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Local authorities and hospitals should develop their services for young psychopathic
patients.
Local authorities, in collaboration with the hospitals should be responsible for
organising diagnostic clinics and case conferences for severely sub-normal and psychopathic
patients.
The National Assistance Board should be responsible for financial grants to patients
in hospital or in the community who need such assistance. Local authorities should be
able to make augmentation grants to patients who are in full-time employment but
are paid a sub-standard wage because of mental disability.
The medical officer of health should be responsible for the central direction of the
local authorities' mental health community services and should be in charge of the
medical and administrative staff and social workers who deal with the needs of individual
patients but local authorities should be free to provide specific services such as residential
homes, etc., under their powers under the National Health Service Acts or the National
Assistance Act as they think appropriate and no one should be excluded from benefiting
from any of the general social services because his need arises from mental disorder
rather than from some other cause, if he can suitably benefit from such services.
Special financial help should be given from the Exchequer towards local authorities'
capital expenditure incurred during a limited period on services for mentally disordered
patients.
Hospitals and homes outside the National Health Service Act and other private care—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.
Comment on the Royal Commission's proposals
Nomenclature and classification of patients—The proposal that many of the terms hitherto
used in respect of persons dealt with under the Lunacy and Mental Deficiency Acts
should no longer be used was expected. The recommendation that many of the persons
at present classified as feeble-minded persons should be described as' feeble-minded
psychopaths' and included in the group of patients to be known as 'psychopathic
patients' or 'patients with psychopathic personality', however, gives rise to some
misgiving, notwithstanding that the term is used in a wider sense than it is commonly
used at present and that the term, together with the terms proposed for the other two
groups of mentally disordered patients, viz., ' mentally ill patients' and 'severely
sub-normal patients ', should be used only for legal and administrative purposes.
The suggestion that, with some exceptions if there are serious personality defects in
addition, the broad dividing line between the seriously sub-normal and the psychopathic
should be an I.Q. of 50-60, would mean that a large proportion of children leaving
E.S.N. schools would have to be classified as 'feeble-minded psychopaths' if they are
to be provided with community or any other form of care within the scope of the
proposed new mental health services. It has been the practice of the Council's Education
Committee, on the advice of the school medical officer, to refer the majority of E.S.N.
school leavers to the Health Committee for supervision under the Mental Deficiency
Acts since it is felt that it is to their advantage that they should be given help and
guidance in the difficult transition from school to working life. Such assistance has in
the main been welcomed by parents. The suggestion of the Royal Commission that
these children should be helped by social workers employed by local health authorities
as a matter of course without formality does not remove the difficulty since legal
classification would be necessary in replacement of the term ' mental defectiveness'
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