotland, whose maintenance is contributed to from public sources, is under the direct supervision of the central authority, and the section of this Report on “Patients in Private Dwellings” is particularly interesting.
There were in private dwellings on January 1st, 1937, in the care of guardians related or unrelated (separate statistics for the two categories are unfortunately not given), 1,141 “pauper lunatics” and 1,470 mental defectives. The following extracts are taken from the reports of the Deputy Commissioners on their visiting of these cases :?
” Good use is made of the farms and crofts of Arran for boarding out male patients. It is interesting to learn how little objection is taken to this by summer visitors who are often very good to the patients, and in some cases give great pleasure by remembering them at Christmas with cards or presents.”
” The patience shown by unrelated guardians towards old patients who have been with them for years is striking. Guardians are often unwilling to part with them even when they could have younger and more useful patients instead. One guardian of 78, referring to her patient, who is now over 80 and very frail and who has been with her for 30 years, said, ‘ I don’t know what I’d do without her. She’s my companion and friend.’”
” A feature of the boarding-out system which rehabilitation engenders, is the renewal of hope, especially in the minds of those patients who have spent a considerable time in Mental Hospitals or in Institutions for mental defectives. Above all, they take their share in the normal routine of workaday family and social life, their horizon is widened and brightened, and there is an awakening and cultivation of the social attributes of life, an appreciation of its pleasures and privileges, and a realisation of its responsibilities.”
In addition to the 1,470 registered defectives in private dwellings, there were on January 1st, 1937, 3,077 in Certified Institutions, and 17 in the State Institution. This represents an increase of 120 in Institutions and of 30 in private dwellings.*
Child Guidance Council
In its Report for 1936, the Child Guidance Council refers to the paramount importance of securing that Clinics are staffed only by trained workers and that their number does not grow so quickly that it overtakes the number of such workers available. The Council is therefore curbing its general publicity propaganda and concentrating chiefly on specialised activities.
The Foreword to the Annual Report for 1936, emphasises the value of the close linking-up of Clinics with the existing educational and medical services, foreshadowing a time “when a routine of psychological study is recognised to * Twenty-Third Animal Report of the General Board of Control for Scotland for the Year 1936. H.M. Stationery Office, lj. 3d.
be as necessary a part of every community and educational system as medical inspection.” It notes the increasing efficiency of the existing Clinics?as experience is gradually acquired?in accuracy of diagnosis and methods of treatment, but at the same time points out two dangers that must be avoided if the movement is to develop along sound iines. First there is the temptation, in appealing lor public support, to make exaggerated claims for Child Guidance as a panacea; second, there is the risk of keeping it in a water-tight compartment and failing to see it “in its proper perspective as a small part of a wider movement for the amelioration of human problems.”
Useful work has been achieved by the Council during the year under review, particularly in the realm of Lecture Courses in Teachers’ Training Colleges and to workers in Children’s Homes, and by means of three Residential Courses. A special training course was also arranged for the workers appointed to be in charge of two houses for nervous and difficult children newly opened by the National Children’s Homes organisation. The course lasted three months and examination papers were set at the end of it.
The Inter-Clinic Committee, consisting of representatives of the various Clinics proposed at the 1935 Inter-Clinic Conference, met regularly throughout the year, and carried on much useful work, in which the Scottish Child Guidance Council has co-operated. This Committee is responsible for a pamphlet ” Some Suggestions for a Clinic Play Room ” published at 2d. A List of the Clinics represented on the Council is a useful feature of the Report giving, as it does, the address of Clinics in 21 areas of England and Wales and in seven Scottish areas.
For copies of the Report apply to the Secretary of the Child Guidance Council, Upper Woburn House, Upper Woburn Place, W.C.I. A very interesting report of the Proceedings of the Third P>iennial Child Guidance Conference held in London on 29th January, 1937, can also be obtained from the Council, price 5/-.
Runwell Mental Hospital
On June 14th the Minister of Health, Sir Kingsley Wood, officially opened this new Mental Hospital in Essex, which has been provided jointly by the County Boroughs of East Ham and Southend-on-Sea.
The Hospital?under the direction of Dr Rolf Strom-Olsen, whose paper on the value of physical education in mental illness read at the Public Health Congress last year we published in our January issue?is planned on the most modern lines, allowing for a complete system of classification. It includes a separate admission hospital, four research laboratories, a general library and a recreation hall with gymnastic apparatus. A new feature is a detached ” closed unit” for 60 male and 100 female patients for whom seclusion is necessary, and?at the other end of the scale?two detached villas for voluntary patients suffering from the milder forms of mental disease, and three parole units for patients capable of enjoying a larger measure of freedom. Ample provision is made for occupational therapy of all types.
units. The Hospital will accommodate 1,010 patients, divided into 25 to 30 separate International Congresses in Paris During July, three International Congresses of interest to Mental Welfare Workers are taking place in Paris.
The Second International Congress on Mental Hygiene will be held from July 19th to July 24th, when papers are to be given on every aspect of the Mental Hygiene Movement by experts gathered together from all parts of the world.
Immediately following on this Congress comes one on Child Psychiatry? the first of its kind to be held?which will last from July 24th to August 1st. During this period also, the International Eugenics Congress meets?on July 24th and 25th?and is to discuss, amongst other subjects, the heredity of cancer and epilepsy.
C.A.M.W. Training Courses
July is also a month of great activity in the C.A.M.W’s. Educational Department, which at this time of year is responsible for four Courses proceeding simultaneously.
The Long (Nine Weeks) Course for Teachers of Retarded Children?this year attended by the maximum number yet reached, viz., 63?comes to an end on July 23rd, while the Board of Education Short Course (Advanced) attended by 60 teachers covers the period July 5th to 24th.
In addition, a Three Weeks’ Course, divided into two sections for Occupation Centre Supervisors and members of Institution Staffs, and for Mental Deficiency Officers of Local Authorities, began on July 5th and ends on July 24th?accounting for another 39 students.
At the end of these Courses there is a short interval until on August 26th begins the Board of Education’s Elementary Short Course for Teachers to be held this year in Leeds. Another record is being broken in this connection, in that the number of students accepted for the Course is 120, whilst a further 142 have had to be rejected for lack of room.
Recent Home Teaching Schemes Stafford.
In the Seventeenth Annual Report of the Staffordshire Mental Welfare Association, recently published, there is an interesting account of a Home Teaching Scheme begun last June in the Cheadle area.
The Home Teacher has 33 names on her list and pays an average of 5 visits a day.
As is always the case in this held of work, the efforts made have amply justified themselves. We read in the Report of the happiness and increased fullness of life which ” Home Teaching” has brought into the households to which it has been taken :
” In a few instances where the children did not want to be taught when first visited, now on the appointed day they are afraid to go from home or out to play in case the teacher should arrive and they not be there to welcome her. One also notes the interest of other members of the family.”
and in summing up the experience gained during the first few months of the scheme, the Executive Committee states :
” We feel that this system of training is going to be far reaching in its results; apart from the actual teaching, the teacher is able to adjust the attitude of other members of the family to the defective, to advise the parents in ways of personal health and general routine and secure for the defective that thought and consideration so often denied him through lack of understanding and which, because of the very nature of his mental condition, should be his birthright.” Devon.
A further proof of the value of Home Teaching comes from Devon, where an additional grant has just been made to the Voluntary Association by the County Council, for the purpose of appointing a second teacher. IV arwickshire.
The Warwickshire Mental Deficiency Committee have recently instituted an experimental Home Teaching scheme for six months, in the Warwick and Leamington areas. A generous offer of voluntary work in this direction for three days a week has been accepted by the Committee, and at the end of the experimental period the whole position is to be reviewed.
Oldham Council for Mental Health
From Miss Elizabeth Martland, Hon. Secretary of this Council, ice have received the following account of its progress:
There are hopeful signs of increasing interest in the welfare of the mentally sick. Reports come in from all sides concerning the need for adequate accommodation for cases of nervous breakdown, mental defect, mental disease and those borderline patients for whom there seems to be no suitable provision. It is painfully evident that few citizens understand where and how advice may be sought, and it would seem that some sort of centre or clearing-house for their assistance should be available in every town. Members of the Oldham Council for Mental Health are doing their utmost to direct to the proper quarter all cases appealing for help, but the lack of sufficient accommodation for cases of various types is a great obstacle, and every effort is being made meanwhile to bring about a better state of affairs.
Educational work proceeds apace. With the help of the National Council for Mental Hygiene, a course of four Lectures was arranged during the spring. Dr Murdo Mackenzie read a witty and stimulating paper on ” Mental Life and the Community”; Dr Larkin, of West Ham Mental Hospital, followed with an extremely instructive and illuminating address on ” Mental Disease and Mental Defect”; the third Lecture on “Child Guidance,” delivered by Dr MacCalman, was one of the most delightful and practical imaginable, giving special pleasure to the many teachers present; and the fourth, on ” Functional Nervous Disorder” by Dr J. Burnett Rae was most deeply appreciated on account of its philosophic tone and the many and profound problems touched upon.
During the summer, expeditions to places of interest in mental welfare work, such as special schools and colonies for mental defectives, have been arranged. Further information about the Council, which is affiliated to the National Council for Mental Hygiene, may be obtained from Miss Martland, Lyndhurst, Queens Road, Oldham.
Psychotherapy in Prison
In the Report of the Commissioners of Prisons and the Directors of Convict Prisons for 1935,* Dr Norwood East, Medical Commissioner, devotes considerable attention to the subject of the psychological treatment of prisoners. With the publication of this Report, three out of the four years’ programme for such a scheme of treatment were completed and although the time has not yet come for a full report a few facts which have already emerged from it are here recorded.
Dr East deplores the still too frequent practice of Justices in asking for a report on the mental condition of a prisoner after conviction and not before, despite the Home Office Circular of 20th April, 1934, urging that this factor shall be taken into account when passing sentence. Moreover, in few prisons, is the medical officer supplied with reports of the life histories of prisoners committed on remand, and thus it may be that in some cases “the key to the whole problem is withheld from the knowledge of the Medical Officer.” These factors in the present situation delay the advance which otherwise might be made in a more scientific approach to criminal problems.
The cases found to be most suitable for psychological investigation and treatment are youths and men under 40 who are likely to co-operate and who are sentenced preferably to not less than 6 months’ imprisonment “for various sex and other offences which from their nature and circumstances, suggest some mental abnormality as a causal factor.” To these are added certain cases of adolescent delinquents of good intelligence.
The practice by which certain Courts postpone sentence until a report on the prisoner’s suitability for psychological treatment is forthcoming inevitably results, Dr East reports, in hostility to such treatment, for sentence of imprisonment appears to be the direct result of medical evidence. Equally undesirable, he points out, is the substitution of medical treatment for imprisonment in cases that are often quite unsuitable where if the consequences of misconduct are evaded, no useful purpose can be served by treatment given in their place. It has been found, further, that some prisoners who appear at first to be suitable subjects for treatment, fail to respond to it because their “anti-social behaviour is found to be fundamentally a demonstration of personality traits which are inherent or so firmly established as to be immovable.” The most hopeful cases so far have been “those in whom environmental circumstances have influenced a personality already predisposed to react to accidental effects.”
In many cases of criminal behaviour, however, Dr East notes that the chief factor concerned is membership of a group and in some cases, change of environment may be more useful than prolonged psychological treatment. He concludes his observations by a note of warning. It is, he contends, a mistake to regard all criminals as neurotics and he deprecates the modern tendency to identify self-control and self-restraint with “repression,” an attitude which tends to encourage anti-social conduct by admonitions to “self-expression” in sex and other matters. Psychological investigation, he writes, may explain criminal conduct but are not intended to excuse it.
The importance of adequate training in those who practice psychotherapy is emphasised and the complexity of the task confronting Medical Officers of prisons is illustrated by a table giving a ” Mental Classification of Criminals.” * H. M. Stationery Officet 2s.
Some Sfatistics. During 1935, 39 prisoners were certified as Mentally Defective (compared with 26 in 1934), of whom 37 were removed to Certified Institutions under Section 9 of the Mental Deficiency Act, 1913. Under Section 8, 214 defectives coming before the Courts were dealt with (1934 : 222). In the Borstal Institutions, 6 youths and 3 girls were certified under the Acts.
2,703 men and women were remanded to prison for observation and reports to the Court on their mental condition, and 97 were certified as insane. In addition, 251 remand prisoners were found by Medical Officers to be insane and were dealt with by the Courts, 20 were found by juries to be insane on arraignment, and 23 were found guilty but insane.
Delinquency and Dullness The Governor of Feltham Borstal Institution, reporting to the Prison Commissioners on the work in 1935, states that in most of the cases allocated to him, “the root cause of delinquency is poor mental capacity or inferiority personality.” This has been borne out by the results of tests administered on reception to 259 lads, their average score (Columbian Test) being 47 per cent. The average Mental Age of a group of 116 lads (with an average chronological age of nearly 18) tested by the Terman method was found to be 10 and 7/12 years.
Despite this unpromising material, however the Governor is able to report that in all except a very few cases, Borstal training is able to effect in the lads undergoing it “a clear improvement in character, alertness and energy.” “If we have taught him humility without depressing him and if life outside is fairly kind to him, he may and usually does continue to lead an honest and fairly useful life after discharge.”..” .. It says a good deal both for after-care and modern social legislation that so many of our dullards succeed in remaining honest.”*
The problem of illiteracy?ever present at Feltham?was seriously tackled during the year under review. Additional classes in reading, writing and arithmetic were organised and special attention was given to certain obdurate cases which were made to do a morning’s work in reading and writing in addition to attendance at the ordinary classes in these subjects; as a result before their discharge they succeeded in gaining some elementary ability in them. The Governor, in referring to the usually accepted belief that dull children must not be expected to concentrate for long at a time, refers to this experience which has led him to feel that “the weaker the powers of concentration, the less the risk of overstrain and that backward lads must learn by saturation rather than by repeated injections.”
A disquieting fact revealed by the Governor in this Report is that during 1935, nearly 16 per cent, of the lads admitted to Feltham had previously received one or more sentences of imprisonment; the figure had previously never exceeded 10 per cent.
Statistical returns made by the Borstal Association show that of the numbers discharged
from all the six Borstal Institutions for boys between 1932 and 1934, 57.9 per cent, had not, up to the end of 1936, been re-convicted, and 22.6 per cent, had been re-convicted only once in periods varying from two to five years after discharge.
Information Service for Research Workers in Human Genetics We are asked by the Bureau of Human- Heredity, 115 Gower Street, London, W.C.I, to publish the following information:
One activity contemplated in setting up the Clearing-House for Human Heredity is the organization of information service for research workers in the subject. The value of such a plan has been demonstrated in the information service already established for workers on Drosophila, etc. It should be noted that apart from convenience of ascertaining easily centres at which comparable work is going on, the circulation of notice by those engaged in a particular enquiry of their work is a safeguard in dating priority?a point to which it is natural to attach some importance.
Workers are requested to address to the Bureau a short paragraph describing the work on which they are engaged. These notices will be multiplied and circulated to all those co-operating. In the first instance this bulletin will be issued every twelve months. Later supplementary bulletins will be issued more frequently. Those using this service are asked to subscribe 5s., a sum equalling approximately one quarter of a pound sterling equivalent in the currency of their country.
The accepted languages are : French, German, English. The Tavistock Clinic, 1936 In his Report of the work of the Institute of Medical Psychology for 1936, the Chairman (Sir Henry Brackenbury) records the reversion to its old name, made necessary by the growing use of the newer name by other bodies and the confusion arising therefrom.
Unfortunately it has not been found possible to proceed with the erection of the new In-Patient Hospital on the site acquired, owing to lack of the necessary financial support, and unless this is forthcoming, the drastic curtailment of the existing work?despite its urgent need?is foreshadowed. The need is made strikingly apparent in the Report of the Medical Director (Dr J. R. Rees), when he says (italics are ours.) :
” There has been a decrease of 114 in the number of new patients seen during the year. This is due primarily to the fact that the waiting list has been closed for the greater part of the time under review.”
Particularly is there pointed out the urgency of adequately providing for the treatment of adult patients suffering from the psychoneuroses to which it is now generally recognised by doctors that at least one third of all sickness belongs. The value of the special facilities offered by the Clinic in training medical practitioners in psychiatry is also stressed, and an account of its work in this direction is given by the Director of Studies (Dr J. A. Hadfield).
The Report contains interesting sections on the various branches of the Clinic’s work?the In-Patient Department at 12 Endsleigh Street to which 37 patients were admitted during the year; the Childrens’ Department with its 4,574 attendances; the Educational Psychologist’s Department in which 424 intelligence tests were administered; the Social Service Department with its many and sometimes insoluble problems, particularly those connected with employment and living conditions during treatment.
Copies of the Report can be obtained from the Tavistock Clinic, Malet Place, London, W.C.I. * Total number of nciv patients treated in 1936: Adults, 741; Children, 351.
North-Eastern Council for Mental Welfare*
In March, 1935, the Committee of this Council was constituted, under the chairmanship of Alderman W. Locke, Lord Mayor of Newcastle, to institute ?with the co-operation and financial help of the C.A.M.W.?a scheme of Guardianship work for defectives and of social work for Mental Hospitals in the area. The Committee was a representative one, consisting of members of the Local Authorities of Darlington, Durham County, Middlesborough, Newcastle-on-Tyne, Sunderland, and Gateshead?all of whom agreed to participate in the scheme for an experimental year and to contribute to its expenses on a basis apportioned according to rateable value. This First Annual Report is an interesting record of the work achieved by Miss Crosse and Miss Williams, the two C.A.M.W. officers responsible for it, and by Miss Cullen, the C.A.M.W. organiser who helped in its initiation. During the year, 43 cases of mentally defective patients have been referred by Local Authorities for placing under guardianship, 24 of whom were placed, whilst arrangements for others were in process of completion at the time of writing the Report. In addition psychiatric social work was carried out for two of the Mental Hospitals in the area?(Newcastle and Gateshead). To the value of this work a generous tribute was paid at the first Annual Meeting held recently, by Dr Bamford, Medical Superintendent of the Gateshead Mental Hospital. At the end of this experimental year, the C.A.M.W. has agreed to continue a financial contribution for a second year, and two further Local Authorities (Tynemouth and West Hartlepool) have come into the scheme, which is henceforth to be known under the title of the North Eastern Council for Mental Welfare.
Dame Ellen Pinsent
Many readers of Mental Welfare will remember Mrs. Pinsent when she was a Commissioner of the Board of Control and will wish to join in congratulating her on the occasion of her being made a Dame Commander of the British Empire. Dame Ellen has devoted a large part of her life to work for defectives, and was a member of the Royal Commission on the Care and Control of the Feebleminded which sat from 1904 to 1909. She was an Honorary Commissioner of the Board of Control from 1913 to 1920, a Commissioner from 1921 to 1930, and Senior Commissioner from January, 1931, till her retirement in July, 1932, and on the Joint Committee on Mental Deficiency she represented the Board from 1924 to 1929. Although she has retired from official duties, her Report on the Mental Health Services in Oxford, Oxfordshire and Berkshire, a review of which is to be found on page is an indication that she is by no means at an end of her active life.
An outstanding service was rendered by Dame Ellen to Research when in 1924, she joined with Sir Horace and Lady Darwin in offering a sum of ?5,000 to the University of Cambridge for the purpose of promoting research ” by studentship or otherwise, into any problem having a bearing on mental defect, disease or disorder.”
Address: 22 Ellison Place, Neu*castle-upon-Tyiie, 1.
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