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17
MENTAL HEALTH
(Tables 18—20)
MENTAL ILLNESS
Community Care
In the year under review only relatively minor changes occurred within this Section but as these concerned
the appointment of key staff, partly into new posts, this should substantially improve the after-care
services for the mentally disordered in the Borough. Community services depend to a very large extent on
the enthusiasm and skill of professional staff without whom even the best appointed establishments cannot
wholly fulfil their purpose. Officers of the desired calibre in most fields are always in short supply but this
problem is particularly acute in Mental Health at the present time when qualified social workers are at a
premium. It is not always easy to judge what attracts good staff; certainly remuneration plays a not inconsiderable
part in this, as a salary structure below that of other competing Authorities will of course discourage
a large proportion of potential applicants. However, this apart, it can be said that once a Department, or
indeed a Division, has established a reputation for excellence in the standard of work and is in addition
known to have formed a harmonious congenial group, then these attributes will act as a strong attraction to
staff with the desired level of qualifications.
This is not to say that the size of this Mental Health Division is as yet at its optimum to achieve
all, or indeed most, that it should be its function to do; as yet the vast problems of mental disorders are only
dealt with in certain of their aspects, i.e. in cases where the disorder has already assumed major proportions.
The field of prevention is still virtually untouched in Brent and it is surely here that the richest harvest of
community benefit can be reaped. Sight should not be lost of the fact that many a case treated at great
financial, as well as emotional, cost to society could have been prevented had our resources been adequate
to influence favourably a patient's early emotional environment. A psychiatrically schooled social worker
attached to a midwife's ante-natal clinic, for instance, would be in an excellent position to benefit indirectly
the mental well-being of the unborn child and in addition possibly to teach the professional midwife some of
the simpler skills to prevent maternal mental stress. As yet, unfortunately, such a worker cannot possibly be
spared from mental health as each one has to cope with too large a case load as it is. But if primary prevention,
as instanced above, is still as yet a future aim, secondary prevention should be a definite possibility even
with our somewhat scant resources. I refer to the prevention of further breakdowns in the mentally ill who
have returned to the community after often relatively short stays in psychiatric hospitals. The descriptive
term "revolving door" is a self-explanatory comment on the "open door" concept. It refers of course to the
patient who needs re-admission, often repeatedly, because of an adverse community setting. It is very disappointing
to have to report that about half of all patients discharged from Shenley Hospital in 1968 needed
to be re-admitted — many of them in crisis. This can happen from a variety of circumstances — as for
instance omitting to take the prescribed medication. This specific cause should become less frequent with the
recent introduction of psycho-therapeutic drugs in the form of long-lasting injections. More and more patients
who are suspected of poor co-operation regarding oral medication have needed the services of our domiciliary
psychiatric nurse for this purpose. However, other environmental forces leading to further mental breakdown
and possible re-admission to hospital are often of a more subtle kind and need the presence of a skilled mental
health social worker. Work of this kind is very time consuming and an officer can be tied to such a patient's
household for many hours over a number of days. But how rewarding to have achieved within days an
improvement in the patient's condition which would have taken several weeks' treatment in hospital. More
economical by far from the point of view of the nation's resources — but unfortunately not immediately
appreciated by the ratepayer although he carries the burden in his other role as a taxpayer.
It has therefore to be stated that long-term improvement in the well-being of a large part of the
community cannot be effected if short-term economies are deemed of paramount importance. Let us not forget
when reviewing the year's statistics and finding that approximately 1,000 persons are receiving community
care, that this number is only the tip of an iceberg. The magnitude of the problem is better illustrated by the
few surveys carried out by General Practitioners who find in conservative estimates that at least one-third of
all their patient-attendances are due in greater or lesser degree to mental or emotional disorder.
Boarding-Out Scheme
As was reported last year a decision was taken to re-introduce in the Borough the boarding-out
scheme formerly operated jointly with the London Borough of Harrow on the basis on which it had been
taken over from the former Middlesex County Council but which had declined following the resignation of
the Boarding-Out Officer. The purpose of the scheme is to place in suitable lodgings, with social worker
support and a measure of financial subsidy if warranted, patients who have progressed beyond the need for
hostel facilities, those on discharge from hospital without suitable accommodation or an unsatisfactory home
environment, or sub-normals capable of functioning with some support from a family. A part-time mental
health social worker for boarding-out duties had been included in a revised staff establishment. An officer
had been appointed towards the end of the year and had embarked on recruiting suitable landladies, vetting
candidates for inclusion in the scheme and had in point of fact made the initial few placements.
"Brentholme" Hostel, 9 Willesden Lane, N.W.6
On the 1st January, 1968, the new Superintendent took up his post with the full complement of
supporting staff. Within a couple of months the Hostel was filled to capacity (i.e. 27 male and female
psychiatric patients). It soon became evident that the staff's capacity for tolerating even very difficult cases
made a strict policy regarding admission criteria almost unnecessary. However, the acceptance of such cases
warranted generous professional support which it was possible to provide. In addition to the Senior Medical
Officer (Mental Health) and the seconded mental health social worker, the part-time services of a Shenley
Hospital Consultant Psychiatrist as well as those of the attached General Practitioner were made available to
help the Superintendent in his onerous task.