Year’s Course for Supervisors and Home Teachers
It will be remembered that this year, from January to July, the C.A.M.W. held a Six Months’ Training Course for Supervisors of Occupation Centres and for Home Teachers. Eight students enrolled, all of whom reached the standard required, and those who were not already in posts to which they returned, secured work in Occupation Centres at the end of the Course. A Diploma will be awarded on the completion of a year’s subsequent experience. The Council of the C.A.M.W. considered the result of this experimental Course to be so successful that they decided to extend and develop it and a representative Committee has been appointed to deal with all matters affecting Occupation Centres and to be responsible for the arrangement of Training Courses for the work.
The new Course is to cover a minimum period of three terms. The first two terms will be spent in Occupation Centres approved by the Council for purposes of training, except in the case of students who can produce evidence to show that they have received training equivalent in content and duration in an Institution or Home for mental defectives. The third term will be spent in London (non-resident), and will consist of advanced theoretical and specialised practical work.
Applicants for the Course must give evidence of education up to a Secondary School standard, of some musical ability and aptitude for handcrafts, and of previous experience in the handling of young children. In addition, they must show that they have?or will have by October, 1939?when the theoretical period of training is to begin?practical experience and preliminary training consisting of (a) two terms’ work in an Occupation Centre recognised for the purpose of the Course as a Training Centre, or (b) experience and training equivalent in duration and content to that given in an approved Training Centre.
Students who complete the Course satisfactorily will be eligible to sit for the written examination for the Diploma which will be issued under the authority of the C.A.M.W. and will be awarded by a selected body of Examiners. There will also be a practical examination. The fee for the full Course, including the Diploma examination, will be Ten Guineas, and applications should be received not later than November 30th, 1938, on forms to be obtained from the C.A.M.W., 24 Buckingham Palace Road, S.W.I.
The C.A.M.W. Meetings at Public Health Services Congress
Two meetings are being arranged by the C.A.M.W., at the Public Health Services Congress to be held at the Royal Agricultural Hall, Islington, London, in November, 1938.
The meetings will take place on Friday afternoon, November 18th, and on Saturday morning, November 19th.
At the first meeting, with Sir Laurence Brock, Chairman of the Board of Control, in the Chair, the subject for discussion will be: “The Relative Functions of the Occupation Centre and the Mental Deficiency Colony in the Training of Defectives.” The discussion will be opened by Dr C. J. Earl (Caterham Mental Hospital) and Mrs. Anderson (C.A.M.W.).
The C.A.M.W. hopes to hold its own Congress in February, 1939, and notice of this will
be sent to any reader of Mental Welfare who desires to receive it.
The subject for the second meeting’ is to be ” Some Problems in connection with the Education and Notification of Mentally Defective Children,” and the chief speaker will be Dr Henry Herd, School Medical Officer, Manchester. Full particulars, and admission card, can be obtained from the C.A.M.W., 24 Buckingham Palace Road, S.W.I.
L.C.C. An Enquiry into the Working of the Mental Treatment Act At St. Ebba’s Hospital, Epsom?one of the Mental Hospitals under the control of the London County Council?1,051 patients have been treated under Section 1 of the Mental Treatment Act during the past seven years. It was therefore considered that enough experience had been acquired to justify an investigation into results, and in a recent number of the British Medical Journal an informative article on this subject was published.*
The enquiry was concerned with the first 500 direct admissions under the Act received at the Hospital, the majority coming from Observation Wards, the Maudsley Out-Patient Department and other L.C.C. Psychiatric Clinics. The first fact that emerged was that in-patient treatment is far too frequently delayed. In only 183 out of the 500 cases had the illness lasted six months or less; in 79 cases it had lasted between six and twelve months; in 88 between one and two years, and in 150 over two years.
With regard to the patients’ mental condition, it was found that 341 were certifiable and but for the existence of the Mental Treatment Act could only have been treated if certified. About two-fifths of the patients left hospital in the first three months although in the great majority of cases it is considered that at least twice that length of stay would have been advisable if definite stability was to be established. At the time of departure, 171 out of the 372 had completely recovered, most of the 62 ” improved ” would ultimately have recovered had a longer period of treatment been accepted, and 139 left ” unimproved”. 250 patients left with full medical approval, while 122 left against medical advice. The destination of 298 of the 372 patients leaving, was home, and of these only three later committed suicide. 55 of the cases discharging themselves against advice had to be sent to observation wards for certification and five were certified in the hospital owing to special circumstances.
A “follow-up” of all the 500 cases discharged, revealed that 112 of them had remained quite well and re-established themselves in their home environment, and 37 had proved to be static or relapsing. Only 89 had been admitted to mental hospitals (including the 55 sent for certification to observation wards). In summing up, the investigators point out that it is obvious from their findings that :
“if Section I of the Mental Treatment Act is worked to its fullest advantage, only a small proportion of certifiable patients ever need certification, although considerable time is necessary to persuade patients in the first place to accept treatment, and, secondly, in many cases to dissuade them from leaving hospital prematurely.” The enquiry has, they state, also disclosed the need of the establishment of earlier contact with patients by medical officers of the mental hospital service, as the delay in procuring early in-patient treatment in too many cases frustrates the hopes that accompanied the passing of the Act.
By L. H. Wootton, M.C., M.B., D.P.M., Mcdical Supt., St. Ebba’s Hospital, and Louis
]iinski, M.D., M.R.C.P., D.P.M., Deputy Medical Supt. British Mcdical Journal, 16.7.38. international Medical Congress for Psychotherapy The Tenth International Congress held in Oxford, from July 29th to August 2nd, 1938, was presided over by Prof. C. G. Jung. Last year, the Congress was held in Copenhagen, and in previous years in various towns in Germany. This is the first time that the Congress has taken place in an English-speaking country.
The subjects discussed included Childhood Problems, Problems of Adolescence and of the Mature Personality, Psychosomatic Problems, and Problems of Psychology and Religion.
Prof. Jung, dealing with the difference between the two halves of a life period, drew attention to the special needs of the individual over 40, needs which the great religions sought to meet. Where, he asked, were the schools for adults to teach them about this second half of life for lack of which teaching they might become neurotic or psychotic? Religious experience, he maintained, was as valid as any other experience.
“It was a world-wide and universal phenomenon. If anyone did not know what religious, experience was, he was not normal; it meant that he did not recognise his own religious experience and some other part of life was exaggerated by that amount of energy which should go into religious experience. It was an insanity of the white man that he had lost the religious order of life.”
It was with these words, he said, that he wished to close the Congress.*
Treatment of Schizophrenia
In the Annual Report of the Physician Superintendent of Crichton Royal Institution, Dumfries, there is an interesting comment on the hypoglycaemic ” shock ” treatment of Schizophrenia of which increasing use is being made. Likening the fear felt by the patient after an injection of cardiazol to that induced by the long abandoned devices of the surprise bath and the swinging bed,?a fear which it was the object of these discarded treatments to produce? Dr McCowan writes :?
” There can be no question that our primary aim must be the cure of our patients, and there can be no doubt that the above methods are curative in certain cases, but particularly when a treatment appears to transgress our guidingprinciples, we must be careful not to claim it as a great advance in therapeutics while the possibility remains that it may merely be a refinement of remedies discarded a century ago. Such cures show that there is a door into the mysterious precincts of schizophrenia. Our task is to find and fit the key to that door, instead of as at present smashing in the door to gain admittance. Such treatments may contain the clue, but if so, it still evades us. It has been found that kindness and individual attention are preferable to fear in the education of the young, and this psychological lesson is equally important in psychiatry. We must not transgress the constitutional principle in our psychiatric practice, and unless treatment by hypoglycaemic shock and cardiazol are ultimately shown to be in accordance with this principle, their present popularity is likely to be short-lived.’ * “The Lancet”, 6.8.38.
The British Medical Journal of 2nd July, 1938, contained a Memorandum on the results of the treatment in the Hatton Mental Hospital, Warwick, where, since June, 1937, it has been completed in 59 cases. The general conclusions arrived at by the Medical Superintendent (Dr D. N. Parfitt) and his assistant (Dr Gillman) are that by the use of the treatment the period in hospital is roughly halved, that it shows a slight superiority in the percentage of cures when compared with other methods, and that these advantages justify its continued use.
Middlesbrough’s New Mental Treatment Centre
A Mental Treatment Centre for the reception of in-patients under the Mental Treatment Act has been opened in Middlesbrough. The Centre (Berwick House) is an annexe of the Mental Hospital, but it has a separate means of approach and is to be worked as an independent unit.
Careful arrangements have been made for adequate classification and up-to-date facilities for treatment have been provided.
In opening the Centre, Sir Hubert Bond, Senior Commissioner of the Board of Control, said that he hoped by means of it that the number of ” temporary ” patients admitted to the Hospital under the Mental Treatment Act might reach 12 per cent, or 15 per cent., and the number of ” voluntary ” admissions might growT to 50 per cent, or 60 per cent.
New Special School at South Shields
It is good news that the South Shields Education Committee have recently opened a Day Special School for 100 mentally defective children. The premises were previously occupied by the High School for Boys and extensive alterations were carried out to adapt the building to the necessary requirements for its new purpose.
There are three large classrooms, each accommodating 25 children, practical instruction room, domestic science centre, woodwork and boot-repairing room, medical inspection room, dining hall, shower baths, cloakrooms, etc. The school is situated in a residential area in the centre of the town, and a portion of land is being reserved for the making of school gardens. Free transport facilities are being allowed, where necessary.
Birmingham After-Care Committee
The current Report of the Birmingham Special Schools After-Care Committee gives a wealth of statistics with regard to defectives who have left school since 1901?the total number of cases recorded being 6,914, including 1,095 who have been lost sight of, and 404 who have died.
Throughout the year under review the engineering industry in the area has been in a thriving condition, and much semi-skilled factory work of all tvpes has been available. This accounts to a considerable extent for the fact that 2,434 ex-Special School children (1,552 males and 882 females) were in emplovment, the average wage for males being 27/5d. to 29/-, and for females 20/6d.”to 21/10d.
There are in Institutions, 971 cases, being a proportion of 20% of the total number of school leavers since 1901, as compared with the 57% recorded above as doing remunerative work.
For the past twelve years the Committee have kept records of the family histories of Birmingham ex-Special School pupils known to have married or to have had children. The records now show that 1,953 children have been born into 876 families; in 869 of these, either the father or the mother was mentally defective, and in 7 both parents were defective. This latter group was responsible for 21 children, of whom 3 died. At the time of compiling the Report, 23 children in attendance at the Special Schools had one or other parent who was also a pupil.
The After-Care Committee is now responsible for two whole day Occupation Centres and one half-dav one, the total number of children in attendance being 87. In addition, 26 children are being taught at home by the Committee’s Home Teachers, and in one district a small group of these children meets once a week in the Community Hall and is thus able to enjov physical exercises and country dancing.
Mental Deficiency Reorganisation in Derbyshire
The County Medical Officer of Health for Derbyshire (Dr V. M. Ash), in his Annual Report for 1937 recently issued, records a complete administrative reorganisation of the Mental Deficiency work in the area.
A Mental Deficiency Officer and three Inquiry Officers (two men and one woman) have been appointed to do the statutory work formerly carried out by the Health Visiting staff, with the result that the number of home visits has increased from 2,500 to nearly 10,000. The ascertainment rate has consequently risen by .39 per 1,000.
Feeble-minded children between 14 and 16 are, on leaving school, placed under the supervision of the Assistant School Medical Officers. On reaching 16, each case is given careful consideration with a view to deciding whether it should be dealt with under the Mental Deficiency Act, or whether it can safely be left under the voluntary supervision of the Health Visitors acting as ” follow-up School Nurses.”
Tavistock Clinic Lecture Courses, 1938-39
The Syllabus of Lectures to be given during the coming session at the Tavistock Clinic (London) includes a Course of Eight 1’ublic Lectures on ” The Principles of Mental Health ” by Dr J. A. Hadfield, Director of Studies, to be held on Tuesdays at 6 p.m., beginning on October 11th, 1938, at a fee of One Guinea for the Course, or 3/6 per single lecture. A Course of ten Discussions for Magistrates and members of the legal profession will be given weekly in the New Year, beginning on January 31st.
Other Courses will be given on ” Mental Health in Childhood “, ” Elementary Mental Testing”, Advanced Mental Testing”; a course on ” The hirst Ten Years of Life” by Professor Charlotte l.uhler is announced to take place early in 1939.
Courses for Psychologists and for Medical Practitioners extending over three University Terms also begin in October.
Particulars and further information can be obtained from the Educational Secretary, Tavistock Clinic, Malet Place, London, W.C.I.
Domiciliary Assistance to Defectives
In the Annual Report on the administration of the Mental Deficiency Acts in Sheffield, there is an interesting section on the payment of ” Domiciliary Assistance grants ” in accordance with a scheme adopted by the City Council under Section 5 (1) of the Local Government Act, 1929, providing “that all assistance to necessitous persons shall be provided exclusively by virtue of the Act or Acts under the heading of which tin* Service is set out, and not by way of Poor Relief.”
There were, on March 31st, 1938, 275 defectives in receipt of such grants, of which number, 268 were under Statutory Supervision, 5 were on licence from Institutions, and 2 were under Guardianship. The aggregate weekly expenditure for this purpose (?142 16s. 2d.) is reckoned as a part of the cost of the Mental Deficiency Service. The scale of payment was revised three times during the year and on the last occasion a 5 per cent, increase was given to meet the increased cost of living. The average weekly expenditure per head works out at 10s 4.6d The allowance is collected each week, in the majority of cases, by a member of the defective’s family, sometimes by the defective himself, and the opportunity of close contact with the staff which this ensures is considered to be in itself of definite value.
Cheltenham Occupation Centre
IV c arc indebted to Miss Marion IVhytc, Social Worker at the Cheltenham and County Child Guidance Clinic, for the following note on recent developments in local mental zvclfare work.?En.
This centre began in June, 1936, with two children, ages 12 and 13, excluded from a senior school on grounds of imbecility. Mrs. Olive Weaver kindly undertook to ” occupy ” them once weekly in a room of an old school. Their parents were full of appreciation. Other children began attending until there are now five to six in regular attendance, and twelve to fourteen in all have been on the register from time to time. Public interest has gradually been aroused in this work?(a) by inviting visitors to see what is done?visitors from the local branch of the National Council of Women, and from the Town Council, (b) by a small exhibit of hand-work on the Mental Hygiene Stall at the Health Exhibition some months ago, (c) by an address to the Theosophical Order of Service by Miss Mary Kay, Headmistress, Red Cross Street Special School, Bristol?on ‘ The Defective Child (d) by an address from Mrs Anne Anderson, C.A.M.W. Organiser of Occupation Centres.
This last was under the auspices of the National Council of Women who framed the following resolution and sent it to the Clerk to the Mental Deficiency Committee?” In the opinion of this meeting, it is desirable that a voluntary association for mental zvclfare be established in Gloucestershire to facilitate work for the mental defectives in the County and that the Central Association for Mental Welfare be invited to co-operate in the formation of such an association. The Cheltenham Occupation Centre has lost its very good friend, Mrs. Olive Weaver, but has been fortunate in being sponsored by Mrs. Court and Miss Irene: Wright. It will shortly meet twice weekly and we hope before long it may become part of a Gloucestershire Voluntary Mental Welfare Scheme.
The Adolescent Defective
In a Report on the work of the Keller Institute, Denmark, for the four years 1934 to 1938, the Medical Superintendent, Dr Wildenskov, draws attention to the special needs of the feeble-minded adolescent.
In view of the instability so frequently manifesting itself at this period, he urges the importance of ensuring that no defective between 14 and 20 is left without special observation and that all ‘who show signs of the development of behaviour disorders should be provided with institutional care.
” The psychic instability resulting from puberty in the feeble-minded,” he says, ” will often last even up to the twentieth or the twenty-first year, interrupted by periods of psychic balance… . No form of treatment or milieu?no matter how good?can change this development and make the feeble-minded socially able in puberty. This simple physiological and psychiatrical fact has always been very hard for parents and teachers to understand, and hence every good period was previously used to try out the young transgressor in a new job?and always with the same unfavourable result… And such experiments are not made with impunity, as nobody is more susceptible to bad influence from the surroundings than is the feeble-minded. … It is essential therefore, to make an effort to get hold of the young feeble-minded as soon as he shows the first unfavourable expressions of puberty and then try to situate him in such a way that psychiatric therapy may be carried through until the specialist thinks that the puberty is over.”
In his experience, if institutional training and treatment is provided and continued throughout these critical years, the great majority of such feeble-minded patients can, at the end of them, be safely discharged to a suitable home, although in most cases he considers that sterilisation is a necessary pre-requisite.
The Prevention of Mental Defect
At a Conference of Medical Officers of Health and of members of the Medical Staffs of Public Health Departments arranged by the Public Health Department of the Essex County Council on July 22nd, 1938, Dr L. S. Penrose gave an interesting summary of the findings resulting from the enquiry into 1,280 cases of mental defect undertaken by the Research Department of the Royal Eastern Counties Institution.*
In dealing with the practical measures which should be taken for the control of mental deficiency, Dr Penrose pointed out that, in view of the fact that only 8 of every 100 defectives of a given generation are derived from the defectives of the previous generation, sterilisation?even if applied to all subjects with an 1.0. of below 70, would only lessen the number by 8 per cent. He urged, as a more practical and effective proposition, the need for the accurate ascertainment at as early an age as possible, of all school children whose I.Q.’s were below 70, with a view to their registration and careful following up by means of an aftercare organisation, the value of which had been fully demonstrated. Experience had shown that efficient after-care lessened the tendency for defectives to marry each other, an important point in view of the fact that as many as 30 per cent, of the children of mental defectives are themselves defective. The prevention of such marriages by law, the discouragement of cousin marriages (by reason of * Published by H.M. Stationery Office, price 2/6. Reviewed in our last number.
the likelihood of a rare recessive condition manifesting itself amongst the offspring), and the encouragement of motherhood at an earlier age (the age of the mother was a specially important aetiological factor in Mongolism) were other preventive measures suggested. Dr Penrose further emphasised the need for further research to supplement our very incomplete knowledge of this whole subject.
At the end of the meeting. Dr Penrose answered a number of questions disclosing a keen interest in the subject’under discussion. Bureau of Human Heredity From the Secretary of the Bureau zvc have received the following note on recent progress:
Despite continued financial handicaps, the Clearing-House for data on human heredity at 115 Gower Street has grown steadily. This is largely thanks to enthusiastic help from a number of voluntary workers collaborating in every side of the office activities.
Generous co-operation from research workers everywhere is a most encouraging feature. This year, the Council in London reported to the International Human Heredity Committee and it is encouraging to find that body now embarking on enlargement of membership with the object of keeping research directors in intimate touch with each other.
It is illuminating to learn that since the files were opened, over 600 human differences have found a place in the index. Problems on which research is concentrating are the questions of the constitutional factor in cancer; the limits of resistance and non-resistance to infection in tuberculosis; the diathesis in a number of infectious diseases; constitutional factors in rheumatism. Research in feeblemindedness and the psychoses is concentrated?in the former, searching for distinctive types. All modern work is coloured by the endeavour to ascertain linkage in the series of normal traits. Very intensive twin studies are being carried out by observations in summer camps devoted to identical and non-identical pairs.
A New Colony
On September 22nd, Sir Laurence Brock, Chairman of the Board of Control, formally opened the Bromham House Colony, for which the Bedfordshire and Northamptonshire Joint Board for the Mentally Defective is responsible.
The Colony can accommodate 260 patients and is fully equipped for industrial and educational training, with a school, workshops of various kinds and a farm. In addition to the original mansion, there are five new blocks, one for 60 adult males, two for 100 females, one for 50 boys under sixteen, and one for 50 girls. Each ” home ” is almost a self-sufficient unit, and is brightly and prettily furnished. The utmost possible freedom is allowed? patients go out on parole and visit the cinema in Bedford?and the object of the Colony is to train for a useful life in the ordinary community all those for whom such a destiny can be made possible.
The cost of the scheme has been ?110,000, of which Bedfordshire is contributing ?45,100, Northamptonshire ?45,100, and the County Borough of Northampton, ?19,800.
Institute for the Scientific Treatment of Delinquency
The Institute announces the establishment of a University Extension course of training, consisting of 24 lectures 011 ” Social Psychology ” to be given by Dr }. M. Blackburn (Lecturer on Social Psychology at the London School of Economics). The lectures are complete in themselves but they also form the first year’s work of a four-year course for the Diploma in Social Studies, University of London. If possible, the three succeeding courses will be arranged as follows2nd year, ” The Structure of Society”; 3rd year, ” Social Philosophy”; 4th year, ” Criminal Law and its Administration” and the Psychology of Delinquency “. The present course begins 011 October 3rd, and lectures will be held weekly on successive Monday evenings.
The Fifth Annual Course of Seminars for Probation Officers and Social Workers on various aspects of Delinquency will begin on Thursday evening, October 20th, and will include the following subjects : ” Organic disease and delinquency” (by Dr T. Rowland Hill); ” Alcoholism” (by Dr Alexander Baldie); ” The Psychiatry and Psychotherapy of Delinquency ” (by Dr Frederick Dillon), and “The Relation of Intelligence to Delinquency” (by Dr W. H. Gillespie). For the complete Course, the fee is 17/-, but each section can be taken separately, or single lectures can be attended at a fee of 1/6. Further particulars can be obtained from the General Secretary, Institute for the Scientific Treatment of Delinquency, 8 Portman Street, W.l. (Telephone: Mayfair, 8311.)
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