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many still 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.
The needs of parents of patients and relatives are various. For some a friendly visit
and re-assurance that help is available is enough, others may require constant care over
a long period. Visits may need to be frequent and of a length that enables social worker
and patient or relative to develop a knowledgeable and friendly relationship that will be
supportive whilst also, where possible, enabling a progressive independence to be
established.
For cases requiring special skills, psychiatric social workers in the mental health teams
are available. They are also able to offer advice and consultation to mental health social
workers who seek help with their more difficult problems. Steps taken to prevent further
breakdown or assist rehabilitation 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 potential
breakdown (which may be due to failure to continue drug treatment or increase of family
stress or any other factor) and may, by timely liaison with the general practitioner or
out-patient clinic, be able to avert the necessity for in-patient treatment.
One effect of the new Act, with the consequential expansion of the community care
service, is that inevitably a great variety of people with mental health problems are referred
from many sources. For a number of these no very constructive help is possible but it is
nevertheless impossible to shelve responsibility entirely, except in a very limited number of
'hopeless' cases. For the remainder, time and energy is often spent fruitlessly but unavoidably.
A number of mentally ill (also subnormal) adults find their way into London from the
provinces; some of these have spent earlier years in psychiatric hospitals. Before the establishment
of a community care service many floated, more or less happily, from lodging
house to lodging house, only coming to the notice of the authorities if they appeared before
the Courts; a number are now referred to the mental health social worker. In some cases it is
possible to help constructively but many have well established wandering habits and have
become unemployable. Frequently they are not sufficiently ill mentally to be made the
subject of compulsory orders and there is a tendency to wander in and out of hospital
voluntarily. This is also the pattern of life of many of the mentally disordered who are
Londoners and the burden is shared by all agencies, voluntary or otherwise, concerned with
the homeless and destitute, including, of course, the Council's Welfare department. Bodies
such as the Salvation Army and the Church Army provide temporary and sometimes
permanent havens for them and co-operate with the mental health workers in efforts at
rehabilitation.
The severely subnormal—Mental health social workers remain in close touch with all
severely subnormal children and also with the small number of children who are not severely
subnormal but are reported under sec. 57 of the Education Act, 1944 (as amended by the
Mental Health Act). By visits to the homes they are in a position to assess the situation and
to recommend short term care in times of crisis or when the family need a rest from the
demanding care of such children. It is also the function of the officers to explain more
permanent hospital care to enquiring parents and to help them to come to terms with the
problem whilst awaiting a hospital vacancy—frequently a very long wait.
They play an active part in explaining the value of training-centre training and in
persuading any reluctant parent to agree to the child attending. They also attend medical
examinations at the centres and in most cases arrange for any necessary treatment. A
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