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Although the largest single source of referrals for the provision of after-care is
from mental hospitals, there are various factors that keep this number lower than might
have been expected : amongst these are probably :
(a) the administrative and treatment gaps that since 1948 are involved in
making referrals to local authority psychiatric services. Apart from the break
in relationship with the patient, it is very understandable that psychiatrists,
who have taken considerable interest in cases under their care, feel some
concern about referring these to almost unknown workers whose professional
standards they have little chance of assessing and over whose approach they
have no influence because the present pressure on both services seldom allows
time for personal contacts ;
(b) the open question whether, having come to rely on one doctor or
social worker, it is in the interest of patients or their relatives to be asked to
change to another psychiatric service, when they are prepared to make the effort
to keep in touch with their hospital; for example, through out-patient clinics;
(c) the geographical problem in London—where in most cases patients are
taken so far from their own neighbourhoods for in-patient treatment. This
makes it very difficult for the local authority psychiatric social worker to
maintain any previous contact there may have been, or, with new referrals,
to make the first approach while they are still in hospital and their relationship
to the psychiatrist and other staff is actively appreciable. The fact that the
community care psychiatric social worker knows so little of this aspect is
usually a great handicap in trying to carry the patient's hospital treatment
through into normal life ;
(d) the almost inevitable frustration involved in administrative co-operation
conducted mainly through the post, and sometimes also through several
official levels.
The ultimate saving by time spent in liaison is not yet fully recognised. Certainly,
if through the national shortage of trained personnel the service should have to continue
at the 1957 strength of four psychiatric social workers for the whole of London, there
will, regrettably, be little opportunity of demonstrating this economy.
The number of referrals from general practitioners was comparatively few. This is
regretted, since it is felt that from this source cases could be taken up at an earlier stage
of illness.
Mental
welfare
officers
In London, a staff of mental welfare officers and assistant mental welfare officers,
under the direction of a senior mental welfare officer, is employed virtually exclusively
on the work of taking the initial proceedings in providing care and treatment for
persons suffering from mental illness. This arrangement, which as shown below, does
not mean that the officers' duties are confined strictly to taking statutory action under
the Lunacy and Mental Treatment Acts, has resulted from the way the mental health
services in London have developed. Such an arrangement is possible only because of
the volume of the work and the comparative compactness of the area. It has advantages
and disadvantages : the principal disadvantage is that, apart from a small amount of
escorting of mental defectives, the officers are subjected to the strain and tension of
dealing continuously with persons suffering from acute or chronic mental illness and
having to decide what action shall be taken in respect of them frequently against their
wishes.
The Council's mental welfare officers provide a continuous service available throughout
the 24 hours of each day. Most calls for their services come from general practitioners
but requests are received also from hospitals, from other health and welfare services
of the Council, from social agencies of every kind, from the police and from other
sources, including ordinary members of the public.
As stated earlier many voluntary patients are admitted to mental hospitals by arrangement
between the patient's doctor or out-patients clinic and the hospital without
reference to the mental welfare officers. Persons referred for action by those officers