STUDIES IN MENTAL INEFFICIENCY.
The Work of Local Possible By Aphra L.
Voluntary Associations Future Developments.
Hargrove, Organising Secretary,
and
S .E. Lancashire Association.
Editorial Note. It
might be advisable, to set out article, the constitution and functions those readers who
are
more
fully, by way of preface to this Associations, for the benefit of
of Local
not familiar with their work.
The first Associations, of which there are now forty-nine in existence, were formed almost directly after the Mental Deficiency Act came into force in 1914. One of their main objects was the co-ordination of all public and voluntary work undertaken for defectives in their own homes, throughout the area, covered by a Local Authority under the Mental Deficiency Act, i.e., a County or County Borough. The Constitution of these Associations varies according to Local conditions but they all have certain features in common. They consist of Representatives of Public Bodies in the area, dealing with defectives, such as the County or County Borough Mental Deficiency Committee, the Education Committees, and Boards of Guardians; of Voluntary Homes and Institutions for Defectives; and of any Societies and Organisations which come into touch, either directly or indirectly, with defectives. They are therefore most representative in character, and in this way are able to be in touch with all defectives who are living in the district. These Associations, at the request of their Local Statutory Authority, undertake all or some of the following duties for it, under the Mental Deficiency Act. Under Section 30 of this Act, it is the duty of the Local Authority to ascertain what persons in the area are defective and subject to be dealt with under the Act. By being in touch with all defectives in their own homes, these Associations are particularly well fitted to assist in this duty, and to supply full information to the Local Authority, as to any cases which should be dealt with, and where the parents or relatives of the defective are anxious to secure help. The Local Authority has also the duty of providing supervision in their own homes for any defectives subject to be dealth with, and when this supervision is inadequate to send the defective to an institution or place him under guardianship. Local Associations, undertake the supervision of such cases, and by having a visitor constantly in touch with these defectives are able, not only to give advice and help as to their care and training, but also to report at once when home care becomes inadequate. They also find vacancies in Institutions for those defectives who require institution care, and secure guardians. In some areas the Secretary of the Association prepares all the papers for and presents the petition to the Judicial Authority committing a defective to an Institution. Again when there is a question of a defective being discharged from an Institution, these Associations are particularly well fitted to make a report to the Visiting Committee of the Institution as to what care and supervision will be available if the defective is discharged. Where desired by Education Committees, these Associations also act as a Care Committee for those educable mentally defective children between the ages of seven and sixteen who are under the care of the Education Committee, and attending a Special School. Where no such school exists they visit those children who would be in a Special School if there were one. They also often act as After
8
STUDIES IN MENTAl, INEFFICIENCY.
Care Committees for children who have left the special schools. They also assist Poor Law Guardians in various ways, for example, by visiting the "ins and outs" of the workhouse who are not certifiable under the Act, but need help and friendly
supervision.
The above are the various ways in which Local Associations co-operate with Public Bodies. There are however a large number of defectives, who are in need of help and advice, but for whom no Authority is responsible. The care of these It is unnecessary to is one of the chief "Raisons d'etre" of these Associations. enumerate these as that branch of the work is dealt with fully in the article. Though voluntary help in visiting, etc., is made use of to a large extent, it is practically essential for most Associations to have a paid Secretary with especial knowledge of defectives, to be responsible for the organisation of the work in the There In some of the larger associations an assistant is also necessary. area. are also travelling and office and other incidental expenses to be met, which vary considerably according to the, locality. The question of finance, therefore, is an
important
one.
Section 48 of the Mental Deficiency Act runs as follows: "Where a Society has undertaken the duty of assisting or supervising defectives whilst not in Institutions under this Act, there may be paid to the Society out of money provided by Parliament towards the expenses of the Society in connection with such persons, such sums and on such conditions as the Secretary of State with the approval of the Treasury may recommend.'' These Associations therefore receive grants of varying amounts, according to the population of the Area, direct from the Treasury, through the Board of In addition the Local Statutory Committee make a grant in respect Control. of assistance given to it in the discharge of its duties of the Mental Deficiecny Act. The Treasury refunds to the Local Statutory Committee half the amount of any grant so made, In many cases the Education Committees and Boards of Guardian Several of these make grants, and there are also private subscriptions. Associations have now been working a sufficiently long time amply to justify the very high hopes that were expected of them and to prove that they are both a highly efficient and economical means of securing adequate care for defectives. The Board of Control in its last annual report lays great stress on their usefulness.
Present Work of the Associations. The chief functions of follows:?
(1) (2) (3) (4) (5)
Voluntary
Associations at the present time
are as
To assist Local Authorities to carry out certain of the duties laid upon them by the Mental Deficiency Act. To befriend and assist defectives who, as a result of the limited scope of the Act do not come under it. To give advice and assistance in 'borderland'' cases which are not certifiable. To arouse and educate public opinion and Generally to act as a link between the different Authorities concerned with defectives and so to ensure some co-ordination in the work. '
The
proportion
functions, i.e.,
organisation
to
used
of
an
Association's time which is devoted to the first of these
"Statutory" work, depends upon the particular method of by its Local Authority, and upon the degree of vigour with
9TUDIES IN MENTAL INEFFICIENCY.
9
which the Act is administered.
Thus in some areas, Associations are employed for and officially "supervision," perhaps "ascertainment," only; in others they are asked in addition to undertake the investigation of all new cases notified to the Local Authority, the finding of vacancies in Institutions and the escorting of ' cases thereto, and the finding of 'guardians": whilst in others again, the Secretary of the Association is also the Executive Officer of the Local Authority and has consequently to devote the greater part of her time to Statutory work. But an effort should always be made not to allow the second function enumerated above?that of befriending defectives who are outside the provisions of the Act?to be thrust into the background, for in it lies perhaps what is the chief raison d'etre of a Voluntary Association's existence. None of the following classes of defectives can be touched by a Local
Authority:?
(a) Young children under seven, who cannot be deemed to be "neglected." (b) "Educable" defectives between the ages of seven and sixteen for whom, by reason of the present dearth of Special Schools, no educational provision can (c)
be made. Children
leaving Special Schools who cannot be notified by the Education Authority under Section 2 (2) (b) of the Act by reason of the present limitation of this clause to defectives who need institutional care or guardianship. (d) Adult defectives amenable to control and living in good surroundings, and those who though of immoral or criminal tendencies, are for the time being, self-supporting. (e) "Borderland" cases who?though certifiable under neither the Lunacy Act nor the Mental Deficiency Act?are subnormal or unstable and in need of advice
or
treatment.
The visiting and befriending of classes (a), (c) and (d), in order that help may be at hand when any emergency arises, thus forms an important part of a Voluntary Association's work, and the service it is able to render in advising the mothers of young children as to methods of "home-training" is one that is of particularly lar-reaching value. As regards class (d) every Association could give instances where the parents of a defective have been weighed down by the dread as to what will happen to him, should they die or not be able to look after him. In these cases the existence of an Association and the consequent knowledge that there is a friend to turn to in any emergency is a very great relief. Another great service these Associations can render is by being prepared to Such parents are often help middle-class parents of defective children. urgently in need of advice and assistance but would not normally apply direct to a Public Authority. In these cases an Association does very valuable work, by putting them into touch with the right Authority where financial help is needed, or?where parents themselves can afford to send the child to a school or Home?by advising as to what Home would be most suitable and securing a vacancy, or again, by making suggestions as to how Training can be given at home. Feeble-minded children between seven and sixteen come of course within the province of the Local Education Authority but in some areas?more especially in scattered rural ones?Associations undertake their supervision by special arrangement with the Authority in question. The problem presented by the "borderland" class of case is at present? owing to lack of facilities both for diagnosis and treatment?only too far from solution but here and there tentative efforts are being made to deal with it and
IO
STUDIES IN MENTAL INEFFICIENCY.
some
Associations
are
able to record
a
certain
measure
of
succcss
in individual
cases.
The work of educating public opinion is one that Associations carry on side that for individual defectives and is of equal value to the community. Much of the alleged failure of the Mental Deficiency Act is due to ignorance of the powers given by it?the power to deal with criminal defectives (Section 8), being a case in point?and in the dispelling of this ignorance a Voluntary Association plays an important part. One hears too much complaint about the slackness with which the Act is administered, but that much of this slackness is due to the lack of any pressure in the shape of public opinion is shown by the fact that in areas where such opinion has been aroused either by active Voluntary Associations or by some other means, administration is almost without exception speeded up. The establishment of "Occupation Centres"*?chiefly for children excluded from school?has been added by a few Associations to the normal routine activities outlined above, but this is a phase of the work which is at present still in its
by side with
infancy. Possible Future Developements. Is their importance What now of the future of Voluntary Associations? with the of that to diminish completion preliminary spade work which likely Or if not what new opportunities now forms such a large part of their activities ? of service are likely to present themselves, and how are they likely to be used? I have said that a large part of the present activities of Voluntary Associations are in the nature of spade work. By that I mean that they are due to the fact that the Mental Deficiency Act, 1913, and the Elementary Education (Defective and Epileptic Children) Act, 1914, have only been in operation a short time, to the almost insurmountable difficulties that have stood in the way of their being put into active operation, and to their inherent imperfections which could only be revealed by practical experience. But let us for a moment project ourselves into the future and conceive a state of things in which there is no defective over seven who has not been "ascertained "; in which every 'edueable'' defective child between seven and sixteen is provided for in a Special School with the certainty of being sent on, if necessary, to an institution; in which no difficult or undesirable "excluded" imbecile is left in his own home, and in which?in cases of mentally defective delinquents?Section 8 of the Act is the first and not the last remedy resorted to. All this will involve the release of those energies of Voluntary Associations which have now to be devoted to the anxious supervision of cases which ought to be in institutions, to the weary search for "vacancies" and to the laborious enquiry into the "early history" of adult defectives who have only recently been "ascertained." It should be noted that these developments are not likely to reduce the number of cases to be dealt with by Associations, for although many of the lowgrades with whom they are now so largely occupied will have been taken out of their hands, the number of high-grades will be considerably increased. And this for two reasons. First, one of the suggested amendments to the Mental Deficiency Act is to the effect that a Local Education Authority shall be empowered (under Section 2 (2) (b)) to notify a child leaving a Special School, for "supervision" as well as '
*
See article
on
"The Lilian
Greg Centre"
in "Studies in Mental
Inefficiency" October,
1920.
STUDIES IN MENTAL INEFFICIENCY.
for institutional
II
This in itself will add greatly to the number of cases under Secondly, with the general establishment of Special Schools and the perfected methods of diagnosis that are likely to result many cases of mental defect that now escape notice will be detected and referred ultimately to Voluntary Associations. And it is then that the problem of how to supervise will have to be faced in earnest, and a part of the released energy to which I have referred will surely be deviated to the tackling of this very difficult problem. No longer shall we be satisfied with that "quarterly visit and report" which so often under present conditions is what we mean by "supervision," we shall begin to ask what constructive work we can do for our feeble-minded cases, and particularly for those: care.
Statutory supervision.
(1)
who
quite amenable to discipline and capable unsatisfactory conditions. have good homes but who are unable to hold are
living (2)
of work, but who
are
under
who labour market.
their
own
in the open
Voluntary Associations may consider the possibility opening?as experiment?hostels where defectives may receive skilled supervision and guidance, but from which they may go out daily to work and to the support of which they may therefore largely contribute. Such Hostels would thus constitute a sort of half way house between the artificially restricted life of an institution and the complete freedom of an ordinary home and would at the same time afford a testing place for cases in which there is a doubt as to whether or not removal to an Institution is necessary, and conversely for cases in which there is doubt as to the wisdom of releasing from an institution. For the second type of case a reverse need seems to exist, viz.: the provision of suitable work, no change in their home surroundings being necessary, and the Voluntary Associations of the future may well consider the question of opening an Industrial Centre?on the model of the workshops at Darenth and other Institutions?to which defectives can go daily and be happily and usefully occupied, perhaps in some cases earning small wages in return for their work. An Occupation Centre for lower grade cases?mention of which has been made above? might be combined with such a venture and the two run together, and one can think of various other activities to which it might give rise. For those defectives living in rural scattered areas where attendance at an industrial or Occupation Centre is impossible, some other means of providing training will have to be devised. Would it not be possible for an Association to employ a peripatetic teacher, as is done by some Blind Societies, who would herself visit these defectives at regular intervals and give them and those responsible for their care, definite teaching and training, and also give instruction to the voluntary visitors as to the best means of training the individual cases they are visiting? For the higher grade defectives, capable of being taught some simple manual occupation, I think it should be possible to secure the co-operation of Women's Institutes in the different villages, and obtain volunteers from their members to provide training in some handicraft. Such experiments may reasonably be expected to be assisted financially by the Authorities?Local or Central?but it is not to "Authorities" we look for the initiating of them. Experimental work?in this country at any rate? essentially belongs to the field of voluntary effort. The other important development in the work of Voluntary Associations For the first type of
of
for which
case
an
we
may
?
look, is in connection with
'
r
*?..
-
'
'borderland''
I
?
cases.
12
STUDIES IN MENTAL INEFFICIENCY.
Whereas, up to a comparatively short time ago, such cases were only recognised to exist by a few medical and psychological experts, the experience gained in the War has now brought the problem into the arena of practical politics, and within the last two or three months the inclusion of a Clause dealing with the treatment of incipient mental disorder in the Ministry of Health (Miscellaneous Provisions) Bill has shewn that the subject is receiving the earnest attention of the Government Departments concerned. The establishment of Psychiatric Clinics?such as already exist here and there?in every large centre will lead to the detection of large numbers of "border'' land cases at present unrevealed and in response to the new need facilities for meeting it will not fail to come into being. Information as to the patients' home surroundings, as to the way in which the treatment prescribed is being carried out and as to the progress of those who have returned from treatment away from home will be needed by the clinics. Voluntary Associations, who have had considerable experience in dealing with these borderline cases, should, it seems to me, be able to do a good deal of such social work in connection with these clinics, and should, therefore be able to train their workers to have some understanding of these difficult cases. It is moreover virtually certain that to such clinics will be brought?in hope of cure?cases of actual mental defect already known to the Associations, and it will thus prevent much overlapping and duplication of visiting if it is to them that the "following up" of all suitable cases attending is entrusted. * Such a development as this will of course bring with it the need for a higher degree of expert knowledge than is at present possessed by the average secretaries and workers of our Associations. But "Short Courses"?on the model of those already provided by the C.A.M.D. for other sections of workers?would probably meet this need once the demand is great enough. On some such lines as these then would seem to lie the chief possibilities of expansion for Voluntary Associations. From their present inevitable preoccupation with the legacy left by the neglect of the past, and with the struggle to overcome the tremendous obstacles with which the war has strewn the way of progress; they will evolve into bodies of enthusiastic experts ever seeking to devise new methods of dealing with their problem as a whole and of giving a fuller life to the individual defective under their care, and always ready to be used in the cause of the promotion of mental health. It may be said that I have painted a too rosy picture of a future that will never be realised^ and I am aware that its complete realisation is as yet far off. But "where there is no vision the people perish" and it is only by continually reminding themselves of the possibilities that may lie before them that Associations will be able to preserve their individuality and prevent themselves from becoming mere cogs in the wheel of the machinery of Local Authorities. Opportunity may not yet come, but when it does come let us not fail to use it because the conception of our destiny has been too low. * The greatest obstacle in Voluntary Associations for the
the way of this development would seem to lie in the name of Care of the Mentally Defective and a change may have to be
made in it to suit new conditions.
The Work of Local Possible By Aphra L.
Voluntary Associations Future Developments.
Hargrove, Organising Secretary,
and
S .E. Lancashire Association.
Editorial Note. It
might be advisable, to set out article, the constitution and functions those readers who
are
more
fully, by way of preface to this Associations, for the benefit of
of Local
not familiar with their work.
The first Associations, of which there are now forty-nine in existence, were formed almost directly after the Mental Deficiency Act came into force in 1914. One of their main objects was the co-ordination of all public and voluntary work undertaken for defectives in their own homes, throughout the area, covered by a Local Authority under the Mental Deficiency Act, i.e., a County or County Borough. The Constitution of these Associations varies according to Local conditions but they all have certain features in common. They consist of Representatives of Public Bodies in the area, dealing with defectives, such as the County or County Borough Mental Deficiency Committee, the Education Committees, and Boards of Guardians; of Voluntary Homes and Institutions for Defectives; and of any Societies and Organisations which come into touch, either directly or indirectly, with defectives. They are therefore most representative in character, and in this way are able to be in touch with all defectives who are living in the district. These Associations, at the request of their Local Statutory Authority, undertake all or some of the following duties for it, under the Mental Deficiency Act. Under Section 30 of this Act, it is the duty of the Local Authority to ascertain what persons in the area are defective and subject to be dealt with under the Act. By being in touch with all defectives in their own homes, these Associations are particularly well fitted to assist in this duty, and to supply full information to the Local Authority, as to any cases which should be dealt with, and where the parents or relatives of the defective are anxious to secure help. The Local Authority has also the duty of providing supervision in their own homes for any defectives subject to be dealth with, and when this supervision is inadequate to send the defective to an institution or place him under guardianship. Local Associations, undertake the supervision of such cases, and by having a visitor constantly in touch with these defectives are able, not only to give advice and help as to their care and training, but also to report at once when home care becomes inadequate. They also find vacancies in Institutions for those defectives who require institution care, and secure guardians. In some areas the Secretary of the Association prepares all the papers for and presents the petition to the Judicial Authority committing a defective to an Institution. Again when there is a question of a defective being discharged from an Institution, these Associations are particularly well fitted to make a report to the Visiting Committee of the Institution as to what care and supervision will be available if the defective is discharged. Where desired by Education Committees, these Associations also act as a Care Committee for those educable mentally defective children between the ages of seven and sixteen who are under the care of the Education Committee, and attending a Special School. Where no such school exists they visit those children who would be in a Special School if there were one. They also often act as After
8
STUDIES IN MENTAl, INEFFICIENCY.
Care Committees for children who have left the special schools. They also assist Poor Law Guardians in various ways, for example, by visiting the "ins and outs" of the workhouse who are not certifiable under the Act, but need help and friendly
supervision.
The above are the various ways in which Local Associations co-operate with Public Bodies. There are however a large number of defectives, who are in need of help and advice, but for whom no Authority is responsible. The care of these It is unnecessary to is one of the chief "Raisons d'etre" of these Associations. enumerate these as that branch of the work is dealt with fully in the article. Though voluntary help in visiting, etc., is made use of to a large extent, it is practically essential for most Associations to have a paid Secretary with especial knowledge of defectives, to be responsible for the organisation of the work in the There In some of the larger associations an assistant is also necessary. area. are also travelling and office and other incidental expenses to be met, which vary considerably according to the, locality. The question of finance, therefore, is an
important
one.
Section 48 of the Mental Deficiency Act runs as follows: "Where a Society has undertaken the duty of assisting or supervising defectives whilst not in Institutions under this Act, there may be paid to the Society out of money provided by Parliament towards the expenses of the Society in connection with such persons, such sums and on such conditions as the Secretary of State with the approval of the Treasury may recommend.'' These Associations therefore receive grants of varying amounts, according to the population of the Area, direct from the Treasury, through the Board of In addition the Local Statutory Committee make a grant in respect Control. of assistance given to it in the discharge of its duties of the Mental Deficiecny Act. The Treasury refunds to the Local Statutory Committee half the amount of any grant so made, In many cases the Education Committees and Boards of Guardian Several of these make grants, and there are also private subscriptions. Associations have now been working a sufficiently long time amply to justify the very high hopes that were expected of them and to prove that they are both a highly efficient and economical means of securing adequate care for defectives. The Board of Control in its last annual report lays great stress on their usefulness.
Present Work of the Associations. The chief functions of follows:?
(1) (2) (3) (4) (5)
Voluntary
Associations at the present time
are as
To assist Local Authorities to carry out certain of the duties laid upon them by the Mental Deficiency Act. To befriend and assist defectives who, as a result of the limited scope of the Act do not come under it. To give advice and assistance in 'borderland'' cases which are not certifiable. To arouse and educate public opinion and Generally to act as a link between the different Authorities concerned with defectives and so to ensure some co-ordination in the work. '
The
proportion
functions, i.e.,
organisation
to
used
of
an
Association's time which is devoted to the first of these
"Statutory" work, depends upon the particular method of by its Local Authority, and upon the degree of vigour with
9TUDIES IN MENTAL INEFFICIENCY.
9
which the Act is administered.
Thus in some areas, Associations are employed for and officially "supervision," perhaps "ascertainment," only; in others they are asked in addition to undertake the investigation of all new cases notified to the Local Authority, the finding of vacancies in Institutions and the escorting of ' cases thereto, and the finding of 'guardians": whilst in others again, the Secretary of the Association is also the Executive Officer of the Local Authority and has consequently to devote the greater part of her time to Statutory work. But an effort should always be made not to allow the second function enumerated above?that of befriending defectives who are outside the provisions of the Act?to be thrust into the background, for in it lies perhaps what is the chief raison d'etre of a Voluntary Association's existence. None of the following classes of defectives can be touched by a Local
Authority:?
(a) Young children under seven, who cannot be deemed to be "neglected." (b) "Educable" defectives between the ages of seven and sixteen for whom, by reason of the present dearth of Special Schools, no educational provision can (c)
be made. Children
leaving Special Schools who cannot be notified by the Education Authority under Section 2 (2) (b) of the Act by reason of the present limitation of this clause to defectives who need institutional care or guardianship. (d) Adult defectives amenable to control and living in good surroundings, and those who though of immoral or criminal tendencies, are for the time being, self-supporting. (e) "Borderland" cases who?though certifiable under neither the Lunacy Act nor the Mental Deficiency Act?are subnormal or unstable and in need of advice
or
treatment.
The visiting and befriending of classes (a), (c) and (d), in order that help may be at hand when any emergency arises, thus forms an important part of a Voluntary Association's work, and the service it is able to render in advising the mothers of young children as to methods of "home-training" is one that is of particularly lar-reaching value. As regards class (d) every Association could give instances where the parents of a defective have been weighed down by the dread as to what will happen to him, should they die or not be able to look after him. In these cases the existence of an Association and the consequent knowledge that there is a friend to turn to in any emergency is a very great relief. Another great service these Associations can render is by being prepared to Such parents are often help middle-class parents of defective children. urgently in need of advice and assistance but would not normally apply direct to a Public Authority. In these cases an Association does very valuable work, by putting them into touch with the right Authority where financial help is needed, or?where parents themselves can afford to send the child to a school or Home?by advising as to what Home would be most suitable and securing a vacancy, or again, by making suggestions as to how Training can be given at home. Feeble-minded children between seven and sixteen come of course within the province of the Local Education Authority but in some areas?more especially in scattered rural ones?Associations undertake their supervision by special arrangement with the Authority in question. The problem presented by the "borderland" class of case is at present? owing to lack of facilities both for diagnosis and treatment?only too far from solution but here and there tentative efforts are being made to deal with it and
IO
STUDIES IN MENTAL INEFFICIENCY.
some
Associations
are
able to record
a
certain
measure
of
succcss
in individual
cases.
The work of educating public opinion is one that Associations carry on side that for individual defectives and is of equal value to the community. Much of the alleged failure of the Mental Deficiency Act is due to ignorance of the powers given by it?the power to deal with criminal defectives (Section 8), being a case in point?and in the dispelling of this ignorance a Voluntary Association plays an important part. One hears too much complaint about the slackness with which the Act is administered, but that much of this slackness is due to the lack of any pressure in the shape of public opinion is shown by the fact that in areas where such opinion has been aroused either by active Voluntary Associations or by some other means, administration is almost without exception speeded up. The establishment of "Occupation Centres"*?chiefly for children excluded from school?has been added by a few Associations to the normal routine activities outlined above, but this is a phase of the work which is at present still in its
by side with
infancy. Possible Future Developements. Is their importance What now of the future of Voluntary Associations? with the of that to diminish completion preliminary spade work which likely Or if not what new opportunities now forms such a large part of their activities ? of service are likely to present themselves, and how are they likely to be used? I have said that a large part of the present activities of Voluntary Associations are in the nature of spade work. By that I mean that they are due to the fact that the Mental Deficiency Act, 1913, and the Elementary Education (Defective and Epileptic Children) Act, 1914, have only been in operation a short time, to the almost insurmountable difficulties that have stood in the way of their being put into active operation, and to their inherent imperfections which could only be revealed by practical experience. But let us for a moment project ourselves into the future and conceive a state of things in which there is no defective over seven who has not been "ascertained "; in which every 'edueable'' defective child between seven and sixteen is provided for in a Special School with the certainty of being sent on, if necessary, to an institution; in which no difficult or undesirable "excluded" imbecile is left in his own home, and in which?in cases of mentally defective delinquents?Section 8 of the Act is the first and not the last remedy resorted to. All this will involve the release of those energies of Voluntary Associations which have now to be devoted to the anxious supervision of cases which ought to be in institutions, to the weary search for "vacancies" and to the laborious enquiry into the "early history" of adult defectives who have only recently been "ascertained." It should be noted that these developments are not likely to reduce the number of cases to be dealt with by Associations, for although many of the lowgrades with whom they are now so largely occupied will have been taken out of their hands, the number of high-grades will be considerably increased. And this for two reasons. First, one of the suggested amendments to the Mental Deficiency Act is to the effect that a Local Education Authority shall be empowered (under Section 2 (2) (b)) to notify a child leaving a Special School, for "supervision" as well as '
*
See article
on
"The Lilian
Greg Centre"
in "Studies in Mental
Inefficiency" October,
1920.
STUDIES IN MENTAL INEFFICIENCY.
for institutional
II
This in itself will add greatly to the number of cases under Secondly, with the general establishment of Special Schools and the perfected methods of diagnosis that are likely to result many cases of mental defect that now escape notice will be detected and referred ultimately to Voluntary Associations. And it is then that the problem of how to supervise will have to be faced in earnest, and a part of the released energy to which I have referred will surely be deviated to the tackling of this very difficult problem. No longer shall we be satisfied with that "quarterly visit and report" which so often under present conditions is what we mean by "supervision," we shall begin to ask what constructive work we can do for our feeble-minded cases, and particularly for those: care.
Statutory supervision.
(1)
who
quite amenable to discipline and capable unsatisfactory conditions. have good homes but who are unable to hold are
living (2)
of work, but who
are
under
who labour market.
their
own
in the open
Voluntary Associations may consider the possibility opening?as experiment?hostels where defectives may receive skilled supervision and guidance, but from which they may go out daily to work and to the support of which they may therefore largely contribute. Such Hostels would thus constitute a sort of half way house between the artificially restricted life of an institution and the complete freedom of an ordinary home and would at the same time afford a testing place for cases in which there is a doubt as to whether or not removal to an Institution is necessary, and conversely for cases in which there is doubt as to the wisdom of releasing from an institution. For the second type of case a reverse need seems to exist, viz.: the provision of suitable work, no change in their home surroundings being necessary, and the Voluntary Associations of the future may well consider the question of opening an Industrial Centre?on the model of the workshops at Darenth and other Institutions?to which defectives can go daily and be happily and usefully occupied, perhaps in some cases earning small wages in return for their work. An Occupation Centre for lower grade cases?mention of which has been made above? might be combined with such a venture and the two run together, and one can think of various other activities to which it might give rise. For those defectives living in rural scattered areas where attendance at an industrial or Occupation Centre is impossible, some other means of providing training will have to be devised. Would it not be possible for an Association to employ a peripatetic teacher, as is done by some Blind Societies, who would herself visit these defectives at regular intervals and give them and those responsible for their care, definite teaching and training, and also give instruction to the voluntary visitors as to the best means of training the individual cases they are visiting? For the higher grade defectives, capable of being taught some simple manual occupation, I think it should be possible to secure the co-operation of Women's Institutes in the different villages, and obtain volunteers from their members to provide training in some handicraft. Such experiments may reasonably be expected to be assisted financially by the Authorities?Local or Central?but it is not to "Authorities" we look for the initiating of them. Experimental work?in this country at any rate? essentially belongs to the field of voluntary effort. The other important development in the work of Voluntary Associations For the first type of
of
for which
case
an
we
may
?
look, is in connection with
'
r
*?..
-
'
'borderland''
I
?
cases.
12
STUDIES IN MENTAL INEFFICIENCY.
Whereas, up to a comparatively short time ago, such cases were only recognised to exist by a few medical and psychological experts, the experience gained in the War has now brought the problem into the arena of practical politics, and within the last two or three months the inclusion of a Clause dealing with the treatment of incipient mental disorder in the Ministry of Health (Miscellaneous Provisions) Bill has shewn that the subject is receiving the earnest attention of the Government Departments concerned. The establishment of Psychiatric Clinics?such as already exist here and there?in every large centre will lead to the detection of large numbers of "border'' land cases at present unrevealed and in response to the new need facilities for meeting it will not fail to come into being. Information as to the patients' home surroundings, as to the way in which the treatment prescribed is being carried out and as to the progress of those who have returned from treatment away from home will be needed by the clinics. Voluntary Associations, who have had considerable experience in dealing with these borderline cases, should, it seems to me, be able to do a good deal of such social work in connection with these clinics, and should, therefore be able to train their workers to have some understanding of these difficult cases. It is moreover virtually certain that to such clinics will be brought?in hope of cure?cases of actual mental defect already known to the Associations, and it will thus prevent much overlapping and duplication of visiting if it is to them that the "following up" of all suitable cases attending is entrusted. * Such a development as this will of course bring with it the need for a higher degree of expert knowledge than is at present possessed by the average secretaries and workers of our Associations. But "Short Courses"?on the model of those already provided by the C.A.M.D. for other sections of workers?would probably meet this need once the demand is great enough. On some such lines as these then would seem to lie the chief possibilities of expansion for Voluntary Associations. From their present inevitable preoccupation with the legacy left by the neglect of the past, and with the struggle to overcome the tremendous obstacles with which the war has strewn the way of progress; they will evolve into bodies of enthusiastic experts ever seeking to devise new methods of dealing with their problem as a whole and of giving a fuller life to the individual defective under their care, and always ready to be used in the cause of the promotion of mental health. It may be said that I have painted a too rosy picture of a future that will never be realised^ and I am aware that its complete realisation is as yet far off. But "where there is no vision the people perish" and it is only by continually reminding themselves of the possibilities that may lie before them that Associations will be able to preserve their individuality and prevent themselves from becoming mere cogs in the wheel of the machinery of Local Authorities. Opportunity may not yet come, but when it does come let us not fail to use it because the conception of our destiny has been too low. * The greatest obstacle in Voluntary Associations for the
the way of this development would seem to lie in the name of Care of the Mentally Defective and a change may have to be
made in it to suit new conditions.
