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Hospitals and homes outside the National Health Service Act and other private care—The
recommendations of the Royal Commission that local authorities should take over
from the Minister of Health and Justices of the Peace responsibility for registering or
approving hospitals and homes provided for persons suffering from mental disorder
by charitable societies or private individuals and should also take over from the Board
of Control, which will be abolished, responsibility for the general oversight of patients
in private houses not liable to registration would necessitate additional work of visitation
and inspection by the Council's medical officers and other staff but it is thought that
relatively the additional work would not be considerable.
Review of Council's mental health services
Apart from the proposed new admission procedures, the most important feature of
the Royal Commission's proposals is their recommendation for an expansion of local
authority community services both as regards help and advice to be given by social
workers and the provision of day and residential occupation and training centres and
homes and hostels.
So far as London is concerned, and no doubt many other areas as well, the pattern
of the service proposed by the Royal Commission already exists although of course
there is scope for almost unlimited expansion, if and when the resources of finance,
staff and accommodation permit.
Mental
deficiency
social work
Social workers have been employed on mental deficiency work in London ever
since the Mental Deficiency Act, 1913, came into operation. From the beginning the
social inquiries necessary for the ascertainment of new cases were carried out by social
workers directly employed by the Council but the supervision of defectives living in
the community was undertaken on the Council's behalf by social workers employed
by the London Association for Mental Welfare. This organisation was taken over by
the Council in April, 1931, and now social workers based on four district offices are
engaged exclusively on mental deficiency social work under the direction of a senior
social worker on the central staff. The duties of these workers include the social inquiries
necessary for the ascertainment of new cases (769 in 1957), the visitation of 5,061 cases
under statutory supervision and 1,494 cases under voluntary supervision and the supervision
of 108 cases under guardianship in London and 111 cases on licence from hospitals
and institutions. (The figures given relate to the position at 31st December, 1957.)
In addition these workers also report in the course of each year on the home circumstances
of many patients in hospitals in connection with applications for leave of absence
or discharge and the statutory review of orders of detention.
For the purposes of ascertainment the social workers visit the homes of mental
defectives to obtain necessary information as to the social background and to discuss
the future welfare of the defective : they obtain relevant data from many other sources
such as school reports, Children's Officers' papers, hospital reports, etc., and condense
the whole into manageable proportions, and in a form which, with the addition of the
social workers' recommendation, provides a basis for the decision of the medical officer
and for future action.
Although there remains a legal distinction, there is now very little difference between
statutory and voluntary supervision as regard the help and assistance that are given
and it is envisaged that if the recommendations of the Royal Commission are implemented
this legal distinction will also disappear. The overwhelming majority of mentally
deficient persons remain in their own homes under supervision. It is the responsibility
of the social workers as far as possible to gain the confidence and co-operation of the
parent and the defective, without which supervision—statutory or otherwise—would
in most cases be ineffectual and meaningless.
It is for the social workers to make some assessment of the relative urgency of cases
awaiting institutional care, and, with the continuing long waiting lists for such care,
it is their function to help the family to accept and adapt themselves to a situation which
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