News and Notes
41 Mental Treatment” in 1937
In the Board of Control’s Report for 1937, it is noted that overcrowding in Mental Hospitals became more serious during the year, and the warning is given that:
“assuming the death rate remains at or near its present level, there can be no improvement in the position until the new mental hospitals in preparation at Lathom Park for Lancashire and at Margaretting Hall for Essex, are ready to admit patients,”
The total number of patients under care increased by 2,201, as compared with an average annual increase of 1,687 for the previous five years, whilst the aggregate number of patients in excess of the authorised bed space rose to 3,608 on 1st January, 1938?the highest figure ever recorded. Direct admissions during the year numbered 30,579, divided as follows:? Voluntary patients under Mental Treatment Act … … … 35.8% Temporary patients under Mental Treatment Act 5.1% Certified patients 59.1% Of these, 87.9 per cent, were admissions into County and County Borough Mental Hospitals.
The proportion of Voluntary admissions to total direct admissions showed wide variation. In 15 Hospitals, it was 45 per cent, and upwards; in 18, it was 44 per cent, to 35 per cent.; in .21, 34 per cent, to 25 per cent.; in 36, 24 per cent, to 15 per cent.; in 4, 14 per cent, to 10 per cent.- and in 4, under 10 per cent. The proportion of Temporary admissions to total direct admissions also varied widely. In 1.8 hospitals, it was between 26 per cent, and 10 per cent.; in 24, 9 per cent to .5 per cent. ; in .52, 4 per cent to 0.5 per cent. In one, it was under .0.5 per cent., and in 6, it was nil.
The number of Mental Treatment Out-Patient Centres has remained practically stationary, viz., 167 as compared with 165 in 1936. Attention is drawn to the fact that many of these Centres are still mainly diagnostic in character and the view is expressed that more might be done in the way of providing actual treatment, and it is suggested that to meet the staffing difficulty, part time physicians might be enlisted to help the Mental Hospital staffs responsible for the work.
Considerable space is devoted in the Report to the value of Psychiatric Social Workers, and a summary is given of the tasks which can be delegated to them by mental hospital medical officers.
Courses for Teachers of Retarded Children, 1939 In addition to the usual Ten Weeks’ Course and two Short Courses for Teachers?
The following Courses for Teachers will be held by the C.A.M.W. in 1939:?
Long Course, May 1st to July 8th, at Morley College, London. Advanced Course, July 3rd to 22nd (organised for the Board of Education), London.
Elementary Course (Board of Education), August 28th to September 15th, at Bristol.
In addition to these Courses which are held annually, two special Courses have, this year, been added, viz., a Refresher Course and a Mental Testing Course.
The Refresher Course is being held whilst we go to press, at King’s College for Women^ Kensington. 28 students are attending, all of whom have already been to previous Courses, and special opportunities are being provided for discussion and the interchange of ideas and experience, in order that the utmost practical benefit may be gained. Lectures on the educational treatment of backwardness are including ” The Teaching of Civics to Backward Children ” and ” The Teaching of Science to Backward Children.” The Course is under the general direction of Miss Grace Rawlings, C.A.M.W. Educational Psychologist, assisted by two other members of the Association’s psychological staff, Mrs. Hamilton and Miss Ruth Thomas, and by several outside lecturers. The Mental Testing Course will be held in the London area from April 17th to 29th. This has been arranged in response to many requests, for teachers who have attended either a Long Course or two Short Courses. The Course will be under the direction of Miss Lucy G. Fildes, Ph.D., assisted by the Association’s Psychologists?Miss Grace Rawlings, Mrs. Hamilton and Miss Ruth Thomas. It will include lectures on the principles of mental testing and the interpretation of tests and demonstrations given, whilst in addition students will spend 14 to 16 sessions in themselves testing individual children under expert supervision. Discussion of the results of these tests will be an important feature of the Course.
The fee for the Course (non-resident) will be three guineas, and applications from those qualified to attend are invited. These should be received not later than February 28th.
Courses for Medical Practitioners
The 1939 Course in Mental Deficiency for Medical Officers’ Practitioners, will be held in conjunction with the University of London, from March 20th to April 1st.
Part II of the Course (on Problems connected with Retarded and Difficult Children) will be held for a week in November.
The Association is again arranging the practical work in connection with the Course on Mental Deficiency held by the London School of Hygiene and Tropical Medicine as part of the Diploma Course in Public Health.
Board of Control
The Board of Control, with the approval of the Minister of Health, have appointed Mr. R. G. Anderson, M.D., D.P.M., to be a Commissioner to fill the vacancy caused bv the retirement of Surgeon Rear-Admiral J. Falconer Hall C.M.G., F.H.S., R.N. (retired).
Mental Health and Delinquency
During the year 1937, the Prison Commissioners report that 121 prisoners were certified as insane whilst serving; sentences in local prisons; 291 were found to be insane whilst in prison on remand; 31 were found by juries to be insane on arraignment, and 16 were pronounced ” guilty but insane.” This total group numbers 459, as compared with 393 in the preceding year. Whilst undergoing sentences in local prisons, 30 persons were certified as mentally defective (compared with 34 in 1936) and of these 25 were moved to Certified Institutions under Section 9 of the Mental Deficiency Act, 1913. The remainder were on discharge handed over to the care of the Public .Assistance Authority or were brought to the notice of a Voluntary Association for Mental Welfare. Under Section 8 of the Act, 152 defectives were dealt with by the Courts (compared with 194 the previous year). One girl was removed to a Certified Institution whilst undergoing Borstal training, and 4 Borstal youths were certified insane.
The results of the 4-year programme of psychological investigation and treatment of selected prisoners at Wormwood Scrubbs instituted in 1934, are now being examined, and a report will subsequently be published by Dr. Norwood East and Dr W. H. de B. Hubert. ————————————– A further report which will be anticipated with interest is that of an exhaustive investigation now proceeding at Wormwood Scrubbs into the causes of delinquency amongst adolescents, the material for which comprises :some 4,000 cases.
During 1937, under the auspices of the Borstal Association, research was carried on by Dr Mannheim and Mr. Dryden Donkin into the records of <606 boys discharged from Borstal Institutions during the 15-year period, 1922 to 1936. In 243 cases the delinquency was found to be associated with unsatisfactory home conditions, such as lack of parental control, too strict ?control, over-indulgence, neglect, or psychological conditions connected with, ?e.g., the existence of a step-mother, illegitimacy, etc. In the case of 144 lads, mental backwardness or instability were noted as significant factors producing the delinquent conduct.
It is interesting (especially to those concerned with promoting special ?education for the retarded child) to read the observations of the Governor of Feltham Borstal Institution, with reference to mental retardation amongst the boys sent to him.
” The abysmal depths of ignorance,” he writes, ” from which seven or eight years of State education has failed to rescue many of the lads received here?or to which they have reverted after two or three years of complete mental vacuity?would be inconceivable and probably incredible to anyone not in touch with this problem. The worst of these cases seldom present such an inherent or long-standing degree of defectiveness as to warrant certification as mentally defective under the present Acts, yet, on reception, it is difficult to believe that they are really fit to be allowed to cross a busy street or to go on errands by themselves.”
And he proceeds to emphasise the importance, in such cases, of devoting ?energy and time to the simplest form of training in the most elementary things ?cleanliness, personal hygiene and the correction of habits which if left unaltered would mitigate against the success of any subsequent experiment at placing out in lodgings.
Another mental health problem is referred to by the Governor of Aylesbury Borstal Institution for Girls. Recording such happenings as shopping expeditions, netball matches against outside teams, and tea parties at private houses, she writes :?
” These constitute the small and obviously inadequate attempts to minimise the dangers of discharging, even though under supervision, a giri who has probably known nothing but institution life for years and is now required to live the life of a free adult without ever having been a free child. Within the institution, too, every effort is made to provide opportunities for girls to develop communal responsibility, but these opportunities are necessarily limited, and have very little relation to the responsibility required of them in life outside. It is clearly impossible to allow girls the freedom allowed to boys, but the lack of this freedom probably accounts both for the reluctance of some of them to take the plunge into the outside world and for the irresponsibility and lack of judgment shown by many others who go out full of confidence.”
Dr W. Norwood East
The Prison Commissioners, in their 1937 Report, note with great regret the retirement of Dr Norwood East, Medical Commissioner, who joined the Prison Service in 1899 as a Deputy Medical Officer and after nearly 25 years’ service in H.M. Prisons at Portland, Manchester, Liverpool and Brixton, was ?appointed Medical Inspector of Prisons in 1924, and Medical Commissioner in 1930. Always interested in the psychological aspects of medical work in prisons, Dr East was responsible for the initiation of the experiment in the psychological treatment of selected prisoners in Wormwood Scrubbs, as well as for the Wormwood Scrubbs investigation into the causes of adolescent delinquency. It will be remembered also that he is the author of ” Forensic Psychiatry ” and ” Medical Aspects of Crime.”
Dr East has for long been a friend of the C.A.M.W. and for a number of years served on its Council as one of the representatives of the Prison Commission. We offer to him our good wishes in his retirement.
Criminal Justice Bill
The Criminal Justice Bill, which passed its Second Reading on November 29th, contains a number of important provisions of special interest to Mental Health workers. To these we hope to refer at length in a subsequent issue, and the following brief notes are designed for the purpose of placing on record the initiation of a piece of social legislation whose results are likely to be profound and far-reaching.
Clause II empowers the Secretary of State to provide Remand Homes for persons under 17 “requiring special medical observation” and the new ” Remand Centres” to be set up under Clauses 10 and 28 to which young offenders are to be sent whilst on remand or committed for trial in custody (instead of to prison) ” are to serve not only the purpose of custody but also the purpose of observation, that is, the making of such medical or other investigations as may be desirable in order to assist the court in deciding how best to deal with the offender.”
An entirely new experiment is that provided for under Clause 12, by which the Secretary of State may institute ” compulsory attendance centres ” at which offenders between 17 and 21 may be required to attend on half holidays or in the evening after work. This is to be a substitute for the imposition of short terms of imprisonment for minor offences or in default of payment of fines. Similar centres for delinquents between 12 and 17 may also be provided by local authorities.
The proposal (Clause 13) to set up ” Howard Houses ” for young offenders between 16 and 21 who, whilst continuing in ordinary employment, need for a time to be removed from their home surroundings, constitutes another experimental innovation which will be watched with great interest.
Clause 38 of the Bill is designed to facilitate the obtaining of medical reports on the mental condition of offenders brought before the Courts. At present, there are difficulties in this procedure in cases where the offender is npt remanded to prison. It is now to be made possible for an offender on bail to be required to submit himself to medical examination, the cost if necessary being borne by public funds. It is also proposed (Clause 19) that offenders on probation may be required to submit themselves to mental treatment if they are suffering from some form of mental illness or abnormality which is deemed to be susceptible to such treatment.
Clause 39 brings the procedure with regard to offenders found by the Court to be insane, into line with that under the Mental Deficiency Acts in the case of those found to be mentally defective.
Under Clause 68, it is proposed to transfer the responsibility for the control and management of the Broadmoor Institution from the Home Office to the Board of Control and to designate it ” Broadmoor State Mental Hospital.”
The provisions of the Bill are now being submitted to close scrutiny by the various bodies specially interested, and various amendments are being considered, but taken as a whole it has received a warm welcome on every hand for?to quote the Times Educational Supplement?it ” fulfils to a great extent the hopes of all those social workers who believe, with good reason, that the best means of reforming the potential criminal is by education and training outside the prison walls.”
The C.A.M.W. and the Ministry of Agriculture
Recently there has been some discussion between the C.A.M.W. and the Ministry of Agriculture concerning cases placed by Mental Welfare Associations on farms, small-holdings, etc. The Ministry are naturally anxious that no such persons should be exploited, and moreover, that the public should feel confident that such persons are fully protected.
As our readers are aware, permits can be granted under the Agricultural Wages (Regulation) Act, 1924 by an Agricultural Wages Committee, exempting a worker from the provisions of the Act if he is “so affected by any physical injury or mental deficiency or any infirmity due to age or any other cause that he is incapable of earning” the minimum rate of wages. We find on enquiry that Associations differ in their methods of dealing with this question of permits. Some leave the onus of applying for a permit to the employer concerned, others make themselves responsible for seeing that the necessary permit is obtained; in some areas the representative of the Agricultural Wages Committee visits the place of employment, in others they rely on the Association’s statement. This is a matter for local arrangement, though we feel that where possible the Association should be in direct touch with the Agricultural Wages Committee in regard to each case.
There is one point which arose in the discussion with the Ministry. Not everyone may be aware that if an employer is willing to provide board and lodging, even without cash payment, in return for services rendered, it might be held that the relations between the employer and the person concerned would be tantamount to a contract of service and would bring that person within the scope of the Act. In all such cases, therefore, a permit should be obtained.
The main discussion with the Ministry, however, centred upon those cases which are boarded out on maintenance and are occupied in certain ways about a farm, but are not ” employed.” In the first instance, the Ministry suggested that if a permit were obtained for such cases, there would be an additional safeguard against exploitation; the C.A.M.W. contended that it would be illogical to ask for a permit, when in fact the person was not employed, though they were willing to co-operate in any way possible. “The Ministry now appear satisfied that cases placed out on maintenance are adequately supervised and that no further steps need be taken to protect them. The Ministry emphasised, however, the need for very great care, so that should a man cease to be ” on maintenance ” after a period of trial and come within the scope of the Act, application for a permit would be made at once. We have assured the Ministry that the Officers of the Association keep in close touch with the cases they place out, and that they would immediately be aware of any change in conditions, and that we agree that great vigilance must be exercised, so that no person on whose behalf a permit should be applied for, is overlooked. C.A.M.W. Annual Report, 1937-38
This Report has recently been issued and is designed to interest those concerned with the problem of Mental Health administration as a whole, in addition to those interested chiefly in the activities of the C.A.M.W. An Appendix gives a survey of the progress of the whole movement during the year under review, whilst other Appendices include special branches of the Association’s work, such as the Community Care of Epileptics, and the administration of the Middlesex County Council’s Occupation Centres. Copies of the Report can be obtained free from the Secretary, C.A.M.W., 24 Buckingham Palace Road, S.W.I.
National Council for Mental Hygiene
The Fifth Biennial Conference on Mental Health, opened by H.R.H. The Duke of Kent on January 12th, is being held in London under the auspices of the National Council for Mental Hygiene as we go to press. The subjects dealt with in the three-day programme comprise ” Is Our National Intelligence Declining?”, “Should Mental Treatment be Practised Solely by Doctors?”, “The Psychological Factor in Sexual Delinquency”, “Problems of Adolescent Instability and of Juvenile Delinquency “, ” Education and the Emotional Needs of the Child ” ” The Place of the Social Worker in Mental Health”, ” Out-Patient Mental Treatment Clinics “, ” Mental Hygiene and the Press.”
The papers will be published during the year in the National Council’s organ, ” Mental Hygiene (annual subscription 4/6) to be obtained from 76/77 Chandos House, Palmer Street, London, S.W.I.
Child Guidance Council. Forthcoming Events
The Fourth Biennial Inter-Clinic Conference will be held in London on January 27th and 28th, 1939, at the British Medical Association, Tavistock Square, W.C.I. The session on Friday, January 27th, at 2.30 p.m., will be devoted to the subject of Juvenile Delinquency, and will be open to the public. The Rt. Hon. the Lord Alness will take the chair. Tickets of admission, price 2/6, can be obtained on application to the Child Guidance Council, Woburn House, Upper Woburn Place, W.C.I.
Preparations are in hand for a Regional Course of Training for Institutional Workers. This is being organised by the Council in conjunction with the Bristol Vocational Training School and will take place from January 16th to March 20th, 1939, in Bristol. The lectures will be held on Monday afternoons from 2.30 to 4.30 p.m., at the Vocational Training School.
The Course will be practical in character and will cover training from the three following aspects: (a) the physical care of the child; (b) domestic care, including diet, food values and practical cookery demonstrations; (c) child psychology and the handling of children’s difficulties.
An Easter Vacation Course on ” The Difficult Child ” will be held at Southlands Training College, Wimbledon, S.W.19, from Wednesday, April 12th to Monday, April 17th, 1939. Fee : 3? guineas resident, 1-1 guineas non-resident (payable in advance). Applications should be made before Monday, March 27th, addressed to the Secretarv of the Child Guidance Council. The final programme will be available shortly.
Anti-Semitism and Child Guidance
In a note on the East London Child Guidance Clinic contained in the 1937 Annual Report of the Jewish Health Organisation of Great Britain, attention is called to the psychological suffering which is beginning to be created amongst children in the East End as a result of anti-Jewish feeling. ” It is deplorable that, despite the general prevalence of nervous disorders which is already very heavy, there is no adequate realisation yet of the serious effects of fear and hatred on a child’s nervous system to bring in sufficient financial support for the work of the Clinic. The mental anguish and nervous troubles of these children have raised a new problem for the Community, and the Committee feel sure that in these troubled times, the special importance of having a clinic in a district where the majority of Jews in this country still live, will be recognised.”
Birmingham Society in Aid of Nervous Children
This Society, which was founded in April, 1937, has just issued its First Annual Report.
Its object is to provide for the boarding-out of nervous and difficult children (the majority of whom are referred by the Child Guidance Clinic)j on farms specially selected for the purpose, and during the first year, 16 children were dealt with. The changes wrought in these children have fully demonstrated the faith of the founders in the need for their pioneer enterprise. Under the chairmanship of Dr C. L. C. Burns, the work during this experimental year was carried out entirely by voluntary workers using as a headquarters the house of the Hon. Secretary, Mr. Frank Mathews. It was then found necessary owing to the increased demands made upon the Society, to appoint a trained assistant and to rent an office, which makes additional financial support an urgent necessity.
St. Catherine’s, Doncaster
In October, Mr. Robert Bernays, M.P., Parliamentary Secretary to the Ministry of Health, opened extensions to St. Catherine’s Institution, Doncaster, which include a school for 100 children and an assembly hall to seat 476 persons. The Institution, for which the South-West Yorkshire Joint Board for the Mentally Defective, is responsible, has now accommodation for 480 patients,, and when the buildings are finally completed, this number will be brought up to 640.
During the proceedings, Mr. Bernays paid a generous tribtue to those* who care for defectives in Institutions such as these :?
” They have,” he said, ” all the trials and difficulties of the teacher many times intensified without having the reward of the teacher of ordinary children,. that of seeing the child develop into maturity. They have to know and train most diverse types of men, women and children of all ages with varying grades of mental defect. It is a task requiring infinite skill and patience to lead these people into a sense of responsibility, and it ought to be a source of pride to all concerned that this work is being done and, in .fact, extended.”
St. Catherine’s caters for defectives in the administrative areas of Barnsley, Dewsbury, Doncaster, Halifax, Huddersfield, Rotherham and Wakefield, whose Authorities comprise the Joint Board.
Play Therapy
In his Report for 1937, the Chief Medical Officer of the Board of Education (Dr Arthur MacNalty) deems it expedient to issue a warning against a too facile and dogmatic interpretation of the play of maladjustedchildren.
” While in all branches of therapy,” he writes, ” study of the case material is necessary if progress is to be made, and while there is no desire to hinder investigation and research, it must be reiterated that the children are primarily patients to be cured, and not experimental material for over-enthusiastic psychiatrists obsessed with some particular theory… . Much may be learned by unobtrusive observation of a child’s activities at play and the knowledge gained may be applied for the child’s benefit. But children will not play naturally or enjoy themselves if they are constantly looked at through a magnifying glass as Gulliver was by the wise men of Brobdingnag. Neither should any system be encouraged which reads into some spontaneous and innocent action of a child, a dark chapter in its parental, prenatal or infant history. The interpretation of the play of maladjusted children is, therefore, beset with pitfalls; the conclusions drawn from it must be treated with the greatest reserve, and corroborated if possible from other sources before action is taken upon them.”
In commenting on the progress of the Child Guidance movement throughout the year, Dr MacNalty draws attention to the wide variation as between one Clinic and another in the proportion of children referred for any one specific reason. Thus whilst at the Maudsley Hospital Clinic only 13% were referred for ” backwardness,” at the Bristol Clinic, which is in closer touch with the schools, 30% of the cases were referred for this reason.
Occupation Therapy
In the Board of Control’s Report for 1937, attention is drawn to a diverting device consisting of a toy electric railway, which has been installed at Wadsley Mental Hospital (Sheffield). This has been found very useful in interesting the more confused schizophrenic patients, and has shown the possibility of reaching even the patient previously considered to be ” inaccessible.” The Board sympathetically express the hope that ” some equally ingenious distraction could be devised for the female side, for the fascination of model trains is apparently an exclusively male reaction.” ( !) The Occupational Therapists’ Association, though still in its infancy, has published the first number of a new journal, to be issued quarterly (price 1/-). The journal contains news of the founding and progress of the Association, messages of goodwill from its President, Sir Hubert Bond, from Miss Ruth Darwin and Dr J. R. Rees, and articles on ” Occupational Therapy and Mental Nursing,” ” Cord Knotting as a Therapeutic Measure,” ” Bookbinding and Bookcraft in Occupational Therapy,” ” Weaving as a Curative Agent.” It is attractively printed and produced, and should fill a real need.
The Editor of the Journal is Miss Nancy Ross (Occupation Therapist at Cambridge Mental Hospital) and the Sub-Editor, Miss English (Woodside Hospital), 15 Onslow Gardens, London, N.10, from whom copies can be obtained.
St. Francis’ House, Sudbury
Our readers will be glad to hear of a new venture recently undertaken by the Society of the Crown of Our Lord?which has for many years carried on its beneficent work for the helping of mental patients by personal service. The Society has opened St. Francis’ Home, Sudbury, Middlesex, for educated women of the professional classes, suffering from slight nervous illness or threatened with nervous breakdown and in need of complete rest at very moderate cost.
The house stands in its own grounds of 2acres including an attractive garden. A fully-trained nurse is in charge of the medical side and a Lady Warden is responsible for the general comfort of the residents. Single bedrooms are provided and the house is well warmed. There is accommodation for 11 or 12 patients and admissions are made only on the recommendation of a doctor who may, if he wishes, continue to be in attendance. Otherwise, patients are under the care of the psychotherapist and physician who are the Home’s medical advisers.
There is a Chapel which all are invited to attend if they wish, but patients of all denominations or of none are accepted.
For fuller particulars, apply to the Lady Warden, St. Francis’ House, Harrow Road, Sudbury, Middlesex. Telephone : Arnold 2834.
New Joint Special School
Under the Lanarkshire Education Committee there is to be shortly erected a fifth Special School. The new school will be situated near Hamilton and will make provision for ” physically invalid and mentally invalid children and also for deaf-mute children.”
The number of classrooms for each type will be eleven for the physically defective, six for the mentally defective and four for the deaf-mute. In addition, the plans provide accommodation for manual instruction (Woodwork, Tailoring, Shoemaking, Basket-Making, etc.) and for Cookery and Housewifery, and for a dining-room, rest room, clinic, baths, etc.
The Scottish Association for Mental Hygiene
In May, 1938, there took place an amalgamation of the Scottish Association for Mental Welfare and the Scottish Child Guidance Council. The new Association thus formed consists of three Sections, viz., Mental Deficiency, Child Guidance and Mental Health. Each Section has its own Chairman, and has made recommendations to the Executive Council concerning future activities. On the Executive Council there are 5 representatives from each Section in addition to representatives from various Public Bodies. Dr Constance Hunter is the Secretary of the Association, whose offices are at 25 Palmerston Place, Edinburgh.
Home Teaching in Nottinghamshire
The County Medical Officer for Nottinghamshire has kindly supplied the following particulars with regard to the appointment of a Home Teacher for defectives in the area.
Following the successful establishment of the Mansfield Occupation Centre in 1934, serving the Borough of Mansfield and the adjoining Urban Districts, the Committee for the Care of the Mentally Defective further sought to fulfil their statutory obligations in regard to the training of defectives by preparing a Home Training Scheme for those defectives living in the smaller urban areas and scattered rural districts.
There was an unfortunate paucity of applicants for the post of Home Teacher, but in July, 1938, a suitable appointment was made. The Scheme provides for a three-weekly cycle of visits to some sixty cases, twenty-eight of whom are under Guardianship, and the remainder under Statutory supervision. The programme will be extended to embrace new cases when the progress of those now being visited warrants lessening the frequency of visits.
Up to the end of the year some 440 visits have been made by the Home Teacher in the course of giving approximately 380 hours’ instruction. Reports show that the training given is producing highly satisfactory results, even after only one or two visits, and appreciative letters have been received from parents.
An Apology
In our last issue, under the title of ” The Adolescent Defective,” we quoted an extract from a Report issued by the Keller Institute, Denmark. Our attention has been drawn to the fact that the Report in question came from the Institution at Ebberodgaard and not from the Keller Institute, and to the Medical Superintendents of both the Institutions involved in the mistake, we offer our sincere apologies.
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