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may continue for many months, and to assess whether, and at which stage, efforts
should be made to relieve this by short-term care.
The social workers are the link between the home and the occupation centre, and
they attend at the periodical medical examinations carried out at the centre. It is their
function too to assist as far as they are able in settling the higher grade mental defective
into the employment and social setting, by discussion and/or co-operation with other
social agencies.
Suitable boys and girls leaving schools for the educationally sub-normal are placed
under the personal guardianship of the social workers. This usually involves finding
suitable lodgings, hostel, or other accommodation and invariably necessitates close and
careful supervision, particularly in the early stages.
Except for those placed under personal guardianship of the Council's social workers,
mental defectives placed outside the County are normally supervised by the appropriate
local health authority, but, in many cases, occasional informal contact is maintained,
and infrequent periodical visits are paid to all those placed and supervised by the
Guardianship Society, Brighton, on the Council's behalf.
As stated above the Council's social workers have continued to do a good deal of
work on behalf of the regional hospital boards in respect of the patients in mental
deficiency hospitals. Their function as regards patients who return to their homes on
licence is mostly to assist rehabilitation and the indications are that this will play an
even larger part, with the changes foreshadowed by the recommendations of the Royal
Commission.
Psychiatric
social work
The Council early recognised the importance of social work m the care and treatment
of the mentally ill. Psychiatric social workers were employed at the Maudsley Hospital
even before the first mental health course for psychiatric social workers in this country
was started at the London School of Economics in 1929. Some of the staff of the
Maudsley Hospital assisted in the training of the students taking the course and in 1930
psychiatric social workers were employed at the mental observation wards in the
Council's hospitals and subsequently at the County mental hospitals. When the
hospitals were transferred to the Minister of Health in 1948, the social workers employed
at the hospitals were of course retained in the hospital service. In the scheme which
the Council submitted to the Minister in 1948 under section 28 of the National Health
Service Act, 1946, however, it was stated that the Council would consider appointing
psychiatric social workers as might be necessary and as they became available, to provide
care and after-care for persons who were mentally ill.
The first community after-care service for the mentally ill was started in 1943 at
the request of the Ministry of Health by the National Association for Mental Health
for ex-service personnel discharged from the services on psychiatric grounds. In 1948,
however, the numbers of ex-service personnel needing to be dealt with had dwindled
to negligible proportions and the overwhelming majority of persons needing assistance
were civilians. The Ministry accordingly suggested that local health authorities should
undertake responsibility for this work under section 28 of the National Health Service
Act, 1946, either through their own staff or through the National Association and
reimburse the Association for its services.
In London, the work was first carried on by the National Association for Mental
Health and the Mental After-Care Association jointly acting as agents of the Council,
but from April, 1953, the service was undertaken directly by the Council which, since
then, has been building its own service by the direct engagement of psychiatric social
workers under the general direction of the consultant psychiatrist employed by the
Council as its adviser in mental health. In 1955 the number of psychiatric social workers
rose to four—one of the positions becoming a senior post during 1957.
Nature of
psychiatric
case-work
Psychiatric social workers working in the community, as opposed to the more
specific environments of hospital or child guidance clinic, see a very wide range of mental
illness and employ accordingly varied means in trying to help patients remain out of
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