Educating = and involving = - -

the decision maker No, nurse. You should not be sitting down

eating with the patients: it’s not only bad for discipline, but you’re eating their food. In any case, you’ll have to pay the fuIl cost of the meal, And that ridiculous spotted shirt you’re wearing - quite unprofessional! Appropriate uniform is provided and paid for by the management and approved by the Whitley Council. Haven’t you heard of the national uniform for nurses?

And while I’m about it, I see you’re using odd pieces of crockery at the table-that’s not Ministry issue - all the colours are diferent. What’s that? Bought it out of ward funds? What ward funds? Wheie is your account book und receipts? You’ve what.? You let the patients club together - the money’s in a cocoa tin! Does the treasurer know? Who turned that side-room into a disco? And papered the walls? The patients did it? Did the works officer approve the paper you used? Is it washable, or firepsoof? I’ve had complaints from committee members about nude pin-ups in- the men’s dormitories: they say you are putting ideas into innocent minds.

Did I see patients at the stove when I passed your kitchen just now? Cooking snacks? For themselves? You know there’s a hospital regulation against it - ever since Doris Brown got burned in 1957 and we had that committee of inquiry. And what about that student volunteer group from the university this evening? W e can’t have these people unsupervised. You’ll be with them yourself? But according to the list you’re ofl duty at five. You’re going ofl now and coming back later? Does the allocations officer know? Don’t you know the group nursing policy about hours of duty? What’s the good of having central policies if people like you don’t conform?

Reader, no! No one person could ever say all those things to a

subnormality charge nurse, not all at one time any- way. But the hospital organisation does, and very often, either through its standing orders, or its officials, or its chief professional officers, or by attitudes, or even by the lift of the chairman’s eyebrows. These things are said - and plenty more besides. Not everywhere, not in every hospital, but in too many for my liking.

It’s not because the top people are wicked or thick- headed, or unsympathetic to the mentally handicapped. Members and top officials have a lot of sagging worries: there’s shortage of money, like an ever- present black cloud, not to mention such things as inquests, operation mishaps, waiting lists, emergencies, complaints and so on. They worry a lot about their hospitals and they have to have rules if they are going to give equal treatment all round. And, at the end of the day, they are accountable for what happens in their hospitals.

JAMES ELLIOTT Associate Director, King Edward’s Hospital Fund

The trouble is, the mentally handicapped don’t live in real hospitals at all: or they shouldn’t do anyway. Almost all the things which would help the mentally handicapped are anti-hospital: things like variety, homeliness, individuality, colour, personal choice, off-beat activities, non-standardisation. If we are to develop the mentally handicapped, professional boundaries have to go fuzzy, compartments have to disappear, behaviour has to be modified, and environ- ment has to be used to help change people. Most of all, a lot of things have to be played by ear at ward level.

I came late to mental handicap, and I had to learn fast. The question I asked when I first walked into a mental handicap hospital was: “What results are you trying to achieve?” The second question was “How?” This was not a matter of casual interest. I had to understand, if my administrative contribution was to be a contribution instead of a hindrance. I didn’t have to learn the details - the things it takes a professional years to acquire - but I did have to understand what the hospital was driving at, what its staff and its patients were trying to do. Fortunately I had the help and advice of the professionals, and on top of that I did plenty of homework.

But this is the whole point: I had to become aware of my own ignorance, and the professionals had to convey complicated ideas to me in a simple, quick and direct way.

We hear a lot about training these days, but nobody seems to consider the need for non-clinical people to become familiar with the modern philosophy for mental handicap and the way in which this should revolutionise the life and organisation of the large institution. I mean people like members of the new regional and area health authorities, and community health councils; members of social services and education committees; administrators, finance officers. area nursing officers, supplies managers, community physicians, works officers, engineering and building officers, personnel managers, civil servants. They all need a good grounding. They ought to be prevented from making decisions which affect the mentally handicapped unless they at least understand that the criterion of their every action or decision must be, “Will this action or decision help the handicapped person to become less handicapped?” There must be no other criterion.

If this were to happen, there would still be occasions when requests would be turned down or new ideas rejected, but at least it would happen in an atmosphere of understanding, and decisions would be better related

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to the heart of the mental handicap enterprise. The chasm between those who administer such services and those who give direct care should diminish until eventually it can be jumped over.

We would have authorities and chief officers who recognise why it is sometimes good for staff to dine with residents; how mufti can help to reduce social distance; why a job-lot of crockery can help in the recognition of differences; why the mentally handl- capped have to learn to handle their own money, and why real money in a cocoa tin is more meaningful to them than an entry in a ledger; why it is good for residents to express their own ideas on decoration, and how they acquire self-esteem and independence by cooking for themselves; why hours of duty should be

shaped by the social needs of the handicapped, instead of by a routine schedule; what is meant by negative and positive reinforcers; why a weekend camping expedition in Wales may be more educative for handicapped people than an out-of-season week at Butlins - and so on.

It’s just an idea that keeps on popping up in my mind - Educatiizg the Decision-Makers. Educate the decision-makers, and you may involve them. Mental handicap may gain some valuable new friends and allies. We’re going to need them as we enter the coming economic Ice Age.

Come on Institute - what about it?

Urgent need in mental handicap A call to the Government to take action to ensure

an improvement in services for the mentally handi- capped was made by Mr. James Loring, director of the Spastics Society, at the opening of Coombe House, Kidderminster.

Coombe House was bought by the Spastics Society and converted, extended and equipped by the Mid- Worcestershire Hospital Management Committee to provide a home in the community for 20 mentally and physically handicapped adults from Lea Castle Hospital. Most of the residents are cerebrally palsied. In addition, two beds will be provided for short-stay accommadation for similarly handicapped people in the area.

Mr. Loring said that the Spastics Society called on

give special financial assistance to enable all local authorities to meet their urgent needs in the field of mental handicap; put severe pressure upon local authorities who are failing in their duty even to plan adequate facilities; ensure immediately that the mentally handicapped, the most neglected people in the community, should not suffer even more from the cut back in social services expenditure.

the Government to:

He said: “I learned with great relief that the &1,200 million cuts in public expenditure announced by Mr. Anthony Barber on the 17th December will not affect in any important way the building of new schools for handicapped children and that, apart from some minor projects in the discretion of local authorities, all major projects in the field of special education will go ahead. That apart, the Government is, I think, to be congratulated upon protecting education of thc handicapped from the effect of global cutbacks of public expenditure. I wished one could say the same about the field of health and local social services. Facilities for the mentally handicapped will be seriously affected.

“So far as local authority services for the mentally handicapped are concerned the picture is even

gloomier and must be seen against a background of years of neglect before the cuts were announced.

“As in June 1973, eight local authorities of 140 failed to provide any sheltered accommodation, that is to say hostel or similar accommodation, what- soever for the mentally handicapped. Whilst all authorities in the sample made some provision for day care of the mentally handicapped the number of places which were provided was less than 27,000, whilst the target for all authorities was 73,500. The Society is deeply concerned that many local authorities have been denied loan sanction for community care projects. It is ironic that these services, generally considered to be grossly inadequate, should be put in jeopardy by a bureaucratic decision of the central Government.

“The White Paper Better Services for the Mentally Handicapped forecast that 36,000 places in sheltered accommodaton would be needed for mentally handi- capped adults. The local authorities in the sample to which I refer were only providing approximately 6.500 places. The usual reaction to criticisms of this sort is that there has been an improvement since 1971, but this sort of explanation is not good enough. Subnormality hospitals are being pressed to reduce their number of beds, and being pressed to reduce admissions, but this only makes sense if local authorities not only make suitable provisions for those released from hospital or denied admission but make the provision where it is really required.

“In a great many areas services for the mentally handicapped will have quite clearly a low priority in local authority spending. Not only is the Government withholding loan sanction but some local authorities prefcr geraniums and long-playing record libraries to the needs of human beings.

“In brief. a need for community care of the mentally handicapped, particularly in the deprived areas, is very great. The proposed cuts in social service expenditure will exacerbate the situation and much of the progress that has been made during the last two or three years will be lost.”

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