How the Mental Deficiency Act is Working
The Ninth Annual Report of the Board of Control has just been issued. * It is perhaps of special interest this year in that it deals not only with the work done during 1922 but contains a critical historical retrospect of what has been accomplished since the passing of the Mental Deficiency Act in 1913. Taking as their criterion the principles enunciated by the Royal Comm ssion on the Care and Control of the Feeble-minded,?especially the basic principle of all, viz., that of ‘ ‘unity and continuity of care and control?the Commissioners set themselves the task of considering how far the Act, as it is worked at present, can be said to embody those principles, and in what directions improvement in methods and amendment in machinery are needed. The result as recorded in this Report, is not very inspiriting, unless we regard the fact that the problem has in this way been lighted up by the searchlight of official criticism as itself an augury of hope. The intrinsic defects of the Act and the present difficulties of its administration are ruthlessly laid bare. ‘ ‘It cannot be said,’’ we read, ‘ ‘that the Mental Deficiency Act is at present exercising unity or continuity of control, though it undoubtedly aimed at creating the machinery by which these conditions could be secured. It is still to a large extent true that mentally defective persons pass from one Authority or Institution to another, helped or detained a little in each, but permanently cared for by none.
The Report then proceeds to justify this criticism by discussing how far the few clauses of the Act which do make some provision, however inadequate, for continuity of control are working by showing in each case how great is the need for more co-operation between the different authorities concerned, and by indicating possible lines of advance.
The Need of Co -operation. ————————-First in importance is placed the need for greater co-operation between the Local Authority and Education Authorities, for the provision of the Act which gives the latter the power to “notify” feeble-minded children needing protection is 4 ‘the one provision which seems to have been framed with the idea of preventing disaster and securing continuity of care for those who need it and if thoroughly carried into effect it would go far towards meeting the whole problem.” As everyone knows however this provision is in too many instances a dead letter and must remain so until the Education (Defective and Epileptic Children) Act is put into active operation. If this cannot be done at once, the Commissioners urge the making of some temporary provision whereby it shall be made a duty for Local Education Authorities to notify feeble-minded children leaving or not suitable for ordinary elementary schools, in order to ensure their being brought under the protection of the Mental Deficiency Act.
Co-operation between the Local Authority and Poor Law Authorities is again too often conspicious by its absence, for although Section 30, Proviso ii of the Act provides means whereby continuity of control for defectives coming into the hands of the Guardians may be secured “only a comparatively few” * To be obtained from His Majesty’s Stationery Office, Imperial House, Kingsway, W.C. Price 7s.
It have been dealt with in this way. The Board reiterate the suggestions previously made by them on this point?the establishment of some system by which all defectives leaving Poor Law Institutions are reported to the Local Authority, and, as soon as possible, the enactment of legislation simplifying the whole procedure of transference. Section 16 of the Act provides for the transfer of a defective from a Mental Hospital to an Institution, but notwithstanding this, numbers of defectives still remain in Mental Hospitals, and until Medical Superintendents or Visiting Committees make a point of reporting every such case on discharge, here again no “continuity” can be secured. Dealing finally with the position with regard to co-operation between the Local Authority and Criminal Courts, the Report states that although there is here a ‘ ‘slow but steady advance’’ many prisoners, not dealt with under Section 0, are still discharged from prison without any steps being taken to communicate with the Local Authority so that protection under the Act may be forthcoming.
Ascertainment. ————-Turning to the question of ascertainment the Commissioners can report but little progress. Some Authorities report the ascertainment of as high a number as 3.50 per thousand, but there are still others who have not yet ascertained a single case. Some interesting statistics are given in this connection. Five Urban and five Rural areas in which the largest proportions of defectives have been found have been selected. “The five Urban areas have a combined population of 3,500,681. The total number of defectives ascertained is 5,793 or a ratio of 1.65 per thousand. The five Rural areas have a combined population of 1,214,730 The total number of defectives ascertained is 2,286 or a ratio of 1.88 per thousand. If similar proportions obtain in the whole of England and Wales as in the above ten areas, the estimated number of defectives to be ascertained works out at 64,783.”* The total number actually ascertained on January 1st, 1922, was 25,470 or a proportion of 0.67 per thousand of the population which makes it evident how much ground there is still to be covered.
Supervision. ———-The same unsatisfactory position exists with regard to the provision ol supervision. On January 1st, 1922, 9,854 defectives were being dealt with in this way but the effectiveness of the method depends almost entirely upon the personality of the supervisor and the “importance of obtaining for this Avork persons of good judgment and with the requisite experience cannot’ ‘ in the Board’s opinion ‘ ‘be over-estimated.’’ This Section of the Report contains a sympathetic reference to Occupation Centres which it is expected will ‘ ‘tend to decrease the number of cases who will ultimately have to be sent to an Institution.’ ‘ Guardianship. ———–At the close of 1922 only 370 defectives were under Guardianship. The Commissioners regret that “there has been no organised effort to increase the number of cases’’ and they commend to the attention of the larger Local Authorities the possibility of organising a scheme of work somewhat on the lines of that carried out by the Brighton Guardianship Society. * Page 45.?
la this connection attention is drawn to an anomaly in the Act which, while providing machinery (Section 7) for the transfer of cases from Guardianship to Institutions contains no provision for the reverse process?transfer from Institutions to Guardianship. ‘ ‘The want of this creates a constantly recurring difficulty and militates against the whole spirit of the Act which was intended to prevent defectives from being detained in institutions longer than is necessary.’’
Institutional Accommodation. ————————–The existing accommodation at the present time is as follows:? On January 1st 1923, there were under care a total of 15,786 defectives. Of those, 10,017 were in Certified Institutions, leaving (nominally) 1,215 vacancies; these were, however, chiefly in one or two large recently opened Institutions and generally speaking were only available for cases from a particular locality. In “Section 37 Institutions” there were 4,391 cases, but again, although this appears to leave a large number of vacancies the position is misleading: such accommodation is only suitable for a comparatively limited number of defectives (of whom the great majority must be adults) besides being often confined to patients living within the boundaries of the Unions providing it; moreover, the whole of the total number of beds certified is not invariably actually available, for some may be unavoidably occupied by ordinary Poor Law patients. In short, the difficulty in securing vacancies remains as great as ever, and no new Institutions have been opened by Local Authorities during the year.
“A fair amount of progress” is the final verdict of the Report on the year’s work, and even this temperate estimate may seem to some to err on the side of undue optimism. No mental welfare worker can rise from a reading of it without feeling the need for redoubled effort, so clear is it that as yet only the fringe of the problem has been touched, and that years of hard steady work lie ahead.
In the State Institution In Certified Institutions In Certified Houses In Approved Homes In Approved Poor Law Institutions (Section 37) 368 11,232 330 379 6,953 Total.. 19,262
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