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supervision, could be discharged but have no suitable homes of their own. Some of
these patients could go to Mental After-Care Associations homes or welfare homes
but much more accommodation would be needed. It is not possible to indicate the
extent of this need but at a meeting which I had in October, 1956, with physiciansuperintendents
of mental hospitals and representatives of the Metropolitan Regional
Hospital Boards, it was the general feeling of those present that the need for hostels
for patients in the latter category was considerable. In view of the extensive demands
which would be made on local authorities for the transfer of hospital patients to homes
and hostels it would be very desirable that the hospitals should agree to re-admit those
patients who prove unsuitable for care outside a hospital.
In addition to the staff which would be necessary to conduct the day-to-day running
of all these homes and hostels, it would be necessary for medical staff to be employed
for supervisory and clinical work and social workers to carry out the social work.
There is the further point to be borne in mind that, with the exception that if they
go out to work hospital patients may be required to contribute towards the cost of
their maintenance, hospital care and treatment is provided free, whereas services by
the local authority under section 28 of the National Health Service Act, 1946, are
normally provided subject to payment, according to means, by the recipient or liable
relatives. The transfer of patients needing prolonged residential care from a free service
to one for which payment is required would be likely to give rise to controversy,
although the question would not arise in many cases because of the absence of means.
Health and welfare services—With regard to the Royal Commission's recommendation
that children not attending school should receive health and welfare services similar
or equivalent to those provided for school children, children attending the Council's
occupation centres are at present virtually receiving all the health and welfare services
(meals, milk, medical and dental inspections) provided for school children but there
are a small number (100-200) who are too low-grade or otherwise unsuitable to attend
occupation centres to whom some small extension of some of these services might be
necessary if practicable.
Diagnostic services—The need for the provision of additional diagnostic clinic services
for severely sub-normal and psychopathic patients as recommended by the Royal
Commission is probably less in London than elsewhere. The Council already has
clinics throughout the County for backward children under five attended by a specialist
doctor, a mental deficiency social worker and a health visitor. It employs a number of
medical officers who have specialised in mental deficiency who hold regular sessions
at the County Hall where consultation with appropriate specialists, e.g., otologist,
neurologist, oculist, etc., is readily available if required. In addition there are 33 child
guidance clinics (4 administered by the Council and 29 by hospital authorities). Regular
case conferences are held under the aegis of the Council to consider maladjusted children.
All of these facilities will doubtless be made available for the young psychopath.
Guardianship of relatives—The view of the Royal Commission that the National Assistance
Board should be responsible for financial grants for patients in hospital and in the
community re-opens the question of the position of defectives who are under the
guardianship of relatives and friends and receiving financial assistance from the Council.
In 1948 there were 162 such cases for whom the Council was responsible. Following
the issue of a Ministry of Health circular (December, 1948) pointing out that these
persons were now entitled to assistance under the National Assistance Act, it was
decided (January, 1949) that no new cases would be placed under guardianship for the
sole purpose of providing financial assistance and that the existing cases should be
reviewed. As a result of the review 51 patients were discharged from guardianship
but the Council decided that the remainder for reasons peculiar to them should remain
under guardianship. In the light of the Royal Commission's recommendations the
position is to be reviewed shortly.
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