1963
N.A.M.H. A.G.M. DEBATES
Local
Mental Health Services in the
Authority Blue
Ten-Year Plan
Health and
The Development of Community Care*, stringently, by a Panel under the Cha' manship of Timothy Raison, editor of New Society, at the 1963 Annual Gener Meeting of the N.A.M.H. ^ In the morning, the Local Authorities' Ten Year Plan had already been debat* | at the Fifth A.G.M. of the Local Associations, when Dr. G. A. V. Morgan, gist at the Ministry of Education (Welsh Department) and one of the Panel the Plan in the perspective of the intentions of the 1962 Hospital Plant, ?f the mental health services of 14 local authorities of similar size to Swansea, Swansea's own plan. He stressed the gaps between the needs of the mentally d j ordered and elderly (which had been statistically assessed) and the actual beds induced and care within the local authority community services; places available lively discussion. j At the N.A.M.H. meeting, the Panel dealt first with this question: 7j the L?c, with too little and Plan too much with concerned peop' buildings Authority Dr. J. J. A. Reid, County Medical Officer of Health for Northampton, said: 'The object of the Plan is, I hope and believe, to help people; if we are and trained staff to succeed with our Plan, we require
Welfare: THEdiscussedBook, vigorously, sometimes
even
Psych0^ exarmne^ actU0f an^,-s. a^
.
buildings
.
.
.
.
.
.
.
.
.
.
.
In the past, in Local Authorities, we have gone ahead sometimes with inadequate premises, with social workers trying to conduct their interviews without any privacy. We have conducted Junior Training Centres in old church halls, in any kind of shack which would do now I think we must look towards good facilities [but] if a fair amount has to be spent for buildings, they are not an end in themselves. They are merely a way of helping to get staff and of providing a good service for the people we want to help.' A Ministry lead? When the Panel was asked: 'To what extent should the Ministry of Hea^ lead authorities, and how far do they do so or check the good intentions which l'1 Plan embodiesV Mr. E. J. McCoy, P.S.W. and Principal Mental Health Officef' Coventry, commented: 'I think the Ministry of Health have surely given a lead already in one the people who are going to staff these very important respect .
.
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.
.
.
.
.
.
.
services.'
.
McCoy particularly complimented the Ministry on its development of ne.1 courses for social workers, following the Younghusband Report, but criticised for its failure to expand the training of psychiatric social workers. In a supplementary from the Chairman, who asked: 'Where there are so mo? divergent opinions on how to treat mental illness, how can you lay down c"teffective plans'V Dr. S. A. MacKeith, O.B.E., Physician Superintendent, Warlingh3111 Park Hospital said: 'I think that the answer to the doubt which you are raising is likely Mr.
to arise not from theoretical medical debate but from active medical social work between psychiatrists and psychiatric social workers and other welfare social workers on individual cases. I am a great believer in the relative sterility of theoretical discussion and the immense fertility of discussion on the individual patient, because that brings an atmosphere of reality, practicality and pragmatism into the discussion.'
1973, H.M.S.O. 24/-. t/4 Hospital Plan for England and Wales, H.M.S.O., Cmnd. 1604, 18/6d.
?Cmnd.
188
^
Pr- MacKeith then criticised the request to Local Authorities to produce Sl?n of their plans each year.
r
a
Most newsworthy Jud8ing
bev
by the i?urnalists
new
press publicity it received, it was the next question which the crowded at tables on both sides of the platform found most
'Adult Training Centres for the Subnormal are listed in the Plan. functions of such centres'? Could they be used for all the mentally rdered in the communityV e Guardian report of Professor A. D. B. Clarke's contribution is an example ?{ t, e
^sworthy: at'are the
dls
true
news-coverage: 'Professor A. D. B. Clarke, professor of psychology at the University ?f Hull, criticised the sentimental approach in adult training centres for lhe subnormal. This suggested that such people were handicapped and therefore "we must not press them to work but merely occupy them". "This", he went on, "damages the people in whose name it is put forward. There is no reason why handicapped people of any sort should be cushioned and sheltered from life. They should be able to do a job and enjoy doing it." 'American research had made it clear that between 15 and 20 per cent at least of subnormal people should have some simple job in the community. In Britain, partly because of public prejudice, we were falling down on this. 'Of junior centres for the subnormal he said they were waiting for Godot, waiting for a lead from someone, working in isolation and using '
old curricula from the year dot.
'More research was needed and the more so because 66 local authorities had said categorically they were not pursuing any research subnormality. If industry adopted such an attitude England would jnto be a bankrupt nation.'
^esearch activities next question examined reJe*^e activities. Dr Reid
the part Local Authorities play in the fostering of the Local Authorities in general were far ?n research as far as medicine is concerned. In many cases there was with universities, and the training of medical staff for Local Authorities the D.P.H. course did not fit them for research. Dr. Reid commented: 'The D.P.H. curriculum is rather a fossilised, elderly one and research is regarded as something only to be undertaken by people with very targe heads behind very high walls. Local Authorities must be educated 0ut of it, because if you are going to run a decent service of any kind, y?u must carry out operational research the whole time people shouldn't be scared to speak about research to their committees and shouldn't think that research is always such a high-powered thing. You can have good research without the use of computing machines and without enormous staffs. If we have more research, better links with universities, the general standard of Local Authority Health Services would undoubtedly rise and I believe the universities would benefit by having a field open to them.'
behj0^ ti0
thro
thought that
.
.
.
.
...
?
and
psychiatric services lowing extract from the
Gillie ReportJ was next under discussion: arnHy doctor, who must be in charge of the patient when at home, should inQcf lftate the psychiatric services in the community, which are at present often Tthe Panel was asked to discuss the fact that the Plan does not mention "ie a,nily doctor's role in this connection. Dr. G. A. V. Morgan said: think it is quite unrealistic to expect a family doctor in the present
c?.0
*"Th7"^T; 'eld
???
of Work of the
Family Doctor", H.M.S.O., 4/6d. 189
circumstances to be able to integrate psychiatric services I think it would be admitted that many, if not most, would not feel themselves their training on the whole qualified to do so directly .?though this is being modified?does not put them immediately in sympathy .' with a psychiatric approach. ^ Dr. Morgan pointed out, however, that it was not quite accurate to say that care did not mention but the doctor community plan family 'as so often in this document the statement is rather in the form of and and It does not quote any examples suggestion possibility hope. of liaison taking place I think we have a long way to go to reinstate the family doctor in his central position.' } On the next question: 'Why is co-operation between hospital and authorities so badV Dr. MacKeith commented: 'the probable reasons for poor co-operation between hospitals and Local Authorities are rooted in extremely complex and extremely interesting differences in their histories and traditions and their present staffing and, associated with that, different patterns of prestige, different tensions between different professional and occupational groups. ...
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.
.
.
.
.
.
...
...
...
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.
.
When the ordinary average general practitioner, the ordinary average or other social worker, or psychiatrist, are able easily and comfortably to meet together to discuss the treatment of an individual patient whether it be an actual treatment or rehabilitation, it is very rare for co-operation to be bad.'
P.S.W.
Voluntary organisations
M
The place of the voluntary organisation and the unqualified volunteer it1 expansion of services which the local authority services envisage was a particul3 pertinent question to the A.G.M. of the N.A.M.H. Mr. McCoy insisted that: 'most of the services which are described in this collection of plans should be provided and carried out by the Local Authorities themselves but we are then left with the fact that voluntary bodies grow and many important and valuable organisations have sprung up in recent years, obviously in response to very, very pressing social needs ,{l Mr. McCoy saw the role of the voluntary associations particularly as 'local out and as to at their start. helping carry plans groups' Later in the debate Miss Applebey commented: 'the fact that we have this kind of meeting here this afternoon seems to me to suggest that at the voluntary level there is a very widespread and informed interest which is simply longing to help, and the authorities who are undermanned, underpaid, and' under-privileged really neglect .' this enormous fund of national help at their peril. m The last question placed before the Panel asked: 'Is there a danger that planned run-down of the mental hospitals will place an increasing burden on authorities which they will become reluctant and increasingly unable to accept? Morgan expressed his pessimism about this issue, and?as he had in his speech morning?stressed the differences between the Hospital and Local Authorities' P' ; and the probable position by 1972, the terminal year of the Ten Year Plans. 1* a salutary note of warning on which to end the meeting. .
.
.
.
.
.
.
.
.
.
^
N.A.M.H. A.G.M. DEBATES
Local
Mental Health Services in the
Authority Blue
Ten-Year Plan
Health and
The Development of Community Care*, stringently, by a Panel under the Cha' manship of Timothy Raison, editor of New Society, at the 1963 Annual Gener Meeting of the N.A.M.H. ^ In the morning, the Local Authorities' Ten Year Plan had already been debat* | at the Fifth A.G.M. of the Local Associations, when Dr. G. A. V. Morgan, gist at the Ministry of Education (Welsh Department) and one of the Panel the Plan in the perspective of the intentions of the 1962 Hospital Plant, ?f the mental health services of 14 local authorities of similar size to Swansea, Swansea's own plan. He stressed the gaps between the needs of the mentally d j ordered and elderly (which had been statistically assessed) and the actual beds induced and care within the local authority community services; places available lively discussion. j At the N.A.M.H. meeting, the Panel dealt first with this question: 7j the L?c, with too little and Plan too much with concerned peop' buildings Authority Dr. J. J. A. Reid, County Medical Officer of Health for Northampton, said: 'The object of the Plan is, I hope and believe, to help people; if we are and trained staff to succeed with our Plan, we require
Welfare: THEdiscussedBook, vigorously, sometimes
even
Psych0^ exarmne^ actU0f an^,-s. a^
.
buildings
.
.
.
.
.
.
.
.
.
.
.
In the past, in Local Authorities, we have gone ahead sometimes with inadequate premises, with social workers trying to conduct their interviews without any privacy. We have conducted Junior Training Centres in old church halls, in any kind of shack which would do now I think we must look towards good facilities [but] if a fair amount has to be spent for buildings, they are not an end in themselves. They are merely a way of helping to get staff and of providing a good service for the people we want to help.' A Ministry lead? When the Panel was asked: 'To what extent should the Ministry of Hea^ lead authorities, and how far do they do so or check the good intentions which l'1 Plan embodiesV Mr. E. J. McCoy, P.S.W. and Principal Mental Health Officef' Coventry, commented: 'I think the Ministry of Health have surely given a lead already in one the people who are going to staff these very important respect .
.
.
.
.
.
.
.
.
.
services.'
.
McCoy particularly complimented the Ministry on its development of ne.1 courses for social workers, following the Younghusband Report, but criticised for its failure to expand the training of psychiatric social workers. In a supplementary from the Chairman, who asked: 'Where there are so mo? divergent opinions on how to treat mental illness, how can you lay down c"teffective plans'V Dr. S. A. MacKeith, O.B.E., Physician Superintendent, Warlingh3111 Park Hospital said: 'I think that the answer to the doubt which you are raising is likely Mr.
to arise not from theoretical medical debate but from active medical social work between psychiatrists and psychiatric social workers and other welfare social workers on individual cases. I am a great believer in the relative sterility of theoretical discussion and the immense fertility of discussion on the individual patient, because that brings an atmosphere of reality, practicality and pragmatism into the discussion.'
1973, H.M.S.O. 24/-. t/4 Hospital Plan for England and Wales, H.M.S.O., Cmnd. 1604, 18/6d.
?Cmnd.
188
^
Pr- MacKeith then criticised the request to Local Authorities to produce Sl?n of their plans each year.
r
a
Most newsworthy Jud8ing
bev
by the i?urnalists
new
press publicity it received, it was the next question which the crowded at tables on both sides of the platform found most
'Adult Training Centres for the Subnormal are listed in the Plan. functions of such centres'? Could they be used for all the mentally rdered in the communityV e Guardian report of Professor A. D. B. Clarke's contribution is an example ?{ t, e
^sworthy: at'are the
dls
true
news-coverage: 'Professor A. D. B. Clarke, professor of psychology at the University ?f Hull, criticised the sentimental approach in adult training centres for lhe subnormal. This suggested that such people were handicapped and therefore "we must not press them to work but merely occupy them". "This", he went on, "damages the people in whose name it is put forward. There is no reason why handicapped people of any sort should be cushioned and sheltered from life. They should be able to do a job and enjoy doing it." 'American research had made it clear that between 15 and 20 per cent at least of subnormal people should have some simple job in the community. In Britain, partly because of public prejudice, we were falling down on this. 'Of junior centres for the subnormal he said they were waiting for Godot, waiting for a lead from someone, working in isolation and using '
old curricula from the year dot.
'More research was needed and the more so because 66 local authorities had said categorically they were not pursuing any research subnormality. If industry adopted such an attitude England would jnto be a bankrupt nation.'
^esearch activities next question examined reJe*^e activities. Dr Reid
the part Local Authorities play in the fostering of the Local Authorities in general were far ?n research as far as medicine is concerned. In many cases there was with universities, and the training of medical staff for Local Authorities the D.P.H. course did not fit them for research. Dr. Reid commented: 'The D.P.H. curriculum is rather a fossilised, elderly one and research is regarded as something only to be undertaken by people with very targe heads behind very high walls. Local Authorities must be educated 0ut of it, because if you are going to run a decent service of any kind, y?u must carry out operational research the whole time people shouldn't be scared to speak about research to their committees and shouldn't think that research is always such a high-powered thing. You can have good research without the use of computing machines and without enormous staffs. If we have more research, better links with universities, the general standard of Local Authority Health Services would undoubtedly rise and I believe the universities would benefit by having a field open to them.'
behj0^ ti0
thro
thought that
.
.
.
.
...
?
and
psychiatric services lowing extract from the
Gillie ReportJ was next under discussion: arnHy doctor, who must be in charge of the patient when at home, should inQcf lftate the psychiatric services in the community, which are at present often Tthe Panel was asked to discuss the fact that the Plan does not mention "ie a,nily doctor's role in this connection. Dr. G. A. V. Morgan said: think it is quite unrealistic to expect a family doctor in the present
c?.0
*"Th7"^T; 'eld
???
of Work of the
Family Doctor", H.M.S.O., 4/6d. 189
circumstances to be able to integrate psychiatric services I think it would be admitted that many, if not most, would not feel themselves their training on the whole qualified to do so directly .?though this is being modified?does not put them immediately in sympathy .' with a psychiatric approach. ^ Dr. Morgan pointed out, however, that it was not quite accurate to say that care did not mention but the doctor community plan family 'as so often in this document the statement is rather in the form of and and It does not quote any examples suggestion possibility hope. of liaison taking place I think we have a long way to go to reinstate the family doctor in his central position.' } On the next question: 'Why is co-operation between hospital and authorities so badV Dr. MacKeith commented: 'the probable reasons for poor co-operation between hospitals and Local Authorities are rooted in extremely complex and extremely interesting differences in their histories and traditions and their present staffing and, associated with that, different patterns of prestige, different tensions between different professional and occupational groups. ...
.
.
.
.
.
.
.
...
...
...
.
.
.
When the ordinary average general practitioner, the ordinary average or other social worker, or psychiatrist, are able easily and comfortably to meet together to discuss the treatment of an individual patient whether it be an actual treatment or rehabilitation, it is very rare for co-operation to be bad.'
P.S.W.
Voluntary organisations
M
The place of the voluntary organisation and the unqualified volunteer it1 expansion of services which the local authority services envisage was a particul3 pertinent question to the A.G.M. of the N.A.M.H. Mr. McCoy insisted that: 'most of the services which are described in this collection of plans should be provided and carried out by the Local Authorities themselves but we are then left with the fact that voluntary bodies grow and many important and valuable organisations have sprung up in recent years, obviously in response to very, very pressing social needs ,{l Mr. McCoy saw the role of the voluntary associations particularly as 'local out and as to at their start. helping carry plans groups' Later in the debate Miss Applebey commented: 'the fact that we have this kind of meeting here this afternoon seems to me to suggest that at the voluntary level there is a very widespread and informed interest which is simply longing to help, and the authorities who are undermanned, underpaid, and' under-privileged really neglect .' this enormous fund of national help at their peril. m The last question placed before the Panel asked: 'Is there a danger that planned run-down of the mental hospitals will place an increasing burden on authorities which they will become reluctant and increasingly unable to accept? Morgan expressed his pessimism about this issue, and?as he had in his speech morning?stressed the differences between the Hospital and Local Authorities' P' ; and the probable position by 1972, the terminal year of the Ten Year Plans. 1* a salutary note of warning on which to end the meeting. .
.
.
.
.
.
.
.
.
.
^
