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THE PREVENTION OF MENTAL ILL HEALTH
Last year I wrote about the theory of human conduct. If we could ensure
that the theory even in a simple form was well understood by everybody, it
may well be that a great deal of mental ill health could be prevented; for
conduct is predictable; so departures from normal accepted codes would be
better understood. Briefly the theory stated that the essential need for all
animals, including the human animal, is self preservation; this is most readily
safeguarded when the animal or person is in good standing with the herd or
group. For rejection by the herd or loss of acceptance by the group places
the animal in danger of annihilation by enemies. It is the group which is strong,
the individual who is weak, and in the strength of the group lies the safety of
the individual.
Now in seeking acceptability by others—be it parent, family, workmates,
employer, political association or club—the individual is constantly adjusting
his conduct so as to conform to the accepted codes of the desired group and
to obey the wishes of the important persons. When the individual feels that
the security of the group is being denied to him he will resort to one of a number
of lines of conduct, all of which are well known reactions to the threat of isolation;
the purpose of the chosen line of conduct is to reinstate himself, even
if only in his own imagination.
Now most mental breakdowns originate from small beginnings as when
an individual feels himself outcast. Unless tackled and corrected in the early
stages, or happily by resolution of the difficulties themselves, the person may
well go on to a major nervous breakdown or even to a severe mental derangement.
There is a growing awareness of the need for professional advice to
assist people in the early stages to readjust their views. This is evident in the
enthusiasm which the health visitors are showing in asking for training and
knowledge in the prevention of mental breakdown. Recently two of our health
visitors attended a course of instruction at the Cassel Hospital at Richmond
and came back full of enthusiasm for what they had learnt. This knowledge
is essentially similar to that given to psychiatric social workers. Training
in psychiatric social work is slowly emerging as a result of the changing attitude
and conscience of the community to mental illness. But we have far too few
psychiatric social workers to cover the needs of our area. We have three who
are attached to the child guidance service for Area 10 and these are fully
occupied with the problems of children. Only slowly over the last 30 years
has the need for trained psychiatric social workers been recognised. Their
function is to obtain details of the social environment, to keep in touch with
the patient and relatives, and to work to try to adapt the social setting for the
benefit of the patient and relatives so that the patient may have the best chance
of adaptation and recovery. In many cases this needs the re-education of
father and mother and perhaps a resolution of conflicting views and even a
change of set ways of life. The job is exceedingly difficult and requires enormous
tact and perseverance. The full training of a psychiatric social worker includes
psychology, psychiatry, child development, mental deficiency, physiology,
sociology, law and administration in mental health, and criminology. The
training is long and expensive; so far the number of trained workers available
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