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Toward mental health
PUBLIC
HEALTH
The Journal of the Society of Medical Officers of Health Vol. LXXIV
August I960
TOWARD
MENTAL
No. II
HEALTH
A little over a year ago the Society organised a seminar on the theme "'Planning for the Mental Health of the Family". Papers read at that seminar have been publishc~ in this journal and not only the papers but the discussions on them were of considerable value. There were two main criticisms of the seminar, both valid. One was that though the Royal Medico-Psychological Association took a substantial share in organising it and providing speakers, the psychiatrists in attendance were greatly outnumbered by the public health doctors, so much so that the discussions tended to be out of balance. The second was that no general practitioners were in the group. The initial omission was deli~rate; the Sociely and the R.M.P.A. intended it to be for public health doctors and psychiatrists. As the seminar went on, however, it became perfectly clear that though psychiatrists and public h e a l t h doctors were both involved in the maintenance of mental health and would need to co-operate increasingly in the care of the mentally ill under the provisions of the new Mental Health Act, the G.P. had an important part to play in both treatment and prevention. Without recapitulating the themes of the seminar papers we would remind readers that again and again in papers and discussions two motifs' were prominent. The first was the vital importance of informed team work. In this particular field it is quite impossible to deiine spheres of work and to leave each member of the team to do his job within his sphere. The risk of leaving gaps between the spheres of work, however well each member of the team does his job, is quite obvious, but it is not the only, or even the greatest risk. Personal relationships are paramount in mental health work and manner in which a particular task is carried out can be critically important. Each member of the team, therefore, must have some knowledge of the disciplines in which the other members work, so that he will not merely know what they do but understand the reasons behind it. Moreover. because everything which is done to help a mentally ill or emotionally vulnerable person must l~e done 401
402
PUBLIC
HEALTH
VOL.
LXXIV
NO.
I1
with the patient's own co-operation it not infrequently happens that the "wrong" person is in the best position to do the right thing! This is no mere rhetorical paradox. Every child wdtare doctor, every school M.O. and every G.P. who has any human sensitivity at all has had experience of situations in which a patient needed and was ready to receive some psychiatric first aid from him, but would have retreated at the very suggestion that a psychialrist should be called in. Every psychiatrist has known cases in which social help by the health department was indicated but in which it was best that he should analyse the situation and himsdf introduce the patient to the social services. We appreciate to the full the dangers that might accrue from trying to make every G.P. and every health department M.O. an inferior psychiatrist, with the brash over-confidence that ignorance breeds. They are greal, but no greater than those produced by the psyetda~rist who strides boldly outside psychiatry on the strength of a little knowledge which does not include the knowledge of his own limitations. We believe, however tha~ a compromise can be found and that it must be sought with some urgency, since the search will not be short and when the answer is arrived at it will need a good deal of thought and experiment before it becomes truly practical. It seems, therefore, a most happy idea that, as a contribution to World Mental Health Year the Society should be joining with the R.M.P.A. and the College of General Practitioners in a conference, which, as members will already know, is to be held in London on October 7th and 8th. The second motif of the seminar has not been forgotten. It was that essentially mental health was at least as much a way & living as a state of being and that ways of living must be taught. When mental illness begins an almost invariable factor of importance is that the victim lacks the skills to deal with the stresses and strains of life; had he but been better prepared for the buffetings of fortune he might not have yielded that first inch which started his regress to situations of increasing disadvantage. When the patient is on the road to recovery, the ultimate test of his ability t o leave the hospital for the world at large is whether he is going Io be able to deal with people in general rather than with selected people in a special environment. The success of the new Mental Health Act will:hinge on this and ~so upon the complementary question of whether people in general will b e able to get on with the newly discharged/patient, Gener;
fact quadfipartitei the fou: Education. I n due course we shall publish some account of. t h e proceedings and, we hope, read: Meanwhile we exhort members of the So~ ~rence is well attended; to us it is an .... i on . . of . . great ?" " " occas slgnllicance and potentiai value.
HEALTH
The Journal of the Society of Medical Officers of Health Vol. LXXIV
August I960
TOWARD
MENTAL
No. II
HEALTH
A little over a year ago the Society organised a seminar on the theme "'Planning for the Mental Health of the Family". Papers read at that seminar have been publishc~ in this journal and not only the papers but the discussions on them were of considerable value. There were two main criticisms of the seminar, both valid. One was that though the Royal Medico-Psychological Association took a substantial share in organising it and providing speakers, the psychiatrists in attendance were greatly outnumbered by the public health doctors, so much so that the discussions tended to be out of balance. The second was that no general practitioners were in the group. The initial omission was deli~rate; the Sociely and the R.M.P.A. intended it to be for public health doctors and psychiatrists. As the seminar went on, however, it became perfectly clear that though psychiatrists and public h e a l t h doctors were both involved in the maintenance of mental health and would need to co-operate increasingly in the care of the mentally ill under the provisions of the new Mental Health Act, the G.P. had an important part to play in both treatment and prevention. Without recapitulating the themes of the seminar papers we would remind readers that again and again in papers and discussions two motifs' were prominent. The first was the vital importance of informed team work. In this particular field it is quite impossible to deiine spheres of work and to leave each member of the team to do his job within his sphere. The risk of leaving gaps between the spheres of work, however well each member of the team does his job, is quite obvious, but it is not the only, or even the greatest risk. Personal relationships are paramount in mental health work and manner in which a particular task is carried out can be critically important. Each member of the team, therefore, must have some knowledge of the disciplines in which the other members work, so that he will not merely know what they do but understand the reasons behind it. Moreover. because everything which is done to help a mentally ill or emotionally vulnerable person must l~e done 401
402
PUBLIC
HEALTH
VOL.
LXXIV
NO.
I1
with the patient's own co-operation it not infrequently happens that the "wrong" person is in the best position to do the right thing! This is no mere rhetorical paradox. Every child wdtare doctor, every school M.O. and every G.P. who has any human sensitivity at all has had experience of situations in which a patient needed and was ready to receive some psychiatric first aid from him, but would have retreated at the very suggestion that a psychialrist should be called in. Every psychiatrist has known cases in which social help by the health department was indicated but in which it was best that he should analyse the situation and himsdf introduce the patient to the social services. We appreciate to the full the dangers that might accrue from trying to make every G.P. and every health department M.O. an inferior psychiatrist, with the brash over-confidence that ignorance breeds. They are greal, but no greater than those produced by the psyetda~rist who strides boldly outside psychiatry on the strength of a little knowledge which does not include the knowledge of his own limitations. We believe, however tha~ a compromise can be found and that it must be sought with some urgency, since the search will not be short and when the answer is arrived at it will need a good deal of thought and experiment before it becomes truly practical. It seems, therefore, a most happy idea that, as a contribution to World Mental Health Year the Society should be joining with the R.M.P.A. and the College of General Practitioners in a conference, which, as members will already know, is to be held in London on October 7th and 8th. The second motif of the seminar has not been forgotten. It was that essentially mental health was at least as much a way & living as a state of being and that ways of living must be taught. When mental illness begins an almost invariable factor of importance is that the victim lacks the skills to deal with the stresses and strains of life; had he but been better prepared for the buffetings of fortune he might not have yielded that first inch which started his regress to situations of increasing disadvantage. When the patient is on the road to recovery, the ultimate test of his ability t o leave the hospital for the world at large is whether he is going Io be able to deal with people in general rather than with selected people in a special environment. The success of the new Mental Health Act will:hinge on this and ~so upon the complementary question of whether people in general will b e able to get on with the newly discharged/patient, Gener;
fact quadfipartitei the fou: Education. I n due course we shall publish some account of. t h e proceedings and, we hope, read: Meanwhile we exhort members of the So~ ~rence is well attended; to us it is an .... i on . . of . . great ?" " " occas slgnllicance and potentiai value.