News and Notes
Sterilisation and Mental Deficiency. ———————————–The C.A.M.W.’s pamphlet on this subject, to the preparation of which we referred in our January number, is now published.
It consists, first, of a statement drawn up by the Executive Council on the policy of Sterilisation in its social bearings, and secondly, of the report presented to the Council by its Medical Committee, embodying their views on Sterilisation in its medical aspects.
The theme of both reports may be summarised as follows:?
That Sterilisation is not a practicable policy at the present time.
(b) That at any time the sterilisation of certifiable mental defectives would only have a very limited effect in preventing mental deficiency. The fact of the transmission of mental defect by mentally defective parents is not disputed, but in the majority of cases defectives are the offspring, not of parents who are mentally defective, but of those who are apparently normal, although frequently “carriers” of defect, or who are suffering from insanity, psychoneuroses or a mild degree of mental or physical abnormality which is not certifiable. The sterilisation, therefore, of only certifiable defectives cannot achieve any very startling results. (c) That a policy of sterilisation, whilst thus achieving comparatively little in the way of prevention, might be attended with serious harm in other directions. For it would lead to a false sense of security and result in many defectives being thrown upon the world who should be under care, to the disadvantage of themselves and the danger of the community.
The C.A.M.W. therefore place on record their conviction that the only sound foundations upon which a national policy for dealing with the problem of mental deficiency can be built up are those consisting of segregation for defectives who cannot adapt themselves to the existing social code, and of Supervision (including the use of Occupation Centres and Employment Classes) for those who are not possessed of marked anti-social tendencies?in brief, by the active carrying out of the Mental Deficiency Act.
Copies of the Report (price 2d. each) can be obtained on application to the offices of the Central Association for Mental Welfare, 24, Buckingham Palace Road, S.W.I, and we hope that our readers will assist us in securing for it a wide circulatic n.
Courses organised by the C.A.M.W. Course for Medical Practitioners. This Course of Lectures in Mental Deficiency arranged by the University of London Extension Board in co-operation with the C.A.M.W. was held during the week beginning Monday, May 28th, in accordance with the arrangements announced in our last issue.
Forty-one Medical Practitioners attended, all of whom expressed their appreciation of the Course and its value to them in their work. Short Course for Teachers.
This Course, organised by the Board of Education in conjunction with the C.A.M.W., is being held at Birmingham as we go to press.
Fifty-three teachers are in attendance, of whom four are from schools in Scotland and four are overseas teachers from South Africa, New Zealand and Australia, who are taking the Course as private students.
Proposed Course for Magistrates. ——————————The Council of the C.A.M.W. decided at its meeting in April that should there be a sufficient demand, they would be prepared to organise a Course for Magistrates on their work in connection with the certification of cases under the Lunacy and Mental Deficiency Acts. It is suggested that the Course should be held for four days, if possible in London, in the autumn, and should consist of (a) lectures by medical men and other experts, and (b) visits to Institutions, Mental Hospitals, etc., for demonstrations. The fee would probably be fixed at Two Guineas.
The Course will only be held if the demand for it is sufficient and Miss Evelyn Fox, 24, Buckingham Palace Road, S.W.I, will be glad to hear at once from magistrates who would like to attend. Suggestions as to subject matter and length of the course will also be welcomed.
The C.A.M.W. Film. —————–The Film showing methods of training defective children, the preparation of which we announced in our last issue, has now been completed and has been shown already at the Annual Meetings of two Local Voluntary Associations, as well as at the Annual Meeting of the Central Association on July 9th. The general title of the film is “A Simple Record of Modern Progress in the Care and Training of Mental Defectives.” It is divided into some 60 scenes, half dealing with low-grades and half with high-grades, and takes about 20 minutes to show. Amongst the subjects are:?low-grade children being taught to walk; exercises for increasing muscular control; the game of ‘ ‘Rabbits’’; the toy band; skipping, stepping, jumping and balancing exercises with planks, boxes, wheelbarrows, etc.; a washing-up lesson; dancing; a lesson in word-building; high-grade defectives working at brush-making, mat-making, tailoring, stockingknitting, etc.
The experiment is, we think, a complete success, for by showing so vividly the actual process of training defectives, the film arouses an amount of sympathetic interest which speeches and pamphlets, however eloquent, can never arouse to a like extent.
Application for the use of the film at meetings should be made to the Central Association by whom terms and conditions will be gladly supplied.
Meeting of British Medical Association at Portsmouth. —————————————————-At the Annual Meeting of the British Medical Association to be held at Portsmouth from July 24th to 27th, the section of Medical Sociology has chosen for July 27th the subject of “Mental Deficiency in its Social Aspects.” The C.A.M.W. will be responsible for exhibits of apparatus for Mental Tests, and of the work of defectives in Special Schools and Institutions and is also shewing its new film on methods of training defectives.
Dr Brackenbury, the Chairman of the Education Committee of the C.A.M.W., is the Chairman of the discussion on “Mental Deficiency in its Social Aspects,’’ and the speakers asked to take part include the Hon. Secretary of the Association, Miss Evelyn Fox, and two members of its Medical Committee, Dr. Potts and Dr Prideaux (Hon. Medical Secretary.)
The full programme of the discussion is as follows:?Morning Session: Opening Papers by Dr Potts and Mrs. Pinsent; by Dr Devine on “Segregation,’’ and by Dr Macfie Campbell, U.S.A., on “Organisation for Supervision.” Afternoon Session: Papers by Miss Evelyn Fox and Dr Prideaux on “The Education of Defectives,” by Dr Norwood East on ‘ ‘The Incidence of Crime and Mental Defect,” and by Dr Robert Gibbons on “Sterilisation.”
Tickets for the meeting may be obtained on application to the Central Association, 24, Buckingham Palace Road, S.W.I.
Mental Treatment Bill. ——————–This Bill, promoted by the Ministry of Health, has successfully passed the House of Lords, in which it was introduced, and as we go to Press is awaiting consideration by the Commons. It constitutes in our opinion, a piece of progressive legislation for which there has for long been a demand, and passed into law it should be of great value to mental welfare workers, who should therefore acquaint themselves with its provisions.
Briefly the Bill enables early cases of mental disorder to secure, without being certified under the Lunacy Acts, treatment in Mental and other Hospitals approved for the purpose and further empowers Local Authorities, subject to certain conditions to pay for such treatment.
Clause 4, provides that on the recommendations of two medical practitioners, any person suffering from mental disorder who is considered likely to benefit from temporary treatment in an institution, may, without a reception order under the Lunacy Act, be received as a patient into an approved Institution for a period not exceeding six months. This period may be extended for a further period not exceeding one year, if it appears “reasonably probable” that he will recover during that time.
Patients recommended for treatment under this clause must express themselves as willing to submit to it. unless they are minors when the consent of the parent or guardian must be obtained, or are “incapable of volition,” and in these two latter cases the recommendation for treatment must be supplemented by a statement signed by a magistrate or by a minister of religion.
A patient received under this Clause may leave the Institution at any time, after giving 72 hours’ notice, unless he is a minor when the notice must be given by his parent or guardian.
An approved Institution may be a Mental Hospital, a Registered Hospital, a Licensed House, or any other Hospital approved by the Board of Control. Other Clauses of the Bill which should be noted are:?
Clause 1. To empower Local Authorities to co-opt a limited number of members on their Visiting Committees under the Lunacy Acts, and to lay down the stipluation that on every such Committee appointed under the Act, at least two members shall be women.
Clause 2. To empower Visiting Committees, subject to the approval of the Board of Control and to the consent of the Local Authority appointing them:?(i) to take joint action with other Local Authorities: (ii) to provide or arrange for the treatment as out-patients of persons suffering from mental disorder; to receive voluntary boarders in any Institution under their control; (iv) to make provision for the After-Care of Mental patients on discharge: (v) to undertake research in relation to mental disorder and to make contributions towards the expenses of any body of persons engaged in such research.
Clause 3. To reduce the number of paid Commissioners under the Mental Deficiency Act to 8, and to give to Inspectors the powers with regard to visitation and inspection which are now held by Commissioners.
Clause 7. To empower Local Authorities to defray out of the rates any expenses incurred by a Visiting Committee under this Act. We hope to deal at greater length with this important Bill in its relation to Mental Welfare work in a later issue.
New Home for Mentally Defective Blind Babies. ——————————————-There is to be opened in the autumn a Home for Mentally Defective Blind Babies and young children at Reigate, in Surrey, primarily intended for lowgrade cases for whom so little provision at present exists.
It will be certified by the Board of Control and cases will be also received from Boards of Guardians.
The Home which has secured the patronage of Miss Ellen Terry is being run as one of the activities of the Braille and “Servers of the Blind” League. Enquiries and applications for terms, etc., should be addressed to the Org. Secretary, Arthur Burgess, Esq., 3, Upper Woburn Place, London, W.C.I.
Royal Eastern Counties Institution, Colchester. ———————————————This Institution has recently bought Bridge Home, Witham, Essex. Bridge Home was till recently used by the Metropolitan Asylums Board as a training home for high grade mentally defective youths. The Home will make the sixth branch belonging to the Royal Institution, and will be used for four classes of Mentally defective male patients over sixteen years of age. It has accommodation for over two hundred cases and will bring the total number of beds in the Institution up to about a thousand and fifty. It consists of a central administrative block with wings on either side, another detached block, a hospital block, a steam laundry, accommodation for five training shops, a chapel, a gymnasium, and a large orchard from which in the past, tons of jam and preserved fruit have been made. Alterations and improvements are now being carried out, a*id it is expected the new branch will be occupied in August.
The rooms at the main Institution at Colchester, vacated by the four classes going to Witham, will be used as additional accommodation for women patients. The Possibilities of Spinning as an Occupation for Defectives.
The following is an account?kindly sent to us by Miss Evelyn MacKenzie, Hon. Sec. of the Cambridgeshire Voluntary Association for Mental Welfare?of an experiment that failed, but failures have often as much to teach as successes and wc draw attention to this one as illustrating some of the difficulties which beset the path of those are are trying to explore the possibilities of ‘ ‘self-supporting employment classes for defectives:?
In October 1922 an attempt was made to start an Occupation Centre for girls over School age that would be self-supporting. There is a demand locally for home-spun wool and it was hoped that some high-grade mentally defective girls might be taught to spin sufficiently well to contribute out of their earnings towards the expenses of a room and a Supervisor. It was proposed to train cripple girls also, and a grant of ?15 was given to the Voluntary Association by the Cambridge Invalid Children’s Aid Association. A large room in a central quarter of the town was hired at the low rate of 7s, 6d. a week (including gas firing), and a Supervisor who could spin was engaged to look after the girls. As she was a knitter by profession she was paid only 12s. 6d, a week on the understanding that she might work at her knitting while at the Centre. The room was open for five hours on five days and three hours on one day in the week. A local Weaving Industry undertook to supply fleece and to buy the yarn when properly spun.
The Centre opened with two mentally defective girls who had previously had some lessons. One had lately left a Special Class for “backward” children, and came from a very poor home; the other was the daughter of well-to-do parents and was aged 23, but was subject to fits of violent temper and had never been able to do any regular work. Later, two cripple girls were admitted and three or four mentally defective girls were tried for varying lengths of time. The cripples learnt quickly, but the mentally defective girls proved so slow that it was found impossible to pay them for the yarn they had spun. After nearly six months the Centre had to be closed.
The chief difficulties were:?(1) The limited supply of high-grade girls near enough to get to the Centre. (2) Parents’ objection to allowing their daughters to attend where there was no monetary gain for some time; they prefer the girls at home to help in the house or to be nursemaid to their own or to the neighbours’ children. (3) The Supervisor, though very kind, was unused to mental defectives and did not get the best out of them. The success of the cripples damped her interest in the defectives. (4) The commercial element had some drawbacks; a great deal of fleece was spoilt at first and the girls were made to re-spin it, which kept them back when they were improving, disheartened them unnecessarily and prevented them from earning anything.
The Centre, however, gave the girls very real pleasure and all the parents testified to their mental improvement; even the cripples developed independence and self-confidence by “going out to work” for the first time. Now the Centre has closed, one cripple has her wheel at home and is able to earn about ?1 a week; the other was hindered by illness. Of the mental defectives, one has at last learnt to spin yarn that is saleable, thanks to the encouragement of her mother; another also had her wheel at home, but the mother took no interest and the girl has done nothing. The other mental defectives who were tried all proved failures while the Centre was open.
Experience has shown that a Centre of this kind would only be worth running if six or eight girls could be found to attend regularly under a Supervisor with a knowledge of special teaching, and with other simple industries besides spinning, which takes months to learn. Normal girls should not be admitted, and there should be no question of making money, either by the girls and their parents or by the Association. Full expenses should be met by the Association, and in course of time it is possible that the girls may make saleable goods and be able to earn and to make some return to the Centre.
“Extra-Institutional Care.” ————————-Two interesting documents have recently reached us from the United States in which this problem of the provision of care for defectives in the community is discussed. In the 4th Annual Report of the New York State Commission for Mental Defectives, we find, in a section headed ‘’‘“General Policies’’’ this significant pronouncement (the italics are ours):? “During more than a decade this restricted custodial policy has been modified. The parole and discharge of inmates has increased and with this change and many others, a new era in the care of mental defectives has taken place in New York State.” …. While the exact number of mental defectives in the State cannot be determined at this time, it is now quite well agreed that all do not require continued institutional segregation.’’ But lest this should be taken to imply a reversion to a policy of laisser-faire, the writers of the report are careful to point out:? “While a large number of mental defectives can live in the community and be self-supporting if supervised to some extent, it cannot be too strongly emphasized that they require this supervision. If not supervised, they become dependent sooner or later, they do not remain self-supporting and a certain number of them become criminals.’’
How is this supervision to be effectively provided? One solution is the provision of what is known as “Colony’’ care, and those of our readers who were interested in an article in a recent issue of this journal by Miss Susan Hoagland, are recommended to obtain a copy of the 28th Annual Report of the Board of Managers of the Rome State School, New York State, where exhaustive statistics on this work amongst girls are given.
Some equally interesting statistics casting a searching light on the intricacies ?f the problem, so much greater than the early advocates of permanent institutional care for all defectives realised, are given in the same Report by the Medical Superintendent (Dr Bernstein) as to the categories into which an Institutional population of 2,500 cases are likely to fall, viz:?
Of 2,500 cases made up of a general run of admissions and all accepted: 20% will be of school age, of which about 10% will ultimately be returned home, and 10% will be suitable for colony life. 40% will be purely custodial cases, of which about 10% will be good workers but delinquent and needing close care.
40% will constitute the “stable and economically efficient high grade imbecile and moron group suitable for colony and parole life.” and of these 20% will pass each year to an independent existence.
It would be interesting to know whether this classification of Dr Bernstein’s is found to be in general agreement with that of Superintendents of similar Institutions in this country.
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