Mental health

Casualties of the age of anxiety

Joan Woollcombe

There is a call for wider facilities for after-care for those patients in Ps,Ychiatric hospitals who could be discharged —I were there anywhere suitable for them to go. The statistics are sombre: one in every Sit women and one in every nine Men spend some time as psychiatric Patients in hospital. In any one year about 200,000 are discharged back Into the community, of whom Possibly 47 per cent may have to be re-admitted — so many because there is not support or help for them in their convalescence.

And yet a survey of the present Possibilities reveals people and °rganisations working overtime to Provide 'half way houses' or group homes or other forms of support that will save the ex-patient at risk. Twice at risk, the mental patient needs help: first, before he becomes a Patient, to avert that breakdown, and second, after, he has had treatment in hospital, to help him negotiate the return to normal life. For to return, unhelped, to the e, nvironment that contributed to ,_n?s breakdown inevitably makes him a casualty again. The family tensions, the lonely bedsitter, work Problems (if he gets work), sexual Problems, depressions and fears, dreary solitary drinking — all these produce the 'revolving door' situation and he goes inside again. But, even if there is not enough of it, there is help. In fact, Britain was one of the first countries to make Provision for community mental care on paper, in the Mental Health Act of 1959, which gave to local authorities wide powers to provide for their mentally sick and convalescent. But, the hoped-for homes and hostels did not materialise so quickly everywhere; possibly because the patient was chargeable to the rates if cared for in the community and to the Exchequer if left in hospital. So, a typical British Mixture of official and voluntary action has resulted. 'Someone to talk to' can release SO much worry and tension and first on my list is the National Association for Mental Health (MIND)*, now at 22 Harley Street, !-,otidon WI (01-637 0741) where ,Mquiries are welcomed, whether pY.letter, telephone or visit, though it is wise to make an appointment to visit them. Their Social Services bepartment dealt with 2,500 appeals for advice and help in a year, Which included requests for accommodation for elderly 'confused'

relatives, help for people in need ot psychiatric treatment and for those in need of help to avert breakdown or in the need of half-way houses for their convalescence after treatment. They befriend those who need advice and support and there are some 100 local Health Associations affiliated to them throughout the country, steadily and increasingly providing help and support.

There was Miss G, discharged from a hospital in Cambridge with — literally — nowhere to go. The Mental Welfare Association took her into a room in one of their half-way houses. Here she had her own bedsitter where she could do her own 'housekeeping' but there was also a communal sitting room with television, and although there is no resident warden, the communal parts of the house are kept clean.

Once a week the friendly senior psychiatric social worker calls for a chat, as does a member of the Association who Comes to collect rents. They found Miss G. a job which she took, but she was comforted to have this house to return to in the evenings. Her rent, which includes light and heat, can be made up by the local authority ot the district from which she comes. Sheltered and secure, she can find her feet until she is ready to look for an independent home. The largest Voluntary Association for residential mental care is the Richmond Fellowship with twenty-four half-way houses providing therapeutic community life for those who have been in hospital or who need help to avert a breakdown. The Richmond Fellowship provides 11 per cent of all the mental after-care in England and Wales. It was fourteen years ago that Lily Jansen, a Dutch theology student, with nursing training and experience of maladjusted children and adolescents, decided to practise Christianity rather than to study theology and opened her first half-way house at Richmond in Surrey. Today there are extensions of her work to the United States and Australia and her headquarters in London provides a programme of education in mental health. The Richmond Houses provide residential or day care for the mentally or emotionally disturbed of all age groups for — among others — recovering alcoholics, disturbed adolescents and whole families in need of group therapy.

The Mental After Care Association* has ninety years' experience of human emergencies, since it was founded by the then chaplain of Colney Hatch Asylum to befriend discharged patients who had neither friends nor resources. At present the Association maintains four rehabilitation hostels and eight long-stay homes.

Mrs L, then aged fifty-three, was sent out under licence from a psychiatric hospital. Her husband, suing her for divorce, refused to have her home and, of her three children, her married daughter cut herself off from her parents and her younger son was forbidden to see her. Mrs L was "emotional and apprehensive" on admission to the hostel and, although released from certification in a few weeks, she remained dull and depressed. The warden and staff persevered, and within a year she had gone out to a part-time job as a kitchen hand, returning to the hostel after work and dependent on her friends there. There were many set-backs but she started to work full-time and then took a holiday with her elder son, whom she was able to visit after his marriage. Back to the hostel again, she was promoted in her work and finally made manageress of the canteen there. Eventually she was able to find her own rooms nearby and was reunited with her three children and lives happily enough, often seeing her friends at the hostel.

Experimental Group Homes have been a success and are described by the Psychiatric Rehabilitation Association* in co-operation with the most enlightened Claybury Hospital* at Woodford Green in Essex. Here after-care and community therapeutic methods have been developed for the treatment of their psychiatric patients. Two senior nurses at Claybury describe their first Group Home. They selected the first half-dozen patients who they hoped would be able to contribute to the running of the Group Home being set up for them. Two had been in hospital for twenty years, one for thirty, one was an old age pensioner, and two seemed unemployable.

Claybury first pre-conditioned them by putting them to live together in a hostel ward, where they catered for themselves and were taught about marketing, telephones, launderettes and so on.

During this preparation, individuals took on the roles they were later to hold: one became housekeeper, another her assistant, an older man became a respected grandfather and one of the others revealed a flair for form-filling and coping with finance, while one had to be dropped as unsuitable. One Saturday they moved into their new home and were left to it by their friends when, after finding that no one owned a watch, two alarm clocks were hastily bought. It was planned to visit them the following Friday. Their Claybury friends worried and went on the Tuesday instead, only to find their ex-patients filled with enthusiasm and pride, although making it quite clear that, while expected visitors were welcomed with cups of tea, they really wanted to be left on their own to make good. This bold experiment by the Psychiatric Rehabilitation Association and an enlightened hospital has opened the way for more Group Homes.

The Warlingham Park Hospital in Surrey* has pioneered psychiatric nursing in the community: their community psychiatric nurses, four men and two women, are mobile and carry out supervision of patients under treatment at home, the follow-up of dis:charged patients, the running of out-patients' clinics and the organisation of clubs. As the number of patients treated in the community has increased it has been possible to reduce overcrowding in the hospital. Since its start this service has developed as part of the comprehensive mental health service in Croydon itself — which has ten, half-way houses for its psychiatric patients. The Rees House Day Hospital can tell you much about the Warlingham Park Group Hospital Management work.

Inevitably, one comes back to the individual — the person for whom one fears on his or her return to the outisde world, or who needs help to avert breakdown. When someone is at risk, then there should be no delay in seeking advice from the organisations I have all too briefly described as able and willing to help.

So often the initial difficulty is to get the patient to accept help — there is nothing either shocking or shameful in having had a mental illness, nor in being in need of help to avert one: and as' this is increasingly accepted, so shall we be able to lighten the load that mental convalescents and their 'families, carry.

Many patients could be discharged from psychiatric hospitals if they had somewhere suitable to go. Advice and help are available for those at risk in our `age of anxiety.' The following are the addresses of organisations referred to in Joan Woollcombe's article:

National Association for Mental Health — MIND 22 Harley Street London WIN 2ED (01-637 0741) The Richmond Fellowship 8 Addison Road London WI4 8DL (01-603 6373) The Mental After Care Association Eagle House 110 Jermyn Street London SW1Y 6HB (01-839 5953) The Psychiatric Rehabilitation Associa tion The Groupwork Centre 21a Kingsland High Street Dalston, London E8 (01-254 9753) Claybury Hospital Woodford Bridge ' Woodford Green I Essex (01-504 7171) ' The Cambridge Mental Welfare . Association 19 Gloucester Street Cambridge (Cambridge 50247) Warlingham Hospital Warlingham Surrey CR3 9YR (Upper Warlingham 2101) Nursing Officer Rees House Day Hospital 2-4 Morland Road Croydon CRO 6NA.