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31. We are convinced that preventive mental health activities carried out within
the maternity and child welfare service will be welcomed by the general public. Here
we would again stress that the proposal that such work should be done by public health
staff and in child welfare centres constitutes no more than an extension of accepted
principles and existing practice. Those who make use of the maternity and child welfare
services expect advice to be given sympathetically and in terms which are readily
understood; in the practice of preventive mental health there is no need and indeed no
place for 'jargon' and unfamiliar terms, which may frighten rather than help those who
seek advice. Moreover, in cases which may have to be referred to child guidance clinics
previous contact with child welfare staff who are well known to the mothers may
induce encouragement and confidence, and conversely may enable the specialist team
to call on the centre doctor and health visitor for continuity of care and follow-up.
Increased responsibilities of public health staff
32. The ways in which preventive mental health work can be developed as an
integral part of a maternity and child welfare service must now be considered in somewhat
greater detail. From the point of view of the broad dissemination of principles a
great deal has been and is being done already. Both centre doctors and health visitors—
particularly those more recently qualified—have become increasingly alive to the
necessity of making parents aware of certain principles of mental health, such as the
child's basic need for security, but much more of such work will be required in the
future.
33. It is the function of the health visitor to help parents in the care and management
of their children in the widest sense. Home visits enable her to make a first assessment
of each family. In giving advice, she must bear in mind important principles of mental
health. Thus, when it falls to her in an emergency, such as the mother's admission to
hospital, to make practical arrangements, she must realise their far-reaching implications
for emotional adjustment. For instance, through team work with her colleagues in the
field, e.g., home help organisers, children's officers, hospital almoners, etc., she may,
by suitable arrangements to keep the child within its home environment, lessen the
impact of physical separation from the mother.
34. In a programme of preventive mental health, however, even more will be
expected of the health visitor. She has the earliest opportunity to help the mother to
deal wisely and confidently with the normal problems of emotional development, and
in her contact with the mother during the ante-natal period can anticipate stresses and
strains arising from new situations, such as the advent of a new baby, and help the
family to find health adjustments. She can help the mother to face the anxiety which
inevitably arises from time to time in bringing up young children, and in particular
she can give valuable support to the mother who suffers from conscious or unconscious
over-anxiety.
35. The basic function of public health activities in the maternity and child welfare
field is health education. Centre doctors and health visitors in dealing with problems
such as feeding difficulties, toilet training, temper tantrums, etc., are constantly called
on to give guidance and advice which demand a preventive mental health approach.
The discussions within the Study Group, as well as frequent comments of colleagues,
have revealed a very general desire on the part of members of the public health staff
to understand fundamental principles of causation and management of such problems,
so that they may undertake with confidence the dissemination of broad principles
relating to normal developmental phases.
36. A wider understanding may be achieved not only by individual contact with
mothers and discussion of their anxieties, but on a broader front through group discussion
in the centres. Initially, this will cover only a small proportion of young parents,
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