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Mental health work of local authorities
26 T h e Central Advisory Water Committee, set up under the chairmanship of Lord Milne to advise the Government on the conservation and allocation of water resources, has had an unenviable task, especially in preparing its third report*, which is on the co-ordination of the various river interests. T h e committee has investigated the desirability of setting up for each watershed area a single river authority responsible for some or all of the functions exercised by the existing bodies. There is general agreement that if such bodies are to be established the watershed area is the appropriate unit ; but many of the interested parties who tendered evidence were very reluctant to admit any interference with their work. For example, the County Councils Association wanted catchment and land drainage and other functions, except the prevention of pollution, left in the hands of existing bodies. T h e Canal Association objected to any general transference of powers and functions relating to navigation. Among the fishery interests there was doubt as to the wisdom of transferring control of fisheries to a comprehensive river authority. T h e British Waterworks Association objected to any interference with or diminution of the statutory powers and duties of water undertakers. But on the question of pollution the great majority of the bodies which gave evidence were in favour of comprehensive control over the river from source to sea by one authority. I n the Committee's view the principal disadvantage of the present situation is not that the functions of the various bodies overlap or that the interests conflict, but that no single body is charged with the duty of co-ordinating the various river interests or of ensuring that the requirements of such interests are properly served. It proposes accordingly that river boards be set up to replace certain of the existing bodies and to take over some of the powers and duties of others. These boards will be responsible for the conservation of water resources, for enforcifig the statutory provisions with regard to pollution, and for planning drainage and other works in such a way as to ensure that all public interests are adequately safeguarded. It is proposed that each board should administer a watershed area or, in the case of smaller rivers, two or more such areas. Twenty-nine areas have been mapped out in England and Wales. Northumberland and Durham, for example, have two : the T y n e and Wear and the Tees ; Yorkshire has t w o : the Ouse and the Hull area. Another group consists of most of the Lincolnshire rivers, except the Nene and the Welland, which empty from the Lincolnshire coast, and are allocated to another area consisting not only of parts of Kesteven and Holland but of Rutland and Northamptonshire. T h e Thames and Lee are excepted from the scheme, because the evidence before the committee was that the existing conservancy boards were working satisfactorily to all concerned. T h e boards will be constituted, as to the majority of their members, of representatives of the county and county borough councils of the area, but there will be direct representation of all interests likely to be affected by the Board's work, including local authorities, water undertakers, industrial interests, agricultural and fishery interests, internal drainage interests, and navigation. Judging from the amount of objection by the many important bodies tendering evidence, it may be some time before the recommendations find a safe home in legislation, but here in the meantime is another example of the tendency towards regionalisation. We hope, however, that the boards, in their concern for their larger functions, such as drainage, reservoir construction, control of pollution, and coast defence, will not lose sight of the amenities of the river which have meant so much to both town and country life in England.
Mental Health Work of Local Authorities T h e development of joint schemes to include all mental health services, as well as child guidance, within the area of a local authority is making progress and is justifying itself where it has been undertaken. A report on the scheme in Portsmouth was given by Dr. Thomas Beaton to the conference, mainly of * Cmd. 6465. Price Is. 3d. net.
PUBLIC HEALTH, December, 1943 delegates from local authorities, recently summoned in London by the provisional National Council for Mental Health, a body which incorporates the Central Association for Mental Welfare, the Child Guidance Council, the National Council for Mental Hygiene, and the work of the Mental Health Emergency Committee. Dr. Beaton said that the essential factors in the Portsmouth scheme were the setting up of a central mental treatment department to provide an adequate social psychiatric service and to act as a basis for the organisation, and the formation of a mental treatment committee of the local authority to cover the whole field of mental and nervous disorder and mental deficiency, with the use of the mental hospital for in-patient treatment. He exhibited a plan which showed the central department linked up with the mental hospital, the out-patients' clinic, the voluntary hospital, the mental deficiency training centre and projected colony, the observation wards in the mental deficiency section of the municipal hospital, the child guidance and juvenile deliquency clinics, the education authority, the probation officers, the social welfare organisation, the labour and employment exchange, and the public assistance relieving officer. T h e municipal hospital, he said, is visited daily by a psychiatrist. It is difficult, of course, to put any results into figures, but some index is afforded by the n u m b e r of residents at the mental hospital at the end of each year. T h e n u m b e r rose rapidly until 1937 or 1938, when the mental health service began to affect the position and caused a distinct fall. T h e figures for the next two years were complicated by evacuation and bombing, but the situation has now been stabilised, the population of Portsmouth is again rising, but the curve continues its downward course in spite of an increase of admissions. This can be due only to the recoverability of the early voluntary case after a short stay in the institution. T h e development of a joint scheme for child guidance was described to the conference by Mr. E. R. Davies, deputy clerk of the Berkshire County Council. Following upon complaints by dissatisfied householders concerning the behaviour of evacuated children, the council decided to set up a child guidance clinic. T h e Ministry of Health, while favouring the scheme, pointed out that it should serve the whole geographical county, including the county borough of Reading. It was then considered whether the clinic should be established under the Education Acts as a school medical service or under the Mental Treatment Act. It was decided to act under the Mental Treatment Act, because a mental health authority covering the whole of the geographical county was already operating and the clinic could be linked up with existing mental health services. The clinic is administered by the committee of visitors, and its income is made up from payments by the Ministry of Health for evacuated cases, by child welfare authorities for young children, by local education authorities for children of school or higher school age, and for private cases. T o enable the clinic to function adequately, the control of admissions to and discharges from certain residential hostels administered by various local authorities has been handed over to the clinic. T h e scheme, which is intended to be permanent and not a war-time measure, is said to be operating satisfactorily, and to be recommended as a method of establishing child guidance clinics for moderately sized authorities. It is the first clinic of its kind to employ two whole-time psychiatrists and a full staff of educational psychologists and psychiatric social workers. The question of the residential school was brought before the conference by Mr. J. Duncan, headmaster of Lankhills Special School. Among the points which he stressed were the advantages of boarding schools for children of any intellectual level, and he considered the possibility of giving all children at about the age of t3, when the need for community living is felt, a term of six months or a year under boarding school conditions, also the need for residential schools for children, again irrespective of intellectual level, who are subnormal emotionally. Sir Laurence Brock, chairman of the Board of Control, referred, as the Minister of Health had done in opening the conference, to the reduction ha the incidence of psychosis during the war, but there had been more csses of neurosis, due probably to failure to stand up to the strain of removal from normal surroundings.
Mental Health Work of Local Authorities T h e development of joint schemes to include all mental health services, as well as child guidance, within the area of a local authority is making progress and is justifying itself where it has been undertaken. A report on the scheme in Portsmouth was given by Dr. Thomas Beaton to the conference, mainly of * Cmd. 6465. Price Is. 3d. net.
PUBLIC HEALTH, December, 1943 delegates from local authorities, recently summoned in London by the provisional National Council for Mental Health, a body which incorporates the Central Association for Mental Welfare, the Child Guidance Council, the National Council for Mental Hygiene, and the work of the Mental Health Emergency Committee. Dr. Beaton said that the essential factors in the Portsmouth scheme were the setting up of a central mental treatment department to provide an adequate social psychiatric service and to act as a basis for the organisation, and the formation of a mental treatment committee of the local authority to cover the whole field of mental and nervous disorder and mental deficiency, with the use of the mental hospital for in-patient treatment. He exhibited a plan which showed the central department linked up with the mental hospital, the out-patients' clinic, the voluntary hospital, the mental deficiency training centre and projected colony, the observation wards in the mental deficiency section of the municipal hospital, the child guidance and juvenile deliquency clinics, the education authority, the probation officers, the social welfare organisation, the labour and employment exchange, and the public assistance relieving officer. T h e municipal hospital, he said, is visited daily by a psychiatrist. It is difficult, of course, to put any results into figures, but some index is afforded by the n u m b e r of residents at the mental hospital at the end of each year. T h e n u m b e r rose rapidly until 1937 or 1938, when the mental health service began to affect the position and caused a distinct fall. T h e figures for the next two years were complicated by evacuation and bombing, but the situation has now been stabilised, the population of Portsmouth is again rising, but the curve continues its downward course in spite of an increase of admissions. This can be due only to the recoverability of the early voluntary case after a short stay in the institution. T h e development of a joint scheme for child guidance was described to the conference by Mr. E. R. Davies, deputy clerk of the Berkshire County Council. Following upon complaints by dissatisfied householders concerning the behaviour of evacuated children, the council decided to set up a child guidance clinic. T h e Ministry of Health, while favouring the scheme, pointed out that it should serve the whole geographical county, including the county borough of Reading. It was then considered whether the clinic should be established under the Education Acts as a school medical service or under the Mental Treatment Act. It was decided to act under the Mental Treatment Act, because a mental health authority covering the whole of the geographical county was already operating and the clinic could be linked up with existing mental health services. The clinic is administered by the committee of visitors, and its income is made up from payments by the Ministry of Health for evacuated cases, by child welfare authorities for young children, by local education authorities for children of school or higher school age, and for private cases. T o enable the clinic to function adequately, the control of admissions to and discharges from certain residential hostels administered by various local authorities has been handed over to the clinic. T h e scheme, which is intended to be permanent and not a war-time measure, is said to be operating satisfactorily, and to be recommended as a method of establishing child guidance clinics for moderately sized authorities. It is the first clinic of its kind to employ two whole-time psychiatrists and a full staff of educational psychologists and psychiatric social workers. The question of the residential school was brought before the conference by Mr. J. Duncan, headmaster of Lankhills Special School. Among the points which he stressed were the advantages of boarding schools for children of any intellectual level, and he considered the possibility of giving all children at about the age of t3, when the need for community living is felt, a term of six months or a year under boarding school conditions, also the need for residential schools for children, again irrespective of intellectual level, who are subnormal emotionally. Sir Laurence Brock, chairman of the Board of Control, referred, as the Minister of Health had done in opening the conference, to the reduction ha the incidence of psychosis during the war, but there had been more csses of neurosis, due probably to failure to stand up to the strain of removal from normal surroundings.