§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. E. Wakefield.]
§ 11.31 p.m.
§ Mr. Compton Carr (Barons Court)
I do not apologise in any way for detaining anyone here tonight, and I only wish that I could speak for longer than I am permitted to do. However, if I may be as brief as possible on a subject so important and so well documented, and at the risk of appearing to try to teach my hon. Friend the Parliamentary Secretary to suck eggs, if I may use such an inelegant phrase of so charming a Parliamentary Secretary, I would like to run through the position as it now exists as far as mentally handicapped children are concerned.
We have no longer idiots, imbeciles and the feeble-minded, but we still have an artificial division between children of one grade of mental handicap and those of another. We have the educationally subnormal, those who come under the education authority, and we have those who are described as ineducable and who come under the health authority.
Ineducable means only that these children are ineducable in normal schools. It seems to me that although we are doing a great deal for these children there are some things to which we could well pay attention. There are a number of these children. It has been estimated that there is one mentally handicapped child in every street in the country. That means that there are about 80,000 of them, of whom some 22,000 are able to take their part in the community in some way by being helped in an occupation centre. However, only two-thirds of those 22,000 are able to obtain any help at the moment. There is such a shortage of places in the occupation and training centres.
In the past we have heard about the possibility of exploiting high grade mental defectives, and sometimes one fears that they are kept for too long in residential colonies and so forth. But the fear of those who are concerned with the lower grade mental defectives, the middle grade, is not that they will be exploited but that they will be left in oblivion. 1441 That is a fear which is expressed by many parents of such children, because places for them are still hard to find.
There are three points which I would like to mention. There is the question of teachers. We do not call them teachers, but I feel that they might very well be given that title. They are called supervisors. Despite the fact that they do not come under the Ministry of Education, I think that to call them teachers of the severely subnormal, or something of that nature, would give them greater standing. Something that would give them even greater standing would be a national training scheme.
I know that at present we have a one-year training scheme under the National Association of Mental Health, but quite often, and I say this without offence to the people who take that diploma, the only qualification needed for entering the service is that they should be between the ages of 20 and 40. As against teachers of the educationally subnormal who have done two years, or perhaps only one year's training, plus one year of educationally subnormal training, supervisors have only one year's training. This bears hardly on the children who, in many cases, really require very much more attention, perseverance, patience and cheerfulness from their teachers.
There is something much more serious which arises out of these factors, and that is the difference in salary scales between the two types. The woman teacher of E.S.N. children may reach a maximum of about £796 a year—I may be out of date, and if so, I am on the low side—but the maximum which an assistant supervisor can reach, dealing with children very often much more difficult, is £535 a year. We have to do something about that difference of about £250 per year. We still tend to rely on voluntary help in this kind of work, and we must get away from that.
As for the training of the children themselves, many authorities already do a tremendous amount but, having seen these children, I feel that we could still aim for a higher standard. Our aim is still not set high enough. The higher we force anybody, the more achievement we find possible on the part of people in respect of whom in the past we have decried the possibility of achievement. It is also necessary to be flexible. Many 1442 authorities are flexible, but some are not. I think it is possible to do much more in this country on the lines of what is done on the Continent, where defectives are fitted into the work pattern of the neighbourhood. Local crafts are seized upon and the defectives are given instruction in them. It is not always possible here, of course, but on the Continent the Brussels lace industry is one which has taken defectives and given them some ability to succeed in outside life and obtain a pride of achievement.
There is one type of centre which the Middlesex County Council has, to all intents and purposes "invented". and that is a special care unit for exceptionally disturbed children. It has had great success with upgrading these children. Some have even filtered back under the education authority as educationally subnormal children although they had previously been given up as completely hopeless. Others, although not reaching that state, have been able to go on to a junior occupational training centre, though they were completely and grossly disturbed when they arrived at the original centre.
I should not like anyone to think that in anything I say I am decrying what has already been done. I am merely asking for more and more. I should like to see us moving far faster into research. Everyone has this problem. I have a copy of the Journal of Mental Deficiency Research for December, 1958, in which there is a paper written by a Russian who makes it clear that no one has gone any further in Russia than they have here. It is rather clumsily put, but he says:… It is quite clear that a primary derangement of any particular link may inevitably lead to disintegration of the whole system, and that genuine analysis of the nature of derangements in this system is possible only if we disclose this primary disorder, as well as the systemic consequences which it entails.We have a long way to go towards achieving that analysis of causation.
As we have seen by announcements in the newspapers recently, help has been given to the work at the Institute of Child Health on chemical deficiencies which themselves cause mental derangement and mental deficiency, and mental deficiency which can be cured, if taken 1443 early enough, by correcting the chemical inbalance in the children.
There is also the exciting work being done on chromosomes as far as mongolism is concerned. This is only something to discover the sources of the disease. I am proud to say that I have a brother who is working in the University of Western Ontario on this very problem, and I know that the work is going on all over the world and that everyone is extremely excited about it.
There is also the work, which was reported by Dr. Tizard in the British Medical Journal of 2nd April, on residential care of mentally-handicapped children, again showing that there are new factors which can be taken up and new successes which are still available.
The most exciting thing, which is still a frontier to be crossed, is the work on causes and treatment of so-called autistic —sometimes called schizoid, sometimes psychotic—children, which is almost unknown territory. These children are apparently schizoids who live in a dream world. They seem intelligent, but it is impossible to touch them even with treatment that is nowadays giving success in 75 per cent. of normal adult schizoids. We must pay attention to that factor.
I would like to say that I have a testimonial to what I have said, that there is no lack of good will but lack of space, lack of ability to do things more quickly. This letter is from a parent who wrote to me and said his six-year-old daughter was awaiting final diagnosis in the Maudsley, but she could not get in because of the long waiting list. It said:It is certainly not lack of understanding or will that we have encountered, but of material facilities.I close in the hope that my hon. Friend the Parliamentary Secretary will be able to say something in reply which will give added force to the moving words in a leaflet sent by the National Society for Mentally Handicapped Children to parents:You have friends; you are not alone.
§ 11.42 p.m.
§ Mr. Kenneth Robinson (St. Pancras, North)
I want to intervene for a minute to support almost everything that has been said by the hon. Member for Barons Court (Mr. Compton Carr) on this ex- 1444 tremely important subject, which we discuss all too seldom in this House. It is part of a wider field in which I have been interested for a long time, and, in particular, I would like to support his plea for more research.
It seems to me that, without pitching one's hopes too high, there are signs of a real break-through if we can throw in all the resources that we have in this country, particularly so far as mongolism and the new chemical processes being investigated at Great Ormond Street, at the Institute of Child Health, are concerned. I also support the hon. Gentleman's plea for better conditions and better salaries for supervisors, who constitute one of the worst-treated categories in mental health service where salaries generally are far too low.
§ 11.43 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
I congratulate my hon. Friend the Member for Barons Court (Mr. Compton Carr) on choosing for his Adjournment debate something which is of tremendous human interest and which commands the sympathy of us all. I hope to show that considerable progress is being made in providing better training in better premises for mentally handicapped children.
The children we are discussing are those who are unsuitable for education at school, as we now refer to them. Formerly, they were described as "ineducable". There is a wide-ranging provision for the educationally subnormal child within the education system, but when a child is found to be unable to benefit from this provision, he becomes the responsibility of health departments of local authorities and thus of the Ministry of Health.
My hon. Friend has asked for further progress and higher standards, and has referred to the care of mentally-handicapped children both in training centres for the mentally subnormal run by the local health authorities and in hospitals. I want, first, to say a few words about the training centres, because I gather that that is the subject to which my hon. Friend attaches major importance. Local health authorities have a duty under the Mental Deficiency Acts to provide suitable training or occupation for the mentally handicapped child living in the community. 1445 Local health authorities have been required to submit proposals showing how they intend to carry out those services following the amendments made by the Mental Health Act, 1959. Nearly all those proposals have been received and will be approved at the end of the statutory two months' period of objections.
In recent years, local health authorities have been making great efforts to provide more places for mentally handicapped children. In 1948, there were about 100 centres altering for about 4,000 children. At the end of 1959, there were 293 whole-time centres catering for juniors or mixed age groups and 51 part-time centres, that is, a total of 344 catering for 10,500 children, so there has been an appreciable increase. In 1953, 65 per cent. of all children known to be suitable for training were received in training centres and in 1959 the figure had gone up to 80 per cent. In the financial year 1960-61, local health authorities have submitted 68 schemes for training centres for juniors or juniors and adults mixed.
A year ago, my right hon. and learned Friend asked all local health authorities to review their mental health services in the light of the Report of the Royal Commission on Mental Health. In a paragraph on priorities, a circular suggested that authorities should keep in the forefront the need for adequate provision for training children up to the age of 16. It was also suggested that the authorities should consider the desirability of providing residential accommodation in hostels for children who could not reasonably be transported to a training centre every day.
We think that the provision of such hostels will go a long way to provide places for 2,600 children who at the moment are not receiving training. Many of those children live at distances from the centres which make it extremely difficult and against the interests of the child to convey the child every day to and from the centre. The children will be able to stay in the hostels either for the whole term, or from Monday to Friday, returning home at the week-end.
In addition to the provision of hostels for these children, local health authorities are progressively replacing unsatisfactory rented premises by new buildings. They are also turning part-time centres into 1446 full-time centres and bringing into the ambit of the centres those children who previously had only been visited by a home teacher perhaps for a short period every week.
My hon. Friend asked me about the teaching staff in the training centres. We are very much aware that problems are likely to arise as a result of this rapid expansion which I have already mentioned and the expansion in the provision for the mentally handicapped over the age of 16 who require a somewhat different type of training. Earlier this year, the Standing Mental Health Advisory Committee set up a sub-committee on the training of staff of training centres for the mentally subnormal. That subcommittee is now receiving evidence and has issued a questionnaire to local health authorities and hospitals.
We hope that the results of that committee's deliberations will help us provide more and better staffs for training centres. As my hon. Friend said, at present the only accepted training course is a course run by the National Association of Mental Health, which lasts only one year, and there is no requirement, even on the staff of centres, to take that course, although we believe that many of them have done so. The staffs of the centres are, of course, paid on scales agreed by the local authorities' National Joint Council, so that pay is a matter for the local authorities. I am hoping that when the report of the sub-committee is available local authorities will be prepared to consider it again.
I want to say a special word about grossly handicapped children. As my hon. Friend has particularly referred to Middlesex, I would say that what is going on there is going on in other areas, because a number of authorities are developing what are called special care units. They are intended to cater for children of very low intelligence and those who are physically as well as mentally handicapped, or are so emotionally disturbed that they cannot be dealt with in the ordinary small classes of the training centre. Specially adapted rooms and toilet facilities are provided adjoining the centre, and there is a higher staffing ratio. Middlesex has three of these units, and has been doing some excellent work in caring for these very unfortunate children.
1447 In addition, they have admitted to these units some children who are probably not severely subnormal, but who are so disturbed and handicapped in addition that they may appear to be of very low intelligence. With a great deal of intensive care they have had some success with these children. We are watching these experiments closely, and we hope that local health authorities everywhere will gradually be able to increase their provision for children of this type.
Turning to the hospital service, education and training is one of the main objects of mental deficiency hospitals. The aim is to develop to the greatest possible extent all the capabilities of the patients, so as to enable them to live the fullest life they can and to make them as useful citizens as possible. This is true of all patients in these hospitals, and not merely of children. The number of children in mental deficiency hospitals at any one time is comparatively small. The Royal Commission found that at 31st December, 1954, just under 7,000 patients in these hospitals were under the age of 15; that is, 12 per cent. of the total. But a substantial number of each year's admissions are of young people.
Training may take various forms. Education in the formal sense is not generally appropriate, but there are a few patients who need 3R work—for example, adolescents and adults who have failed to learn at the usual time, for various reasons, but who can make progress in the security of a hospital. Education of this sort is provided in many hospitals for such patients as can benefit from it. It is clearly desirable that a patient who may return to the community should be able to read a little, even if it is only the names of the destinations of buses. The nature of the occupation or training prescribed for an individual patient must depend on his needs and capabilities, and also on the facilities of the hospital.
Work in the wards and in hospital utility departments—laundry, sewing, room, kitchen—is of considerable value, and can give useful occupation to a large number of patients. Hospitals also offer a wide range of specialised activities in workshops of various sorts, 1448 occupational therapy departments, gardens, and so on. In some cases the patients obtain a high degree of skill and produce useful and beautiful work, but it is obvious that there are many who could not undertake the more advanced activities of this kind.
Training and education does not merely cover this kind of activity, but extends to the whole of the patients' lives in hospital—to recreation and to all their relationships with other patients and with the staff. The patient has to be helped, so far as his abilities allow, to live with his handicap in a community, and this process affects all aspects of his life in hospital. Not all hospitals provide services up to the standard we would like to see. There is a serious shortage of accommodation, and apart from this many hospitals do not have the facilities they would like for providing training and occupation.
It is perhaps worth citing as an example a hospital which provides a very wide range of occupation and training. In the unit for women there is a school for children, run by a headmistress and three assistants. For the severely subnormal children there are occupational therapy classes where a very wide range of skills is taught. At the unit for men a wide range of skills are taught and many of the workshops are supervised by skilled tradesmen instructors. There is also a school for those who can benefit from it. A similarly wide range of activities, though at a lower level of achievement, is provided at the unit for low-grade men. In addition, there is a training hostel for high-grade adolescent girls, a hostel which provides training in domestic science, and a school for boys aged nine to 16.
I quote this to show what can be done. The importance of providing such facilities for those patients who can benefit from them is being increasingly clearly recognised. Many improvements have been made through recent new building and upgrading of existing building, and further developments will take place.
My hon. Friend referred to Dr. Tizard's unit for mentally defective children at the Fountain Hospital. This is a very small unit with a high staffing ratio, which was started with the idea that mentally defective children would 1449 benefit from living in something approximating as nearly as possible to a family atmosphere. Their mode of life would be similar to that of normal young children at the same stage of mental development. The unit is run on much the same lines as a small residential nursery and has achieved very satisfactory results.
This was probably to be expected, for doctors generally would agree that the possibility of individual attention conferred by a high staffing ratio can achieve much for patients of this type. But inevitable limitations on capital programmes, and the difficulties experienced in recruiting staff, means that schemes of this sort, however good the results achieved, can at present have only a limited application.
My hon. Friend, and the hon. Gentleman the Member for St. Pancras, North (Mr. K. Robinson) both referred to research into this question. A good deal is being done in this field, particularly on the genetic basis of mongolism and in the biochemistry of the body and its relation to subnormality of the mind. The National Health Service is playing its full part in this work.
We would not wish to interfere with the freedom of universities to develop research in their own way and money is available in the usual way through the universities, the foundations, and the Mental Health Research Fund for studies 1450 of this kind. The Medical Research Council is also carrying out studies in genetics and on the psychological and educational problems of the severely subnormal. I hope that I have shown that we are most conscious of this problem. Considerable progress has been made in providing training centres or adequate hospital facilities, but there is much more to be done, we know, and we intend to go on doing it.
I have always had the greatest admiration for the parents of these children, particularly the mothers. They do a wonderful job in the care that they give the children and the love—it seems to me the extra love—which they lavish on a child which is so unfortunate. The general community has a debt to parents who carry this responsibility, and, in turn, the community should help in providing services which will give relief to the parents concerned. Indeed, the community should provide the services at such an early stage that we may hope that these children will play their part in normal life, limited though it may be, and be prevented from coming under the necessity of going into hospital.
For that reason, I am particularly glad that we have had an opportunity to discuss this matter tonight, no matter how late the hour.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to Twelve o'clock.