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a most difficult task and one which is not statutorily his responsibility. He has to arrange transport,
act as an escort and allay relatives' and patient's anxiety as well as coping with the actual problem of
the acutely disturbed person. He has responsibilities in respect of patients' children and their
property—this can include livestock—so that it will readily be seen that a referral of an acutely
mentally ill patient can involve the mental health social worker in many varied and complex problems.
The main catchment area hospitals for the City are Horton and Banstead, both in Surrey about
15 miles away. This in itself adds to the time-consuming nature of hospital admissions.
Community care of the mentally ill and subnormal and severely subnormal patients is the field in
which the greatest development can be expected. Each member of the staff has a personal caseload
and is responsible for the well-being of the patients in his or her care. Apart from general supportive
therapy to the mentally ill, mental health social workers arrange for attendance at out-patient clinics,
rehabilitation centres and clubs, and provide introductions to other agencies such as the National
Assistance Board and the Ministry of Labour.
An interesting development since 1st April, 1965 has been the increasingly close association of the
mental health service not only with other sections of the personal health services but also with other
Departments of the City Council, particularly the Children's, Welfare, Housing and City Solicitor's
Departments.
No community care service for the mentally ill can be soundly based unless close co-operation exists
between the local authority, catchment area hospitals and general practitioners. Regular attendance
at Horton Hospital's discharge conferences has already begun and has continued, and in October,
1965 arrangements were made for the mental health social worker staff in addition to attend regularly
at the out-patient clinics held by Horton Hospital at Paddington General Hospital. This has resulted
in vastly increased co-operation between the local authority and the hospital and is proving of great
benefit to the patients, their relatives, and the medical staff and social workers concerned and has in
it the elements of a neighbourhood service. Similar arrangements have been made with Banstead
Hospital and here increased co-operation is already bearing fruit.
Community care for the subnormal and severely subnormal had been well developed in London
under the Mental Deficiency Acts and had continued with increased flexibility under the Mental
Health Act, 1959. Work in this field rarely creates the acute problems encountered in the work for
the mentally ill, but the continuing needs of such patients and their relatives necessitate long-term
support which must be varied in intensity to meet the current situation. No age group is missing
from the subnormal and severely subnormal work. Our patients in community care range from infants
under one year to patients of fifty or more. It is obvious that many different requirements need to
be met. For the parents of children under five, counselling clinics are provided. These are held at
maternal and child welfare premises and are staffed by a senior medical officer with special experience
and a mental health social worker. Interviews are by appointment and only about four patients are
seen in any one session. At the first visit the mother is usually accompanied by her health visitor.
The existing clinic at the Harrow Road maternal and child welfare centre has been extended during
the year to meet the demand and a new clinic was opened in July, 1965 at Bessborough maternal and
child welfare centre to bring this service to the southern part of the City. Through the community
care service and close co-operation with the health visitors, a very high proportion of mentally handicapped
children in Westminster are known before the age of five years and are seen at these counselling
clinics. When, therefore, the problem of their education arises, and the procedures under Section 57
of the Education Act, 1944 (as amended) have to be undertaken for children unsuitable for schooling,
assessment examinations are usually carried out by the City Council's medical officers already known
to the children and the somewhat complicated legal procedure is explained to the parents by social
workers with whom they are already familiar. This eases for parents a difficult period of adjustment.
Whenever possible arrangements are made for the admission to training centres of those children
who can benefit from them. Although the City Council has no centres within its own boundaries,
neighbouring authorities are co-operating most generously in continuing the previous pattern and
only occasionally is there a waiting period before a suitable child can be admitted. Transport is
provided for these children and the City Council's mental health social workers keep in close touch
with the family and the centres to ensure that Westminster children are receiving proper service.
On leaving at 16 years of age patients are transferred to adult centres where they remain indefinitely.
These centres have developed recently on industrial lines and are extremely progressive in outlook.
A joint holiday for trainees attending London training centres has been arranged for years at St.
Mary's Bay Holiday Camp, Dymchurch. This has been continued and the Westminster trainees
took part as usual. The Inner London Education Authority bring to the City Council's notice leavers
from schools for the educationally subnormal and maladjusted. These boys and girls are placed in
community care and valuable help and support is given to help them to adjust to working life and