The Mental Health Services in Oxford City, Oxfordshire and Berkshire
- Author:
Pinsent,
D.B.E., Hon. M. A. (Birmingham), formerly one of the Senior Commissioners of the Board of Control. Printed at the University Press, Oxford, for Barnett House. 2/-.
Mental Health workers owe Dame Ellen Pinsent a debt of gratitude for this very valuable report of an investigation undertaken for the Survey Committee of Barnett House, Oxford, for dealing as it does with an administrative progressive area like Oxford City and with the two average rural areas of Oxfordshire and Berkshire, it gives a picture of a Mental Health situation typical of that to be found in the country as a whole.
The enquiry in each area covers every aspect of the problem. Thus in Oxford City we are told of the provision made for retarded children, viz., the Educational Clinic, the Observation School, the Special M.D. School and the Backward Classes in the elementary schools; of the facilities for mental treatment at the Mental Clinic and the Mental Hospital, and of the Public Assistance Institutions’ arrangements for the defectives and the mental patients still in their care. In the section on the administration of the Mental Deficiency Acts full details are given with regard to ascertainment, statutory supervision, the Occupation Centre, Guardianship, and the Boro’ Court Colony.
Readers of an article in Mental Welfare on ” Mental Health Administration in Oxford” will remember how progressive is the scheme of the City Council under which the work is co-ordinated through a Mental Health Committee closely co-operating with the Education Authority, and Dame Ellen pays a tribute to the energy and enthusiasm which have been put into the initiation of this scheme. Even now, however, there still remain gaps ?such as the lack of adequate supervision for defective children leaving the ordinary schools and of any form of after-care for ” problem ” children, and the question of adequate co-operation between the Mental Health Committee and the Public Assistance Committee has yet to be effectively tackled. The better classification of patients in the latter’s institutions is also a question at present under consideration.
One need of the area, in particular, is stressed in this Report?that of the enlargement of the Special School to allow of proper classification and equipment and of the admission of all the defective children in the area, about 80 of whom continue to remain in the elementary schools. And yet we read that when the Oxford Education Committee recently applied for permission to go forward with a scheme the Board of Education refused to sanction it.
In her survey of the situation in Oxfordshire, where (as also in Berkshire) educational provision for defective children is nil, Dame Ellen refers again to the lack of encouragement or pressure from the Board of Education to get Education Authorities to carry out their statutory duties in this respect and she shows how this official attitude militates against the probability of any thoroughgoing ascertainment of these children. In returning to the subject at still greater length in her last chapter, she writes :? ” The harm to the community of not ascertaining training and protecting mental defectives is serious. The first line of defence, namely the ascertainment by Local Education Authorities in early life, is being omitted, and the dangerous break in continuity between 14 and 16 destroys all possibility of accurate statistics and research, in addition to neglecting the children at the time when they need most guidance. We cannot avoid the supposition that many cases of juvenile crime might have been prevented if the Board of Education had used their influence to carry out the law.”
In Oxfordshire, as in Berkshire, the work of Ascertainment, Supervision and Guardianship, is carried out by the County Health Visitors and though this method ensures regular visitation, the Report draws attention to the inherent disadvantage of its being in the hands of workers who have no specialised training in Mental Deficiency. A course of lectures on the subject is advocated as one way of getting over this difficulty. Dame Ellen’s review of the conditions in both Oxfordshire and Berkshire, reveals the difficulty of establishing in rural areas Clinics for Child Guidance and Mental Treatment, and amongst the recommendations put forward in the last chapter?based on the needs disclosed by this Survey? is that every Authority should include on its medical staff one man who is a trained and experienced psychiatrist, who should have direct access to the appropriate Committees. This appointment might, it is suggested, sometimes be made jointly by two adjacent Authorities. Such an officer would co-ordinate the Mental Health Services of his area and ensure that the same standard of diagnosis was taken by School Medical Officers, Poor Law Medical Officers and general practitioners. Incidentally, Dame Ellen points out that if such an expert diagnostician were available, the Notification of defective children leaving Elementary Schools (attended because of the lack of special provision for them) could be safely recommended to meet the present deplorable ” gap” that exists in this department of mental deficiency administration.
The Survey Committee has not yet reached its final conclusions on its investigations as a whole, but we are told that ” it is agreed that this Report is of such value that it should be made available without delay This opinion we enthusiastically endorse, and we commend the book to the notice of all who, as students, lecturers, social workers, or members of an administrative body, are directly concerned with the Mental Health problem. It should indeed be in the hands of everyone who seeks to understand the implications and obligations of citizenship. A.L.H.
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