TAKE 2 Abandoned & forgotten
Dr. D. A. SPENCER Over 20,000 patients languish in subnormality hospitals written off by the local authorities and by their families. Dr. Spencer, medical director of Westwood Hospital, Bradford, is determined that someone should accept responsibility for them In Britain today, between twenty and thirty thousand human beings exist abandoned and forgotten in hospitals for the mentally subnormal. There are over 60,000 patients in these hospitals and surveys in many of them have shown that from a third to a half of their patients are never visited. A few patients, irrespective of the severity of their mental condition, have regular and faithful visitors. In some cases patients have relatives or friends who travel long distances and make the most commendable efforts to keep in touch with the hospital, but other patients have either no living next-of-kin or have lost contact with their families. The Ministry of Health Circular, H.M. (65) 104, 'Improving the effectiveness of the hospital service for the mentally subnormal', makes it clear that the aim of hospital care, whenever possible, is to help the patient to return to the general community. But in practice, admission to a hospital for the mentally subnormal is too often still regarded as being for 'permanent institutional care', a 'compromise' or 'social euthanasia', conveniently consigning the subnormal person out of sight and out of mind until he dies. Families and local authorities assume that the hospital has completely taken over their responsibilities and obligations. This should not be so today, when the care of a mentally handicapped person is supposed to involve a team which includes the family, the general practitioner, the local authority, the hospital, voluntary bodies and indeed the whole community. The severely mentally subnormal child with no parents or relatives may be taken into the care of a local authority and become the responsibility of a Children's Department, which acts in loco parentis. Because most local authorities still have no special accommodation for the long-term residential care of the severely subnormal (who are seen 34
as
an
embarrassment to
home) pressure is
a
nursery
or
childrens
brought to bear into a subnormal^
sooner or later
for the 'disposal' of the child hospital. Once the child is transferred to hospital' the local authority is spared any further cost ft providing for the child, which is another illustration
of the financial absurdities of the National Health Service. After admission, nurses or house mothers wb? have known the child before admission may visit the hospital on a voluntary basis. But often, there Is are no official inquiries as to whether the child still alive or continues to need hospital care frofl1 the local authority which still has responsibility' In fact, the Mental Health Act places no bar ofl a children's authority receiving a mentally dis' ordered child into their care. Some children are at risk of becoming abafl' doned by the very department officially for them. At the age of eighteen the patient v taken off the books of the Children's and may be doomed to spend the rest of his in hospital, unless he is capable of working outsit and living in a hostel?if a hostel place can the11 be found for him. The Mental Health Act also states that wbefe 3 a local authority is acting in loco parentis fof the of child and has taken over the functions nearest relative of a mentally disordered then the authority shall arrange for visits to be made to him and shall take such other steps 111 relation to the patient as would be expected frolT1 his parents. From time to time, hospitals for the mental'* subnormal are expected to accept a mentally re tarded child who has been rejected by his For example, a mongol baby, a few weeks d"' whom the parents refuse to take home and t? whom the local authority cannot find a place'
responsible
Departme111
patiefl1'
family
In any one hospital, only a few children may fall into these categories but over the whole country, some hundreds of children are virtually being abandoned. There is a pressing need for Accommodation in the general community for men-
tally
retarded infants and children who need resicare, as distinct from medical and nursing
dential
help.
The other groups of patients who receive
visitors
no
those admitted for social reasons, after lhe death or illness of their relatives, and those Miose relatives have lost touch with them. Not infrequently, and especially where there are new schemes, relatives change their addresses informing the hospitals, so that official fetters are returned marked 'Gone away' and are
fusing
^ithout
demolished'.
Some hospitals are isolated and difficult to reach public transport. It is usually impossible for lhe hospital to offer its own transport but somehtties, where bus operators and voluntary organisal'ons have arranged special transport, visitors have ^iled to support it. Today, the cost of fares for
hospital some distance from the patient's prohibitive to families with low ^comes. Concessionary travel vouchers for railto visit patients have been stopped, ^y journeys ^elp with travelling expenses is not available to V)sitors through the Department of Social Security, ^less they are already in receipt of assistance. Occasionally, it is argued that the severely subnormal patient cannot appreciate visitors. The ^swer to this is that there are such patients who 3re visited regularly and that contact with them be established by handling and playing with ^n. he patients and by dressing, washing and feeding hem?even if ordinary conversation is impossible, onetimes visitors 'adopt' other patients in a ward ?r help in the routine. 'If you visit one patient in *
^siting home
a
may be
Ward, you visit them all' is a motto in at least 0tle subnormality hospital because sub-normal
People
usually friendly and affection-seeking spontaneously to the visitor. The plaintive plea of so many subnormal patients "[hospital is to go home. This is often impracticare
come
.
?le,
but the communication with home and rela-
'?Qs through visitors makes visiting day an impor^t event in the life of the patients and the failure visitors to come, especially when a visit has Sen promised, can lead to disappointment, tanruttis and disturbed behaviour.
^
of Friends and 'link schemes' llh local societies and voluntary workers can help a gap by taking an interest in the patient who no visitors. Nurses and teachers will often give
^Hospital fail .
Leagues
to certain patients, though, ^ecial attention favouritism must be avoided. Hospital piously, ^nagement Committees have not always shown
enthusiasm about visiting; they have sometimes adopted a cautious conservatism, even in the face of the Department of Health's recommendations and the wishes of associations like that pressing for the unrestricted visiting of children. Committees often accept the situation that few patients in hospitals for the subnormal are visited as an unavoidable fact of life, like overcrowded wards and shortage of staff, rather than a subject about which they should be seriously concerned and for which they should constantly be stirring the public conscience. In the past, of course, visitors and voluntary helpers have not been welcome in every hospital and they have suffered from the pettifogging restrictions dear to administrators. Even though times are changing, inflexible attitudes to visitors and voluntary workers are still found. The problem of abandoned and forgotten patients in hospitals is not a new one and yet it is far from clear just who is responsible for these people. The Patients' Association raised the problem of abandoned children in hospitals in August, 1967, with Mr. Kenneth Robinson. The complex legal points raised are still under consideration. The Association of Child Care Officers is working on the problem of children in hospital who are neglected by their parents. Some newspaper writers are interested in the subject. It has been suggested that a person, independent of the hospital authority, should have responsibility for the welfare of the patient who has no relatives. If the patient were discharged from hospital, the local authority would usually have to provide for him. It could be argued that if the patient without relatives is in the care of a local authority outside hospital, someone independent of that authority should take an interest in his welfare. If the experience described above is any guide, there are no grounds for assuming that local authorities are any more compassionate than hospitals for the mentally subnormal where?in spite of the recent criticism of these establishments?most of the staff are deeply interested in the well-being of the patients and feel strongly about those who are abandoned and forgotten. Although it is needed, official guidance and clarification of the legal position alone will not solve the problem of the thousands of abandoned and forgotten patients in hospitals. Whilst these
patients may not obviously suffer cruelty or neglect through not having visitors, their lives are so much the poorer. Their plight will continue to offer great scope for the devotion, generosity, kindness and sympathy of voluntary organisations. It also needs the concern of the whole community, of which the hospital for the mentally subnormal should now be regarded as a part. ?
Dr. D. A. SPENCER Over 20,000 patients languish in subnormality hospitals written off by the local authorities and by their families. Dr. Spencer, medical director of Westwood Hospital, Bradford, is determined that someone should accept responsibility for them In Britain today, between twenty and thirty thousand human beings exist abandoned and forgotten in hospitals for the mentally subnormal. There are over 60,000 patients in these hospitals and surveys in many of them have shown that from a third to a half of their patients are never visited. A few patients, irrespective of the severity of their mental condition, have regular and faithful visitors. In some cases patients have relatives or friends who travel long distances and make the most commendable efforts to keep in touch with the hospital, but other patients have either no living next-of-kin or have lost contact with their families. The Ministry of Health Circular, H.M. (65) 104, 'Improving the effectiveness of the hospital service for the mentally subnormal', makes it clear that the aim of hospital care, whenever possible, is to help the patient to return to the general community. But in practice, admission to a hospital for the mentally subnormal is too often still regarded as being for 'permanent institutional care', a 'compromise' or 'social euthanasia', conveniently consigning the subnormal person out of sight and out of mind until he dies. Families and local authorities assume that the hospital has completely taken over their responsibilities and obligations. This should not be so today, when the care of a mentally handicapped person is supposed to involve a team which includes the family, the general practitioner, the local authority, the hospital, voluntary bodies and indeed the whole community. The severely mentally subnormal child with no parents or relatives may be taken into the care of a local authority and become the responsibility of a Children's Department, which acts in loco parentis. Because most local authorities still have no special accommodation for the long-term residential care of the severely subnormal (who are seen 34
as
an
embarrassment to
home) pressure is
a
nursery
or
childrens
brought to bear into a subnormal^
sooner or later
for the 'disposal' of the child hospital. Once the child is transferred to hospital' the local authority is spared any further cost ft providing for the child, which is another illustration
of the financial absurdities of the National Health Service. After admission, nurses or house mothers wb? have known the child before admission may visit the hospital on a voluntary basis. But often, there Is are no official inquiries as to whether the child still alive or continues to need hospital care frofl1 the local authority which still has responsibility' In fact, the Mental Health Act places no bar ofl a children's authority receiving a mentally dis' ordered child into their care. Some children are at risk of becoming abafl' doned by the very department officially for them. At the age of eighteen the patient v taken off the books of the Children's and may be doomed to spend the rest of his in hospital, unless he is capable of working outsit and living in a hostel?if a hostel place can the11 be found for him. The Mental Health Act also states that wbefe 3 a local authority is acting in loco parentis fof the of child and has taken over the functions nearest relative of a mentally disordered then the authority shall arrange for visits to be made to him and shall take such other steps 111 relation to the patient as would be expected frolT1 his parents. From time to time, hospitals for the mental'* subnormal are expected to accept a mentally re tarded child who has been rejected by his For example, a mongol baby, a few weeks d"' whom the parents refuse to take home and t? whom the local authority cannot find a place'
responsible
Departme111
patiefl1'
family
In any one hospital, only a few children may fall into these categories but over the whole country, some hundreds of children are virtually being abandoned. There is a pressing need for Accommodation in the general community for men-
tally
retarded infants and children who need resicare, as distinct from medical and nursing
dential
help.
The other groups of patients who receive
visitors
no
those admitted for social reasons, after lhe death or illness of their relatives, and those Miose relatives have lost touch with them. Not infrequently, and especially where there are new schemes, relatives change their addresses informing the hospitals, so that official fetters are returned marked 'Gone away' and are
fusing
^ithout
demolished'.
Some hospitals are isolated and difficult to reach public transport. It is usually impossible for lhe hospital to offer its own transport but somehtties, where bus operators and voluntary organisal'ons have arranged special transport, visitors have ^iled to support it. Today, the cost of fares for
hospital some distance from the patient's prohibitive to families with low ^comes. Concessionary travel vouchers for railto visit patients have been stopped, ^y journeys ^elp with travelling expenses is not available to V)sitors through the Department of Social Security, ^less they are already in receipt of assistance. Occasionally, it is argued that the severely subnormal patient cannot appreciate visitors. The ^swer to this is that there are such patients who 3re visited regularly and that contact with them be established by handling and playing with ^n. he patients and by dressing, washing and feeding hem?even if ordinary conversation is impossible, onetimes visitors 'adopt' other patients in a ward ?r help in the routine. 'If you visit one patient in *
^siting home
a
may be
Ward, you visit them all' is a motto in at least 0tle subnormality hospital because sub-normal
People
usually friendly and affection-seeking spontaneously to the visitor. The plaintive plea of so many subnormal patients "[hospital is to go home. This is often impracticare
come
.
?le,
but the communication with home and rela-
'?Qs through visitors makes visiting day an impor^t event in the life of the patients and the failure visitors to come, especially when a visit has Sen promised, can lead to disappointment, tanruttis and disturbed behaviour.
^
of Friends and 'link schemes' llh local societies and voluntary workers can help a gap by taking an interest in the patient who no visitors. Nurses and teachers will often give
^Hospital fail .
Leagues
to certain patients, though, ^ecial attention favouritism must be avoided. Hospital piously, ^nagement Committees have not always shown
enthusiasm about visiting; they have sometimes adopted a cautious conservatism, even in the face of the Department of Health's recommendations and the wishes of associations like that pressing for the unrestricted visiting of children. Committees often accept the situation that few patients in hospitals for the subnormal are visited as an unavoidable fact of life, like overcrowded wards and shortage of staff, rather than a subject about which they should be seriously concerned and for which they should constantly be stirring the public conscience. In the past, of course, visitors and voluntary helpers have not been welcome in every hospital and they have suffered from the pettifogging restrictions dear to administrators. Even though times are changing, inflexible attitudes to visitors and voluntary workers are still found. The problem of abandoned and forgotten patients in hospitals is not a new one and yet it is far from clear just who is responsible for these people. The Patients' Association raised the problem of abandoned children in hospitals in August, 1967, with Mr. Kenneth Robinson. The complex legal points raised are still under consideration. The Association of Child Care Officers is working on the problem of children in hospital who are neglected by their parents. Some newspaper writers are interested in the subject. It has been suggested that a person, independent of the hospital authority, should have responsibility for the welfare of the patient who has no relatives. If the patient were discharged from hospital, the local authority would usually have to provide for him. It could be argued that if the patient without relatives is in the care of a local authority outside hospital, someone independent of that authority should take an interest in his welfare. If the experience described above is any guide, there are no grounds for assuming that local authorities are any more compassionate than hospitals for the mentally subnormal where?in spite of the recent criticism of these establishments?most of the staff are deeply interested in the well-being of the patients and feel strongly about those who are abandoned and forgotten. Although it is needed, official guidance and clarification of the legal position alone will not solve the problem of the thousands of abandoned and forgotten patients in hospitals. Whilst these
patients may not obviously suffer cruelty or neglect through not having visitors, their lives are so much the poorer. Their plight will continue to offer great scope for the devotion, generosity, kindness and sympathy of voluntary organisations. It also needs the concern of the whole community, of which the hospital for the mentally subnormal should now be regarded as a part. ?
