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overcome his self-consciousness. He dislikes feeling that people do things for him out
of pity, with the result that he becomes withdrawn and will not meet his old friends.
He must be educated to accept his handicap and to acquire other skills and recreations,
and his relatives must be educated to avoid over-protectiveness.
Group activities can help to overcome loneliness and self-consciousness. Both
social and occupational activities, including training in craftwork, are organised in many
clubs and centres provided and run by voluntary associations, sometimes with the help
of welfare authorities. But what can be done in this way is limited by the knowledge and
skill of the voluntary helper; the danger is that patients may be encouraged to engage
in unsuitable activities which may be prejudicial to their disabilities. It must also be
realised that even where craft training is suited to the patients' disabilities it is of little
use in the case of a disabled housewife unless she has first been helped to be personally
independent in her own home by aids to daily living. Nor is it of much use to a mentally
alert young handicapped man with a long expectancy of life if it is not likely to bring him
financial independence.
Once personal independence has been established the main aim should be to achieve
the maximum degree of financial independence. It is, of course, always difficult for
disabled and immobile people to earn an adequate living by their own work; some help
from the State there must be, but it should be linked as closely as possible to the efforts
of the individual patient. It is better to subsidise the goods which can be made by
disabled people, but which cannot be marketed at competitive prices, than to pay
handicapped benefit grants.
In the past, voluntary associations have often trained homebound patients in craftwork
which had no commercial value. Recently, however, some welfare authorities—
particularly Derbyshire— have succeeded in training handicapped people to do parts of
an industrial process in their own homes (e.g., the making of mop heads or the fixing of
hooks to rubber strips) and have co-operated with local factories in the delivery and
collection of the goods. But this is a difficult and unreliable scheme to operate. Most
people engaged in the rehabilitation of the disabled feel that it is a second-best alternative
to the more varied work of an occupational centre and only to be considered when it is
quite impossible to provide special transport for homebound patients.
Welfare authorities are just beginning to set up occupational centres— which must
not be confused with the occupation centres provided for the mentally defective. A
great many more are needed, and will, I am sure, be forthcoming in the next few years.
They offer handicapped people places where they can go each morning, meet and mix
with other disabled people and do work which is within their powers under the close
supervision of occupational therapists in a friendly, non-competitive atmosphere. The
most successful have been those where the welfare authorities pay the people who make
the goods part of the price at which they are sold. In Croydon, for example, where
40-50 people attend the occupational centre, a worker gets 2/6d out of the 25/- received
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