Mental Handicap Hospital Research Articles

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

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

A REWARD SCHEME: for patients in mental handicap hospitals

SUMMARYA system of payment to patients working in mental handicap hospitals is described. Adapted from the Netherne Industrial Pay Scheme, it has been running for four years. It presents few administrative difficulties and is felt by staff and patients to have some incentive value.

Mental handicap policy in Great Britain: the advent and demise of the institution

At no time in Britain's history has the function and purpose of mental handicap hospitals been so seriously questioned and their future so imperilled. Recent policy documents have been produced to try to devise methods for phasing out the institution and for developing a full range of community services in its place (DHSS, 1980, 1981). It is, therefore, appropriate to take stock of mental handicap policy. This paper briefly traces the development of the institution and its subsequent “medicalisation”, and looks at the future of mental handicap hospitals and social obstacles which may prevent the implementation of government policy. Finally, it suggests that, although these institutions may disappear they will leave a legacy which could pose serious problems for mentally handicapped people in the future.

Prevalence of autism and related conditions in adults in a mental handicap hospital.

The proportions of subjects with severe social impairment and those retaining the features of childhood autism were investigated in a population of mentally retarded adults in a long-stay hospital. The results confirmed the findings of an earlier study of mentally retarded children (Wing & Gould, 1979) that the administrative category of mental retardation includes a substantial minority of people with severe impairment of two-way social interaction. Such social impairment occurred in 38% of the adult population and was very significantly associated with abnormalities of communication and imaginative activities. Muteness, repetitive stereotyped behaviour, including repetitive speech, and a range of behaviour problems also occurred more frequently in the socially impaired group. Two methods of sub-classifying the socially impaired were compared. Classification based on the severity of social impairment gave more statistically significant associations with behavioural and psychological variables than did a method based on the presence or absence of typical autism. The implications of these findings and their relevance for management and planning of services for the mentally retarded were briefly discussed.

Maintaining New Procedures Using Feedback to Staff, a Hierarchical Reporting System, and a Multidisciplinary Management Group

Two studies are reported. In the f i s t it was shown that the introduction of activity period procedures by ward staff in a mental handicap hospital resulted in a marked increase in the level of residents' engaged behavior (mean 6.5% to mean 49.5%). with corresponding reductions in the incidence of neutral and inappropriate behavior. However, resident improvement alone did not result in the maintenance of these procedures during a 6 month follow-up period. The second study involved all levels of staff in the introduction of maintenance procedures, including private feedback to individuals, public display of resident engagement data, a reporting system using the existing hospital hierarchy, and a multidisciplinary management group. The introduction of this system in parallel with the reintroduction of the activity period procedures resulted in (a) further improvement in resident behavior (mean engagement levels increased from 19.1% to 6.16% and (b) consistency by the staff in following specified procedures. These high levels of resident engagement (mean 62%), and consistent staff practices were still maintained 30 weeks after the study ended.

THE HOSPITAL INFORMATION BOOKLET

Most mental handicap hospitals today provide free some form of information sheet or booklet for the parents and relatives of their patients, and for visitors. As such handouts act as a form of ambassador for the hospitals, they need to be compiled with care.

Issues in the Training and Evaluation of Behaviour Modification Skills for Staff Working with Profoundly Retarded Multiply Handicapped Children

Kiernan and Riddick's programme for training operant techniques was employed to teach behaviour modification to a variety of staff in a children's mental handicap hospital. The aim was to evaluate the course in relation to a carefully defined group of profoundly retarded multiply handicapped children. Evaluation of the course is described and significant improvement in trainees' skills with respect to the use of physical prompting and reinforcement noted. Some problems of staff in implementing the learnt technique are considered. Finally, the relation between the applicability of behavioural techniques and the characteristics of profoundly retarded multiply handicapped children is considered in the light of more detailed studies of their learning characteristics.

Moving out of mental handicap hospitals

Moving out of mental handicap hospitals

A survey of blind and partially sighted residents in the mental handicap hospitals of Devon

A survey of blind and partially sighted residents in the mental handicap hospitals of Devon

RAWP and mental handicap

Because of a defect in the RAWP formula, Regional Health Authorities (Regions) using RAWP principles to allocate revenue funds to Areas are insidiously depriving the mental handicap hospitals of millions of pounds.

The tourist in the mental handicap hospital

Journal of the Institute of Mental Subnormality (APEX)Volume 7, Issue 4 p. 115-115 The tourist in the mental handicap hospital D.A. SPENCER, D.A. SPENCER Consultant Psychiatrist, Meanwood Park Hospital, LeedsSearch for more papers by this author D.A. SPENCER, D.A. SPENCER Consultant Psychiatrist, Meanwood Park Hospital, LeedsSearch for more papers by this author First published: March 1980 https://doi.org/10.1111/j.1468-3156.1980.tb00476.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume7, Issue4March 1980Pages 115-115 RelatedInformation

Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: Revenue costs

The revenue costs of small locally-based hospital units for the severely and profoundly mentally handicapped in Wessex were compared with those of traditional mental handicap hospitals. Contrary to expectations, the revenue costs in such units were not excessively greater than average costs in many large mental handicap hospitals. Indeed, estimates of the cost per inpatient day in wards of two large hospitals in Wessex with clients of comparable degrees of dependency showed that revenue costs in the locally-based hospital units were competitive. Rationales of the inevitable presence of “economies of scale” should not be used in the perpetuation of large residential complexes; unsupported assertions of greatly increased running costs should not prevent development of small locally-based residential alternatives.

Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: Staff performance

Systematic observational measures were taken of the minute-to-minute behaviour of staff in two types of residential unit for mentally handicapped people. Houseparents in Wessex locally-based hospital units spent, on average, a greater proportion of their time contacting clients than junior nursing staff in traditional hospital villas, and the houseparents spent more of their time praising or cueing client activity. The performance of charge nurses and sisters in the villas was similar to that of junior nursing staff, but the wardens and deputies of the locally-based hospital units spent little time contacting clients. Given higher staff/client ratios, there were greater numbers of staff in the locally-based hospital units contacting clients and handling materials designed for their use, thus showing that equivalent standards of staff performance can be attained in alternatives to large mental handicap hospitals. Given the variability between units and recent research in this area, the key independent variables now open to further study are the deployment of staff and the scheduling of activities to maintain high quality care.

Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: Family contact

A number of small locally-based hospital units for severely and profoundly mentally handicapped people requiring residential care have been provided in Wessex, each sited within a catchment area considerably smaller than the territory served by any of the large mental handicap hospitals in the region. A comparison of the rates of contact between clients and their families in the first five locally-based hospital units to be provided and in five villas on a large mental handicap hospital campus showed that the provision of locally-based hospital units resulted in greater family contact with the handicapped residents.

Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: Client engagement

Systematic observational measures of the minute-to-minute behaviour of severely and profoundly mentally handicapped people of comparable levels of dependency were taken in two types of residential unit to establish the level of engagement in activity. Higher engagement levels were found among those clients living in Wessex locally-based hospital units compared with those living in villas of a traditional mental handicap hospital. Thus, concern that such small “domestic” units, sited in the community among the people they serve, would not be a feasible alternative to traditional campus-type hospitals appear to be unfounded. Moreover, the prediction that traditional practices, such as grouping clients by clinical or diagnostic criteria and grouping living units to provide peer “support” to staff and supposed better access to specialists, are essential to the maintenance of high quality residential care is not borne out by the evidence. More attention needs to be paid to the important variables of staff deployment and scheduling of activities in the maintenance of high levels of client engagement in activity.

Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: Staff recruitment and continuity

Data on daytime staffing levels and turnover were abstracted from the personnel records of small locally-based hospital units for severely and profoundly handicapped children or adults and from the nursing report books of five villas of a large mental handicap hospital. These were compared to evaluate predictions that difficulties in staff recruitment would be found in the locally-based hospital units and that they would suffer much higher staff turnover than in a large hospital. The data showed that full staff establishment was substantially maintained in the locally-based hospital units and that, due to the frequency of staff transfer between villas of the large hospital, the continuity of staff in the locally-based hospital units was considerably greater than the continuity of staff on any of the villas. Thus, concern that small “domestic” residential units sited in the community among the people they serve would not be a feasible alternative to traditional large mental handicap hospitals for the care of severely and profoundly mentally handicapped people, because such units could not be satisfactorily staffed, appear to be unfounded.

Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: Client progress

The ‘progress’ made by severely mentally handicapped children and adults living in locally-based hospital units (experimental) was compared with that made by similarly handicapped people living in traditional forms of residential care (control). The results for the overall groups showed that people placed in the locally-based hospital units maintained their existing skills and that in six skill areas for children and seven for adults significantly more people gained than lost skills. For those in traditional care significantly more gained than lost skills in two skill areas for children and none for adults. The results for sub-groups of different disability showed that for those categorised as non-ambulant or severely behaviour disordered there were more skill areas for experimental than for control subjects in which significantly more gained than lost skills. The results of this study do not support the assertion that severely and profoundly mentally handicapped people can only be adequately cared for in large mental handicap hospitals.

Services to the community — from a mental handicap hospital out‐patient clinic

Journal of the Institute of Mental Subnormality (APEX)Volume 7, Issue 2 p. 56-58 Services to the community — from a mental handicap hospital out-patient clinic JENNIFER DIXON, JENNIFER DIXON Senior Social Worker Chelmsley Hospital, Marston Green, BirminghamSearch for more papers by this author JENNIFER DIXON, JENNIFER DIXON Senior Social Worker Chelmsley Hospital, Marston Green, BirminghamSearch for more papers by this author First published: September 1979 https://doi.org/10.1111/j.1468-3156.1979.tb00446.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume7, Issue2September 1979Pages 56-58 RelatedInformation

Staffing requirements for nursing the mentally handicapped — A pilot study

A pilot study was conducted at Norah Fry Hospital in Somerset to estimate the number of nurses required to care for patients in a ward for the mentally handicapped. The patients' disabilities and behaviour problems were taken into account using the Mental Handicap Register. It was concluded that this ward should have 20 staff instead of the present 10.5. The Mental Handicap Register was shown to be a reliable and valid measure of total handicap. The study has now been extended to all the patients of mental handicap hospitals in Somerset.

The elderly mentally handicapped in the community and a psychiatric service

The contacts of a Mental Handicap and a General Psychiatric Service with elderly mentally handicapped patients were surveyed over a six year period for a district with a population of approximately 200,000. Only 10 individuals were referred, seven to the mental illness service. Behaviour disturbance or psychiatric symptomatology was usually present, but self‐care was relatively good. Another eight elderly patients were discharged from the mental handicap hospital to residential homes for the elderly; this was usually successful. The reasons for the low referral rate are discussed.