TH QUIET REVOLUTlOn The mentally ill?and those recovering from a mental illness?are people who need people. The natural response to this sort of statement is?'So does everybody' and, of course, this is true. Nobody likes being entirely solitary, almost all of us thrive on human contact. Our relationships, our interaction with the world about us and the people in it, are what gives life meaning. But a mental illness often strips life of this meaning, the mentally ill often shrink from people and from the world and, when they are better, reestablishing contact is no easy task?especially when the community is indifferent, suspicious, afraid and


Modern treatment of mental illness aims to restore people to their normal lives as quickly as possible. In this context yolunteers?normal people from the normal, everyday world?have a most important part Edward 'Nifty' Neale


by example.

Patients and ex-patients benefit personally and from the involvement of volunteers in the mental health movement and they benefit jointly and indirectly from the way in which the voluntary movement is changing the climate of public opinion towards mental illness itself and towards mental hospitals which have been places of dread for so many



an old lady to to read her letters. voluntary worker in Somerset, helps an

Tony Othen


play. Volunteers add a dimension of reality to the lives of patients and ex-patients and, in so doing, help them to maintain, develop and strengthen links with the community. Voluntary workers are performing two vital functions?they are taking part, in a very real sense, in the process of treatment and recovery and, since they are of the community, they are educating the community


More than cake


In the past people have tended to think of voluntary work in the cause of mental health as a kind of 'icing on the cake'?a sort of bonus that was gratefully received when it did exist but not actively sought after if it did not. But, in the last few years, doctors, administrators and Directors of Social Services have been making it more and more plain that a vigorous and efficient voluntary movement is a vital factor in the provision of a good mental health service at community level. It is now widely accepted that even if there was unlimited money to pay for unlimited numbers of staff in the mental health service?doctors, nurses, social workers and therapists of all kinds?there would still be a need for volunteers. In fact, there would still be jobs that could only be done by volunteers.

This wide acceptance of the importance of volunhas had to be won, it was not granted easily and without dispute. Much ofthe pioneering work ofinvolving volunteers in the mental health movement and closing the great divide between mental hospitals and the community was done by the National Association for Mental Health through its sponsorship and support of local associations for mental health in towns and cities all over the country. This pioneering development got into its stride during the 1950s?when it was breaking entirely new ground?and continues to go from strength to strength in the 1970s (there are now 100 of these local associations). The first appointment of an organiser of voluntary services at a psychiatric hospital was my own in September 1963 at Fulbourn Hospital, Cambridge. This experimental appointment came about because of the determination and vision of Dr. Patrick Tyser, then medical officer of health for Cambridgeshire, Dr. David Clark, the physician superintendent at Fulbourn, and Lady Adrian who was a qualified psychiatric social worker and, at that time, was both chairman of Fulbourn Hospital Management Committee and vice-chairman of the National Association for Mental Health.


and drift

convinced that medical services for the incomplete unless the public were involved in the work of the Hospital. The Hospital had encouraged volunteers to come in for some time ?to help arrange entertainment and sports?and the All three






Tony Othen


^ c



An old house-owner watches the progress of a young volunhelping to paint the outside of her house.


response had been

good, predominantly from the University and from a local theological college. But, although the response had been good, the contact with the Hospital was usually short-lived and volunteers drifted away. While on a trip to the United States, Dr. Clark had been impressed by the numbers of volunteers involved in the work of psychiatric hospitals and by the way in which the volunteers remained in contact with the hospitals. This continuity was largely achieved in the United States by hospitals having a member of staff with enough time to locate opportunities for voluntary work within the hospital and then go out into the community to recruit people and place them in appropriate voluntary jobs. Through Dr. Tyser's persistence, a three year grant to finance the appointment of an organiser of voluntary services on an experimental basis was secured from the Nuffield Provincial Hospital Trust.

My three years at Fulbourn were spent in a mainly interpretative role. My instinct, as a social worker who had not previously been connected with the psychiatric field, was that a mental hospital was an 'abnormal'

environment that needed to be made as normal as possible. People seemed to be in the Hospital for a variety of reasons?often non-medical?and the problems did not seem insuperable except that it was not recognised that the community as such could do anything to improve the situation. I do not think that I brought any new ideas to Fulbourn, I simply brought an awareness that resources did exist within the community and I began to devise ways in which the resources could be harnessed. By the end of the three years it was clear that the necessary ingredients for involving the everyday community existed in plenty and that using them was largely just a matter of liasion, planning and preparation.

Another cause for concern was the piecemeal way in which appointments of organisers of voluntary services were being made and there became an urgent need to co-ordinate all the information available on the subject and to pool experience in what was still a highly experimental field. Issues like these, together with the publication of the Aves Report, The voluntary worker in the social services, in 1969 and the appearance of the Government circular HM(69)58, National Health Service: voluntary help in hospitals, also in 1969, led to the establishment of the Voluntary Service Information Office at the Hospital Centre in the same year?financed



Another experimental appointment of an organiser had been made at St. Thomas' in London by this time and the interest of the Hospital Centre of the King Edward's Hospital Fund for London had been aroused. Jean Finzi (from St. Thomas') and I were asked to take part in conferences at the Hospital Centre and this, together with Jan Rocha's King's Fund Report Organisers of Voluntary Services in Hospitals, triggered off a great deal of interest in the new


In 1966 the* King's Fund had agreed to finance a scheme organised by the National Association for Mental Health to find out whether a voluntary services organiser based in the community would be as successful as those actually attached to a hospital. This project (carried out by Hans Muller in Croydon) has been a spectacular success and, with Mr. Muller still in post, the appointment became one jointly financed by the local authority and the hospital authority and has now come under the wing of the Croydon Social Services Department as part of the unified administration of the Croydon Voluntary Services. In this new form there is to be a co-ordinator, a deputy and three assistants responsible for hospitals, day care and residential care together with liasion with schools. One of the major issues at that time (as it still is today) was whether volunteers wanting to work in psychiatric hospitals should have any sort of'training' for the kinds of work they might find themselves doing or whether 'training' as such defeated the object of

voluntary work.




Fund and with


Information Officer.

work in hospitals the prerogative of any one section of the community, but appeals to all sorts of



Interest aroused

again by


people regardless

of age, sex,

social position Discipline in volunteers is not necessarily in direct proportion to age or social status. Hair and skirt length are no guide to reliability and efficiency either way"

occupation .




Organisers of Voluntary Services in Hospitals by Jan Rocha. King Edward's Hospital Fund, 1968.



The creation of posts for orgarfisers of voluntary services in hospitals had begun to mushroom by this time and there was something of a 'band-wagon' effect taking place?it quite suddenly became'fashionable' to appoint an organiser. The rapid expansion of organisers (shown in graph form within this article) was given further impetus when Richard Crossman, then Secretary of State, championed the cause of the mentally handicapped and urged the appointment of 43

organisers of voluntary handicapped. Such


services in

brief survey of the

voluntary help organisers

being thoroughly done and without clear ideas of what an organiser is supposed to achieve, the results have sometimes been unspectacular and they have certainly

for the


development of the hospitals and

movement in


the community?a development which has gone from tentative origins to achieving almost a 'cure for all ills' status in the space of 10 years?runs the risk of giving the impression that all has been plain sailing. It is all too easy for the momentum of the appointments of organisers and the involvement of volunteers to mask the fact that the problems of making voluntary services valuable, of actually getting the schemes and projects to work properly and to the advantage of patients, hospitals, communities and volunteers themselves, have been numerous. In effect, the same problems of philosophy, co-

been immediate.

Protective shell Organisers ofvoluntary services run the risk of finding themselves installed in an extremely conservative world. Psychiatric hospitals in particular, often after years of neglect and being regarded as virtually apart from the rest of the community, have developed a protective shell which may be very hard to penetrate, especially with new ideas which may disrupt the well-established 'system' and bring changes that neither the administrators nor the staff are sure that they want in the first place. When Hans Muller had completed the first year of his project in Croydon and was beginning to win the support of ward staff for what he was trying to do at Warlingham Park Hospital, the Assistant Hospital Secretary remarked that Mr. Muller had been 'flogging a dead horse for the first six months because

operation, communication, implementation, funding and interpretation have cropped up time and again almost as each new appointment has been made. With hospital authorities being urged on all sides to appoint an organiser and plunge their hospital into the brave new world of voluntary services, there has been a tendency to make a swift appointment and then expect spectacular results. Without preparatory work

Growth of appointments of organisers of voluntary services in hospitals 1963 December 1972*

O 10


tH+ 44_

1963 Organisers Organisers Organisers Organisers



psychiatric hospitals in mental handicap hospitals in geriatric hospitals in general hospitals in

1965 ?


1966 *






'?????? ^


The plotting on this graph does not allow for appointments made of organisers for hospital groups. Group appointments have become increasingly frequent since 1971 and there were 48 of them by December 1972. In all there were

160 organisers appointed by


1972 and

14 assistant


of the staff really understood what it was that he trying to do This was in the comparatively early days of the history of organisers but the remark

none was



persistent problem of communication of making it clear to professional staff just what an organiser of voluntary services is 'organising' and just what the volunteers he is organising are going to be 'organised' to do. It is crucial to the success of the project that both the need to use volunteers in a hospital and the possibility of appointing a voluntary help organiser must be discussed and agreed by hospital management and staff at all levels. The day to day work of the organiser and the volunteers is done at ward level but if staff at that level have not been consulted about voluntary services, do not understand the principles involved and do not give it their support, then the chances of success are very


Staff have felt that a 'grand plan'?and a threatening one at that?has been foisted on them from above; they have felt that volunteers are being brought in to ease them out of their jobs as an alternative to a full establishment of trained staff; they have felt that volunteers have been drafted in to undertake all the pleasant aspects of psychiatric nursing leaving the professionals with only the drudgery. In fact, it is essential that all paid staff and volunteers should understand that the proper purpose of voluntary help in a hospital is to improve the quality of life for the patient, and to develop in the hospital and its neighbourhood an overall sense of community involvement. Even if there was unlimited money to pay for unlimited numbers of staff, patients would still need volunteers to provide ordinary human contact from outside the hospital.

No substitute A volunteer's work is

substitute for the work of a be complementary to it. A paid employee, volunteer's work must never put a patient at risk; it must never put paid staff at risk. There are many activities which can be undertaken by volunteers in the wards and departments of a hospital, but, except in times ofepidemics or similar emergencies, volunteers should never be used as replacements for paid staff; as a reason for reducing the establishment of paid staff; or as a mask to cover the real requirement for additional paid staff. Equally, it should be made clear from the start (and reiterated whenever necessary) that the voluntary help organiser acts as a bridge between paid staff on the one hand and volunteers and voluntary organisations on the other. On the staff side he must help to it




Tony Othen


A volunteer in an old people's ward of a Croydon psychiatric hospital encourages an old lady to join in a ward entertainment.

determine the






volunteers, and must ensure that, when volunteers are allocated, they are properly controlled.

the role for

On the volunteer side he


co-operate with

existing voluntary organisations to help ensure that the hospital can enjoy the fullest benefit from the services they have to offer, and he must also be responsible for recruiting, training and placing individual volunteers in suitable work in consultation with paid staff. Clearly, the efficient functioning of a voluntary help scheme can be of immense value to the patient, to the paid staff, who are enabled to make their services to the patient more effective, and to the community, which gets to know and understand its hospital and the services which it provides. Despite the drafting of guidelines, several publications and constant liaison and consultation, there is still a good deal of confusion about the voluntary help movement and more than a little hostility towards it. The Confederation of Health Service Employees at its ioth annual delegate conference in 1972 declared its opposition to voluntary help schemes. 45

John Bro oke an impromptu A behind the the stumps at aa psychiatric in Warwickshire Warwickshire finds finds himself himself behind Volunteer at impromptu stumps during Service Volunteer during an A Community psychiatric hospital hospital in Community Service

cricket match cricket match 46

the resolution made it clear anti-volunteers but that his opposition was on the political issue involved. He said: 'They [the Government] have actually created a second-tier, cheap labour force in the Health Service'. The words of a member of the National Executive Committee of COHSE accepting the resolution were rather more depressing: 'I have been asked to accept for the very good reason that this the resolution organisation has, for many years, advocated and worked for a professional and a qualified service, and because we believe that any job that can be done by a voluntary worker can be done considerably better by a paid member of staff'.



that he






Ominous grey


lot of misunderstanding and a lot more to be done on this issue and there is still an ominously large grey area which blankets the kinds of jobs being carried out by volunteers in hospitals and the extent to which they really are jobs which should be reserved for paid members of staff. There is no doubt that volunteers can be abused and mis-used although they themselves would be innocent of the fact. There is a lot to be said for on-going research and monitoring of the work volunteers are asked to do since brushes with the Unions can do the voluntary service movement nothing but harm. On the other side of this particular coin, it seems clear that hospital administrators are sometimes vague about the purpose of voluntary schemes and may encourage the use of voluntary labour in the wrong way. Hence, once again, the vital importance of consultation with staff at all levels. Equally, the hospital itself may have unreasonable expectations of its volunteers and, if these expectations are not confirmed, enthusiasm wanes and co-operation may There is still


talking and convincing

become more grudging. It cannot be said too often that it is crucial to have

plans, duties, expectations, communication hammered

collaboration and lines of out throughout all tiers of staff and administrators before any voluntary service scheme gets under way. With the almost constant reorganisation of the Health Service, and particularly with the upheavals of April 1974 in mind, it is becoming increasingly clear that some organisers of voluntary services are being appointed to impossible jobs. One man, for example, was appointed recently to be organiser for a Group made up of 22 hospitals. He has a job with which it is impossible to come to grips without assistance, and

thinking behind the job definition must have been extremely woolly. This sort of case illustrates again that some hospital administrators have a strange concept of the organisation of voluntary services and quite unrealistic expectations of it.


Substantial skills But there

are signs that, as the nature of the job of becomes more thoroughly understood, so those resonsible for making the appointments are asking for the right people and the right people are coming forward to apply for the jobs. There are substantial skills needed to be a good organiser, it is not a sinecure and it is certainly not a 'soft option'. One problem about attracting people to a job as an organiser is that there is still no clear career structure in sight. At the moment a young man with ability who makes a success of an organiser's job may find that the growing responsibilities of a young family mean that he can no longer afford to go on doing the job. The organiser is seen as an off-shoot of the hospital management team and progress upways is still ill-defined. A career structure may arise out of the Health Service re-organisation, the South West Metropolitan Regional Hospital Board, for example, now employs Jean Finzi as Regional Voluntary Services Officer to advise on the development of voluntary services in their region but, at the moment, this appointment is financed by a King's Fund grant. Looking ahead to the 1974 reorganisation, it might be that a closer tie up with the Social Services will be the future pattern. There are already several ways in which co-ordinators of voluntary services in hospitals have begun to integrate with the Social Services and to widen their contacts in the community. Such programmes not only make it easier to recruit volunteers because it is easier to avoid overlapping but also it seems to be more logical when one is thinking about total health care, and the integration of health services in 1974. It may be that voluntary service schemes in hospitals will, in the future, frequently come within the scope of a unified Health Service, as in the Croydon scheme, and so present a different sort of picture. There can be no doubt, despite occasional setbacks, that volunteers have a crucial part to play in the treatment process especially of the mentally ill. Voluntary service in the National Health Service is here to stay and, as far as the mental health service is concerned, it represents one concrete factor in the otherwise nebulous concept of community care.



John Brooke

Mary Croft,


Croydon voluntary worker, plays guitar for a group of old ladies in hospital.

Out of date At the same time, it is equally obvious that the whole basis of voluntary service, its principles and philosophy, is undergoing a transformation. The concept upon which voluntary organisations have been based in the past is now out of date. It is a sad fact that too many organisations are more concerned with just keeping themselves going rather than asking whether the service they go on providing is really relevant

today. Young people,

many of whom are desperately anxious to accept responsibility for what goes on in our society, see many voluntary organisations in terms of the rich giving to the poor and are beginning to demand more radical solutions?they want to get to grips with the origins of problems rather than tinker about with the results. The young have made us all question our actions, attitudes and priorities and it has been a very healthy inquisition; but idealism is hard to harness and there 48

is still a great deal that can be done to correct the here and now as well as preventing the perpetuation of many of our social ills. It is sometimes hard to reconcile the fragmentary and militant climate of opinion of the 1970s with the degree of organisation and co-ordination necessary to work in with the statutory services, but not to do so would be to negate our responsibilities now and would not say much for our priorities if a better future is to be secured for the mentally ill.

* The Volunteer?friend or foe? An exhibition (at the King's Fund Hospital Centre, 24 Nutford Place, London WiH 6AN), which tries to illustrate the contribution and role of volunteers in hospitals and to demonstrate some of the factors in developing effective partnerships between those who provide service and those who use them. 9.30-5.15 Monday to Friday until March 30th. Group visits should be booked in advance with Mrs. W. M. Arnett-Rayson (262 2641).

The Quiet Revolution.

Reflections on the progress, prospects and problems of the voluntary service in mental health movement...
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