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down depends on the pressures put upon the person which vary, and the results vary as
individuals vary in their make up. The patient may have an exaggerated idea of the
antagonism of the world outside which the home help may do something to allay, and
she may in fact provide something to which the mental patient may cling at a time of
crisis.
She can help enormously in the relief of pressure on a child which can be so damaging
at an early age to a child in an environment where mental ill health reigns. The modern
trend towards the early discharge of mental patients and the early attempts at rehabilitation
in the community can be assisted by the services of a home help, and I believe that the
future will show this to be of increasing value.
Already local authorities in Great Britain are reporting increased demand for services
from psychiatric social workers, from psychiatrists and from mental hospitals generally.
In the case of the mentally sub-normal, I suppose the biggest contribution the home
help can make in the household is to help to relieve the tensions and pressure on parents
and relatives brought about by the presence of a sub-normal child or young adult. The
degree of subnormality varies widely. In my own area we have a case of a man of 50
who was certified as a mental defective some years ago. Because his home circumstances
were good it was decided he would not need help so supervision was discontinued, but the
chain of events some three or four years ago caused some confusion and difficulty; the
fother died just before Christmas about three years ago, the mother died within a few
weeks of the fother and the patient was left on his own in a council house. He is sufficiently
intelligent to do a job, although he has great difficulty in looking after his own affairs.
The Court of Protection took charge of his finances and the home help took over the
running of the household. He has had the same home help ever since. She described
to me how when she first tried the job she felt she wanted to run away because she was
afraid of what this man might do. In fact she found him very amenable to discipline,
he goes out to work and produces the money for her to buy his food and clothes. She
now arranges to have her own holiday at the same time as he has his. The only complaint
she has is that she might have been told a little more about what to expect when
she went into this household.
Under certain circumstances it is important that the Organisers should be in possession
of the medical details of the cases being served by her staff. Infectious diseases
spring to mind in this connection as well as mental illness. It is important that the
home help herself should be aware of some of the possible reactions of the patient in
cases of mental illness and that she should have some general understanding of people's
reactions to situations. To this end a course of training may help. This could either
precede service or be given after a couple of years practical experience.
This leads us to consider whether the psychiatrist should not be more closely associated
with the work of the local authority to be able to give the staff involved some insight
into the problems of particular cases, and some help in knowing how to deal with
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