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It is estimated that of the 5,000 cases at present under statutory supervision nearly
3,000 are over 16 and in employment. This arises because of the conditions of full
employment that exist and because of the policy of the Council of reporting under
section 57 of the Education Act, 1944, the majority of children leaving special schools
for the educationally sub-normal who are of the highest mental grade of persons a local
health authority is called upon to deal with under the Mental Deficiency Acts. Although
it would still be possible under the Royal Commission's proposals for these young
persons still to be visited on a voluntary basis if they and their parents desired it, no
doubt visiting would be discontinued or at least very much reduced after a period which
in most cases would not need to exceed two years. The fact that under the Royal
Commission's proposals a considerable proportion of this group would not be subject
to any sort of compulsion as regards hospital or institutional care or guardianship after
the age of 21 unless they committed a criminal offence would also tend to reduce the
number of persons visited.
On the other hand, the scope of the duties of the local authorities in the field of
social work would be very much extended by the Royal Commission's proposals.
They would have to take over the visitation of patients discharged from mental
deficiency hospitals which in some instances is now done by the hospitals themselves.
They would have to keep in touch with patients admitted to hospitals and homes and
hostels and their relatives for the purpose of advising on the suitability for discharge,
finding employment and many other matters. This expansion would greatly increase
the usefulness of the work, but of course it would necessitate a reduction in the case
load of individual social workers.
In the Council's evidence to the Royal Commission it was stated that, at 31st
December, 1954, 555 children of school age were attending occupation centres and
that the parents of 70 children refused to allow them to attend. If attendance is made
compulsory, as recommended, more accommodation will be needed but not to the
extent to cause serious difficulty.
Homes and hostels—The proposal of the Royal Commission that the function of the
hospitals should be restricted to patients who need specialist medical treatment or
continual nursing attention, including the helpless severely sub-normal, although
perfectly logical, would throw an enormous burden on the local authorities as regards
the provision of residential homes, hostels and training centres, etc., particularly for
patients at present classified as mentally defective. This proposal involves a partial return
to the pre-1948 position. It is, however, much more difficult to effect the change now
than it would have been to retain the patients concerned within the ambit of the local
health authorities in 1948. There are at present over 7,000 London mentally defective
patients accommodated in mental deficiency hospitals and institutions and about 300
new admissions are arranged each year. There is at present a waiting list of about 150.
It could be that a third of these patients (or even more) would be the responsibility of
the local authority, according to the Royal Commission's definition of duties of the
hospitals and local authorities. A wide range of residential homes with training and
entertainment facilities for the higher-grade patients and with occupational and entertainment
facilities for the lower-grade and hostels for those suitable for employment would
therefore be needed.
In view of the Royal Commission's opinion that local authority residential homes
should not be large and that 20-30 residents might be the usual size, with a maximum
not much over 50, it is obvious that the Council would need a very large number of
such establishments and it is doubtful whether the Royal Commission's suggestion
that some hospital buildings might be transferred to the local authorities would contribute
much since there are few such buildings as small as suggested.
In addition to these residential homes for the mentally defective (as classified at
present), residential homes and hostels will be needed for the aged mentally infirm and
for those mentally ill patients in mental hospitals who, although needing a minimum of
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