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Mental Health
With the advent of the Social Service Act all responsibility
for adult mental health service was transferred to the newly
formed Social Services Department with effect from 1st
April. Former junior training schools became day special
schools within the meaning of the Education Acts and
children placed in them are now regarded as handicapped
pupils ascertained under section 34 of the Education Act
1944. Reports on these schools and statistics relating to the
children are included in the section of the report which
deals with handicapped pupils.
The role of the principal medical officer has undergone
some change and is now advisory and comprises liaison with
hospitals and various consultants, liaison with other
authorities, principal medical officers and general
practitioners, careers officers, disablement rehabilitation
officers and probation officers, overall supervision and
liaison with principals and staff of the ten various mental
health establishments (four of which are residential),
liaison with social workers in particular with regard to their
work with subnormals and their families, inspection of
registered mental nursing homes, liaison with parent
associations and support to local mental health associations
and friendship club.
Clinical work with children has not greatly changed and
involves home visits to nearly all young new cases. The
parents having recently been confronted with the fact of
their child's subnormality are usually shocked and depressed
and many find it difficult at this stage to face journeys
outside the home with their child. They are able also to
relax and talk better in familiar surroundings rather than in
the more impersonal clinical setting. Two or more of these
home visits may be necessary before it is felt that parents
can be asked to attend a clinic. Counselling at this stage
must be full and detailed and all the relevant medical and social
aspects are discussed at length and often repeatedly.
A prognosis (in its widest sense) is given as accurately as
possible. The parents at this stage are given some idea of
the services that can later be provided, i.e. visits are
arranged to special schools and perhaps adult training
centres and hostels. They are encouraged to join parents
associations etc. to combat social isolation. Genetic
counselling can be usually given locally but referral to a
hospital genetics unit is sometimes desireable. This general
counselling is considered a very necessary exercise in
preventive psychiatry. If the parents are helped to adjust
realistically to the problems that face them the outlook for
the family as a whole is much improved and the problems
of the subnormal can be kept in perspective. In the past
many parents without such support have tended either
(a) grossly to overprotect the subnormal child which has
added to the child's handicap by restricting his opportunity
to learn a degree of independence and self reliance,
(b) to lose perspective whereby the rest of the family
becomes neglected in their concentrated efforts to help the
subnormal, (c) to pressurise the subnormal to do more than he
is capable of doing and by becoming unrealistic in the demands
for education, (d) to reject the subnormal, (e) to develope overt
mental illness (usually depression). Normally four clinics are
held each month at which parents and/or patients are seen.
Counselling and medical examinations of various elder
children either at school or at home is undertaken and any
necessary referrals arranged,i.e. to a psychologist, hearing
clinic, ophthalmologist etc.
Adults are now the responsibility of the Social Services
Department but when required the principal medical
officer's role is still to provide on-going support and
counselling of the families of older subnormals, particularly
when the parents themselves begin to feel the effects of age
or when one or other of the parents die. The almost
universal lifelong anxiety as to the future care of the
subnormal is then exacerbated and parents must be helped
to realise that they are not the only people capable of
caring humanely for subnormals and visits to hospitals,
hostels and adult training centres are arranged. Many
parents need persuasion and education in order to get them
to accept the appropriate placements, be it education or
residential for their children.
The principal medical officer continues to act in the role
of factory doctor to Acton Lodge Adult Training Centre.
The following report has been submitted by C F Herridge
MA MB BChir MRCPsych DPM, Consultant Psychiatrist.
Report on the hospital psychiatric services for the London
Borough of Hounslow
This has been an eventful and in many ways a sad year for
the community orientated psychiatric services run by
Springfield Hospital in conjunction with the Borough of
Hounslow. On the 1st April control of psychiatric social
work in all its aspects in the Borough passed from medical
to social work control. Whilst consultant medical advice is
still sought, medical direction is now no longer the case, and
so the anomalous situation exists whereby an administrative
barrier exists between ongoing clinical care in that potential
arguments at least exist as to what is "psychiatric" and
what is "social".
This is particularly unfortunate in a Borough which had
been for years a pioneer in developing integrated hospital
and local authority psychiatric services. It seems to lend
support to the fallacious view that psychiatric illness is
entirely a function of social maladaptation, when the
Borough had previously adopted the much wider eclectic
viewpoint. In particular specialist training in mental illness
for Social Workers dealing specifically with this field is not
now regarded as important, and it is felt that psychiatric
illness in the community can be dealt with by the "generic
social worker". Whilst it is appreciated that this is a
national administrative policy, it is one which I personally
deplore.
One immediate effect on patient care has been that the
close liaison between the hospital services and a small
intimate group of Mental Welfare Officers no longer
exists. The Hospital Services still attempt, with some
success, to hold seminars and meetings, and we are glad to
see as many local authority social workers as possible
present at hospital case discussions. With such large
numbers of social workers involved, however, breakdowns
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