PROGRESS OF MENTAL HYGIENE

Evening Star, Issue 21254, 8 November 1932, Page 8

PROGRESS OF MENTAL HYGIENE

ERAS OF HUMANE REFORM FROM SHACKLES TO SUCCOUR In the course of an address on progressive movements in mental hygiene before the Otago branch of the Trained Nurses’ Association at the Otago Medical School, Dr A. R. Falconer said :~ “ Mental hygiene has as its goal such prevention of mental disease as will ‘ maintain the strong, refit the weak and sick to their health and opportunity and deliver them to a useful life in the community, and that pursuit of happiness which is the proper province of creatures.’ The care and treatment of mental disorder is only one part, and not the most important past, of . the comprehensive problem of mental health and its preservation. “ Mental disorder, says Gillespie, in one form or another, has been recogi nised from time immemorial, but it is only in comparatively recent years that serious attempts have been made to study and understand it. Progress in this branch of medicine lias been slow, but the difficulties to be contended with •—professional apathy, public prejudice, and the inherent complexity of the snb- ■ ject—have been very great, and the advance which has taken place has not been sufficiently recognised. In the Middle Ages mental illness was almost part of demonology when superstitious beliefs in witchcraft and the like flourished. Treatment by herbs and binding in chains and fetters are mentioned in old chronicles. The modern era of the care and treatment of mental illness dates from the end of the eighteenth century, and may be divided into three periods—(l) The period of humane reform, associated with the names of Pinel. in Franco, and Tuke, in England; (2) the introduction of nonrestraint; and (31 the hospital period with its later stress on the field of prevention (mental hygiene proper). These periods overlap. The era of humans reform began in 1792, when Pinel, in France, was given a free hand by the Revolutionary Committee and liberated in less than a week more than fifty patients, some of whom had been in chains for thirty years. These patients had been unmanageable because they had been robbed of air and liberty. Abolition of restraint was initiated in England by Gardiner Hill in 1837. THE HOSPITAL PERIOD. “The hospital period began as a result of a new conception of disease which is reflected in the changing attitude of the medical profession towards mental and nervous disorders, and in the growing recognition of the importance of psychiatry in the medical school curriculum not only for its own sake, but also because of its relation to problems in internal medicine, gyiuccology, and other branches of medicine. It is reflected in a new understanding of mental and emotional factors in all sickness and disease. The practice of the family physician to-day concerns itself quit© as much with mental and functional disorders as it does with organic disturbances. It is reflected in the growing belief that the general hospital should care for every type of ' patient, and by establishment of psychiatric wards in general hospitals is no longer in the experimental stage. “ Psychiatric wards to a limited extent in recent years have been provided in the main general hospitals in Now Zealand for the skilled observation and treatment of cases of mental illness in their incipient stages, thereby preventing cases from passing intp a chronic stage, and consequently diminishing the number of cases that require prolonged institutional treatment. Such wards also render ‘ first aid ’ treatment and temporary care of acute cases pending their removal to a general mental hospital. As far back as 1906 a ward of the Dunedin Hospital was allocated for this special purpose as one of its functions. It is absolutely essential that every university medical school hospital should have a psychiatric unit in order to allow for intensive research into the nature and causes of mental disease and for the psychiatric education of pliysic- , ians, students, nurses, and social workers. This unit would require the services of a full-time professor of psychiatry. Some day the Otago Medical School will require sixty beds to be allotted for this purpose, and will draw its cases from all over New Zealand, ns is the present practice in many of the States and university hospitals of Canada and the United States of America. Out-patient divisions in various stages of organisation in New Zealand, so that when fully developed people may consult the doctor about their mental ills when the earliest symptoms appear, just as they do for any other sickness, and also so that patients who go out from the mental hospitals recovered or improved may be supervised and rehabilitated in the community. The most serious obstacle to the efficient accomplishment of such rehabilation is the absence of a modern hospital social service system in any of the general hospitals in Now Zealand. In 1925 I referred to this circumstance as the one outstanding defect in the hospital system in New Zealand. A school of social service, associated with the University, which would include psychiatric training, should ho established in Dunedin, and the methods now adopted in London (St. Thomas’s Hospital), Boston (Massachusetts General Hospital), and the Melbourne Hospital should ho instituted here. This proposal is also of special importance to the various other departments of the hospital. BUILDING PROGRAMMES. “ Most countries have comprehensive institutional building programmes, and a modern programme on the villa system lies now in the director-general’s office in New Zealand awaiting the necessary funds for its completion. The public of New Zealand does not realise Slow great has been the advance in New Zealand in recent years in modernising the reception and convalescent wards of our public mental hospitals Away back in 1899 the first of such units in New Zealand was established by Sir Truby (then Dr) King at Seaclilf, who, like Admiral Nelson, against definite Cabinet authority, built out of “ repair ” money the first detached cottage for the reception of women patients. Another marked reform that Sir Truby King had successfully instituted in New Zealand was that of allowing suitable patients parole in the grounds of the institution. The third and greatest progressive movement instituted by Sir Truby King concerned his infant welfare movement and its important bearing on the mental health of the nation.

PREVENTION OF MENTAL DISEASE. “ The most encouraging sign in prevention of mental disability is seen in the interest now taken in almost every country in the prevention of mental disease, mental defect, epilepsy, and delinquency. A fundamental viewpoint is that mental hygiene has to do with all ages from early years progressively

throughout life; that it has to do with each and everyone in the community. Scientists are agreed on the groat importance of the normal development of a child’s habits as regards hunger, thirst, rest, change. and elimination, as well as its attitude of acceptance or rejection towards its environment. Habits laid in infancy prevail throughout life, especially in the field of tastes, conventions, and emotional components, and assist greatly in determining the future mental health of the child. In this respect the Plnnkot infant welfare movement in New Zealand is a valuable asset in its relation to this country’s future mental health. All expert authorities agree that the place for the initial attack of mental hygiene as a preventive force lies in the homo ami in the early years of the elementary school. And so it is that the child guidance clinic as instituted in America and now adopted in London becomes one of the most progressive of movements conserving the mental health of the nation. CHILD GUIDANCE. “ Child guidance is, as a rule, parental guidance, too, since treatment of the child’s problems invariably involves correction of parental attitudes and practices and the readjustment of family situations that contribute so largely to behaviour disorders in the child. Where such child guidance clinics have been instituted it is found that public and private organisations, parents and teachers, physicians, magistrates, clergymen, social workers all have recourse to the child guidance clinic for help in the solution of juvenile problems. A similar type of work is being done for adolescents in the high schools, colleges, and universities in America, leading not merely to the prevention of a mental breakdown but to a happier adjustment of the adolescent to ids life’s situation. .Herein also lies the value of the vocational guidance movement now being introduced into New Zealand. VOLUNTARY BOARDERS. “ More humane methods of admitting mental patients to institutions are replacing older methods, and last year England, at long last, came into lino with the rest of the British Empire in allowing for the admission of voluntary boarders to State mental institutions, which had been the law in New Zealand since 1911. However, tho Mental Treatment Act, which came into force in England in 1931, is a model of its kind. The 1928 M.D. Amendment Act is another reform instituted in New Zealand, by which a patient may be admitted to a mental hospital on the certification of two medical practitioners, which is subsequently confirmed by the magistrate. In this method the legal aspect, though effective, is kept in the background as far as tho patient is concerned. SYSTEMS OF CRIMINAL LAW. “Systems of criminal law and criminal court procedure are being studied with a view to betterment, and in this respect an international committee has recommended that provision be established along tho lines of the Massachusetts procedure for the routine psychiatric examination before trial of all persons charged with serious crime by an impartial body, after observation in a mental hospital where doubt arises, and that also judges he given sufficient discretion to make disposition of prisoners in accordance with findings of abnormal mental conditions not sufficiently marked to constitute legal ‘ insanity,’ and that the court may be properly advised in these subjects by psychopathic clinics and other means. New Zealand seems to be beading also in this direction, though our judges as yet are not entrusted with any discretion in such matters. MENTAL HYGIENE. “ Departments of Educations and Public Health in various countries are including mental hygiene in their work, and the leadership in mental hygiene activities seems for tho time being at least to bo falling definitely to the educational and the public health authorities. An instance is tho newly-organised Mental Hygiene Institute of Montreal, which, while retaining and increasing its community contacts, is in close physical relationship to M‘Gill University, and in a very intimate way related to the Department of Public Health and Preventive Medicine. Lastly, national societies for mental hygiene have been formed in about thirty countries of the world, with an International Committee which has active programmes of public education. Tho first International Congress on Mental Hygiene of representatives of fifty-three nations was hold in Washington in 1930. , This congress is claimed to be epoch-mak-ing in that it is tho first congress to studv man as man. It may bo that its deliberations will eventually prove of importance in years to come as a definite contribution to the future progress of civilisation. The second International Congress on Mental Hygiene will take place in 1935, in Paris.

“ Some speakers at the 1930 Congress stressed spiritual values hi relation to mental health. In this connection a somewhat arresting statement was made early this year by Dr H. B. Brackenbnry. chairman of tho Council of tho British Medical Association, in an address on the ‘ Development of National Health Services.’ • Tho public,’ said Dr Brackenhury, 1 lias a much wider conception of health than formerly. Tho modern conception, to tho statesman or administrator, is something much more than tho mere absence of disease. Moreover, it takes cognisance not only of tho physical, and of the physical and mental parts of man, it embraces the whole trinity of human personality —body, mind, and spirit—and in relation to each of these there are throe aspects to consider—namely, the cure of ill. the prevention of ill, and something more,‘which 1 can only call the perfection of faculty, ft is not enough merely to euro the ills that exist or prevent the formation or recurrence of ills; a still further concern must he the full development of all the powers—physical, mental, and spiritual.—of which man is possesosd. This is, of course, a very much wider conception of health, both in so far as it relates to the individual and to tho community, than many people entertain, but in its broad aspects it repr“ sents tho complete whole which will have to bo taken increasingly into account.’ ’’