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106
and Wales) are supervised by the Council's social workers from the four district offices
on request from the physician superintendents concerned. Medical reports are also
provided when necessary to avoid the return of defectives to institutions at the time of
statutory consideration and reconsideration of orders and when discharge is under
consideration. Of the six mental deficiency institutions which have catchment areas
wholly or partly in London, two (St. Lawrence's and the Fountain Hospitals) now
undertake the supervision of their own patients on licence by their own social workers
who, in the case of the Fountain Hospital, also report on home conditions as required
in connection with the statutory consideration and reconsideration of orders and the
consideration of the grant of leave of absence or discharge. This latter duty is undertaken
by the Council's social workers in respect of relatives of defectives living in London for
all institutions other than the Fountain Hospital.
Voluntary associations
The Guardianship Society, Brighton, assists the Council to find suitable guardians for
patients under the Mental Deficiency Acts and carries out supervisory duties in respect
of those patients so placed on payment of agreed charges. In addition, the Council makes
use of voluntary associations in carrying out services provided under section 28 of the
National Health Service Act, 1946 (see page 39).
Domiciliary
After Care
Service
Prevention of mental illness and care and after-care
Following the receipt of circular 146/48 from the Ministry of Health, arrangements
were made for the National Association for Mental Health and the Mental After Care
Association to provide between them, on behalf of the Council, on payment of 90 per
cent. of the cost of the service to each Association, care and after care for persons
suffering from psychiatric illness. The service, which was a continuation and extension
of the after care scheme for ex-service personnel which had been operated by the
National Association since 1943 at the request of the Board of Control and the Ministry
of Health, is largely carried out by means of domiciliary visits. The service provides
help and guidance in problems of adjustment to social and home life and in finding
employment, etc., for those persons suffering from psychiatric illness who do not need,
or no longer need, in-patient or out-patient treatment. It was made clear to the two
Associations that the arrangements for them to carry out the work on the Council's
behalf were of an interim nature only. A recent review of the cases dealt with by the
associations revealed that about one-third of the cases referred, or seeking help themselves,
are dealt with comparatively quickly and with little difficulty by being referred to
psychiatric out-patient clinics or to their own doctors or by other similar means. Onethird
require help of a varied nature which usually involves co-operation with Government
departments, such as the Ministry of Labour, Ministry of Pensions, etc. The
remaining one-third are long-term cases requiring supervision and domiciliary visits
over a prolonged period. Since the inception of the scheme up to 31st December, 1952,
1,129 cases have been dealt with, 705 by the National Association for Mental Health
and 424 by the Mental After Care Association. At 31st December, 1952, there were 231
active cases on the registers. Careful consideration has recently been given to this service
and it has been decided that to enable the work to be carried out under the immediate
supervision and direction of the Council's medical adviser in mental health, the work
shall be done by the Council's staff and the arrangements with the two associations
terminated on 31st March, 1953. The thanks of the Council have been conveyed to both
associations for the satisfactory manner in which they have carried out this important
and useful service. It is proposed to employ two psychiatric social workers and additional
clerical help as necessarv on this work.
Social clubs
and rehabilitation
centre
A grant is made to the Institute of Social Psychiatry of 90 per cent. of the cost incurred
for London patients attending the rehabilitation centre and five psychotherapeutic social
clubs run by the Institute. The centre is open each morning and afternoon on five days