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16
MENTAL HEALTH
(Tables 18—20)
MENTAL ILLNESS
Community Care and the Social Workers
The social work team was augmented by the appointment of a Deputy Chief Mental Health Social
Worker. An additional senior mental health social worker post, included in the revised establishment, had
not been filled despite intensive advertising. This difficulty in attracting appropriately qualified staff is due
largely to the reluctance of this authority to enter into competition with others in bidding in the form of
salary scales for the services of scarce qualified senior professionals. One mental health social worker and
our sole trainee mental health social worker both succeeded in gaining places of the few available on the
Certificate in Social Work Course. Both these social workers have been seconded by the Council for their
training. It remains to be seen whether, with existing salary and career prospects for mental health social
worker staff in this Department, we will be able to retain the services of these officers when they return
from their courses.
The increased establishment as fixed in 1968 only just enables the basic mental health needs of the
community to be met. In order to plan an effective preventive mental health programme, a substantial increase
in the number of mental health social workers is vital.
To make the best of existing limited facilities, certain social work management techniques have
been introduced. Although initial referrals are taken from any source, social work services are provided only
after a critical examination of the referral by the senior social work staff. Individual case loads are controlled
and supervised to ensure the most efficient use of scarce resources. Thus, the number of effective interventions,
where such are actually necessary, has increased. A re-evaluation of "agency acceptance" criteria, with
Seebohm in mind, has enabled the mental health social work staff to evolve into a family social work service.
Liaison with hospitals serving Brent has been immeasurably improved. A mental health social
worker is attached, for liaison purposes, to each consultant psychiatrist's team. This arrangement, together
with the use made of the psychiatric adviser to the Section, has enabled a meaningful relationship to
develop between the hospitals and local authority mental health services.
Individual social workers have represented the Mental Health Division at various professional conferences,
both nationally and locally. The demand by various voluntary and statutory social service agencies
for senior mental health social workers to give talks and lectures, has increased. This is considered a valuable
service which the social workers perform out of office hours.
Although there are two mental health social workers specialising in social work for the mentally
subnormal, all the mental health social workers have mixed case loads of the mentally ill and the mentally
subnormal. Still in the field of subnormality, a discussion group for parents of subnormal children was held
once-weekly throughout the year. This group, organised and taken by mental health social workers, was an
invaluable though limited in size forum in which professional officers and their clients benefitted mutually
from meaningful exchanges. If the social services of the future are not to become too remote from the public
they serve, such discussion groups should be widely encouraged.
However efficient the mental health services may have developed, mental illness caused by social
breakdown can only be checked and even prevented by a concerted attack on all the causes of social depression
and deprivation by a comprehensive social work agency and not in isolation by mental health workers
alone. There are high hopes that the proposed unified Social Services Department to be set up on the
enactment of the Seebohm recommendations and the proposed new management techniques to be adopted by
the Council will go a long way towards providing this comprehensive approach.
Boarding-Out Scheme
Contrary to expectations, this scheme got off the ground only slowly. It proved very difficult to recruit
suitable landladies in spite of intensive advertising. One of the reasons seemed to be that the public's fears of
the "Mental Illness" label are by no means allayed and that the stigma of such an illness is still very much a
reality. We have a long way to go yet before people will no longer view illnesses of the mind with great suspicion.
The few cases who were placed have been quite successfully so, and slowly a list of landladies is being
built up. Financially the scheme is proving less costly than had been anticipated as ex-patients' earnings are
often on average high enough to meet practically the whole of the boarding charge and few have to be
subsidised. Those out of work are drawing social security benefit and do not therefore require the Council's
financial support.
"Brentholme" Hostel, 9 Willesden Lane, N.W.6
Regretfully I have to report that there has been, once more, a change of Superintendent at this hostel.
Fortunately it has not proved too difficult on this occasion to recruit suitable staff as there were several quite
satisfactory applicants. It would appear that for no apparent reason resident posts of this kind have become
more attractive to reasonably well-qualified persons. It still seems to be the position nationally that recurrent
staff changes will continue to take place in mental after care hostels until such time as there exists a proper
career structure—and this Borough is not unfortunately an exception. It is to be hoped that a certain degree of
specialization will evolve, leading eventually to relevant qualifications as more courses become available at
various colleges.
The hostel has functioned very well in spite of these staff changes and bed occupancy has been
high, no more than a very few vacancies occurring at any time so that over two dozen men and women
were accommodated throughout the year in this 27 bed hostel. There has also been a fairly rapid turnover
of most patients but it had to be accepted that a very small number could not be discharged within the few
months' period expected of most.