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of its promise and the scheme has been welcomed by hospital doctors and general practitioners.
The experiment was later extended to division 1. Thirteen persons were benefiting
from this service at the end of the year and consideration was being given to an extension
of the arrangements to include other divisions.
Social work in the mental health service
The Principal Mental Welfare Officer reports:
The menially ill—As applied to mental illness, preventive care in a broad sense covers
a very wide field in which all public health and other social services are involved, from the
maternity and child welfare clinics to the old people's welfare committees, from the school
to the housing office. It is usual to distinguish between preventive and after-care work,
but this is often an artificial distinction, for the mental health social worker concerned with
community care, as with all after-care, aims at preventing a relapse.
It must be emphasised that the community care service for both the mentally ill and the
subnormal is a permissive one, in that the person concerned and/or the relatives have a
right to refuse to accept it: there is no question of a power to enforce, even where this may
seem very desirable. The only exception to this rule is where the patient is the subject of
a compulsory order, which may be during a period of up to six months on leave of absence
from hospital or where a guardianship order is in existence, but these together represent
a very minute proportion of those receiving community care. It follows that for the
service to be effective the mental health worker must aim at securing the goodwill and
maximum co-operation of all concerned. This calls for qualities of sympathy and understanding
coupled, of course, with the right degree of detachment. It requires the capacity
not only to listen but to withdraw at the right moment and also the willingness to work as
hard as is required at any given moment. The work is therefore physically and emotionally
demanding. The mental health team bears the brunt of this but other social workers in
the department are inevitably confronted by mental health problems with which they must
deal, not least the Council's health visitors who do a great deal of therapeutic value in
the course of their work.
Referrals to the service come from many quarters and the numbers are, as might be
expected, steadily increasing. The community has, of course, always carried a heavy burden
of mental illness but until comparatively recently the load was lightened by long term
incarceration, sometimes for a lifetime. With changed attitudes and—more important
-modern methods of treatment (including the use of new drugs), and the decrease in the
use of compulsory powers, the average stay in psychiatric hospitals is now very short.
On return from hospital, many, although 'cured', do require the supportive help of somebody
who understands without judging and with whom they can make a good relationship;
this of course frequently applies to the relatives as well as to the patients. In most
cases the sense of stigma attached to hospital admission is still very real and the social
worker is able to play a part in offsetting this.
In some cases community care involves frequent and lengthy visits over a period;
sometimes long supportive telephone conversations in times of crisis. So far as possible
those cases requiring special skills are dealt with by the psychiatric social workers but the
bulk of the work inevitably falls to the mental welfare officers. Where there is a psychiatric
social worker employed as such, he or she is available for consultation if mental welfare
officers so wish in cases of special difficulty. In four divisions the divisional mental welfare
officer is a qualified psychiatric social worker. Any possible steps to prevent further breakdown
or to assist rehabilitation are taken. These may include persuasion to attend a day
centre, an out-patient clinic, a day hospital or perhaps an evening club; it may mean
arranging a recuperative holiday or making special contact with the employment exchange
or the National Assistance Board or any other assisting agency. It may also include finding
a hostel vacancy. The social worker is frequently in a position to recognise early signs of
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