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horrors of drug dependence and lo! —these children will no longer show any desire to experiment with this
dangerous commodity. On the other hand, dare we delay until exact knowledge of attitude changes has accrued
before we face our youngsters? However if we decide to carry our propaganda material into the senior classrooms
of Brent, who would be the best persons to give these talks, the teachers (many of whom are inveterate
tobacco smokers!) or the school doctors? Bearing in mind that some of the latter may be quite inexperienced
in teaching techniques it might prove more advantageous for the teachers to take on this task, having been
instructed on the important points at issue. Additionally this tricky subject should form part of a series of
related health talks, and not be singled out as the object of sensationalism. An additional difficulty is of course,
that drug taking does not occur in a vacuum. Therefore attention should be focused on a variety of factors,
such as that abuse may be a style of living, a mere whim of fashion, or more seriously, the symptomatic expression
of the neurotic or delinquent personality who will not respond to conventional health education techniques.
Whatever we choose to do in the way of formal instructions of school children, it must not be forgotten that
these will achieve nothing without the supporting services, such as Child Guidance.
It is of interest that society has put so much pressure on the preventive services to deal with the drug
abuse problem when so very little notice, in comparison, has been taken of the numerically much greater problems
of alcoholism, lung cancer and chronic bronchitis. Could it be that we reap what we sow, a culture that
demands alleviation of every minor twinge, every anxiety, with an analgesic, a tranquilliser, a smoke or a
drink—and finds itself in the end in self-destroying abuse instead of sensible use of these substances.
MENTAL SUBNORMALITY
Community Care—Support in the Home
The majority of mentally subnormal and severely subnormal adults and children are allocated to two
full time mental health social workers as their only type of patient. An increasing number of cases however
has been taken over by many of the remaining mental health social workers/mental welfare officers. This is
an interesting development as some years ago the tendency in this Department was the reverse. Undoubtedly
this points to the increased awareness and acceptance of mental health workers generally that much preventive
work can be done with families under stress and, of course, a family that contains one grossly handicapped
member is always likely to be so stressed. I hope it will be possible during the course of the next year or two,
as opportunity presents, to give each officer an equal and varied caseload of all types of mental disorder.
The services such an officer is called upon to perform are numerous and various. First and foremost
she must show a high degree af availability so that she can be expected to respond to a call for help at a
moments' notice. Crisis occasions of this kind on the whole however should occur rarely if the family has been
regularly contacted. However emergencies do arise and they can be very time-consuming. Illness in the family,
particularly in the mother, means a request for immediate short term residential care and a possibly very long
journey for officer and escort—a whole day can easily be spent on missions of this kind. Latterly arrangements
with the Mental Department of Leavesden Hospital have meant transporting several children together to
Abbotts Langley. A major role is of course the generally supportive one particularly in the case of the mother
with a very young child. The first few years for parents of a severely subnormal infant are often more than they
can bear and marital relationships can be strained to breaking point. Expert management can prevent such a
crisis and the skilled mental health social worker will be in the position to bring out all the feelings of guilt
and aggression that simmer below the surface and may give rise to constant bickering and misunderstanding.
Facing the issue squarely quite frequently means also conquering feelings of humiliation and inferiority, but
many parents need the help of an understanding trained outsider to work through the problem created by the
birth of a grossly handicapped child.
Leavesden Hospital
Close liaison continued between our mental health staff and that of this Hospital for subnormal and
severely subnormal patients. Consultant psychiatrists continued to hold sessions in the Borough, on request, on
various mental health premises, which greatly facilitated the community worker's task. Unfortunately, it has
not been possible to establish a regular out-patient clinic as yet.
Within the Hospital, further progress has been made with the opening of a special unit for subnormal
adolescent girls, so that both sexes are now well catered for.
The placement of a male student nurse in our Neasden Special Care Unit has continued and is appreciated
by both the Leavesden tutorial staff and that of the Neasden Centre.
It is still difficult to obtain permanent hospital beds and in spite of the Leavesden staff's obvious desire
to help, hardship cannot always be avoided when an urgent permanent placement case arises. The now well
established practise of short term care has continued as in previous years, Leavesden Hospital remaining our
largest outlet for such placements.
Guardianship and Informal Foster Care
The provisions of the Mental Health Act relating to the placing of persons in the guardianship of the
local health authority have not needed to be invoked in any instance in the Borough so far.
Informal foster care placements have continued as in previous years, but the difficulty of finding places
for severely subnormal children, where residential care becomes necessary as a result of unsuitable home conditions
due to social factors or parental inability to cope, remained as acute as ever. The larger part of establishments
for the residential care of subnormals, inadequate as it is for total needs, is provided still by the
voluntary organizations, and it is to be regretted that due to financial stringencies and other factors, the aims
of the Mental Health Act in empowering statutory provision of this sort are still a long way from fruition.
Pressures on existing accommodation and the lack of facilities for transferring some suitable subnormals to
hostels from hospitals, have nationally only slightly been abated. The two-fold result is that patients continue