The Development of Policy for the Mentally Handicapped since the Second World War: an introduction

Abstract

In Britain the mentally handicapped first entered the policy agenda at the end of the nineteenth century and became the subject of policy initiatives in the 1913 Mental Deficiency Act and the equivalent Scottish legislation. These Acts gave the mentally deficient a distinctive legal identity and established an administrative and legal framework for their control. Subsequent policy development can be seen as a modification of, or reaction against, this framework. In this paper I provide a short introduction to the development of policy for the mentally handicapped since the Second World War. Broadly I shall identify four policy-making cycles that roughly fit into the four decades: the first was related to the establishment of the National Health Service in the 1940s; the second was associated with the Royal Commission on the law relating to mental illness and mental deficiency and took place mainly in the 1950s and early 1960s; the third started with the inquiries and scandals in the mental handicap hospitals in the late 1960s and the fourth was the period of consolidation in the 1970s. The 1940s marked an important phase in the development of social policy for the mentally handicapped, but it was policy by default. The mentally handicapped were not themselves the main focus of the policy initiatives but broader policy developments had important implications for the organisation and provision of services for the mentally handicapped. The most obvious example was the formation of the Health Service in 1948. In the run up to the establishment of the Health Service there was very little discussion of the future of services for the mentally handicapped [1]. It was assumed that like services for the mentally ill they would become part of the new NHS to establish and maintain a link between services for the physically ill and services for the mentally disordered. However, little account was taken of the differences between the two types of service. The bulk of services for the mentally handicapped were provided within mental deficiency colonies and these institutions were totally different from the acute general hospitals. The medical profession played a different role in the two settings. In the acute hospitals, especially the voluntary hospitals, medical practitioners were clinicians. They took little responsibility for the administration of the hospitals but had the right to use the facilities within the hospitals. In the mental deficiency colonies the medical practitioners acted as administrators and had the title of physician superintendent. The second difference related to the patient population. Residents in mental deficiency colonies generally did not suffer from acute illnesses nor were seen as requiring specific therapeutic programmes. Most were there for supervision or basic care. 227