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Services for the mentally deficient : a description of services in British Columbia in the light of British… Spencer, William Robert 1956

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SERVICES FOR THE MENTALLY D^ICIENT A Description of Services in B r i t i s h Columbia in the Light of B r i t i s h and American Experiences. by WILLIAM ROBERT SPENCER Thesis Submitted in Partial Fulfilment of the Requirements for the Degree of MASTER OF SOCIAL WORK in the School of Social Work Accepted as conforming to the standard required for the degree of Master of Social Work. School of Social Work 1956 The University of B r i t i s h Columbia i i TABLE OF CONTENTS Chapter 1. The Nature and Extent of Mental Deficiency Page Historical background of mental deficiency. C l i n i c a l definitions and concepts. Methods of the study . . . . . . . . . . . 1 Chapter 2. The Pattern of Care in Great Britain Trends i n Great Britain. Identification. Home care and family services. Education, training and custodial f a c i l i t i e s . Rehabilitation to the community. Personnel training and Research. Summary \ , g6 Chapter 3. American Experiences. Identification. Home care and family services. Education, training and custodial f a c i l i t i e s . Rehabilitation to the community. Personnel and Research* Summary and conclusions . . . . * 4'g Chapter A. Services i n B r i t i s h Columbia: Some Comparisons and Implications for Future Planning. Historical background in B r i t i s h Columbia. Identification of mental defectives i n B r i t i s h Columbia. Home care and family services. Education, training and custodial f a c i l i t i e s . Rehabil-itation to the community. Personnel training and Research. A co-ordinated program 79 Appendix: A* Bibliography. TABLES IN THE TEXT Table 1. The Mentally deficient i n the total population of B r i t i s h Columbia, 1955 . . ; ; 84 Table 2. Mentally deficient children in the school age population, B r i t i s h Columbia, 1955 . 84 i i i ABSTRACT This study outlines some hi s t o r i c a l backgrounds and present-day con-cepts regarding the mentally deficient, followed by a review of progress and experiences i n Great Britain and the United States, i n preparation for a description and discussion of services being offered mentally d eficient persons i n B r i t i s h Columbia. This subject i s of particular concern to the f i e l d of social welfare since the mentally deficient represent a large group of persons who, along with their families are dependent upon the Social Services. The Social Worker's responsibilities for the mentally deficient begin with the period of i n t i t i a l diagnosis and planning, con-tinue through training, and are particularly evident through rehabilitation and the supervision in the community. In preparing the material the literature was reviewed and c a l s s i f i e d so that some similarities, differences, and gaps i n the programs of Great Britain and the United States would be readily apparent, and could be ap-plied comparatively to a similar description of services to the mentally deficient i n B r i t i s h Columbia. The latter was obtained from available literature and reports, and especially from a series of interviews with persons from representative agencies who were concerned i n some way with giving services to this group. The study presents, i n outline, the advanced state of services to the mentally deficient i n Great Brita i n and some parts of the United States. The description of B r i t i s h Columbia services shows many gaps, and the need for a comprehensive program which, i f implemented, would enable the mentally deficient person to function at his maximum level, throughout his l i f e . It i s found that the Parents' Associations are becoming a strong force i n the advancement of services to the mentally deficient, especially in the area of education and training. The increased interest on the part of the public can be expected to have a quickening effect on the formation of a new program, and those who are working in this area must be prepared to give leadership. The s tudy presents a foundation of basic information about the mentally deficient in B r i t i s h Columbia upon which i t i s hoped, more specific research studies can be made toward providing better service to the mentally deficient. i v ACKNOWLEDGMENTS I wish to acknowledge my Indebtedness for the co-operation and help of the following persons who are serving the mentally deficient: O r . U. P. Byrne, Miss A. K. Carr o l l , Miss M. C. Hardy, Mr. D. B. Ricketts, Mr. K. R. Weaver, Dr. H. G. Dunn, Miss B. Fin lay son, Dr. R. F. Sharp, Dr.. S. A. Miller, Dr. C. E. Benwell, Miss D. Coombe, Mr. E . N. Berry, Mr. C. Bradbury, Mr. H. McKay, Miss B. L. Davidson, and Miss F. Campbell-Sayers. Acknowledgment i s gratefully made of the generous aid and advice of Dr. L. C. Marsh, Miss A. Furness and Mr. A. Marriage, without whose help this thesis would not have been completed. CHAPTER I THE NATURE AMD EXTENT OF MENTAL DEFICIENCY If a large Canadian c i t y of 150,000 inhabitants happened to be populated entirely by citizens who were mentally deficient, then their more fortunate countrymen would be acutely a w a r e of the magnitude and formidable problems of such a handicapped group. Instead, however* the mentally deficient are distributed throughout the population as a whole where neither their numbers nor their needs have been generally appreciated and where, as we sha l l see, they have often been thrust out of sight and mind by sooiety. Then again, i t has been a d i f f i c u l t group to describe with the result that the public has never had the use of a word whieh stood for a neat and clear description of the mentally handicapped, as contrasted to easily identifiable diseases such as Diphtheria, Scarlet Fever or Poliomyelitis. Mental Deficiency d i f -fers from these because i t i s a broad term which includes a varied group of persons whose only common denominator i s that they, have been intellectually affected. In order to discuss the incidence of mental deficiency a preliminary definition i s needed. Perhaps this could host be introduced with a compar-ison of physical differences i n humans. In a large group of persons the majority would appear to be neither t a l l , nor short* and wouM be called average or normal. A few would be seen to be unmistakably t a l l and some would draw attention for their shortness. Persons who showed extremes i n this matter of height would receive special names such as giant or dwarf. So i t i s also with intellectual stature where the giants are known as men of gen-ius and the dwarfs as idiots with, i n between, the large group of normals, 2. tapering off gradually to each extreme. This continuous transition from the normal to the defective does not provide a natural boundary between these two groups so that i n order to arrive at a definition other methods must be ex-plored* A representative sample of the population might be taken and arranged according to the individuals' mental endowments, i n decreasing order of I n t e l * ligence. A dividing line might then be a r b i t r a r i l y made and a definition based on this decision. However, at any point of demarcation based solely on intelligence, which might be set, i t has been found that there are many pers-ons of lesser intelligence who are functioning well on their own, who would be labelled defective, much to their detriment. Similarly, persons of greater intelligence* who would thus be declared normal have been found to require care and supervision. There i s no single point on this scale of intelligence where injustices would not be done, either by wrongfully including those who are already supporting themselves or by denying care to some who require care due to mental deficiency. The main and f i n a l test has thus become the social criterion. The prac-t i c a l test i s whether or not the individual i s able to make a satisfactory and Independent adaptation to the ordinary environment constituted by bis fellow men. We can now tentatively define a mentally deficient person as one who, as a result of defect of mental competency, i s unable to make an adequate and independent soeial adjustment., In Britain and the United States many careful surveys have been carried out since the turn of the century to ascertain the number of mentally d e f i c i -ent persons i n the population. Enumeration has been very d i f f i c u l t on account of such factors as family feeling about having a defective member, the milder 3* degrees going unrecognised as mental deficiency, and the general lack of plan-ning and f a c i l i t i e s for this group* However, after many varying reports, there i s now substantial agreement on both sides of the Atlantic, so that the B r i t i s h authority A. F. Tredgold supports the American findings as correspond-ing with his results and writes as follows: "Dr. Edgar A. Doll says that generally speaking i t may be concluded that one per cent of the t o t a l popu-lation i s mentally deficient i n the social sense, and that t h i s figure has 1 been confirmed by both intensive and extensive local surveys." Furthermore, they both agree that more than two per cent, of the compulsory school-age population are mentally deficient, the eminent B r i t i s h authority on mental deficiency and the schools, C y r i l Burt ?has found this figure of two per cent. 2 to hold true i n the English school-age group while other surveys i n Scotland and i n America have shown a school-age incidence ranging between about two and three percent.^ The much larger percentage found i n school-age children i s believed to be due to two factors. Firstly,, the life-span of the more severe-l y affected children i s shorter and thus many do not survive into the adult age groups. Secondly, the mildly affected young adult, having l e f t the more definite scholastic standards of the schools, may become self-sufficient i n the outside world and can no longer be regarded mentally deficient as defined. The finding that ten i n every thousand of our population are mentally deficient and, even more startl i n g , the fact the incidence rises to over twenty out of every thousand children of school age, cannot help but bring home to each of us the need to know more about so widespread an a f f l i c t i o n . 1. Tredgold. A. F.. A Textbook of Mental Deficiency* B a i H i e r ^ " London; 1952; p. 18, 2. Burt, C y r i l , Tfefe^Bftckwagd GhiMf University of London Press; 1937; p. 81, 3. Penrose, L. S.. 'The Biology of Mental Defect; Grune and Stratton; Hew York; 1949; p*-21. The White House Conference on Child Health and Protection, i n summarizing the significant findings on the handicapped child, presented a l i s t of nine broad groups of handicapped children with a numerical estimate for e ach. After taking into account differences i n definition, the l i s t s t i l l showed that mental deficiency i s by f a i the largest single handicapped group i n the United States.More recently, Ernest N. fioselle stated that the Connecti-cut Study had compared mental deficiency with other handicapped groups and had found that there were about as many mentally deficient ohildren as there 2 were of a l l other handicapped children put together. Within this very large group are persons of widely differing degrees of intellectual capacity and with varying a b i l i t y to apply this to the problems of l i v i n g . As an aid to understanding and working with the mentally deficient, the group has been traditionally divided into three parts i n order of decreas-ing intellectual competency. They are now known as Mild, Moderate, and Severe 3 . . . Mental Deficiency. This parallels the older but perhaps better known class-i f i c a t i o n of Moron, Imbecile, and Idiot. These three terms* which have been somewhat corrupted by popular usage, do not point up the concept of gradual transition or distribution from one grade down through,the next. One further class of persons, which w i l l be referred to from time to time, embraces those whose mental competency places them above the mentally deficient but below the average or normal group. This in-between class as thus defined we w i l l c a l l the Borderline Group. The borderline group does 1, - • «. nfhe Handicapped Child" j. White House Conference on Child  Health and Protectioni The Century Co., Hew York, 1933, 2, fioselle, E. H.j "Hew Horisons for the Mentally Retarded"; American ,M^m7l Vol. 59 #3, Jan. 1955, p. 3©4. 3, Sloan, W., Chairmanj "Progress Report of Special Committee on nomenclature, A.A..K.D,"; American Journal, of Mental Deficiency. Vol. 59 #2, Oct. 1954, pp. 348-351. 5. not contain persons who are mentally deficient and i s actually made up of a very large number of subnormals, who may require* i n their younger years, special help and attention i n the public school system. Otherwise, they are not particularly noticeable and In adult l i f e they make up the bulk of the unskilled labourers where as such, they are an Important and integral part of society* th i s group i s mentioned here because there can be considerable interchange between persons i n the top levels of the mildly deficient and those i n the lower strata of the borderline. This w i l l take place when, for example, the individuals 1 a b i l i t y i s Increased through training to the point where he can cope successfully with the demands of social l i f e . Conversely, his decline with age, or perhaps his inferior position during times of gen-eral unemployment* may cause him to be reclassified as a mentally deficient person. The Mildly Deficient make up the largest class, accounting for about three quarters of the mentally deficient. 1 They are not only slow starters i n the race of l i f e but can be expected to have a d i f f i c u l t time i n their progress towards already definitely limited goals. I f the child receives an extra share of encouragement, affection and security he may progress through the usual childhood achievements, but w i l l take about twice as long to do this and only after much patience and repetition on the part of the parent. When others are ready for school this child s t i l l requires special help towards working and playing with others and must receive a f a i r l y lengthy pre-school training, fie then requires special schooling where he w i l l re-ceive much individual attention and where the teaching methods are expertly 1, Penrose, L. S. j The Biology of Mental Defectt Orune and Strattonj New York; 1949, p. 20* designed to hold bis interest i n spite of his short span of attention and his slow rate of learning. Most of his class w i l l learn to read and write but fev w i l l reach more than the fourth or f i f t h grade of school. Those i n the mildly deficient group can* however, very often be trained to develop social competence and adequacy i n employment. They may become steady, pleasant, and wil l i n g workers to whom routine repetitive jobs are a challenge. They carry out important tasks which normal persons find too monotonous, (for example, dishwashing), i n many work areas particularly the food, laundry, and auto trades, buildings and janitor work, hospital and personal services, farm and household work. In return they must be offered some protection, due to their definite limitations, which can v e i l be given i n a small shop by understand-ing co-workers. The moderately deficient class w i l l not be expected to achieve much academically beyond such practical things as reading signs for their own protection, elementary counting, and simple operations which would help them to find their way about the community* Their educational program Is usually one of training i n self-care, socialization, and limited economic usefulness. Thus they can be taught to help around the house with cleaning, washing dishes, etc., and outside can do supervised jobs i n the garden. Members of this blase are limited i n their soeial competency and require some supervision of their affairs and many require maximum environmental supervision. The severely deficient person at best can only learn to care for his per-sonal self. There w i l l be l i t t l e interaction v i t h other individuals and con-stant supervision i n a restricted environment i s required* They are completely dependent upon others for the necessities of l i f e and cannot survive without care. Even this most severely deficient group are able to respond to kindly 7. and imaginative care by improving t h e i r personal play habits and being able f o r example, to enjoy seasonal parties and picnics on the lawn. Mental deficiency, besides being a large-scale community problem, can, also bring about p a r t i c u l a r l y t r y i n g experiences to the parents and family of a c h i l d so a f f l i c t e d . / Mrs, Norma L . Bostock of the National Association f o r Retarded Children writes of t h i s both from personal experience and from that of her many fellow parents, She endeavours to share with her readers, who are professional persons, the strong personal feelings and c o n f l i c t s whieh have i n the past been aroused within th® parents and family by the b i r t h of a mentally deficient c h i l d , Mrs. Bostock describes the t y p i c a l s i t u a t i o n with her group* i n which the parents had indulged themselves with the usual dreams of expectant parenthood only to see the dream turn into a nightmare; a mentally d e f i c i e n t c h i l d had been born. A nightmare because the parents had been raised i n a generation when every t r a d i t i o n and custom c l e a r l y placed a stigma on the parents of mentally d e f i c i e n t children. Because of t h e i r up-bringing the parents, and the grandparents too* f e l t g u i l t y and often angry about t h i s happening, which attitudes placed a s t r a i n on family and ma r i t a l relationships and gave r i s e t o many personal doubts and fears* They knew l i t t l e or nothing that was constructive about what might be done f o r such a c h i l d but could only see complete destruction of hopes and plans f o r t h i s and any further children. /Many parents became very sensitive about t h i s event and eit h e r t r i e d to deny the existence of such a c h i l d or withdrew i n shame from t h e i r normal community, and personal s o c i a l a c t i v i t i e s , Under such circum-stances the parents were quite unable to look at the c h i l d objectively and 1, Bostock, Norma L. j "How can Parents and Professions Co-ordinate, etc.": American Journal of Mental Befioiencyt Vol. 60 #3, Jan. 1956, pp. 428-32. s . give him affection for his own sake, but rather i t appears that most adults involved were hopelessly entangled by their own personal feelings about the matter. • . Next, Mrs* Bostock describes the desperate seeking of advice and help for their child, sometimes, we might add, a seeking for only the kind of information which they wished to hear. Their f i r s t professional advisor was the family doctor who may have had the courage to t e l l them about mental de-ficiency but then often advised them to send the child away and forget they ever had him. Many parents were referred to other consultants and c l i n i c s u n t i l f i n a l l y they received much the same advice. Those who accepted the advice, for the good of the child and the family, soon found that entry to a government institution required a court procedure. They had to declare the child Incompetent and to deny themselves the right of jurisdiction as they placed him i n the hands of a governing body. At the institution they found a staff , limited i n numbers, and often i n understanding, who were so busy caring for the children that l i t t l e help could be given to the anxious parentd. Even parents who were w i l l i n g and able to keep up an interest i n helping the ohild were actually discouraged by the staff who often could only see this as another Interfering factor i n an already demanding job. Some parents decided to keep their children at home as long as possible, but they too were met on a l l sides by discouragement, criticism and frustra-tion. It was a constant struggle to combat public opinion, to protect the child from open r i d i c u l e , and to tr y by any method to provide for him some of the things to which he was entitled. In this emotionally highly charged atmosphere a very r e a l problem arose whereby those who had sent their children to an institution directed some of their strong feelings surrounding such & decision to actual criticism of those who kept their child at home. Parents who were making many sacrifices i n order to keep their defective child at home f e l t that the others were shirking their duty. Thus, parents of the mentally deficient were often denied even help and comfort from each other. During the last few years many advances have been made i n the areas of public understanding, professional practice, and parent education and action, l e t these are only recent developments and, as described above, many parents have been subjected te harrowing experiences over the years so that for these people i t w i l l be a long struggle i n returning to active co-operation with the newer and more progressive programs. This concept of change i n outlook and program with i t s accompanying problemst w i l l be more f u l l y dealt with i n the following section on histori c a l background* In the hope of achieving better understanding of the problem and as a guarantee that the vast needs, as sketched out, would be met by society* the White House Conference set forth the rights of the handicapped child 1. To as vigorous a body as human s k i l l can give him, 2. To an education so adapted to his handicap that he can be econom-i c a l l y independent and have the chance for the f u l l e s t l i f e of which he i s capable* 3. To be brought up and educated by those who understand the nature of the burden he has to bear and who consider i t a privilege to help him bear i t . 1, m- - * - njfce H&ndicapped ChUd" J White House Conference on Child fflwMfo,ffflfl JftotecMffin? The Century Co., Hew Xork, 1933, p. 3. 10. 4. To grow up i n a world which does not set him apart, which looks at him, not with scorn or pity or ridicule - but whioh welcomes him, exactly as i t welcomes every child* which offers him identical privileges and identical responsibilities. 5. To a l i f e on which his handicap casts no shadow, but which i s f u l l day by day with those things which make i t worth while, with com-radeship, love* work, play, laughter* and tears - a l i f e i n whieh these things bring continually increasing growth, richness* release of energies, joy i n achievement*" iMfQfitoal Jeokgrffiundr,,,^ Mental Def l e i j n c j Interest i n the care of the mentally deficient has a continuous thread leading back through over a thousand years of history* I t was early i n the seventh century that the mentally deficient began to seek refuge at the shrine of St. fiymphha i n the ancient Belgian village of Gheel. From these early beginnings, the village of Gheel has become a world famous colony to which the mentally deficient as well as the mentally i l l from many lands come to ava i l themselves of the family system of care and treatment for which i t i s noted* Gheel was, however, a rather solitary light shining through the dark-ness of the middle ages when the "village idiot" continued to be the scapegoat and the mental defective generally received a harsh, inhuman, and sometimes 2 hostile treatment* The mentally defective were not separated as a group from the mentally i l l and only the severely defective, the idio t s , were iden-t i f i e d . At the hands of the community they a l l suffered the l o t of "paupers" 1. Zilboorg, G} A History of Medical Psychologyt Norton and Go.j New York, 1941. 2. Deutsch, Albertj "The Mentally 111 i n Americai Columbia University Press; New York, 1949, pp. 333-336. 11, and were put i n the almshouse along with other unfortunates, the sick, the infirm, children, and the insane. In America i n the Eighteenth and Nine-teenth Centuries a crude alternative to the almshouse known as the "New England System" was popular.^" This was a method by which the local govern* ment boarded out the wretched paupers as cheaply as possible at an annual public auction. The paupers, men, women and children, were lined up on the auction block for inspection, particularly with regard to potential labour value. The citiaen who offered a year's support for the least cost to the community von the bid and the pauper became a kind of slave for the year. Some attempts were made to regulate the care given but, as a whole, the i n -dividual was open to great abuses. In 1798 a curious happening led to a series of events which, as Deutsch points out, were of the utmost importance to the whole f i e l d of mental de-2 fioiency. I t was i n that year that a group of sportsmen, hunting In the forest of Aveyron, France, encountered a boy li v i n g in, a wild state, roaming naked through the woods and subsisting on roots and nuts. He was captured and taken to Paris, where he was examined by Dr. Itard, chief medical officer of the institution for the deaf and dumb. The discovery of the "savage of Aveyron8 aroused great interest throughout Europe at a time when there was much discussion about the philosophy, theory, and reform of education. Here, i t was believed, was the chance to study the development of an untutored savage who had been untouched by c i v i l i z a t i o n . Fortunately, Itard held with this theory and began to work patiently with the boy using methods suggested by Locke and Condillac who had pointed out the relation between sensory fac-1. Ibid, pp. 116-120 2. Ibid, pp. 336-338 3. Loc, m. 12. u l t i e s and learning. By the time Itard was f i n a l l y forced to admit that the boy was really an i d i o t , he had already brought about considerable improve -meat i n his patient, He then continued his study of the boy for five years, working out training principles for the idiot group, an experiment he would never have undertaken except for this remarkable occurrence at Aveyron. Dr. Itard handed on his researches to young Dr. Edouard Seguin who then entered into a life*long career i n the study and care of the mentally defic-ient,* He developed a system of training which had the aim of bringing a l l the senses and organs to their maximum funotion i n order of physical, percep-tu a l , and f i n a l l y conceptual training. Seguin looked upon the individuals' l i f e expression as being made up ef many functions, eaoh of which was directly related to a given bodily sense or organ. By training each of these to the mxifrwn of i t s capacity and in relation to the others, they would achieve a harmonious whole. The mentally deficient pupil was f i r s t given physical training so that he could learn to co-ordinate and control his body and some senses, with physical handicaps receiving additional attention. Then the training would proceed with development of the perceptual faculties i n order to gain iaaximuffi awareness and stimulus from the world around him. The pupil would then be i n the best possible position to receive and accept the d i f f i -cult conceptual training* This early academic teaching would again be closely tied i n with the previous methods of training. His programs Included pleasant surroundings, good diet, correction of physical i l l s , along with special imitative instruction, vocational training and farm labour* Seguin had l a i d the firm foundations for training of the mentally deficient* Fur-thermore, his work had an important influence on general education, while the 1. Ibid, p. 338 13. study of this group led to better ui^erstandlag and further study of the needs of normal children. The work of Seguin and other French pioneers was quickly taken up In other western countries. Thus, i n B r i t a i n a private school was opened at Bath i n I846 and soon after came the famous public institutions at Colchester 1 (1849),and Barlswood (1855). In America the f i r s t state institution was opened i n I848 i n Massachusetts, under Dr. Samuel Howe. This school has made many contributions to the knowledge of mental deficiency during i t s century of operation and continues to be a leading institution i n America, i t now being known as the Walter £. Fernald School, named after i t s best known 2 physician. Dr. Seguin hgd been active i n polities i n France and, following the failure of the Revolution of I848 and the accession of Napoleon I I I , he crossed the Atlantic to make his home i n the United States. There he person-a l l y helped to organise three of the f i r s t four institutions for the mentally deficient i n the United States* Dr. Seguin advocated and became a charter member of the organization now known as the American Association of Mental Deficiency, on June 6, 1876*^ The early schools were founded with much optimism on the belief that most mentally deficient children could be trained and rehabilitated to the cpnaann-Ity as self supporting citizens, and thus their problems considered to repre* sent a new f i e l d of education* Seguin himself taught for a long time that mental defect was eurable. Their enthusiasm can be a l l the more appreciated when i t i s realised that diagnostic methods were not so precise as today* nor were the ccpmunity's demands on the individual so complex, so that these 1. JMsl. p. 340. 2. Ibid, p* 343* 3. pp. 345-347. 14. pioneers wore actually working with a more seriously affected group, those who were more obviously mentally deficient. Expedience proved Seguin's educational methods to be effective, and i n fact, they are s t i l l used today, but i t also taught that the degree of success was dependent upon the i n t e l l e c -tual level of the pupil*. The early hopes of curing the idiot through special educational methods had to be abandoned and the schools began to limi t ad-mission to those In the higher levels who could benefit from this instruc-tion. The early schools were started on sound principles, often with great seal i n the face of public misunderstanding and derision, and might have continued on their progressive path had i t not been for influences soon to come from several directions. Within the schools themselves many pupils were remaining who could not respond to training, while others, who had shown some improvement and were ready for family care, had no resource to which they could return i n the community. No arrangements had been made by society to accept these children who could have been returned to their homes with some financial help, or, for example, could have been placed with foster families. Outside the schools the situation was even more urgent, .the vest majority of the mentally deficient having no provision for care except the poorhouses and the prisons* This was also a period of history when various other groups of unfortunates were being separated from the poorhouse, such as children and the insane* These pressures were f e l t directly by the government schools for the mentally deficient and the swing of the pendulum towards custodial care had begun. The ©nd of the nineteenth century and the beginning years of this one brought forth s c i e n t i f i c discoveries of great importance to the world and, i n 15. the study and treatment of mental defect, with unexpected r e s u l t s . Darwin's theories of "natural selection" and Herbert Spencer's " s u r v i v a l of the f i t t e s t , " which had become widely known, were distorted by others to serve and support the "better" classes and f o r condemnation of the unfortunates of our society. Then, Mendel's laws of heredity came into general acceptance. In the unsympathetic climate mentioned above i t was quickly asserted that mental deficiency followed Mendel's laws and thus was simply the r e s u l t of had heredity. In 1905 Drs. Blnet and Simon presented t h e i r famous scale f o r measurement of mental age. I t was quickly put to use with modifications which gave the Intelligence Quotient (the r a t i o of mental age to chronological age) i n terms of a percentage of the normal. Surveys were c a r r i e d out i n i n s t i t u t i o n s and l a t e r i n schools with frightening r e s u l t s . I t was thought, from these mental t e s t s , that most of the delinquent, the immoral, and the dependent therein were mentally defective. Then the shock came when tens of thousands of school children were found to be i n the same i n t e l l i g e n c e group. As Duesch puts i t , "the moron was being discovered on a vast scale." Mental deficiency, u n t i l then, had meant the more severely affected group. This sharper t o o l , tha i n t e l l i g e n c e t e s t , was now accurately o u t l i n -ing the large group of persons wit h i n the Borderline c l a s s i f i c a t i o n , and espe c i a l l y the top l e v e l of mental deficiency, the M i l d l y Deficient (moron) group, whose extent had not been previously r e a l i z e d . I t looked as i f the Western world were heading towards a chaotic c i t i z e n r y composed e n t i r e l y of the feebleminded. The alarmist period had w e l l begun and was to l a s t f o r at le a s t two 1. Deutsch, A l b e r t ; The Mentally 111 i n America; Columbia University Press, New Xork, 1949, p* 35©* I 16. decades of this century. The eugenics movement became a strong and popular group which soon established heredity as the cause of social problem classes as well as physical i l l n e s s * and mental illness and deficiency. Published accounts of so-called degenerate families, for example "The Jukes" and "The Kalllkak Family'1, established i n the public mind that mental d ef icienoy was "the mother of crime, pauperism and degeneracy."^ The experts i n the f i e l d made equally alarming statements, while the eugenics enthusiasts led i n the demand for s t e r i l i z a t i o n , and segregation from soeiety. St e r i l i z a t i o n i s a large and controversial subject but i t may be safely stated that as a eugenic measure i t has, on the whole, been disappointing. The original demand was to s t e r i l i z e a l l those defectives who were i n i n s t i -tutions, but these are the lower groups who. I t has been found* are least 2 l i k e l y to reproduce. Kallman, i n a discussion of the genetic aspects of mental deficiency, states that the Moderate and Severe groups* i f genetically determined, depend upon single major genes and that most of these tend to follow a recessive mode of inheritance.^ This i s confirmed by the observa-tion of a higher rate of parental consanguinity i n these genetically deter-mined, low-grade groups. Moderate and Severe degrees of mental deficiency are, however, caused mainly by environmental factors (including, infection, trauma, etc.), although there i s a pos s i b i l i t y that some severe conditions require the interaction of certain environmental circumstances and the effect of a major gene.^ Because the etiology of Moderate and Severe degrees of Men-t a l deficiency i s mainly a matter of environment, and since the proportion 1. Ibid, p. 3 6 0 2. Ibid, p. 3 7 4 3 . Kallman, F.J.} "Recent Progress i n Relation to the Genetic Aspects of Mental Deficiency1* j American Journal of Mental Deficiency; Vol. 56 #2, Oct. 1951, pp. 3 7 7 - 3 7 9 . 17. which i s of genetic origin i s largely recessively determined, then i t would seem to follow that s t e r i l i z a t i o n would be quite ineffective as a general method of control. The greatest number of the mentally deficient come within the Mild (Moron) classification and within this group perhaps the majority are the 1 2 3 result of genetic factors, according to Kallman, Ister, and Jeryis. The process i s one of multiple genes i n which a large number of small differences may act additively to produce, as only one example, Mild mental deficiency.^ This, however, i s not a genetic problem by i t s e l f but i s only a segment of the t o t a l structure of intellectual inequalities i n the general population. High-grade deficiency, then, forms the lower end of the normal distribution 5 of human intelligence. Again i t would seem impossible to apply s t e r i l i z a -tion measures which would have any appreciable effect on the Mildly deficient group. It has been suggested that society might best concentrate on improving the environmental factors affecting i t s members, while continuing the study of genetics. I t would seem that s t e r i l i z a t i o n , at the present state of our knowledge, may be best thought of i n the individual sense where, for example, children would cause the collapse of a happy, married, adjustment i n the com-6 munity. Thus, Hoyes comes to the conclusion that " s t e r i l i z a t i o n as a general policy i s a superficial method of approaching the problem of feeble-mindedness, 1* feCj>-6ife« 2. Ister, J.j "Scientific Problems, Progress, and. Prospects"; American Journal of Mental Deficiency: Vol, 59 #3, Jan. 1955, p. 423. 3. Jervis, G.A.; "Medical Aspects of Mental Deficiency"} Vocational Rehabilitation of the Mentally Retarded? U.S. Government, Washington, 1950, p. 11. 4. Kallman, F.J.j i g c ^ G J i . 5. froct q%%. 6. Hoyes, Arthur P.; Modern C l i n i c a l Psychiatry; Saunders Co.; Philadelphia, 1953, p. 317. 18. since i t ignores the need for special investigation and research as to i t s cause and prevention." The hue and cry for segregation of the mentally deficient from society, however, had a more lasting effect on this defenceless group. More custodial institutions were b u i l t , and the once progressive curricula sank to a new low. Soeiety had thoroughly rejected these children, placed a stigma on both the Child and parent, and decreed that the mentally deficient remain away from, and out of sight of, i t s citizens. It was never possible to segregate the* whole group as intended and no more than ©ne-tenth have been in s t i t u t i o n a l -ised.* However, the barrier to progress was most effective and persistent. These attempts at solving the problem by single answer, whosesale methods f a i l e d because of the very nature of mental deficiency. It is now recognized that i t covers a heterogeneous group of conditions having widely varying causes and calling for widely different methods of prevention and treatment. The earlier fears about the menace of mental deficiency have gradually sub-sided as public issues to be replaced by more constructive attitudes. This 2 i s exemplified by Penrose who ably refutes this fear .from his biological point of view and demonstrates genetically that the population i s i n equil-ibrium. He asserts^ that the idiot i s now seen as an integral part of the human race i n i t s struggle for evolution and survival, that subcultural mentality i s the inevitable result of normal variation, and moreover, that some of these groups make as strong a contribution to the race, genetically 1. * - * - 3,00%!: Work Yearbook; Russell Sage foundation, New York, 1949, p. 323. 2. Penrose, L. A,.$ "The Supposed Threat of Declining Intelligence"} American Journal of Mental Deficiency; Vol, 53, July 1948, p. 118. 3. Penrose, L.S.j The Biology of Mental Defect; Grune and Strattonj New York, 1949, p. 240. . 19. speaking, as do the highly intelligent who contribute i n fewer numbers. Definitions and Concepts 2 Tredgold i n his definitive text book notes that mental deficiency must f i r s t be differentiated from the other two abnormal conditions of the mind namely mental disorder, which includes the psychoses and psycho-neuroses, and mental decay i n which are various types of dementia as, for example, i n s e n i l i t y . Mental deficiency i s a condition i n which the mind has f a i l e d to reach complete or normal development. He comes to the conclusion that: "the essential purpose of mind i s that of enabling the individual to make a satisfactory and independent adaptation to the ordinary environment of his fellows; i t would be intolerable iff.a person able to do t h i s , to earn his l i v i n g and manage himself and his affairs with reasonable prudence and efficiency, were to be s t i g -matized as defective, and subjected to control, merely on the ground of i l l i t e r a c y and poor scholastic attainments, or because he failed to come up to some a r b i t r a r i l y fixed intelligence quotient. Hence, I regard the social as not only the most l o g i c a l and s c i e n t i f i c concept of mental deficiency, but as the only criteri o n which the community can justly impose. We have now to see what i s the legal conception of mental deficiency. I think i t i s clear that the view taken by the English legislature, and the one which i s coming to be generally accepted in most other countries, i s identical with the social concept just described. The Mental Deficiency Act of 1927 says •mental defec-tiveness means a condition of arrested or incomplete development of mind existing before the age of eighteen years, whether arising from inherent causes or induced by disease or injury.'"^ 1. In this section an attempt has-been.made to trace b r i e f l y the h i s -t o r i c a l aspeets of the care of the mentally d e f i c i e n t . I n following this particular thread of society many important and provocative Issues have been pasaed*by with only the briefest mention, such as Social Darwinism, d i f f e r -e n t i a l f e r t i l i t y and intelligence, and eugenics. The reader, therefore, i s referred to some suggested major sources as follows: Garr-Saunders, A.M.; Eugeniee: Williams and Norgate Ltd., London, 1926. Hobhouse, L.T.J Social Evolution and P o l i t i c a l Theory: Columbia Univer-si t y Press; New York, 1911. Kaclver, R.M.; Community^ a Sociological Study: MacMillan and Co.; London, 1928. Maclver, R.M.j Society., a Textbook of Sociology: Farrar and Rinehart, Inc.; New York, 1937. 2. Tredgold, A.F.; A Textbook of Mental Deficiency: B a l l l i e r r e , T i n d a l l and Cox; London, 1952, pp. 1-6. 3. Ibid, pp. 5-6 20. \ i Tredgold then affirms from further study of the British" Act that the legal concept i s again "that of a degree of arrest sufficient to prevent independent social adaptation and necessitate some form or degree of exter-nal care."* In Britain mental deficiency i s determined by two different methods according to the individual's age. Children to be reported to the Mental Deficiency Authority are: (1) "Any child above the age of two years who i s found incapable of receiving education at school, (2( "Any child i n attendance at School who, by reason of a d i s a b i l i t y of mind i s l i k e l y to require super-vision after leaving school."* In this manner the social cri t e r i o n of our definition i s met, i n c h i l d -ren, by examining the ch i l d i n the light of what degree of s o c i a l adjustment can be expected of him In the future. Tredgold makes a strong plea for the reporting of every such child to the Mental Deficiency Authority i n order that he can be protected and helped by the legislative provisions. The diagnosis of mental deficiency i n adolescence and adult l i f e Can only be made, Tredgold continues, after a f u l l inquiry i s made into the per-sons' l i f e history, including his a b i l i t y to work, how he had looked after himself and his a f f a i r s , investigation into the extent of his general knowl-edge, scholastic a b i l i t y , and such. Two questions oan then be asked - "(1) Does the individual require care, supervision, and control either for his own protection or for the protection of others? (2) Is such care needed by reason of mental defect existing from before the age of eighteen years? I f both answers are i n the affirmative, then the person i s a mental defective within the meaning of the Mental Deficiency Act."^ 1. Loc. c i t . 2. Ibid, p. 431 3. Loc, ejti 21. Sometimes persons display a lack of knowledge and a b i l i t y , along with a kind of behaviour which has a l l the appearances of the feebleminded but which i s due to factors other than mental defect and thus does not come within our definition above. This i s known as pseudo-mental deficiency (or pseudo-feeblemindedness) and i s an apparent intellectual impairment within an indiv-idual who actually s t i l l possesses the potential for future mental functioning* The condition may be particularly d i f f i c u l t to identify i n children who have never shown an e a r l i e r stage of normal behaviour. Many are handicapped by sensory defects or physical conditions, such as blindness, deafness, and spasticity which isolate them from the usual stimulation and Information. - 0fcH^vval^*iBuWer'iag from Juvenile forms5 of mental Illnesses, which are just now being studied. In a recent a r t i c l e , 1 Dr. Leo Kanner i s quoted as conclud-P. 0 ing l a tely that these children have been reared i n "an emotional refrigerator."' Similarly then, perhaps the largest group of the pseudo-mentally deficient comes under the heading of emotional causation* The cuild may f a i l to progress because of emotional reactions such as fear, rebellion, self-punishment, or a desire to return to the infantile state. This is.further discussed with most interesting examples by John D. Macdonald i n a monograph from the Byther Ghild 3 Centre.'' For our purpose© i t w i l l suffice to confirm that pseudo* feeblemind-edness does not come within the definition of mental deficiency* However, emotional factors can and do play an important part i n any child's adjustment to l i f e , not least i n the care and training of the mentally deficient* It was mentioned earlier that the invention of the intelligence test 1. Katz, Sidney; "The Lonely Children"; Maclean's Magazinet Toronto, Vol* 69 #2, Jan. 21, 1956, p. 12 2- Ibid, p. 49 3. Macdonald, John D. j "A Study of Three Cases of Functional Feeblemindedness"; Monograph P I . The Byther Ghild Centre, Seattle, 1948 22. brought forth a new understanding of the distribution of intelligence and the incidence of mental deficiency. Although the sooial concept remains as the cr i t i c a l factor in determining a condition of mental defleiency,. the measurement of intelligence can then be used successfully to help in grading the individuals in the group. The Intelligence Quotient to be used as the dividing level between the Borderline Group and the Mentally Deficient has 1 2 3 been chosen by Tredgold, Burt, and Penrose- as I.Q. Seventy* while the American Association on Mental Deficiency has been considering I,Q, Seventy-five, 1 4 Penrose explains that in addition to being a practical figure that f i t s closely the definition and practice, I.Q, Seventy Is also the point on the theoretical normal distribution of intelligence below which a score would be considered exceptionally or abnormally low. This borderline figure is mainly useful as a matter of convenience, and i t must always be remembered that for the individual this is a flexible level which is related directly to his own adequacy of functioning. For a further discussion of classification the reader is referred to the 1954 Progress Report of the Special Committee on Nomenclature of the American Association on Mental Deficiency. Before set-ting out their classification they too warned that an adequate quantitative figure could only be set after observations, histories, and related findings I. Tredgold, A.F.J A Texf-Book of Mental Deficiency: Bailliere, Tindall and Cox, London, 1952, p. A28 2* Burt, Cyril} The Subnormal Mind: Oxford University Press; London, 1955, p, 92 and 156. 3* Penrose, i.S^j The Biology of Mental Defect: Grune and Stratton; New York, 1949, p. 25* 4. Sloan, W.j Chairman, "Progress Report of Special Committee on Nomen-clature, A.A.M.D." American Journal of Mental Deficiency: Vol. 59 #2, Oct. 1954, pp. 350-351. 5* Ibid, p. 345 23. about the individual, i n addition to psychological test scores, were care-f u l l y studied. I t added that the degree of defect remained relative to c u l -t u r a l norms and stresses, and was modifiable.* This recent classification by the American Association i s similar, with the exception of the upper l i m i t of seventy-five, to that i n use at The Woodlands School. (This training school w i l l be discussed later i n section three of Chapter Four.) It i s this latter scheme which we w i l l adopt. The classification, for our purposes, (with earlier terms i n brackets) w i l l be as follows: Borderline Group: (Dull Normal) Borderline I.Q* 70-90 (Borderline) Mental Deficiency* Mild I.Q. 50^70 (Moron) Moderate I.Q. 25-50 (Imbecile) Severe I.Q. 0-25 (Idiot) Although this classification appears to be simple enough, there have been endless divisions for specific purposes and a confusing array of terms. "Feeblemindedness" means, i n America, the whole range of mental deficiency while i n Great Britain i t refers to the classification of moron only, and this practice has become synonymous with mental deficiency and, s t r i c t l y 2 speaking, i t i s a misleading term. Burt- spoke of retarded children i n describing the educational progress of mentally deficient children but he hastily added "However, this must not be taken to imply that the backward Child i n the end w i l l catch up." "Mentally retarded" has become a popular 1, Ibid, p. 350. 2. Burt, Cyril} The Backward Child: University of London Press: 1937, p. 7. 24. term with a l l parents' organizations, to the exclusion of others, so that i t now appears frequently i n the l i t e r a t u r e . The causation of mental deficiency w i l l be discussed very b r i e f l y i n order to give the present b e l i e f s regarding i t s heredity and also to point up the complexity of the general group.* The f i r s t causes are those due to heredity and, according to the best evidence av a i l a b l e , heredity causes 2 account f o r approximately t h i r t y percent of mental deficiency. This i s only a f r a c t i o n of the e a r l i e r , alarmists estimates* Of t h i s heredity group the greater proportion are only m i l d l y d e f i c i e n t . The remainder are divided into over a dozen c l i n i c a l e n t i t i e s and although comparatively Sew i n numbers they may be severe i n degree, with accompanying physical abnormalities. In the second group are those due to environmental causes, that i s , during pregnancy, b i r t h , and the childhood developmental period. There are Various infections which s t r i k e before or a f t e r b i r t h , f o r example, measles v i a the mother, and encephalitis i n childhood, eaoh wit h i t s p a r t i c u l a r type of damage. There are defects due to trauma and t o x i c agents at many stages and included i s fih incompatibility. F i n a l l y , disorders of the endocrine glands with t h e i r i n t r i c a t e functions are believed to account f o r several types of defect. I t can thus be seen that mental deficiency i s the r e s u l t of many d i f f e r e n t i l l s which, each i n i t s own complex way, has caused a de-fe c t i n mental competency. Methods of the Study I t i s the purpose of t h i s study to f u r n i s h background information on men-1. J e r v i s , G.A.} "Medical Aspects of Mental Deficiency*} Vocational  R e h a b i l i t a t i o n of the Mentally Retarded: D. S. Government, Washington, 1950, pp. 1-17. 2. Noyes, A.P.} Modern C l i n i c a l Psychiatry: Saunders Co.} Philadelphia, 1953, p. 299. 25. t a l deficiency, including some approaches towards solution of the problem by other countries, leading to a description of the present state of services for the mentally deficient i n B r i t i s h Columbia. Some major trends towards furnishing a comprehensive and statewide plan for the mentally deficient i n Great Britain and i n America w i l l be reviewed under five general headings! (1) Identification of the mentally deficient i n the state and provision for diagnostic and parent guidance f a c i l i t i e s , (2) Home Care and Family Services w i l l include services to the family i n the home, parent organizations, and provisions such as day care centres. (3) Education. Training, and Custodial F a c i l i t i e s w i l l embrace a d i s -cussion of public and private education, community or state institutions and occupational training, (4) Rehabilitation to the community In the broad sense w i l l involve such areas as family care programs, provision for employment, sheltered workshops, social and recreational f a c i l i t i e s * continued supervision, (5) Personal Training and Research. The urgent needs In these areas w i l l be outlined. The B r i t i s h Columbia setting w i l l be described and an estimate made of the numerical extent of the problem i n this province. Services to the mentally deficient i n B r i t i s h Columbia can then be de-scribed under the previous five general sections. From this* conclusions can be d rawn and some recommendations made regarding present and future pro-visions for care of the mentally deficient i n B r i t i s h Columbia. CHAPTER 2 i s THE PATTERN OF CARE IB GGREAT BRITAIN Historically speaking, i t w i l l be remembered that both the United States and Great Britain began in the second half of the last century to make provi-sions for the mentally deficient and hopes ran high in the new residential shcools vith their equally new educational system. This vas followed by the periods of disillusionment and then actual hostility and fear on the part of the public vho effectively segregated these unfortunates from society. In America this pattern of institutional care continued on with l i t t l e change right through the nineteen twenties, the years of the Great Depression, and the Second World War. In contrast, the past ten years have seen a quicken-ing of Interest throughout the nation, affording unprecedented opportunities for the mentally deficient.* It vas even more recently that a national parents' group was established which quickly became a powerful influence for progress. In America the care of the mentally deficient i s the respon-sibil i t y of the individual State so i t i s not surprising that some of the older and richer members made steady advances in such areas as institutional care, education and training. However, there continued to be a lack of gen-eral participation by individuals and groups within the community in the care of the mentally deficient. On the other hand, Great Britain began this period with a framework of legislation which included provisions for care in several types of institu-tions and under various forms of guardianship, including private family care. 1. Roselie, E.N., Chairman, "Report of Committee on Administration, American Association on Mental Deficiency, May 2A, 1955."{ American  Journal of Mental Deficiency: Vol. 60 #3, Jan. 1956, p. 661. 27. Much r e s p o n s i b i l i t y lay with the l o c a l governments and from t h i s arose a complex pattern which featured p a r t i c i p a t i o n by many voluntary organiza-tions i n the areas of both care and education. The years following the l a s t war have seen revolutionary advances i n s o c i a l services,education, and health, which have had."far-reaching e f f e c t s f o r the mentally d e f i c i e n t . Trends i n Great B r i t a i n S o c i a l services had long been accepted i n Great B r i t a i n as a natural benefit available to c i t i z e n s of the state, when, during the recent war years, the further idea of s o c i a l security f o r a l l "from the cradle to the grave" was f i r s t given o f f i c i a l expression. This was the famour Beveridge Report on " S o c i a l Insurance and A l l i e d Services", 1942*. I t s recommendations were to be b u i l t upon a foundation of three basic services: a system of children's allowances, comprehensive health and r e h a b i l i t a t i o n servioes f o r a l l , and control of unemployment. I t looked forward to a wide p o l i c y of s o o i a l progress to be achieved by co-operation between the i n d i v i d u a l and the state. Many of these outlines have now been f i l l e d i n by l e g i s l a t i o n which provides f o r family allowances, insurance against i n j u r y and unemploy-ment, and statewide town and county planning. S i m i l a r l y , the National Assistance A c t , 1948, removed the l a s t traces of the old Poor Laws by pro-2 j/' viding a n a t i o n a l l y operated shceae of f i n a n c i a l help from ce n t r a l funds. The setting of standards and r e o r g a n i z a t i o n of care f o r children was done 3 i n the Children Act, 1948. These trends towards natlonrwide oare and r e s -p o n s i b i l i t y f o r those.in need have considerably influenced the care of the 1. -.;- - * " S o c i a l Services i n B r i t a i n , " Central Office of Information. London, 1954* p. 5. 2. I b i d , p. 6, 3. loo,, Q i t . 28. mentally d e f i c i e n t . The main l e g i s l a t i o n concerning t h i s group i s s t i l l the Mental Def ic iency A c t , 1913 to 1930, but i t s object ives have been given f a r greater scope and e f f e c t through the prov is ions of the new and comprehensive Nat ional Health Service Ac t , 1946, and the Education A c t s , 1944 to 1953. The Mental D e f i c -iency Act defines four c lasses of de fec t i ves , namely i d i o t s , imbec i les , i feeble-minded and moral de fec t i ves , and sets out the forms of care . F i r s t l y , I n s t i t u t i o n a l care may be provided i n State I n s t i t u t i o n s f o r the " c r i m i n a l or dangerous", C e r t i f i e d I n s t i t u t i o n s f o r pub l i c custody, C e r t i f i e d Houses f o r p r i v a t e l y paid custody, and Approved Homes which can keep pat ients on a voluntary , unrestrained bas is only . Secondly, there i s Guardianship by a su i tab le person appointed by j u d i c i a l au thor i t y , and t h i r d l y , Supervis ion by l o c a l o f f i c i a l s or assoc ia t ions . Overa l l r e s p o n s i b i l i t y f o r the superv is ion and protect ion of the i n d i v i d u a l de fec t i ve , as w e l l as inspect ion of places of care i s held by the Board of Cont ro l which works through the M i n i s t r y of Health. The Loca l A u t h o r i t i e s , a t the county l e v e l have c e r t a i n dut ies i n i d e n t i f i c a t i o n and r e g i s t r a t i o n while the Loca l Educat ional Author i t ies have fur ther dut ies towards the school age defect ive c h i l d . F i n a l l y , the Regional Hosp i ta l Boards under the Nat ional Health Service Act are required to provide s u f f i c i e n t accommodation i n i n s t i t u t i o n s . I t should be noted here that the above l e g i s l a t i o n appl ies to England and Wales, whi le separate enactments provide s i m i l a r services to Scotland and I re land. With t h i s l e g i s l a t i v e and administrat ive outMne i n mind, the care and opportunit ies ava i lab le f o r the mentally d e f i c i e n t and t h e i r f a m i l i e s can next be discussed. 1. Tredgold, A . F . , A Textbook of Mental Def ic iency . B a l l l i e r e , T i n d a l l and Cox, London, 1952. 29 Identification The majority of mental defectives f i r s t come to o f f i c i a l notice i n the schools 1 where the child i s faced with the normal demands for his age group for the f i r s t time. Furthermore, the Education Act specifically makes i t the duty of the Local Educational Authority to ascertain a l l children who need 2 special educational treatment, from the ages of two to sixteen years. School Welfare Officers, a group whose services evolved from truancy-policing duties to a true lia i s o n between school and hose, now take on important func-tions of identification. In the course of v i s i t i n g a l l families who have not sent their five year old ohildren to school, the Officer may suspect mental deficiency and the ehild i s referred to the School C l i n i c , The parents of such a child over two years of age not only have the right to have their child examined but they may, under the Education Act, be required to have 3 the child examined when requested to do so by the proper authorities. The Local Authority i s required by the Mental Deficiency Acts to ascer-tain what persons within i t s area are defective» under certain categories.^ These include persons subject to neglect or cruelty and those involved i n crimes or imprisonment. The parent also may refer a child who i s i n need of cara and training beyond home f a c i l i t i e s , while th© schools may refer children who are ineducable and those who w i l l require supervision after leaving school. In Great Britain the child welfare centres, whieh we would c a l l well^baby c l i n i c s , have become universally popular and have thus become an important •I; -m * - - "Social Work and the Social Worker i n Britain"} Central  Office of Informationt London, 1951, p. 48. 2% ,0P. ci$. p. 468. 3. - "Children i n Britain"} Central Office of Informationt London, May, 1953. 4 , O P . c i t . p. 46O. 30. r e f e r r a l agency for the mentally defective. Other sources include hospitals, family doctor, relatives, friends and the courts. Para l l e l advances i n child welfare under the Ohildren Act, 1948, have included registration of a l l children i n care or requiring special services which has become another meth-od ©f referral. Thus i t can be seen that measures have been taken to ensure that a oarge proportion of the mentally deficient i n the country are identi-fied at an early age. Diagnositc and planning services are most important as they form the base of any program for the mentally deficient, A system of Child Guidance Clinics i s being bu i l t up from the previously separate f a c i l i t i e s of psychiat-r i c department of general hospitals, l o c a l health services and school c l i n i c s . The responsibility i s divided between the Ministries of Health and Education but i n practice joint c l i n i c s have often been formed. Here the professional team of psychiatrist, psychologist, and soeial worker carefully studies a l l aspects of the child's development i n the light of his environment and family background, Makes a diagnosis, and i n co-operation with the family, a plan for the chil d i s made* Many c l i n i c s provide continuing treatment f o r emotional maladjustments of the c h i l d , and offer guidance to the parents as well. There are travelling c l i n i c s i n some areas, while others supply extensive transpor-tation f a c i l i t i e s so that the client can go to the c l i n i c regularly for treatssent, Psychiatric social workers may also take services directly to the hoiae. The important function of the Child Guidance C l i n i c appears to be gen-erally appreciated, as indicated by the growth of the system and the endeavour to make these services available to a l l . Home Care and Family Services B r i t i s h parents have traditionally been encouraged and helped to maintain their defective child i n their own homes. This has been achieved both through 31. specific legislation and services, and by support of the generally advanced educational and welfare services. The primary need of the mentally d e f i c i -ent child and his family who are providing such care, i s a guarantee that guidance and supervision w i l l continue thoughout Ms l i f e , regardless of what the future may hold for the individuals concerned. In this respect the legislation does recognize that mental defiolency i s a long term condi-tion i n which the person may require varying degrees of care and protection / throughout his l i f e . The Mental Deficiency Acts provide for not only i n s t i -tutional care but the State also assumes considerable responsibility for care in the home by means of Statutory Supervision and Guardianship, Statutory Supervision i s an o f f i c i a l recognition that a person i s mental-l y deficient and, following such registration, the Local Authority undertakes to provide continuing services. Social workers or health visitors make regu-lar calls to the home to see that the person i s being properly cared for and to give help and understanding i n the d i f f i c u l t problems that arise i n the handling of the mentally deficient. Guardianship, goes a step further and i s an order of a j u d i c i a l authority which delegates guardianship to a s u i t -able person, with over-all supervision by the Board of Control. This may be applied to the parents of the mentally deficient which then empowers the local authority to provide financial assistance up to the entire cost of his maintenance. In addition to these provisions, the Mental Deficiency Act als6 requires the Local Authority to provide suitable training, or occupation for those under supervision. The parents can expect understanding and expert help i n meeting the problems of mental deficiency, with financial help where necessary, and can care for their child i n the home, secure i n the knowledge that the r esouroes of the state stand by i n case of emergency. The mentally 32. d e f i c i e n t c h i l d i s guaranteed proper care f o r l i f e , with his own family where possible, while also available i s a wide selection of i n s t i t u t i o n s , t r a i n i n g f a c i l i t i e s and places where he can do useful work. The Education Authority makes appropriate shcooling available nearby wherever possible, spends a good deal on transportation, and often provides v i s i t i n g teachers f o r academic i n s t r u c t i o n and educational parent guidance i n the home. Voluntary children's care committees are a feature of English Schools by which voluntary workers v i s i t the homes to deal with matters af f e c t i n g the welfare of the c h i l d outside the school curriculum, and are often directed by a s o c i a l worker. In England the main voluntary organization i s the National Association 2 f o r Mental Health. I t brings together the interested p u b l i c , professional workers, and goveamment observers, with some grantss'ins'aid from the M i n i s t r y of Health. The Association i s active i n several f i e l d s of mental i l l n e s s and mental deficiency. As a t r a i n i n g body i t conducts s p e c i a l courses f o r profes-s i o n a l workers which have become national standards, and provides lectures to the public. To the parent of a mentally d e f i c i e n t c h i l d i t offers help i n the problems, and advice i n making best use of the many l o c a l f a c i l i t i e s a v ailable. I t provides an information and l i b r a r y s e r v i c e , and makes i t s views known on l e g i s l a t i v e and administrative matters. The Association i s also active In practice and has I t s e l f opened several homes and s p e c i a l f a c i l i t i e s . I t employs a s t a f f of psychiatric s o o i a l workers who act f o r c e r t a i n l o c a l authorities i n providing preventative and after-care services i n the community* Opportunities f o r more dir e c t p a r t i c i p a t i o n and support i s 1. „ - - "Education i n B r i t a i n " j Central Office of Informations London, July 1955. 2. - - - - wSocial Work and the S o c i a l Worker i n B r i t a i n " ; Central  Office of Information: London, October 1951. 33. being provided by a parents 1 assoeiatlon. The National Association of Parents of Backward Children, with headquarters i n London, i s opening many branches and growing rapidly. To the North, the Scottish A ssooiation for Mental Health has led i n setting up occupational centres for the mentally deficient, pro-vides employment services, and offers help and friendship to this group. Other areas of sooial legislation have strengthened the home and family and thus i t s a b i l i t y to care for the mentally deficient member. The National Assistance Act relieved local areas of financial responsibility for the poor and i t would seem that the Local Authority should now be better able to pro-vide for special groups such as the mentally deficient. Housing and community planning legislation w i l l enable more families to provide proper home care. More directly, the National Health Service provides f u l l medical attention* thus relieving the family of a heavy burden which might otherwise have been a factor i n deciding against home care. However* beyond these Various mater-i a l aids, perhaps the greatest single feature of Great Britain's program i s not only the emphasis on good care i n the home, but rather the State's w i l l -ingness to assume a real measure of responsibility for the mentally deficient by providing supervision and guardianship throughout his lifetime., Education. Training and Custodial F a c i l i t i e s Fresh impetus to the work which had been done i n the past for handicapped children was given by the Education Act, 1944* In a publication from the Central Office of Information i t i s stated that the general duty lai d upon every Local Education Authority to provide a sufficient variety of primary and secondary education to suit the different ages, a b i l i t i e s and aptitudes of the children i n i t s area was reinforced by a specific charge to have regard to the needs of pupils suffering from a d i s a b i l i t y of mind or body* and to 34. provide s p e c i a l educational treatment f o r them; and by a further duty to f i n d out what children i n t h e i r area required such treatment.* Thus the school medical o f f i c e r i s now required t o determine whether children are educable or 2 uneducable i n a school provided by the Education Authority. I f the c h i l d cannot make use of education, then he must be reported to the l o c a l Mental Deficiency Authority; i f he i s capable of being educated, then the Educational Authority must provide the type of f a c i l i t y that he needs. Of the group who can pursue academic studies on a l i m i t e d scale there are pupils of Borderline Intelligence (I.Q. 70-90), by our d e f i n i t i o n , who can nearly a U be placed i n "Backward" classes of the regular schools. Those of approximately I. Q. 55*70 can usually best be placed i n a Special School where the c h i l d can proceed at his own pace under s k i l l e d leadership; Spec** i a l Schools teach the primary academic subjects u n t i l , I d e a l l y , the Chi l d i s thirtee n years of age. Importance i s also placed on a r t s and a cra f t s of a creative nature, along with music, drama, dancing and recreation. I t Is rec -ommended that at adolescence a d e f i n i t e break should be made, at which point the c i i i Id can then enter a Secondary (Special) School where, the emphasis would be on a c t i v i t i e s and studies c l o s e l y geared to the approaching r e a l i t i e s of adult l i f e . Thus there would be manual t r a i n i n g , domestic science, charac-t e r and c i t i z e n s h i p t r a i n i n g with opportunities f o r student leadership and di r e c t i o n i n the school, and r e l i g i o u s education. In practice, however, there Is at present a shortage of nearly a l l kinds of s p e c i a l schools provision. In England and Wales, December 1952, there 1. „,.«.. "Education i n B r i t a i n " ; Central Office of Information: London, J u l y 1955, p. 25. 2. Tredgold, A.F.; A Textbook of Mental Deficiency: B a i l l i e r e , T i n d a l l and Cox, London, 1952, p. 427, 3. - - - f "Pupils with Mental or Educational D i s a b i l i t i e s 0 ; A Report  of the Advisory Council on Education i n Scotland: H.M.S.O. Edinburgh, 1951, pp. 40-41. 35. were 20,020 educationally subnormal children attending Special Schools* while 1 the waiting l i s t had reached the t o t a l of 12,500, Scotland has been eneoun-tering d i f f i c u l t i e s with i t s sparsely settled rural areas, and near-inaccess-ible mountain regions. It was estimated that i n 1948 more than forty percent of the mentally deficient children were not receiving the special education 2 treatment they required. The Scottish Advisory Council, which was mentioned above, f i r s t l y rec-ommended that special day schools be provided wherever possible with small classes, and school enrollment of about 150 pupils. Where this eould not be done as, for example, in the one-room rural school, the teacher should receive increased help from Ravelling Child Guidance Clinics i n the natter of iden-t i f i c a t i o n of the mentally deficient and i n the handling of these children. The Council held a firm belief i n the ehild's need for home and family l i f e and so recommended secondly that transportation be provided whereby the child could attend a centrally located special school, or all-ag© class* Falling this* they stated, provisions should be made for the child to reside i n a foster home, or a small hostel, where he could attend a special day school, i n the f i n a l resort there should be a residential, cottage type school available for him where he could receive educational services and a good li v i n g experience. I t was noted that a lack of such f a c i l i t i e s some-times resulted i n a ohild being sent to an institution for the more severely mentally deficient, which was deplored. The Scottish Advisory Council poin-ted out the urgent need for residential schools to care for those mentally deficient children whose homes are gravely unsatisfactory, or who are them-•iinj- •mil i r • r - i ~ r i i r i i n ' i i ' • • • ' • r - - " f — i - - " i - r - i — r — r r — ' • • - i r - " - r r r - ' - i r irr TI1 ••••r~*— i^f V ' j ' " r f — T j r ^ Y t ] r - " , , ' ^ - ^ ' ' - r ~ — *-T r — ' T T I r H ~ m ^ T r i r r - i T X, m - • . "Training and Supply of Teachers of Handicapped,Pupils"j I.M.S.G,, London, 1954, p. 39. 2, OP. e i t . p. 36. . 3 6 . selves emotionally disturbed. It i s important to note that the Education Act of 1944 does not register these educable children as mental defectives but c a l l s them educationally subnormal. However, a large proportion of these children are certifiable 1 and Tredgold emphasises the duty of the schools to inform the Mental D e f i c i -ency Authority of a l l children who w i l l require supervision on leaving school, as such notification makes the child e l i g i b l e for a i l the after-care services. The other group, the ineducable, are immediately made known to the Local Authority and are placed under supervision according to the provisions of the Mental Deficiency Act. The Educational Authorities are s t i l l interested however, i n the i n -educable c h i l d . Provisions for the ineducable chi l d are made i n Occupational centres where those of I.Q.'a about 40-55, who have f a i l e d their t r i a l at special school, may receive training. These centres were originally oper-ated by voluntary organizations i n private houses, church halls and the l i k e . The new Education Act provides for subsidization of these centres, opening of new ones and incorporates this service into the overall scheme. These trainable children are taught personal care and hygiene, simple crafts, and especially are given help towards socialization and expression such as music,, dancing, and games. They may be helped to understand certain everyday warn-ings and directional signs and conventions, and carry out simple domestic and manual tasks. When the child reaches 16 years of age he leaves the Jur-isdiction ©f the Education Act and some local areas or voluntary associations provide Occupational Workshops where it he ineducable; person may work and earn i n woodwork, handwork, knitting machines and simple manual tasks. These centres not only train the child but also render the Valuable service of 37. affording parents a respite from the duty of meeting the demands of these children. For mental defectives requiring Institutional care there are the four different classes of establishments. The State Institutions care for the criminal or dangerous defectives, while the bulk of the group are cared for i n Certified Institutions, under the Regional Hospital Boards. Privately supported premises are Certified Houses and Approved Homes, the latter receiving voluntary patients only* In addition to care and protection, these institutions provide education, training, socialization, and prepar-ation for return to the community wherever possible. Vocational training should be available to a l l educable mentally defic-ient persons when the special school system i s completed i n Great B r i t a i n . The Education Act of 1944 recognized o f f i c i a l l y for the f i r s t time that the educational process was a continuous process through which a l l young people would pass. Secondary education w i l l be more universally provided for this group v i t h emphasis on vocational training at the Special Schools. Rehabilitation to the Community In order to become established i n the community the mentally deficient person almost invariably requires a family with whom he can l i v e and receive some degree of help and supervision. Those who are fortunate enough to have interested and capable parents may l i v e with them and s t i l l receive the ben-e f i t s of supervision, and where necessary, the cost of maintenance may be paid by the state. For the others a home may be found for them through a family care system. In Scotland a famous system of family care has been i n operation for over 38. on© hundred years. Separate provisions were later made for the mentally deficient and the system expanded u n t i l i n 1947 Pollock stated that practic-a l l y 30 percent of the t o t a l certified mental defectives were i n family care. 2 The Board of Control was responsible for supervision while the Local Authority paid maintenance at half the cost of institutional care. The most satisfactory placements were rural d i s t r i c t s with their less de-manding tempo of l i f e . Patients were placed with crofters or small farmers where they shared the family l i f e , i t s table, and i t s work, I t was found that patients generally responded well to placement i n such an accepting environment and practically a l l enjoyed taking some part i n the work on the farm., Pollock believed that there would be d i f f i c u l t i e s i n applying such a scheme to the large georgraphlcal areas of America and saw disadvantages i n the lacks of Supervision and opportunities for social a c t i v i t y . Instead of this dispersion method he advicated a colony system of family care, such as 3 the original which s t i l l flourishes at Gheel i n Belgium. This requires establishment of a small infirmary-reception centre i n a suitable community, perhaps a small town, following successful interpretation and pro&o^ion of the program to i t s inhabitants. The new foster parents would be given t r a i n -ing courses i n the care of the mentally deficient and a large number of placements would be made In the surrounding area. Some family^siaed custod-i a l units might also be added. He believed that such a colony of family 1. Pollock, H.M.J "Family Care of Mental Defectives In Scotland"? American Journal of Mental Deficiency? Vol. 52 #1, July 1947, p. 85. 2. Ibid;, p. 86 3. Pollock, H.M.J "Requisites for the Further Development of Family Care") American Journal of Mental Deflcieneyt Vol. 50 #2, Oct. 1945, pp. 326-329. 39. care, supervised by the state institution or a central agency, would be best for America, although he had much praise for the s k i l l e d and devoted Scottish Guardians. In England the Guardianship Society with headquarters at Brighton has become a huge placement agency with special institutions i n Brighton and a large staff of social workers supervising hope care throughout Southern England, As a private agency i t did pioneer work i n after-care services to those returned to the community and originated special workshops. The larger institutions have also done substantial work i n rehabilitation of the mental-l y defective. In the study reported by Badham,* over 90 percent of a large group of rehabilitees were successful i n adjusting both to foster home l i f e with i t s requirements of acceptable behavlous, and to the work situation. Of these, about two-thirds became f u l l y self-supporting while the remainder were partially self-supporting. The requirements for operation of the rehabilita-tion scheme included careful selection with assessment of patients as to their personality structure as well as vocational aptitude. Emphasis was placed on good job placement, i n which the knowledge about the patient was re-lated to the work to be done and the personality of the employer. A suitable residence was provided and the placement was followed by skilled supervision. Significantly, the study led to the reorganization of training to be i n line with the objective, and pointed out the need for co-ordination of selection, training and rehabilitation under one administrative head. F i n a l l y , Badham stressed the importance of dealing with the patient as an Individual and maintaining close personal contact through continued supervision. 1. Badham, J.H.j "The Outside Employment of Hospitalized Mentally Defective Patients as a Step Toward Eesocialization H5 American Journal of M e n M . D e m t o e v ; Vol. 59 #4, A p r i l 1955. 4.0. i n Great Britain the Ministry of labour operates Employment Exchanges which include a Youth Service and, particularly, the Disablement Resettle-ment Officer (D.R.O.). The work of these officers involves close co-operation with medical and l o c a l authorities and numerous welfare agencies.* They offer vocational guidance and the services of vocational psychologists. The D.R.O. then endeavours to find suitable work for the individual with his handicap. He i s helped by the Disabled Persons Employment Act, 1944* which requires most employers of more than twenty persons to reserve a quota of three percent for registered disabled persons, The D.R.O, may recommend the applicant for industrial rehabilitation or vocational t r a i n -ing, during which the applicant may receive f i n a n c i a l assistance. In addi-tion to these services there are provisions f o r sheltered employment, with some workshops being operated by voluntary organizations with state grants. Thus the mentally deficient person not only receives help from his t r a i n -ing school but there are also these special services available to him, and he faces a society which i s becoming more aware of the needs of the handi-capped. Social and recreationalf a c l l i t i e s are a serious problem to the mentally deficient person out i n the community. It i s not possible f o r him to take part i n many ac t i v i t i e s and he needs most the understanding companionship of persons who are closer to his own level. He often needs the direction of a supervised recreational program i n order to take part i n social activ-i t i e s . The Scottish Advisory Council recommended that recreational clubs be provided i n connection with the schools, such as i s presently done i n some of Britain's larger Ci t i e s . It would appear that the fulfilment of 1, - - - - "Social Services i n Britain"j Central Office of Information^ London, 1954, p. IB. ,41. t h i s need i s l e f t to the voluntary organizations and i t i s to be hoped that s o c i a l opportunities w i l l be made available to the mentally d e f i c i e n t . Personnel,Training and Research The great extension of services to the mentally d e f i c i e n t requires a sim i l a r increase i n the number of trained persons to carry out the l e g i s l a -t i o n . Teachers of the mentally d e f i c i e n t i n s p e c i a l schools are urgently needed, according to the recent report of the National Advisory Council on 1 the Training and Supply of Teachers. To complete the developmental plans of l o c a l educational authorities f o r s p e c i a l schools w i l l require an addi-t i o n a l three thousand teachers. The Advisory Council a l s o found that standards must bo reaised f o r teacher q u a l i f i c a t i o n s • I t recommended that a l l must complete an approved course of t r a i n i n g as a teacher, followed by at least two years' experience i n ordinary schools. After preliminary ex-perience i n a s p e c i a l school the teacher then should undergo s p e c i a l t r a i n -i n g , a one year university course. The s i t u a t i o n i n Great B r i t a i n i s so acute that the Advisory Council had to recommend short courses as a tempor-ary expedient to f i l l the requirements f o r new teachers and to bring those i n the f i e l d up to some standard. Teachers and other s p e c i a l i s t s i n the f i e l d of mental deficiency must also be personally suited to helping t h i s d i f f i c u l t g roup and be able t o bring an understanding a t t i t u d e to the emotional problems a r i s i n g from the individual's handicap. The above report showed that the demand f o r teachers and s p e c i a l i s t s i n the f i e l d was tremendous both i n numbers and i n q u a l i f l -1. — - - "Training and Supply of Teachers of Handicapped Pupils' 1 j H.M.S.O.: Bondon, 1954, p. 13. 42. cations, and recommended f i n a n c i a l assistance during t r a i n i n g , followed by increased f i n a n c i a l reward f o r the s p e c i a l l y q u a l i f i e d . This pattern of great demand, increased q u a l i f i c a t i o n s required, and need f o r higher s a l a r i e s , as described f o r teachers, applied equally to the other groups serving the mentally d e f i c i e n t . The Committee on S o c i a l Workers i n the Mental Health Services* reported that i n 1951 England and Wales alone required 1,500 psychiatric s o c i a l workers, besides a s t i l l larger number of other trained and experienced mental welfare workers. The t r a i n i n g of these s o c i a l workers requires a long u n i v e r s i t y course and includes postgraduate study and practice. Unfortunately s o c i a l work salaries have continued at a low l e v e l while the nature of the work makes great demands of the i n d i v i d u a l . In the l i g h t of these requirements i t would appear that such a great shortage of s o c i a l workers w i l l only be overcome by s p e c i a l inducements to those who would be suitable f o r the work. Probably these would have to Include further educational bursaries and gen-e r a l l y increased salary scales. One aspect of t r a i n i n g i n B r i t a i n deserves s p e c i a l mention because of i t s unique demonstration of a r e a l desire to provide f o r the ch i l d ' s basic needs, namely, the t r a i n i n g of "housefathers 1 1 and "housemothers". B r i t a i n seems to be w e l l advanced i n providing for c h i l d r e n i n small separate homes where s i x to twelve boys and g i r l s are cared f o r by a married couple i n a normal home atmosphere, A government agency operates t h i s course i n prac-2 t i c a l care of children and grants a National C e r t i f i c a t e . From the above discussion i t would appear that Great B r i t a i n ' s outstand-1. " S o c i a l Work and the S o c i a l Worker i n B r i t a i n " j Central Office  Information: London, 1951, p. 47. 2, " S o c i a l Services i n B r i t a i n " ) Central Office of Information; London, 1954, p. 46. 43. Ing program and further plans for the mentally deficient are being seriously restricted by shortage of specialist personnel. It is'noted that the Educa-tion Act of 1944 enables the Minister to foster research* and make grants to various bodies, and i t might follow that further research on personnel prob-lems i s indicated. In summary, services to the mentally deficient i n Great Brita i n began with the establishment of training institutions i n the second half of the last century while during the past f i f t y years, services have been expanded by legislative means and with the continuing support of private organizations. The years following the last war saw the enactment of comprehensive social legislation which had been forshadowed by the famous "Beveridge Report" of 1942. This trend towards nation-wide care and responsibility for those i n need considerably influenced the ear© of the mentally deficient. General measures ensured the better care of children, financial security for families, and the provision of housing, while the encouragement of twon and country planning was directed towards more satisfactory community l i v i n g conditions for a l l citizens. The specific legislation included the National Health Act which set up a new administrative system for institutions, established diagnostic f a c i l i t i e s , and provided free medical care* The Education Acts placed on the schools certain duties of identifying the mentally deficient and the f u l l responsibility for the education of a l l children who were deemed "educable".. Legislatively speaking, Great Britain has reached an advanced 1, "Education i n Britain"} Central Office qf Information; London, 1955, p. 13v 44. stage of development i n the care of the mentally deficient. A brief review of the actual services given w i l l point out the extent to which the l e g i s l a -tion has been put into effect and places where there i s further work to be done. The key service i n any program for the mentally deficient i s early identification, diagnosis, and planning with the parents, and Great Brita i n makes f u l l provision for this i n the Education Act. The School system seems to be a lo g i c a l choice because i t i s here that the majority of mentally deficient children are discovered i n any case, when the child f a i l s to measure up to academic requirements. Similarly, the school liaison officer already has the duty of reporting children who are not sent to school and i s thus i n a position to safer suspected cases to the c l i n i c s for examination. The parents are brought into the planning, and for the same of the c h i l d , may be required by law to present the child for examination. The c h i l d guidance c l i n i o s , often operated jointly by Health and Education Authorities, are well accepted and give f u l l services to chi l d and family, although the c l i n i c system i s s t i l l being developed so as to cover a l l areas. The c h i l d welfare centres and other soeial services have aided i n identification. Thus the Local Education Authority Is responsible for identifying a l l mentally deficient children from two years of age to sixteen, while the Local Authority i s responsible for the protection of any mentally deficient person who suffers neglect, cruelty, or imprisonment. Great Britain has traditionally encouraged the care of the child i n his own home* The Mental Deficiency let provides for life- l o n g supervision or guardianship aa may be required, thus assuring the parents that their c h i l d w i l l receive continued care. The c h i l d and family may receive supervisory 45. v i s i t s , financial aid, and complete medical e a r e . Special educational and training f a c i l i t i e s are usually available l o c a l l y with transportation sup-plied, while teachers w i l l bring training to the home i f required. As the chil d grows up, some provisions for occupational and industrial centres have been made. Voluntary organizations have long been established in this area and additional help i s now being offered by the growing parents 1 organ-ization. In effect, these many and varied services enable the mentally deficient person to function at his best at home, and throughout his l i f e -time. Educational f a c i l i t i e s for a l l educable children are now required by law, at both primary and secondary levels, while for the trainable group provisions are made for occupational centres to provide daily training class-es. Some occupational workshops are being provided. State institutions have been active i n studying their own training programs i n order to improve their rehabilitation schemes, Great Britain's educational and training f a c i l i t i e s for the mentally deficient are recognized as being outstanding. Rehabilitation services are also on a high place with long-established family care programs, statutory supervision and guardionship for the indiv-idual's protection, and special job-finding resources or sheltered workshops. Lessons of the B r i t i s h System The program, as a whole, for the mentally deficient i n Great Britain can be cited as an outstanding example of a country's successful solution of the problem, on a national scale. The program i s complicated to the extreme, including services on a national level by governments, such as the Ministries of Health, Education, Labour, and the Home Secretary} other bodies such as 46. the Board of Control? and private agenqiea such as the National Association for Mental Health, Than, oa a lo c a l level* representatives of the above agencies work together with numerous local governmental and private organ-izations i n providing for the complex needs of the mentally deficients. At the same time, a great number of persons at the l o c a l level are directly concerned with the mentally deficient, whioh i s a strength i n any such endeavour. The schemes are set forth i n national legislation but much of the responsibility rests with the various lo c a l authorities. This Is made possible by the extensive background of supporting soeial services, and probably, by th© B r i t i s h tradition whereby tho individual citizen i s en-couraged to take some public responsibility. The gaps i n the program as applied to Great Britain would seem to be more a matter of degree than of principle. The network of Child Guidance Clinics requires further extension, par-t i c u l a r l y in Scotland, so that a l l can be serviced. This applies equally to the provision of special schools and occupation centres* I t w i l l bs remsm-bered that in Scotland some forty percent of children e l i g i b l e for special educational f a c i l i t i e s were not using them, which indicates the need for alterations and extensions to th© system as well as interpretation to the parents. To serve sparsely populated areas further residential sacools were required. Residential f a c i l i t i e s were also needed for the emotionally di s -turbed child, i n preference to state institutions. Further work i s required i n making available sheltered workshops for th© adult mentally deficient person and, equally important, provision of social a c t i v i t i e s for th i s older group. 47. As noted earlier, the whole program i s being held back as a result of insufficient specialist personnel including special teachers, therapists, and social workers. Further research, followed by decisive action would seem to be necessary before these serious shortages of specialist personnel are alleviated. In addition, there i s need for standardization of personnel qualifications, and general services offered, i n order that Great Britain's fine program should be equally available for every mentally deficient person. CHAPTER 3 AMERICAN EXPERIENCES As a comparatively young country with vast geographical distances and great differences i n stages of development, the United States had produced an equally varied picture i n the many approaches to the care of the mental-l y deficient. Their care i s the responsibility of the individual State so i t follows that we may be assured of at least forty-nine different ways of looking at the problem. A common idea which has persisted u n t i l more recent years i s that of segregating the mentally deficient from society so that today no all-embracing, state-wide program has yet been put into effect. In the meantime a great deal of excellent work has been done i n a technical way on separate facets of the problem, such as design and function of large institutions, and training and rehabilitation. The writings i n the f i e l d , also, are found largely i n the form of separate a r t i c l e s and conference papers, under the auspices of the professional body, the American Association for Mental Deficiency, There has not been a common framework of legislation and practice such as exists i n Great Britain nor, has there been the broad philosophy which enables a real integration of the mentally deficient into the very l i f e of the nation. An American authority i n the f i e l d of mental deficiency, Mr, Ernest M. Roselle,* Superintendent of Southbury Training School, Connecticut, clearly explained the current American situation and future prospects i n an address to the Washington State Convention of the National Association f o r Retarded 1. Roselle, E.N.; "New Horizons for the Mentally Retarded-1; When the State Looks at the Problem as a Whole"; American Journal of Mental  Deficiency; Vol. 59, #3, Jan. 1955. 49, Children, August, 1954. After sketching the outline of a proposed over-all plan for the mentally deficient he stated: "Ten years ago your speaker would have felt that the prospects of such a program being placed in f u l l operation in any state would have been quite impractical, idealistic and even fantasy tic* Today he is convinced i t can be done in many states. This conviction is based largely, of course, on the potentials which l i e in the great national organizations under whose pUspices we are meeting in this gathering. This organization has the power to increase public interest and understanding in this problem including procuring the very essential legislation required to implement the program on its several fronts" Identification Diagnostic and guidance faci l i t i e s throughout the state are seen by RoSelle, as being the keystone of the approach to the problem of mental 2 deficiency as a whole. Such a clinic for this group could give leadership and co-ordination both in locating the mentally deficient and in helping them to make best use of available resources for care, education and estab-lishment in the community. In the more heavily populated urban areas of the United States the public school systems have provided special classes for children whose I.Q. 's were rated at about f i f t y and better.^ The more seriously deficient persons sometimes could turn to a Mental Hygiene Clinio but generally these clinics have had neither the time nor the facilities to work with the mentally deficient child and his parents.^ Thus, about 1949 the newly formed parents' organizations in the Eastern States found that by I* Ibid, p. 366 2. Ibid, p. 366 3. Fried, Antoinettej "Report of Four lears of Work at the Guidance Clinic for Retarded Children, Essex County N.J."j American Journal of Mental Deficiency; Vol. 60 #1, July 1955, p. 83. 4. Garber, R.S.; Discussion Leader, "Outpatient Clinic Services for the Mentally Deficient"; Mental Hospitals: American Psychiatric Association, Wash. D.C; Vol. 7, #2, Feb. 1956; p. 49. 50. far the greater majority of the mentally deficient were being cared for at home, where they had received only haphazard and inadequate planning and 1 educational services. The f i r s t and most urgent project of these voluntary groups was the organization of guidance clinics for mentally deficient children and their parents. The association for the Help of Retarded Ghiodren,.Now York City, established in 1950 what was believed to have been the f i r s t such clinic in 2 the United States designed specifically for the mentally deficient. The basic team consisted of a pediatrician, psychologist, and psychiatric social worker who made f u l l use of consulting services in the areas of psychiatry, neuro-surgery, orthopedics, speech, endocrinology, physical medicine, and laboratory services. At this clinic the child is studied at play and appro-priate tests are administered by the psychologist, while the parents are interviewed by the sooial worker who prepares the social history. Both child and parents are seen by the pediatrician and the consultants, f o l -lowing which the clinic conference is held. Hore a plan of care, training and treatment is decided upon and responsibility placed with the examining pediatrician for directing its course. Another clinic sponsored by a parents group in Hew Jersey, this one on 3 a part-time voluntary basis, is described by A. Fried, with services similar to above mentioned Hew York Clinic. Fried reported that the four year ex-perience of the Hew Jersey Clinic showed successful diagnostic and planning 1. O P . c i t . p. 83 2. Feder,. lathan; "The Clinics of the Association for the Help of Retarded Children, Inc. Hj American Journal of Mental Deficiency: Vol. 56 #2, Oct. 1951, p. 268. 3. Fried, Antoinette, "Report of Four Years of Work at the Guidanoe Clinic for Retarded Children, Essex County, N.J."} American Jo\u?nal of  Mental Deficiency: Vol. 60, #2, July 1955, p. 83. 591. servioes but also pointed up further needs i n the f i e l d s of guidance and education, I t was found that parents required guidance services which would continue after the c l i n i c examination, while the medical practitioner and others i n the community who were concerned with the • mentally deficient also required further information and help i n understanding this special area of practice, (The c l i n i c confirmed that parents of mentally deficient children require special help with personal problems arising from both their own and the community's reaction to the child. The most frequent d i f f i c u l t y encoun-tered was a lack of understanding of the c auses of mental d eficienoy. This lack of understanding led to feelings of gu i l t and shame within the parents with s erious consequences on family and social l i f e , and the parents' own mental health. Secondly, many parents showed rejection of the child with the attempt to cover up by over^protection on the one hand, or by too r i g i d discipline on the other. In either case the a b i l i t y of the child to learn to grow up i s restricted, and an emotional problem may thus be added to this already handicapped child. Further knowledge on the part of professional people, particularly the family doctor, w i l l enable them to help the chil d by facing the defect early, and help the parents by understanding their partic-ularly d i f f i c u l t situation. In America some States have separate systems for the registration of the Mentally Deficient, and i n 1930 seven states had such schemes.* The begin-nings of a more recent state registration, i n Rhode Island, are described 2 by Willoughby. A card f i l e was set up for a l l those who were diagnosed as X. - - - - "The Handicapped Child" ; Whitehouse Conference on Child Health and Protectiont The Century Co., N .X . , 1933. 2. Willoughby, R.R.j "Rhode Island's Experiments i n Registration"; American Journal of Mental Deficiency; Vol. 50 #1, July 1945. 52. mentally deficient by qualified psychiatrists, or a l l those who were rated below I.Q. 70 by adequate psychometric techniques. The main source of infor-mation came from the State Division of Psychometric Services which tests public sehool children, while other sources were the State School for Feebleminded, school c l i n i c s , hospitals, and other agencies. The t o t a l obtained was 7,000 persons or approximately one percent of the population. Information obtained included sex, age, social adjustment, address, degree of defect, family information, marriage, children, physical and ethnic background. To give an idea of the staff required, i t was found that once the system xras i n operation one c l e r i c a l worker at the registry could maintain, 10,000 cards. These 10,000 mentally deficient persons would represent about one million of the general population* Willoughby realized the error of declaring a parson to be mentally de-fi c i e n t on the basis of psychological tests alone and advocated screening by mass tests i n school, followed by a psychiatrist's o f f i c i a l diagnosis. The advantages of such registration can be considerable, particularly i n the area of research and planning, and Willoughby looked upon i t as a minimum essential for intelligent and r e a l i s t i c planning of services. However, there are d i f f -i c u l t i e s involved as shown.by the B r i t i s h experience which was discussed earlier. The diagnosis of mental deficiency i s a serious matter with long term social consequences* Thus the B r i t i s h decided against reporting the higher grade mental defectives i n schools, u n t i l i t was certain that they would require supervision on leaving school. Furthermore, registration I t -self has l i t t l e meaning unless the person Is thereby e l i g i b l e for continued supervision or care. I f , however, life-long supervision i s available for those who require i t , then the registry becomes a control agency which guar-antees that these services w i l l continue to be given, thus placing registration 53. i n a more constructive light. Home Care and Family Services The philosophy and understanding about placing the seriously deficient c h i l d i n an institution, as opposed to care i n the home, has undergone important changes since 1936.* Sr. B. H. J o l l y , found that between 1936 and 194S the number of mentally deficient pationts admitted for the f i r s t time to United States Public institutions had increased gradually by thirty 2 percent. However, he continued, the corresponding f i r s t admissions under the age of five years had increased to three hundred percent. This great relative increase i n the youngest age group coming to the institutions pro-3 dueed a trend which he attributed to three causes. F i r s t l y , better diag-nostic procedures, such as those provided by the c l i n i c s described i n the previous section, have provided earlier identification and thus the problem of institutionalizing has to be faced e a r l i e r * Secondly, and perhaps this i s the most important point, the physicians have been giving iacrieaslngly strong advice for immediate institutionalization. Then, thirdly, as a ra«* Bult, more f a c i l i t i e s were made available f o r babies. These additional demands for c r i b f a c i l i t i e s could not be met at the increased rate so that long waiting l i s t s have b u i l t up i n such institutions. This meant that the parents of a large number of th© mentally deficient who were being cared for at home f u l l y realized their children's need for special care and training. 1. J o l l y , D.H.j "Where Should the Seriously Retarded Infant Be Institutionalized?": American Journal of Mental Deficiency: Vol. 57 #4, A p r i l 1953, p. 632. 2. Loc c i t . 3. m&- P. 633. 54. In the meantime, J o l l y pointed out, much had been learned about the effect of placement on both child and family. Using modern dynamic theories of psychiatry, he showed that i t was a fallacy to say that i t was best to commit a baby before the mother became attached to i t . In most cases the mother was already attached to her child, a process which had been going on throughout pregnancy. It was then necessary for the parents to be with the child for some time to enable them to become "detached 8, time for f u l l p realization of the child's limitations, his need fo r special care, and time to work out their own emotional conflicts. Furthermore, to recommend an institution when such f a c i l i t i e s were not readily available could only serve to place an additional burden of frustration upon the parents. At the other extreme, the child who required institutional placement should not remain i n the home so long that he comes to dominate the family, who then eould not bear to send him away, for the best time for separation had been passed by. J o l l y concluded that there i s an optimum time for separa-2 tion and that this i s seldom, i f ever, i n early infancy. I t i s usually stated that only about one out of every ten mentally ds» fi e i e n t persons i s cared for i n an institution.^ The waiting l i s t s through-out the country are long and have increased with the better diagnostic fac-i l i t i e s . As the number of families with a known defective child i n the home grew, so did the need and demand for help and guidance i n the home. The parents found that there were no public f a c i l i t i e s for the home care and training of the moderate and severe groups of the mentally deficient. I t 1. Ibid, pp. 633*636 Z, Loc. o i t . 3. filliberty, F . . K . and Porter, B.L.H.j "Beginnings of a Home Training Program"| American Journal cf Mental Deficiencyj Vol. 59 #2, October 1954, p. 149. 5 5 . r was this rising number of parents with their better understanding of the services their children required, that led to the formation of the parents' organisations. Mrs, Dorothy Moss, Secretary of the National Association for Retarded 1 Children is quoted by Wlrtz as outlining theg rowth of her organization. She reported that the first organized parents' association for the benefit of mentally deficient children was formed in Cleveland, Ohio, in 1932. It is interesting to note that this was followed in 1934 by what would appear to be the f i r s t statewide parents' group, The Children's Benevolent League of the State of Washington. There were only a few more new groups prior to the s econd world war but following this the r ate of organization quickly increased. The professional people invited parent group representatives to speak at the national conventions of the American Association for Mental Deficiency in 194& and 1949, while in 1950 the activities and problems of the parents were given a definite place on the program. At this latter con-vention plane were made for an organizational conference later in the year at Minneapolis, following which the National Association for Retarded Child-ren officially came into being, on February 6th, 1951. In 1953 the secret-ary reported a total membership of approximately 22,000 with 2A1 local units, 2 just double the membership of the previous year. The parents' groups emerged when individuals became aware of the many problems concerning mentally deficient children which were not being met. 1. Wirtz, M.A.j "The Development of Current Thin&iog About Facilities for the Severely Mentally Retarded"*, American Journal of Mental Deficiency: Voa. 60, #3, January 1956, pp. 499-500. 2«- Loc. clfr. 56. In addition to the lack of actual services for their children the parents very much needed the company of others who were faced with similar problems. Thus the special d i f f i c u l t i e s of caring for such a child and the emotionally charged problems around being parents of a mentally deficient child can each be discussed with others who understand and wish to help. The amelioration of these problems through the group process of sharing and supporting them allows the parents to channel their emotions into healthy, constructive community action. At present i n the United States the parents' organiza-tions are setting up pioneer projects across the country to prove the need for, and v a l i d i t y of, special schools, play groups, c l i n i c s , workshops, social a c t i v i t i e s , auxiliary services to institutions, and home training programs. Many of these services, once proven, can be expected to become part of regular governmental programs. Again* in addition to these concrete services, the parent of the defective child i s particularly helped by the group's educational services, and i n turn many are soon ready to take part i n educating the public. This public Interpretation of mental deficiency co-ordinated with demands for legislative and community action, has been the outstanding contribution of the parents association. The professional groups work closely with the parent organization at a l l levels, f u l l y r e a l -ising that a strong and active parent's group i s the best guarantee that the needs of the mentally deficient w i l l be f u l f i l l e d by an understanding soci-ety. The increased awareness of the needs of the mentally deficient child has led to the early formation of effective plans for his care, training, and education. In Connecticut, the Mansfield-Southbury Social Service 57. Department undertakes much of this work which i s described by Dudley. 1 There are long waiting l i s t s f o r institutional care which swells the number who are being eared for at home. The s o c i a l worker helps the family to make use of available diagnostic c l i n i c a l services and then to come to an informed de-cision regarding their own plan for their child. Outpatients services from the training schools can be made a v a i l a b l e through the worker in the form of consultation, lectures, and home instruction courses at community meetings. Some parents may be able to place their child privately in which case the worker can furnish f u l l particulars of approved homes and schools, and can help to ensure that the family avoids the p i t f a l l of undue financial s a c r i -f i c e at the expense of parents and normal siblings. For those parents who w i l l be caring for their seriously defective child at home, there i s a Day Care Centre i n Hartford, Connecticut, a p i l o t 2 project carried on and largely financed by the training school. Here these children may be placed from nine a.m. to five p.m. at a nominal charge. It has been found that mothers had more time for their families and community work, while several obtained employment. The success of this venture has stimulated formation of more such f a c i l i t i e s by parents' groups. The day care centre serves to relieve the mother from time to time of the constant demands and responsibilities connected with a defective child, giving her renewed strength to f u l f i l l and enjoy her other roles i n the family. In this way the moderate and severely deficient c h i l d can enjoy the benefits of family l i f e without adversely affecting the other members. This writer feels that day care provisions can play a key role i n the home care of the seriously 1, Dudley, Lois P.j "Home Care Program"; American Journal of Mental  Deficiency: Vol. 60 #3, January 1956. 2. Ibid, p. 621. 58. defective child. For the trainable ch i l d , (roughly, the Moderate group of the mentally deficient), "sub-special" classes are becoming available i n Connecticut. Mansfield and Southbury Training Schools, both outstanding institutions i n America, offer a Day School program and the social worker refers families to these f a c i l i t i e s whenever appropriate and possible. For the older ones Sheltered Workshops are i n the planning stage, and there are also special employment provisions. In Connecticut, Dudley* reports that recreational f a c i l i t i e s include separate swimming instruction, special play areas i n parks, daycamps, and a large summer camp i n a State Park for the use of institutions and parent groups. Home care can be further strengthened by bringing training into the home i t s e l f . In America, two such programs which have been i n successful operation for a number of years, i n Massachusetts and i n New Jersey, are 2 discussed by Cianci. The scheme, i n New Jersey, was centred i n the state training school, and was carried out by v i s i t i n g teachers. Referrals came f i r s t from the Department of Institutions and Agencies and later from i -schools, social agencies, c l i n i c s , and the nursing service. For the grossly defective children emphasis i s placed on elementary habit training, emotion-a l control, self-help, speech, and play a c t i v i t i e s . V i s i t s of an hour and a half are made on the average of once every two months. Teaching methods are explained to the parents along with the understanding that this Is a long term process which requires a systematic, established routine with much repetition and perseverance being required. The trainable group are given 1. Ibid. p. 622* 2. Cianci, V.) "Home Training" j American Journal of Mental Deficiency: Vol. 60 #3, January 1956, p. 622. 59. weekly lessons,"again with the participation of both mother and child, in which the child advances to hand work and modified primary studies, which are practised during the intervening week. Household skills are encouraged, both to keep the child busy in a constructive way, and to develop a sense of responsibility and belonging. Companionship was successfully fostered by bringing together two or three suitable children and their parents. 1 Miss Cianci, of the New Jersey Department of Education, points out that the New Jersey program is carried out by the teachers and that the Massachu-setts one is done by the social workers with, she says, the same objectives of better community understanding and better home and family adjustment. She then goes on to explain how parents require insight into their own emotional involvement, and acceptance of the limitations of their child. It seems clear that at this point the functions of teachers and social workers are being lamentably confused. Teachers, especially those who are trained for the mentally deficient, have special knowledge and skills for imparting information, social understanding and philosophy, and other skills, with corresponding training on their use in society, towards the child's growth to maturity. The training of social workers in America does not include sun studies and to do so would require complete teacher training. Social Workers, on the other hand, are prepared with a broad knowledge of the organization of the social services, an understanding of the human behavious as related to helping people with their problems, and a high degree of s k i l l in one of the methods of social work, in this instance casework with the individual and family. Teachers are not trained in these areas and 1. ibid. P. 623 60. should not attempt to practise in them. Fortunately, there should be no dif-ficulty in resolving this confusion over function. Each group should first of a l l keep within its own area of competency, and secondly have a good under-standing of the services given by the other profession. Teachers and social workers should be able to work well together with close consultation between them, and without duplication or confusion. At times a family might require intensive services by the social worker around, say, personalyand family problems or decisions, while at others the emphasis might be on the training of the child, Similarly, the parents and child should be able to easily sep-arate these functions in their own minds, as they are already accustomed to doing in the community. To categorize, teachers do Home Training, while soc-i a l workers are concerned with Home Care. Home care services can be expected to take an important place as the solution of one facet of the complex prob-lem of mental deficiency. Education. Training, and Custodial Facilities. Educational opportunity for every child to the limit of his capacity, Is the basic philosophy in the United States concerning public education. Roselle points out that this is the right of. the child in a democracy and 2 that society clearly has the responsibility to provide the opportunity. Wirta reports the ruling in 1929 by the Attorney General of the State of Illinois that a board of education has no legal right to exclude feeble-minded child-ren from school. This was reaffirmed in 1931 and has since been used by 3 parents in their demand for provisions for their deficient children. 1. Roselle, E.N.j "New Horizons for the Mentally Retarded"* American  Journal of Mental Deficiency; Vol. 59 #3, January 1955, p. 367. 2. Wirtz, M.A.* "The Development of Current Thinking, etc."i American  Journal of Mental Deficiency; Vol. 60 #3, January 1956, p. 502. 3. Loc. c i t . 61. Prom the educational point of view there are three groups within the mentally deficient f o r whom separate and distinct provisions must be made. 1 The Connecticut legislation defines these groups i n a clear and acceptable 2 manner. The f i r s t group i s the Educable Mentally Deficient which contains those whose expected level of intellectual functioning f a l l s between that commonly expected of a seven year old to that of an eleven year old. This would approximately include the Mild group of mental deficiency. The seoond group i s the Trainable Mentally Deficient whose maximum intellectual func-tioning would be less than the seven year old, and approximates the Moderate Group of mental deficiency. They mist be capable of walking, of clean bodily habits, aad o f obedience t o simple conaaands. Thirdly, the Custodial Mentally Deficient i s not expected to attain clean bodily habits, responsiveness to directions, or means of intelligent communication. They would correspond to the Severe Group of mental deficiency* l a America the f i r s t provisions for the Educable group were made i n the 3 Eastern States at the end o f the last century* These became special clas-ses within the regular framework of th© public school system. Special classes for the Educable group have now become the accepted principle i n the United States, although there i s liable to be th© usual lag i n putting the principle into effect, ©specially i n the more remote areas./ In the mean-time soiae states have made i t mandatory for educable mentally deficient children of compulsory school age to attend school li k e the others, for ex-X. - - - - "An Act Concerning Mentally Handicapped Children"; Public Act 432 of 1953, State of Connecticut, Section 1. 2 . "Deficient" i s substituted for "Handicapped" to be consistent, 3. Vlirta, M.A.j "The Development of Current Thinking, etc," 5 American  Journal of Mental Deficiency: Vol. 60 #3, January 195.6, p..495. 62. 1 2 ample California in 1949 and Connectieut in 1953. The latest advance in this area has been the provision of special classes right through the High School grades. In her study of suoh classes in San 3 Diego City High Schools, Clapper notes the success of the program and makes several recommendations.^- In these grades, from ten to twelve, the special classes should remain small with specially trained teachers while academic studies should continue. The mentally deficient pupil should participate in a l l aspects of school l i f e . She recommended a program of vocational guidance, followed by an on-the-job training program, with counselling to pupil and parents as to future planning. This is certainly a true example of the schools endeavouring to help the mentally deficient pupil reach the maximum of his or her capabilities. The Trainable Mentally Deficient group s t i l l requires provision for them in the public schools, and the parents1 groups are leading the demand for this service. The developmental pattern of educational f a c i l i t i e s for 5 the trainable group i s , as Wirt?/ points out, following the early historical path which was blazed by the American pioneers in thqir struggles towards general public education. Many parents groups are being formed with the immediate objective of establishing private classes and schools to train their own children, at their own expense, which forms the f i r s t traditional step in the United States pattern of organizing new school f a c i l i t i e s . Sec-1. Martin, M.F.; "The Hole of State Legislation, etc."; American Jour7  nal of Mental Deficiency; Vol, 59 #1, July 1954, p. 46. 2. - - - * "An Act Concerning Mentally Handicapped Children"j Public Act A32 of 1953, State of Connecticut, Section 3. 3. Clapper, CO.; "A Study of Mentally Retarded Students in San Diego City High Schools"; American Journal of Mental Deficiency; Vol. 59 #1, July 1954, p. 44. 4. Loo,. „c,3fr. 5. Wirtz, M.A.; "The Development of Current Thinking, etc."; American  Journal of Mental Deficiency; Vol. 60 #3, January 1956, p. 501. 63. ondlj, as the private classes grew into full-scale schools the parents have sought financial assistance from private welfare funds, social organization and clubs, and Community Chests. This development corresponds with the old School Societies of the Nineteenth Century which at times shouldered a large proportion of the educational burden. The f i n a l step i s public tax support. Arrangements include combinations of l o c a l and state responsibility with grants-in-aid being made to the private schools i n some cases while i n others th© governmental authority furnishes the f u l l service. 1 2 The experience of the State of I l l i n o i s * with the problem of the trainable group should be of special interest to those who are concerned with the growth of educational f a c i l i t i e s for the smutally deficient. In 1951 there had been a legislative battle between the parents' groups and the educational organization which was resolved the following year by a unanim-ous decision to form a two year study project. The educational authorities were charged with the responsibility of evaluating the effectiveness of a public school program for trainable mentally deficient oluldren, while funds were provided for pi l o t schools.^ The conclusions from the two year experi-ence with the trainable group were clear-cut and, this writer feels, ar© fundamental to an understanding of this d i f f i c u l t area of education. Baumgartner,'4 the consultant for this project, observed f i r s t that a long term program w i l l be required for the f i n a l answers and i n the meantime the 1, Ibid, p. 502 2, . Baumgartner, B.j "Study Projects for Trainable Mentally Handicapped Children i n I l l i n o i s " j American Journal of Mental Deficiency: Vol. 60 #3, January .1956, p. ASS. 3, 0p,t„ c,J4. A. Baumgartner, N.j "Study Projects for Trainable Mentally Handicapped Children in I l l i n o i s " ; American Journal of Mental'-- Deficiency: Vol. 60 #3, January 1956, 64. study found the public school classes for the trainable group to be valuable i f properly e atablished and conducted. Success of the program varied d i r -ectly with the efficiency of the study and selection of children for the classes. The progress of the pupils was i n direct ratio to the capabilities of the special teachers and the degree of understanding supervision provided. The curriculum must be carefully related to the childs' potentialities and requirements i n home and community. Furthermore, i t was found that such a program was directly dependent upon a similar high standard of practice and resources i n the f i e l d s of medicine^, welfare, recreation, research and parent groups. Baumgartner* stressed that i n I l l i n o i s , Welfare has an e qual, although different, responsible along with Education. The social worker has the task of working with the parents, i n the home and with community resources to en-sure that the parents w i l l be able to give their child understanding affec-tion, and family l i f e and direction. Without this background of close family support and good personal growth the efforts of the special teacher cannot be received by the child and are not reinforced by home praetlce. Similarly the courts were seen as needing the help of social workers towards making a better informed decision regarding committal to institutions and, i n making available other solutions such as foster homes. Public school education of the Trainable group, i t was found, requires close co-operation between many agencies, particularly education and welfare. The relationship between the public school system and th© state residen-t i a l training school has been most successfully solved i n F l i n t , Michigan, as 1. jLpc.Cit. 65. described by Ingram and Popp.1 The program for the trainable group was based on an extensive parent training course given by state training school which enabled better understanding of their children, their handling, and use of community resources. The children were then given a f u l l clinic examination which determined whether the child could enter the public school system. The school curriculum included personal car, physical co-ordination, speech and vocabulary training, playing with others and very limited academic activities. Better social acceptability was the goal. Throughout the year the parents were encouraged to take part in school activities and were given additional interpretation in the home. They then took part in the year-end review of their childs* progress and nearly a l l were able to make plans for their child which showed real growth and understanding on the part of the parents. 2 A unique procedure was worked out in this Michigan scheme by which the movement of children between Training School and public school system was made very flexible, according to the child's needs. Representatives of the training shcool took part in clinic evaluation periods so that the parents could be advised and reassured regarding possible placement in the institu-tion. It was found that early admission could be arranged for residential care when required. This was made possible by the other half of the agree-ment which facilitated return of the child to home and public school on a tr i a l basis as soon as he was ready. This scheme seems to combine under-standing of parent-child relationships with exceptional inter-agency co-operation resulting in the beet possible use of a l l f a c i l i t i e s in the 1. Ingram, V.M. and Popp, C.E.j "A Public School Program for the Severely Mentally Handicapped Child , ,j American Journal of Mental Deficiency; Vol. 60 #2, October 1955, p. 285. 2. Ibid, pp. 286-290. 6 6 . interest of the child. For those who cannot make use of special provisions in the education system, or for whom no such facilities are available, the State Training School is the usual alternative. These have histor5.cally borne the main responsibility for the mentally deficient, and in the United States the large institution has been developed to a high level of specialized struc-ture and function. Although the emphasis continues on training, the general trend is towards a higher proportion of seriously defective custodial pa-tients.* The training schools are now rehabilitating the better pupils, while, because of the acure shortage of bed space, they are only admitting the most urgent and severe cases of mental defect. The growth of the public schoollprovisions for the mentally deficient can be expected to bring the situation into equilibrium so that the now repidly expanding training school facilities can finally catsh up to and satisfy the demand for i n s t i -tutional care. However, the primary aim of the training institution contin-ues to be the provision of training and education towards as f u l l and useful a l i f e as the individual's capacities permit. A good example of a modern training school in the United States is the Southbury Training School, Southbury, Connecticut. Under the leadership of its Superintendent, Ernest N. Roselie, i t has become an exceptional institution both in Its physical design and in i t s methods of care and training. In dis-cussing the importance of the physical pland and the need for a great deal of preliminary consultation between architect, engineer, and persons who are 1 . Whitney, E.A.J "Current Trends in Institutions for the Mentally Retarded8 { American Journal of Mental Bef iclencv? Vol. . 6 0 # 1 , July 1 9 5 5 , p. 1 7 , 67. familiar with the requirements of the mentally deficient, Roselle* says: "Gone forever should be the large custodial plants in bur planning of future institutions for children and youth, Let us project for children's institutions home and community aspects which provide something of the inalienable rights of childhood. Let i t be a community-like institution of wide lawns and open spaces with a ttractive and homelike structures in exterior design and planned with the utmost care for the happy, purposeful living of those to whom i t is home.,'*2 Roselle then describes the diverse units which make up the Institution such as hospital-health centre, classrooms, shops, occupational therapy unit, auditorium, gymnasium, service buildings, staff quarters, garden and farm, but i t is the housing arrangement for pupils which is of the greatest 3 interest. According to their age and mental ability, the children live in cottages which are like real homes outside and in, giving the effect of a residential district rather than an institution. They are widely spaced with ample room for lawns, play areas, gardens, garage, and place for pet3. For the mildly deficient the outlook is largely towards return to their homes or foster homes after training 3 0 that normal household experience is given as closely as possible. There is a housemother and housefather who have their living quarters in the cottage and car© for the twenty:-four to f i f t y children. Food is cooked In the cottage kitchen and served in the separate dining room, giving ample opportunity for the pupils to participate. With this comparatively small number of children in each unit much needed personal attention can be given by the houseparents who are in charge of the 1. Roselle, E.N-.j "Some Principles and Philosophy in the Planning and Development of Institutional Plants with Particular Reference to Institu-tions for the Mentally Retarded"} American Journal of Mental Deficiency; Vol. 5S U, April 1954, P* 598. 2. Loc. c i t . 3. Ibid, pp. 607-615 6 8 . oottage and supervise the additional cottage staff. The plans include sleep-ing accommodation upstairs, while on the main floor is living room, sunporch, and stury, where various activities can take place without interfering with each other. In the basement are hobby shops and recreation rooms. The cottages for the Moderately Deficient, care for a somewhat larger group of pupils and are a more simple but comfortable plan. The housepar-ents live-In here also which has proven to be practical and desirable from the point of view of both pupils and staff. The severely deficient child is given an infirmary type of housing with about ninety patients to a unit, each carefully designed with regard to personal care and activities. Roselle states emphatically that such cottage accommodation costs considerably less to build on a per capita basis and that costs of maintenance, food, and personnel are no more than that of the large congregate type of institution.* He presents a strong case for cottage type schools in terms of both favourable financing and far superior, family-like care and attention. 2 At Southbury, according to Roselle and Porter, a group process has been built up whereby a l l the major treatment disciplines confer regularly to plan and guide the child's progress through the school from his admission tochis rehabilitation. This is the Committee on Child Study, Care and Training and includes representatives from Medicine, Psychology, Education and Training, Cottage Life, and Social Service. Following completion of the admission phase the Initial Study of the child begins, about four weeks after : — , - L 1. Ibid. pp. 612-613. 2. Roselle, E.N. and Porter, E.L.H.; "A Procedure for Study, Care and Training of the Mentally Retarded in a State or Other Residential School"j American Journal of Mental Deficiency; Vol. 60 #1, July 1955, p. 21. 69. a r r i v a l . During this period medical and psychological examinations are made, while in the school or vocational assignment his responses and attitudes are observed. The social worker's findings on the child-family relationship are interpreted to the Cottage Life personnel who closely follow the child's reaction to cottage parents, fellow pupils and group activities. In the meantime the social worker obtains further home and family background infor-mation leading up to the admission, including the child's development and behaviour. The parents are given further interpretation regarding the child's condition, and the function of the school in helping him. The par-ental strengths for helping the child are assessed and the worker continues as a personal link between family and child, The Committee then meets, studies the reports, and, after f u l l discus-sion, a training program i s formulated which is the agreed finding of a l l members. The Director of Education and Training i s , in the main, responsible and in this school the training plan is carried right through to the cottage parents so that a l l are working with the child towards the same goals. The Social Service Director may c a l l the committee together when placement is to be considered. The social worker reports on the family resources for the child, and describes the proposed foster home i f placement is..needed, after which a group decision is reached as to the readiness of th© child and the suitability of the plan. Follow-up services are given throughout the State by social workers who represent the two state schools, and two years' succes-f u l placement is usually required before discharge. A special feature of the school is the convertibility of this committee, which may meet under the Director of Psychological Services as a Behaviour Clinic. It Can then study and treat serious behaviour and personal adjust-ment problems. At Southbury then, the child comes to surroundings that have 70, been specially designed for him, he is given f u l l training to his capacity including treatment of personality difficulties, and is given long term social services on his return to the community. Rehabilitation to the Community Perhaps the most direct method of returning the mentally deficient person to the community is through a family care program. By this is meant provision of paid foster care in a home other than the pupil's own, while he continues to remain a responsibility of the institution. A. recent 1 sruvey by Thomas showed that at most only 29 percent of the States have family care programs, although many more were planning such, or were 2 interested. Family care is a difficult and demanding program containing many pitfalls, such as were described by Benson, from his experience in California. The f i r s t group of problems, he found, arose from the foster feim!lies and from the community.. The social worker's foster home finding was made difficult by the trend to small houses which did not offer the space for an extra person. The foster parents f e l t that the basic payment of $70.00 per month was inadequate, although clothing and medical expenses were provided in addition. There were other foster parent difficulties arising from their need to over-protect and "baby" the pupils, and their reaction to the individual's physical handicap, unusual appearance, etc. Some communities made these problems worse by outright hostility to the child and foster family. However, the greatest difficulty seemed to come 1. Thomas, E.j "Family Care"; American Journal of Mental Deficiency: Vol. 60 #3, January 1956, p. 615, 2. Jbidt p. 616. 3. Benson, F.j "Problems Faced by an Institution in Placing Mentally Deficient Patients in Family Care"; American Journal of Mental Deficiency: Vol. 57 HR April 1953, p. 719. 71. from tha pupil's own parents and relatives who often refused to allow the pupil to leave the institution, or later caused trouble with the foster-parents, A rather unexpected resistance came from within the institution i t s e l f where staff were reluctant to lose their best workers and pupils, while hinderances were encountered around the releasing of funds for the operation of the program. Finally, shortage of social workers, and finan-c i a l resources seriously hampered the program. The success of the program at the Lapeer Shcool i n Michigan appears to be due to the overcoomlng of just such problems, resulting i n the placement of 170 pupils i n boarding homes.1 Funds were available for payment to board-ing homes, and for clothing, spending money, and medical care. The additional cost of providing more social workers for foster-home finding, placement, and continued supervision was taken into account. The Lapeer project included a great deal of interpretation by the social workers and close working with the training school staff. This included individual case discussions with nursing staff, close co-ordination with the business office, and extended even to the switchboard operators who handled the ca l l s from foster homes. This whole area of family placement and community interpretation i s a special f i e l d of knowledge and s k i l l of the sooial worker and, with proper resources the social service department made the Lapeer program a success. The family care program resulted i n great individual improvement i n pupils and i n f u r -ther interest by their relatives. For the .school i t soon became one of i t s best methods of interpretation to the community, 1* O P . o i t . pp. 616-618 2. Bishop,. E.B.j "Family Garej The Institution": -American Journal.of  Mental Deficiency*. Vol. 59 #2, October 1954, Pp. 308-318. 72. The Lapeer program placed severe mental defectives of a l l ages from 3 to 78 years, which would indicate that age i s no barrier to placement. 1 In Massachusstts special placement program for the aged was, infect, i n i t i a t e d at the famous Waverley institution, when federal funds became available and, for example, Involved patients who had been i n the school for over f i f t y years.^ The social worker had the heavy role of reshaping individual a t t i -tudes and modes of l i v i n g i n preparation for home l i f e . These elderly patients were given intensive and sustained services during the f i r s t year of placement following which a careful transfer was mad© to the s o c i a l worker flora the l o c a l Old Age Assistance Bureau. In this , as in the other examples, the effect of family care was to allow others to enter the institution where they could make f u l l *ise of the special training school f a c i l i t i e s , with the expectation that they i n turn would eventually be ready for placement i n the family care program. Rehabilitation to the Conaaunitv A large group of the mentally deficient return to the community follow-ing vocational training i n the public schools, or i n the state training schools* These schools have developed the mentally deficient pupil in the 3 areas of a social competence, occupational adequacy and academic learning* Social competence and academic learning are absolute necessities f o r job placement. That i s , the pupil mast have already established proper social patterns of behaviour towards either sex, have self-confidence, and be able to get along with othersi, He must have some knowledge and s k i l l i n elemen-1. Ibid, p. 308 2 . E-kdahl, H.j "The Placement Program for the Aged at Walter E. Fgrnald State School"j American Journal of Mental Deficiency- Vol. 57 #3, January 1953# pp. 498-503. 3 . - - - - "Objectives of the School Program"j Mansfield State Training School, Connecticut, Mimeograph, 1956. 73. tary oral and written communication, and arithmetic. With these accomplish* ments, the pupil may be ready to make use of occupational guidance towards successful employment. The Mansfield School in Connecticut is a good example of an institution which offers a thorough program in preparation for employ-ment.1 The pupil is helped to analyze various jobs with respect to their particular physical and emotional characteristics and requirements. He is then encouraged to measure his own abilities, emotional make-up, experience and interests with the demands made by these jobs. Gnce a job area is chosen he can proceed to study ways of seeking employment and also the requirements for holding the job. Vocational placement may be done through such agencies as the public school placement services, government services, or by the train-ing school itself. For those who are not able to produce satisfactorily under conditions of regular employment but who can produce saleable goods under more favourable conditions, the' Sheltered Workshop is making its beginning in the United 2 States. Di Michael defines a sheltered workshop as 11 a place where any manufacture of handiwork is carried on which i s operated for the primary purpose of providing remunerative employment to severely disabled individuals who cannot be readily absorbed in a competitive labour market." He sees i t as a place where mentally deficient persons can work indefinitely and also as a training resource or stepping stone to outside employment. The rehab-ilitation ideal also serves to keep up general morale in the shop and 1. - . - - "Important Basic Background Understandings for Counsellors, Relating to the Mentally Retarded"j Mansfield State Training School, Connecticut. Mimeograph, 1956. 2. Di Michael, SIG.j "Principles and Methods of Establishing a Sheltered Workshop"; Sheltered Workshops; National Association for Retarded Children, New lork, 1954, p.. 13. 74. prevents the groups of workers from slipping into a feeling of hopelessness and eventual stagnation, which has happened i a some instances. The Sheltered Workshops hold out great hopes for a large number of mentally deficient persons who are not able to compete in the labour market, and the shops are presently being sponsored by parents1 organizations. It is to be expected that the workshops would eventually be supported by public funds which would supplement the workers' own contributions from earnings. To round out the program for the mentally deficient two great areas of need must be fu l f i l l e d . A large proportion of those mentally deficient persons who return successfully to the community, s t i l l will require some supervision and guidance for the rest of their lives. In the United States there are a few instances of such provisions, for example Minnesota, which has a guardianship program dating back to 1917, and where by law a mentally deficient person may be committed to Guardianship of the Director of Public Institutions.^ The district social worker is then enabled, and required, to give supervisory services as needed by the individual. The scheme appears to be quite successful but unfortunately such provisions for continued super-vision and guardianship are not widespread in the United States. The second problem referred to is the need for satisfying social and recreational opportunities. The mentally deficient do not easily f i t into the usual public recreation facilities, and sometimes not at a l l . The parents* groups are now looking into this problem and there are some in-stances of public programs. For example, the Public Welfare Board in 1. Miekelson, Phyllis; "Minnesota's Guardianship Program as a Basis for Community Supervision"; American Journal of Mental Deficiency: Vol. 56 §2t October 1951, p. 313. 75. Minneapolis undertook a study of such needs within its area and, in co-operation with loeal social agencies, established a sooial club for thirty men and women."*" The leader, a social group worker, taught games and recrea-tion following which some members were enabled to use public facilities on their own. Others held to the group as being their closest social contact and the continued attendance at club meetings remained high, with much enthusiasm being shown by members. Personnel Training and Research Following announcement of the Salk polio vaccine success, Dr. Jonas E. Salk declared that research on mental illness should be the next major effort 2 of science. It is to be hoped that further interest will also be directed towards the field of mental deficiency. The National Association for Retarded Children has laready faced this matter squarely, as Powers points out,^ by proposing in Item 2 of its charter: "To further the advancement of a l l ameliorative and preventative study, research and therapy in the f i e l d of mental retardation", while Item A proposes "to further the training and education of personnel.^ 5 In April 1955 i t was reported that a Research Director had been chosen 1. McBride, R.j Kaplan, J . j Hall, K.j "Community Planning to Meet Some of the Social Heeds of the Mentally Retarded Adult"} American Jqurnal,rief  Mental Deficiency; Vol. 58 #2, October 1953, p. "331* 2. - - - - "Hews Motes"; American Journal of Mental Deficiency: Vol. 60 #2, October 1955* 3. Powers, Q.F.; "Research and the National Association for Retarded Children"; American Journal of Mental Deficiency; Vol. 59 #2, July 1954* 4* lbi$. p. 61. 5. - - - - "Parents"} A f r i c a n Journal of Mental ftef jcj^ney; Vol. 59 #4, April 1955. 76. by the parent 3 group, Dr. Richard L. Maaland. The research project started at the very beginnings by deciding to determine x^ rhat research is presently being conducted that i s related i n anyway to mental deficiency, Questions were then asked regarding further areas for research, and mean© of encour- „ aging more scientists into the f i e l d . The National Association for Retarded Children, was heartened by i t s efforts when the Federal Government granted 0750,000. for research i n men-t a l deficiency. Another $750,000. went to related f i e l d s which w i l l help with training of professional personnel for work with the mentally deficient. Summary and Conclusions Services to the mentally deficient i n the United States show a great deal of variation amongst individual states with no one State having achieved a comprehensive program for the mentally deficient. Perhaps Connecticut has come closest to the goal, and this State has been studying it3 services i n order the better to plan for i t s mentally deficient members. In order to outline these services i n America, i t has been necessary to describe a number of separate provisions and shcemes across the country which best show progressive trends. The early identification and diagnosis of the mentally deficient child i s becoming recognized as being of prime importancej but the f a c i l i t i e s are very limited. The presently established mental hygiene and child guidance c l i n i c s have not been able to give f u l l service to the mentally deficient and, to f i l l the gap, parents' groups have in some instances organized special c l i n i c s * Only a few states have s chemes for the r egistration of the mentally" deficient. Help to parents i n caring for their defective children i n the home has been successfully given through special programs which offer home 77. training and parent guidanoe, day care, and recreation, but again this i s limited to a few Eastern States. The strongest influence towards obtaining better services for the men-t a l l y deficient i s coming from the young and vigourous parents' organization, the National Association for Retarded Children. The individual groups have undertaken a wide variety of projects which point out the great lacks i n public services, and include special schools, play groups, c l i n i c s , work-shops, recreation, auxiliaries to institutions, and horns training programs. The establishment of such services by private endeavour follows the h i s t o r i c a l pattern of growth of other social programs in the United States, towards eventual public responsibility. The parents* organization has don© a great deal to interpret the needs of the mentally deficient to the American public and has followed this with effective demands for further legislation and community action. Educational f a c i l i t i e s i n the richer and more populated areas have been established f o r many years but have included only the educable group i n special classes. The needs of the trainable group are presently being met in a few states such as Connecticut and I l l i n o i s but generally have been l e f t to the parents' groups. Special secondary school f a c i l i t i e s have been well developed, for example, i n the c i t y of San Diego, California, but are i n no way representative of national f a c i l i t i e s . The state institution has under-gone considerable evolution i n some progressive areas to the point where family-life conditions are being provided by the cottage type institution, complete with parental substitutes. Some family care programs are i n existence but less than a third -of the states have even the semblance of such a scheme, and the numbers affected are very small i n relation to the t o t a l institutional population. The faot 78. that family care programs have nearly always been operated by the state i n s t i -tutions themselves has had a definite limiting effect on the expansion of such schemes, and on the quality of services given. In the past there have not been sufficient personnel on funds to operate effectively on a large scale. Instead, the family care program has been operated as a loc a l exten-sion of services, of "annex11, of the institution rather than as a state-wide scheme. Furthermore, the American community has, i n general, been severely lacking i n public social services whieh would form the background for these programs, as i s the ease in Great Britain, Some good work has been done i n vocational guidance and training, but again i t i s on a local area basis, Sheltered workshops are just in the beginning stages, while social and rec-reational f a c i l i t i e s are l e f t to the voluntary groups. The great need for continued supervision and guardianship has only been recognized for any length of time by the single state of Minnesota, In conclusion, i t has been shown that in the United States there have been contributions made to individual aspects of the knowledge and practice of caring for the mentally deficient. Particular gains have been made i n the special area of institutional care and training, with the development of the cottage system and integrated training shcemes. The outstanding force for progress i s the parents' organization which i s making i t s appeal on a broad basis of public interpretation and legislative and community action. The sm pie programs which have been described prove that a com-prehenslve plan can be operated i n the United States. The greatest single need at the present i s an integration and development of services to that the mentally deficient child can receive early examination and planning, f a c i l i t i e s to ensure his f u l l development, and a place i n the community where he w i l l receive encouragement and supervision. CHAPTER 4 SERVICES IH BRITISH COLUMBIA: SOME COMPARISON, AND IMPLICATIONS , FOR FUTURE PLANNING The Discussion of services to the mentally deficient in B r i t i s h Columbia should gain i n perspective and understanding i f we f i r s t take into account the influence of the his t o r i c a l background, patterns of growth, and geograph-i c a l features of the Province.''' B r i t i s h Columbia.had i t s beginnings with the establishment of the colony of Vancouver Island i n 1850, the capital being the fur trading post of Vic-toria. With the influx of gold seekers to the Fraser River, the Colony of Bri t i s h Columbia was formed on the mainland i n 1859 and later, i n 1866 the two colonies were joined* In those early years there were no provisions for the "insane" i n the colonies, the unfortunate persons being placed on board ship for return to the homeland, or, perhaps, to a California I n s t i -2 tution* In 1871 the colony entered Confederation to become a Province of Canada. A year later the f i r s t "provincial asylum" was established i n Victoria under the jurisdiction of the Provincial Secretary's Department where the Mental Health Services have since remained. This was followed by the f i r s t mental —i services legislation, "The Insane Asylums Act" 1873 which made no special 3 provision for the mentally deficient. Then i n 1878, the institution was 1. For further discussion of the hi s t o r i c a l aspects, the reader i s re-ferred to the following sources: Clark, R.J.j "Care of the Mentally 111 i n B r i t i s h Columbia"; Unpublished M.S.W. Thesis, School of Social Work, University of B r i t i s h Columbia, 1947. - "Mental Health Services, Annual Report"; Province of Br i t i s h Columbia, Victoria, 1953, 2* IbJ-d,. p. 15. 3. Loo, c i t . 80. moved to the mainland at Hew Westminster where a new building had been com-pleted. This is the site presently occupied by the Woodlands School, which is the provincial training school and institution for the mentally defective. In comparison to these pioneer efforts for the insane which lacked any separ-ate provisions for the mentally deficient, i t will be remembered that several American states, and Great Britain, had been training the mentally deficient in separate institutions for over twenty years, while such a school had been in operation at Orillia, Ontario, since 1 8 7 6 . ^ " At the turn of the century the focus of attention for mental health services: was shifted to the Coquitlam site where the well-known Colony Farm was soon in operation, to be followed by the gradual development of nearby Essondale as the centre of mental health services for the province. For the mentally deficient, tha f i r s t three decades of the century brought few ser-r vices beyond segretation within the hospitals. / However, their special needs did not go entirely unrecognized and Clark states that the Mental Hygiene Survey of 1 9 1 9 recommended the establishment of facilities for diagnosis, 2 training, and special classes for this group. Successive Medical Superin-tendents stressed these needs, which were fully recognized in the findings of the Royal Commission on Mental Hygiene, 1 9 2 5 . These are reported by Clark as emphasizing the urgency and importance of provisions for the mental-'s ly deficient,e specially in the educational field. As a result, further building took place at Essondale and patients were transferred from Hew Westminster, Finally, the old New Westminster institution was renovated and in 1 9 3 1 became a separate institution for mental defectives. However, 1 . - - - * "Mental Health Services in Canada," Memorandum # 6 , Depart-ment of National Health and Welfare, Gtt&wa, 1 9 5 4 , p. 9 . 2 . O P. cit. Clark, p. 6 5 3 . £014. p. 84 81, I t was not u n t i l 1945 that the academic school was bu i l t and staffed, and training begun. From this his t o r i c a l outline i t can be seen that B r i t i s h Columbia does not have an old tradition of services to the mentally deficient nor a long established system of schools and f a c i l i t i e s , upon which to build. The second half of the last century saw the rapid expansion of the training school system i n Britain and the Eastern American States, during which time B r i t i s h Columbia was i n a state of evolution from a band of traders and gold-seekers to a more settled and permanent population. Thus, by the time that the needs of the mentally deficient were becoming apparent In the province, the enlightened era of the training ideal had given way to the period of segregation from society by means of institutional care. I t would,appear that this h i s t o r i c a l factor might have been largely responsible for the lack of services to the mentally deficient i n B r i t i s h Columbia for so many years. This i s supported by the fact that services to the mentally 111 i n the province have shown no such lag but generally kept pace with other areas, maintained a good reputation, and at times have been outstanding. A large factor i n the conversion of the New Westminster institution to the care of the mental defectives would seem to have been the overcrowding they caused i n the mental hospital and the advent of treatment procedures for the men-t a l l y i l l which required better classification and segregation of patients. / jXn any case, the f i r s t fifteen years of the training School were character-ized by economic depression and war so that i t was not u n t i l 1945, v i t h the building of the new academic shcool f a c i l i t i e s , that the mentally deficient i n B r i t i s h Columbia began to receive some of the opportunities and services to which they had long been entitled. I t i s to be hoped that the f a i r l y 82. recent awakening of public interest i n the mentally deficient can be main-tained and strengthened so as to guarantee continued progress in the under-standing and care of the mentally deficient. The physical aspects and population characteristics of B r i t i s h Columbia form a unique pattern which has important implications for the operation of any province-wide program for the mentally deficient. The terrain i s pre-dominantly mountainous and the ratio of urban population to rur a l Is one of the highest i n Canada, over 68 percent being urban i n 1951, as revealed by 1 the ninth Census of Canada. Furthermore, a large proportion of the popula-tion resides i n a relatively small area, the Lower Mainland and Vancouver Island, leaving for the remainder of the province a population density of just under one person per square mile, one of the lowest i n Canada. To Illustrate further, the population of Br i t i s h Columbia i n 1951 was 1,165,210, while that of the Vancouver Metropolitan Area was 530,728, which means that nrealy half of the citizens of B r i t i s h Columbia l i v e i n or around the City ' 2 of Vancouver. There i s another large urban concentration at the southern t i p of Vancouver Island, and other centres in the mountain valleys of South Eastern B r i t i s h Columbia, and the Cariboo. The administration i s thus faced on the one hand, with the provision of adequate services to one of the largest c i t i e s i n Canada and, on the other, with responsibility for the rights of the mentally deficient persons who may be residing i n some isolated location in the interior of the Province. There are problems involved i n bringing the service to the individual, as well as for the family i n main-taining contact with the mentally deficient member, who may be i n an i n s t l -1. - • - . " V i t a l Statistics Report for 1953", Province of B r i t i s h Columbia, Victoria, 1955. 2. - - - - "the Canada Year Book 1955", Dominion Bureau of S t a t i s t i c s , Ottawa, 1955. pp. 135 and 139. 83. tution several days' travel away. In addition to d i f f i c u l t i e s regarding distance and communication, there are great differences in the resources available to the individual, according to his place of residence. In the urban centre the pupil may have at his disposal special diagnostic, educa-tional, occupational, and social services, which may be t o t a l l y absent i n remote rural d i s t r i c t s * It i s this inequality of opportunity which w i l l require considerable planning and action before i t can be overcome i n B r i t i s h Columbia., In discussing the program for the mentally deficient i n B r i t i s h Columbia i t i s essential to know as accurately as possible how many persons there are i n the province who are i n need of the various services., fioselle described the findings of his Connecticut survey of 1954 stating that the problem was not essentially different i n any state either as to quality or proportionate quantities.* This survey recorded i t s findings on the basis of the number per 100,000 of the population, from which the corresponding figures can be obtained for a given population. Roselle stated that the proportion of each group of the mentally deficient i n the general population of the d e f i c i -ent was as follows* 60 to 65 percent are mildly deficient, somewhat less than 30 percent are moderately deficient, and 9 to 10 per cent are severely deficient. It was f e l t that the range of figures given, which centred sound 1 percent of the population, indicated possible variations and would be a 2 help to planning. Table I, page 84, gives the estimated numbers of the mentally deficient by groups, i n B r i t i s h Columbia, as extrapolated from the Connecticut figures 1. Roselle, E.M.; "New Horizons for the Mentally Retarded When a State Looks at the Problem as a Whole"j Washington State Convention, National Association for Retarded Children, Belllngham, Mimeograph, 1954, P* 9. 2* Ibid;, p. 12 84. Table I. The Mental ly Def ic ient i n the Tota l  Population of B r i t i s h Columbia. 1955. Group of Mental Def ic iency Number per 100,000 Tota l P o p u l a t i o n . 1 Estimated Number ' i n B r i t i s h Columbia. M i l d 500 - 700 6,500 - 9,000 Moderate 225 - 325 3,000 - 4,250 Severe 75 - 110 1,000 - 1,500 Totals 800 - 1,135 10,500 - 14,750 Sourcei 1 . Connecticut Survey, 1954, as reported by R o s a l i e . 2 . Based on B r i t i s h Columbia populat ion estimate 1,300,000 f o r 1955, an approximation f o r purposes of t h i s essay. ... - . «The Canada Xear Book 1955, Dominion Bureau of S t a t i s t i c s , Ottawa, 3>955, p, 135. Table 2 . Mental ly Def i c ient Chi ldren i n the Schoo l -Age Popu la t ion t B r i t i s h Columbia, 1955i (Age3 5 - 7 years i n c l u s i v e ) Group of Mental Def ic iency Number per 100*000 School-age P o p u l a t i o n . 1 Estimated Number ? , i n B r i t i s h Columbia'.' M i l d 1,500 - 2,000 4,100 * 5,450 Moderate 30O - , ;450 800 - 1,250 Severe 100 - 150 276 - 400 Totals 1,900 - 2,600 5,170 - 7,100 Source* 1.. Op eflfr.. 2 . Based on School Age population of 272,000 an ext rapolat ion from " V i t a l S t a t i s t i c s Report ' 1 , 1953, Province of B r i t i s h Columbia, V i c t o r i a , 1955, p. 14. 85. for the general population. The t o t a l population of B r i t i s h Columbia for 1955 i s estimated to have been approximately 1,300,000, for the purposes of 1 this essay. Table 2, page 84, gives the estimated number of mentally deficient children i n the school age population, ages five to seventeen (inclusive) i n B r i t i s h Columbia, again from the Connecticut findings. This school age population for B r i t i s h Columbia ie estimated at 272,000.2 The incidence for the school ag© population was found to range between about 2 to 2^ 5 percent,, with the group proportions as follows: s l i g h t l y less than 80 percent are mildly deficient, somewhat more than 15 per cent are moderately deficient, and between § and 6 par cent are severely deficient. With these proportions i n mind for the general and the school populations we can proceed to examine the services being given i n the province. Identification cf„;fche, Mentally Deficient i n B r i t i s h Columbia There i s no co-ordinated scheme i n the province ct ensure the identi-fication, diagnosis, and guidance of the mentally deficient. In the absence of this i t i s necessary to discuss the functions of seme representative agencies who are involved i n providing this service. In Vancouver a large proportion of hospital f a c i l i t i e s are concentraded i n one massive institution, the Vancouver General Hospital, within which, the Child Health Centre i s a small hospital i n i t s e l f , containing over 150 beds.^ Children are brought i n from long distances to make use of the special f a c i l i t i e s available and 1. - - - - The Canada tear Book 1955, Dominion Bureau of S t a t i s t i c s , Ottawa, 1955, p. 135. 2. By extrapolation from: " V i t a l Statistics Report, 1953"J Province of B r i t i s h Columbia, Victoria, 1955, p. 14. 3. O P . c i t . . Roselle, p. 12 4. Interview with Mr. K. Weaver, Director of Social Service Depart-ment, Vancouver General Hospital, and staff. 86, amongst the patients who have been adieitted for observation and diagnosis are young mentally deficient children, who may sometimes occupy half a dozen beds i n the Centre, To examine these children there i s , however, not one psychologist or psychiatrist on the staff of the hospital and both have t o be brought In for Individual consultation. For psychological testing and eval-uation the Centre has to rely on the services of v i s i t i n g professionals from the Metropolitan Health Committee, the Provincial Child Guidance Cl i n i c s and occasionally private agencies. Thus, contrary to what might be expected, there i s n o established diagnostic c l i n i c a l team at Vancouver General Hospital, the largest hospital i n the Province, The social service department of the hospital 1® particularly concerned with resources for mentally defective babies who no longer require medical treatment but who cannot be returned home for reasons such as unsuitable parents and home conditions, the mother being unmarried, i l l , etc. There i s a very long waiting l i s t for admission to the provincial institution, the Woodlands School, and, once application i s made hospital insurance ceases. The parents then become responsible for payments of over sixteen dollars per day. The Children's Aid Societies do not fee l that i t i s their function to accept these children while the hospital social service i s certainly not a child placing agency, and a serious state of impasse results. It has been found that although their numbers are comparatively small, the mentally deficient create exceedingly d i f f i c u l t problems fo r the soeial worker i n this setting. Along with the resulting lack of custodial f a c i l i t i e s there have been many instances of marriages breaking at this time of strain. For some of the older patients, Including for example, an unmarried mother, the protracted waining period before admission to Woodlands School has been d i s -87. astrous, with a repetition or worsening of their problems. The Vancouver General Hospital provides medical care for the mentally deficient patient and social services to the patient i n the hospital and to his family. For diagnosis and planning the services of other diagnostic agencies are used, particularly the Provincial Child Guidance C l i n i c . The Provincial Child Guidance Clinics provide the main diagnostic services i n B r i t i s h Columbia. Established i n 1932 with personnel from the Provincial Mental Hospital, the c l i n i c s have had great demands placed on them for services and have gradually expanded* The main c l i n i c has recently moved into a modern new, building i n Buraaby where two c l i n i c a l teams are available, and from which the travelling team operates in taking services to other parts of the province./ Already there i s need for a second Mainland travelling team, and the obtaining of staff for i t i s expected to be a problem. The second c l i n i c i s i n Victoria where a team serves that c i t y and travels Vancouver Island. The t o t a l personnel include four psychiatrists (one i s i n training), nineteen social workers, ten psychologists, four public health nurses, and a speech therapist. These teams must not only serve the province as a whole but also give regular shceduled c l i n i c s at such institutions as The Children's Hospital, The Health Centre for Children as referred to above, 2 and Jericho H i l l School for deaf and blind. One result of these demands has been the curtailment, or delay, i n being able to give continuing casework services beyond the diagnostic study period. If other social agencies were better equipped to give preventative and treatment services, the c l i n i c s 1. - — - Mental Health Services Annual Report 1955* Province of B r i t i s h Columbia, Victoria, 1955, p. (201) 2. Ibid. p. (199) 88. could function better. Some r e l i e f i s afforded by the diagnostic c l i n i c a l services given by the Metropolitan Health Committee to th© Vancouver Schools, and by a new Burnaby Mental Health Centre. The Child Guidance C l i n i c s , i n the course of examining children regard-ing various problems and disorders, saw 876 new caees, of which 123, or 14 percent, were classified as being mentally deficient. The proportion of 2 Intelligence Quotients below seventy was somewhat higher at 15.5 percent. This sizeable group includes individual referrals, usually through social and health agencies. The c l i n i c already i s the screening agency for St. Christopher's School, for mentally defective hoys, and i s now receiving requests to do group screening for many new parent-operated schools. The increasing demands for services to the mentally deficient are being f e l t by these already overtaxed c l i n i c s and a satisfactory solution w i l l soon be required. Diagnostic services for the mentally deficient w i l l have to be provided on a large scale, particularly with the rapid growth of local educational f a c i l i t i e s and home care, and responsibility would appear to l i e with either the Child Guidance Clinics or the Woodlands School. At present the C l i n i c i s not an exclusive screening agency for Woodlands School although i t does a good deal of this kind of work. With regard to future policy, the Provin-c i a l Child Guidance C l i n i c could possibly be considered for the role of primary screening of the mentally deficient, but only under certain condi-tions.^ The i n i t i a l screening could be done by the c l i n i c , and i t s travel-1. Ibid, p. 206 and 208 2. Jb£d. p. 205 3. Interview with the Director, Dr. U. P. Byrne, and Mr. D. Ricketts, Supervisor, Social Service Department, Child Guidance C l i n i c . 4. St. Christopher's School w i l l be discussed further i n the next section. 89. ling team, with referral then being made to a new clinic at the Woodlands / School where specialized diagnostic and planning services would be available. The assumption of this new role of actively seeking out the mentally defici-ent would require considerable extension of personnel and facilities for the Child Guidance Clinics. It would appear, then, that a new clinic at Woodlands School is the f i r s t requisite in an extension of services, to be followed by allocation of the work in preliminary screening.. In British Columbia there is no separate registration of the mentally deficient although this is done in part by the Crippled Children's Registry in Vancouver. This agency is supported by Federal Health Grants, is super-vised by the provincial Division of Vital Statistics and receives medical direction from an Advisory Panel made up of some sixteen specialists from medicine and psychiatry, representing private and governmental practice. Other advisors come from statistics, nursing, and social work."*" The crippled child is defined as "one who suffers from a handicap suf-ficiently severe that he or she will be at a disadvantage in acquiring an 2 education or earning a livelihood." By the end of 1955 more than 7,000 cases had been registered but of these only some 500 were mentally deficient 3 and many had additional physical disabilities. At present registration is done voluntarily by medical practitioners, many public health and welfare agencies, including particularly the Child Guidance Clinics, various in s t i -tutions, and by notations on birth registrations. The registry advises and directs patients to the best mdeical care and interests itself in the whole problem of rehabilitation including the socio-economic aspects. It acts as a co-ordinator for various agencies and resources, and from statistics 1. - Crippled Children's Registry, Third Annual Report, 1954, Mimeograph, Vancouver, pp. 1-3; and Mimeographed Information Sheets, February 7, 1956. 2. Loc, cjt. 3* Loc. eit. 90. compiled can make recommendations as to areas of care which are not being f u l f i l l e d . The registry for handicapped children has available the f u l l resources of the Division of V i t a l S t a t i s t i c s . Department of Health and Welfare, and already enjoys the participation and co-operation of the fields of health and welfare. Therefore, i t might well be expanded to care f o r a more com-plete registration of the mentally deficient.. The success of any program f o r the identification and diagnosis of the mentally deficient appears to hinge on legislative provisions which require that some agency seek out these Individuals, and present them for examina-tion at c l i n i c s which must be available. This i s done i n Britain through the Education and Mental Deficiency Acts with the co-operation of school and health authorities. I f , for example, the school authorities of B r i t i s h Col-umbia were required to register a l l mentally deficient children we should have taken a firm step towards granting them their r i g h t f u l opportunities* A new c l i n i c at Woodlands School would form the centre of diagnostis ser-vices, and travelling c l i n i c s would take services to the more remote parts of the province. This might be done from Woodlands or from the Child Guid-ance C l i n i c , and i n any case continued close co-operation would be required. The Crippled (Handicapped) Children's registry would have to be prepared for i t s additional function. It might be noted that none of these new services i s particularly expensive to put into effect, but the requirements include trained personnel who are not easily obtained. jfoffa nara ^ F ^ n y Services It has only been recently, i f at a l l , that the parent who decided to care for his child at home received any encouragement from his fellow c i t -91. izens i n B r i t i s h Columbia* The families were not helped with educating the child i n the home, they were given no assurances from the state that super-vision or guardianship would continue throughout their child's lifetime, nor were there financial provisions and community social resources. In short, there was no one to whom the parent could turn for help and encouragement. Social agencies such as the Family Services Association of Vancouver offer intensive casework services on a selective baSis only. The number of cases active i n which mental deficiency i s involved has been small, but they X have been characteristically of a long term nature. Parents have used the agency for help i n methods of handling their defective child as well as understanding their own feelings towards him. An occasional parent arrives at the agency, whose defective c h i l d i s now grown up, and for whom the time for training and learning has long sicne passed by. The agency i s privately supported and has limited resources, requiring a careful selection of cases, and leaving some f a c i l i t i e s for new enterprises and projects. Thus the agency cannot take responsibility for a whole program as such, but can accept referrals In which there i s a constellation of problems of a family nature, one of which might be mental deficiency. The parents of the mentally deficient i n the province are now banding together very quickly, with mounting enthusiasm. On March 24th, 1955, the 'Association for Retarded Children of Br i t i s h Columbia was Incorporated and th© f i r s t annual meeting wes held on May 13th i n Vancouver.^- By the end of the year there were nine chapters with a membership of 1,750. The Associa-tion i s the central organization to which the local units belong, It aims 1. Interview with Miss B. Finlayeon, Assistant Director, Family Services Association, 2. Interview with Dr. H. G. Dunn, Deputy Medical Executive Director; Association for Retarded Children of B r i t i s h Columbia; and mimeographed material he supplied, including minutes of meetings, and newsletters, 1956. 92. to promote the education,training, development and welfare of a l l mentally deficient children whether at home, attending school, or in institutions. Its objects also include enoouratement of further lo c a l units, and encour-agement of research, good public understanding, personnel training, and leg-i s l a t i o n i n this f i e l d . The Association i s very active i n this role of co-ordination and enabling, while a l l individual members belong to lo c a l units where the actual projects are undertaken. The l o c a l units have f i r s t been interested i n forming special classes for those who are not served by the public school,mainly the trainable group. By the end of 1955 there were nine day schools operated by the local chapters across the province. One group has formed an Auxiliary to the Woodlands School whose members v i s i t the pupils, perform a number of much needed personal services for pupil and family and offer social outings. The strong Kootenay Society for Handicapped Children i s planning to build a home to accommodate about f i f t y children. It w i l l function as a day school, boarding school, and parental home for children i n the event of family c r i s i s . This w i l l alleviate a great deal of hardship for families in that Interior District and provide much needed educational f a c i l i t i e s for i t s scattered population. The St. Christopher's School Society i n Worth Vancouver i s also a member of the Association. This Society had i t s origins i n 1928 with the devoted work of Nurse Graham, who opened a c l i n i c , and later, the school for mental? l y defective boys. I t i s a residential school with accommodation for twenty boys and offers a homelike atmosphere, basic training and a c t i v i t i e s , and 1. St. Christopher's School Society i s a non-profit organization, whose Board of Directors receive no remuneration. It has solicited funds for cap-i t a l expenses from private individuals and corporations, and i t s fees are based on the operating requirements of the school. 93. individual attention to special training. This school has carried on alone i n i t s type of service for nearly thirty years and should now benefit from the support of the large Associations. The growth of the movement may be illustrated by the fact that i n Jan-uary 1956 at least seven new chapters were being formed, ranging from Burnaby i n the Greater Vancouver Area, to Dawson Creek i n the extreme North East. Organization was proceeding on a national scale also with a meeting being held i n January1/ 1956 at Winnipeg, of provincial representatives, to found a Canadian Association for Retarded Children. This group w i l l have as members the provincial organizations and w i l l encourage services for the mentally deficient from the national level, and again be a co-ordinating and study group. The appearance of this strong and active Association f o r Retarded Children i s the outstanding feature of the f i e l d of mental deficiency i n B r i t i s h Columbia today. Their f i r s t major Provincial goal has already been achieved through their own efforts with the passage of legislation for the financial support of children i n their special schools, which w i l l be dis-cussed later. With much of the fi n a n c i a l burden of education and training removed, the groups can be expected to turn their attention to improving f a c i l i t i e s . In addition to legislative requirements f o r supervision, guardianship, and financial aid to families such as have been so successful in Britain, there i s also the need for services to the home* There are jaany children and families who need the help of a special v i s i t i n g teacher to direct the training and education. An even larger number of families noed the oppor-tunity to discuss their problems arising from the deficient c h i l d and re-ceive the help i n planning which the social worker can provide. The Gonnec-94. ticut program for family care as previously described, might well be adapted to at least the more populous areas of the province. The many f a c i l i t i e s which offer r e l i e f to parents and happiness to the child should be established as soon as possible, i n order to strengthen and encourage home care* These include occupational centres, recreational f a c i l i t i e s , summer camps and day care centres. Education,. Tr.ajning and Custody The education of ths mentally deficient in B r i t i s h Columbia i s s t i l l i n the "permissive" stage so that each school board may decide whether or not to provide for this group. The result i s a wide variation across the prov-ince In accordance with population density and financial resources^ Dr. Dunn reported that at the end of 1955 there were sixty-four special classes 1 spread over twenty centres in B r i t i s h Columbia. A brief discussion of the Vancouver School provisions w i l l serve to show what progress has been made in a large c i t y . ^ 2 /The Vancouver School Board, has endeavoured to give opportunities to every educable child, approximately dovm to I.Q. 50, and has located the special classes i n the regular schools, since i t i s the School Board's philosophy that the mentally deficient should take part i n the usual activ-i t i e s wherever possible, such as physical education, social a c t i v i t i e s , and student a f f a i r s . / There were 565 of these pupils registered i n the school year 1955-56. With a total school population of 51,648, the mentally de-fi c i e n t made up over one percent of the enrolled school population, which, - 1. Loc c i t . 2. Interviews with Dr. R. F. Sharp, Superintendent of Schools, Vancouver, and Dr. S . A. Miller, Director, Department of Research and Special Services. 95. 1 i t vas considered, indicated a good coverage. The Vancouver schools have diagnostic c l i n i c a l services readily a v a i l -able i n the f a c i l i t i e s of the Metropolitan Health Committee. The principal of the school reports suspected cases of mental deficiency to this c l i n i c for testing and evaluation, following which, the child may be placed i n a special class. There are three types of classes available for this group, Junior Special, Senior Special, and Junior High Special, according to the child's age and development. The child i s encouraged to continue right through Junior High School i n special classes and there were 165 such pupilB in the secondary schools. These classes are located where there are good manual arts f a c i l i t i e s and the courses are heavy i n these subjects, which include woodwork, metal work, and electric wiring f o r the boy3, and sewing and home economics for the g i r l s . In addition to special classes f o r the mentally deficient, there are another 500 students receiving special types of schooling such as sight saving classes, e ducational d i f f i c u l t i e s , hospital and home instruction. The fact that there are v i s i t i n g teachers for the physically i l l i n the home, should give encouragement to those who seek such services for the mentally deficient. Education for the mentally deficient became more complete with the passing of B i l l No. 68, "An Act to Amend the Public Schools Act," at the 2 spring session of the B r i t i s h Columbia Legislature, 1956. This progress-ive measure made financial provision for the education of the trainable group of the mentally deficient. The Board of School Trustees of a D i s t r i c t 1. LoPt c i t . 2. frqc,. c i t . 96. was empowered to make payment to a chapter of the Association f o r Retarded Children of Br i t i s h Columbia for the education of authorized pupils. The amount payable was not to exceed the average cost of educating the normal child i n the province* which was nearly two hundred and f i f t y dollars for the school year, 1953-54** The regulations had not yet been promulgated. The system appeared to be similar to that i n Ontario, except that the latte r made a straight payment of twenty-five dollars for each month that the class was i n operation. The Vancouver schooLs,will carry out this permissive l e g i s -lation, although i t i s expected that an administrative committee of School 3 and Association members w i l l f i r s t be required. It would appear that the next step i n uducation would be to make atten-dance for the educable compulsory, as i s done i n Great Britain and some American States./ F a c i l i t i e s for the trainable should be made available through the province, and attention paid to the need for help with home training* The centre for residential care, training, education, socialization and rehabilitation, i s the Woodlands School at New Westminster, as noted earlier i n the h i s t o r i c a l outline. The name of this ins t i t u t i o n was changed to the Woodlands School i n 1950, and i n 1953 the "Schools for Mental Defective Act" was passed, establishing i t as a specialist unit f o r the mentally de-fi c i e n t and making a l l admissions direct to the school.^ The School offers care, supervision and protection for the mentally deficient who require such services. It then proceeds to treat and educate the pupil to the maximum of X. - "Public Schools", 83rd. Annual Report* Province of B r i t i s h Columbia, Victoria, 1955* 2. - - - - "Assistance i n Payment of Cost of Education of Retarded Children"? Ontario Regulations 114/53, June 1953* 3* PPr cifr. - Dr. R. F. Sharp. 4. - - - - Mental Health Services Annual Report 1953I Province of B r i t i s h Columbia; Victoria, 1953, P* IS. 97. his capacity. There are many professional disciplines which work together towards rehabilitation of the pupil, or improvement of his adjustment to care, possibly i n a family outside the hospital. More recently the treatment ser-vices have been closely co-ordinated in rehabilitation c l i n i c s at which a l l those concerned with the pupil have an opportunity of discussing the case and taking part i n the decision which directs his program towards r e h a b i l i -tative goals. This group process of treatment i s becoming successful as well in the area of staff development and interpretation, and may be compared favourably with the Southbury system which has already been described. The Social Service Department although relatively young and few i n nums-bers has many responsibilities throughout the treatment and training process. The social worker must f i r s t be ready to help the parent i n coming to a de-cision regarding application for admission by careful orientation to the School and interpretation of the School's function i n relation to the parent's situation. The child and parent are given help on admission i n becoming accustomed to the institution and to the separation. The worker brings social history information as part of the planning process for the child and may offer continued services to the individual i n order to help him reach a better level of emotional maturity, and socialization. As the time for re-habilitation approaches the worker becomes very active i n the preparation of the pupil and his family for return to the community. The pupil must be helped to find the kind of employment which would be suitable for him and given continued supervision, as well as services to the family and employer during the probation period. The social service experience i n rehabilitation of pupils has disclosed flaws i n the training program and adjustments are being made. Resources for rehabilitation have been seriously lacking and these gaps i n the program are brought to the attention of the administration. 98. The future role of Woodlands School Is expected to be the care of the trainable, and lower groups, those i n the Moderate and Severe groups of men-t a l deficiency, 1 In addition w i l l be the important function of treating those with emotional problems i n addition to mental deficiency. The schools are expected to care for the educable group i n the community, although i t i s realized that this may require many years of development. At present the Woodlands School population i s over 1,200, and, although a new 300 bed unit i s nearing completion, the waiting l i s t already surpasses this figure for new accommodation. It had been hoped that no new institutional f a c i l i t i a s would have to be built but unfortunately this optimism appears to be based too heavily on the expected effects of the new educational measures. In-creased rehabilitation resources w i l l be required for the return of more patients to the community while better community f a c i l i t i e s are required i n order to encourage more families to care for their child at home. The estab-lishment of a diagnostio and planning c l i n i c at Woodlands may increase the number of the mentally deficient who are identified but at the same time i t can offer alternative plans to the parents and admit only those who can best make use of the School, or who require custodial care. It was noted earlier that the modern concepts of chi l d care and human development called for a cottage type of institution In which the system of house parents and small groups encouraged normal personality growth in a quasi-family environment. These principles, which were l a i d down years ago after the very successful American Experience, could be put into effect with a l l their advantages to the child, for a smaller per capita cost than the 1. Interview with Dr. C. E . Benwell, Medical Superintendent, The Woodlands School, Mew Westminster. 2 . Loc. c i t . 9 9 . outmoded congregate type of building,* A recent example of an institution designed specially for the car© and training of the mentally deficient, i s 2 the new Saskatchewan Training School at Moose Jaw. This school can be a source of pride to those who made use of available experts i n this f i e l d of specialised architecture. Unfortunately, the new three hundred bed unit at Woodlands, a many-storied concrete structure, violates these principles and the rights of the children who w i l l occupy i t . It w i l l be l e f t to an already over-taxed nursing staff to bring i n some kind of family atmosphere. Rehabilitation to the Community A basic objective of the new program of training and education at The Woodlands School i s the socialization of the pupil, which i s the a b i l i t y to l i v e with others i n such a manner that the can become an accepted member of the family and of the corfimunity. A system of foster homes i s now needed for those pupils who have been successful i n their training at Woodlands and cannot return to their homes. Because there i s no family care program for the mentally deficient i n operation i n the province, agencies sueh as the Children's Aid Society of Vancouver receive many requests for services to this group. The problems and views of this Agency i n th© area of foster.home care of the mentally 1. Roselle, E.B., "Some Principles and Philosophy i n the Planning and Development of Institutional Plants, etc."; American Journal of Mental  Deficiency; Vol. 58 #4, A p r i l 1954, pp* 612-13,623. 2. Black, H.K.j "Saskatchewan Training School, Moose Ja«nJ Mental  Hospitals: Vol. 6 #11, Washington, D.C.j Hovember 1955, pp. 21-28. The Moose Jaw institution consists of multiple, single-storied buildings of 50 pupil capacity, with a l l joined to central administration, dining and heating f a c i l i t i e s . Although i t i s a great advance over large hospital type construction, i t is. really a congregate type of institution, It therefore f a l l s short of the goal of family-like cottage l i v i n g under the supervision, not of nurses, but of cottage parents. 100. deficient w i l l therefore be b r i e f l y reviewed.* The c r i t i c a l problem which the society faces i s the care of the severely deficient child awaiting admission to Woodlands School, and le caused by the serious, shortage of accommodation at that institution. Referrals are often of an emergency nature when, for example, parents become i l l , or b abies have to be removed from acute hospit-a l s , as previously discussed. It i s very d i f f i c u l t to find accepting foster parents for this severely defective group and the special needs of these individuals are more than a foster home can offer. Their problems take a large proportion of the social worker's time and attention. The Society has been advocating establishment of special f a c i l i t i e s for the emergency place-ment of the grossly mentally deficient child, while the Medical Advisory Committee of the Association for Retarded Children of B r i t i s h Columbia have also made representations. The second problem i s the long range planning for the boarding-out care of the mentally deficient c h i l d . At the present time the Children's Aid Society i s caring for a number of children described as seriously mentally retarded. Special bearding rates are being paid but again the group does not f i t i n well with the general program. From i t s experiences with the indiv-iduals from this group, the Children's Aid Society questions the benefit of foster home placement for the child himself. The Children's Aid Society has com© to the belief that a family care program for the mentally deficient i s principally the responsibility of the Mental Health Services. The Society, however, continues to be willing to take part i n further discussions around this and related problems. 1. Interview with Miss D, Goombe, Executive Director, Children's Aid Society. 101. The Administration of Mental Health Services, for Its part, recognizes the need for a family care program, and plans for implementation are at an 1 2 advanced stage. The Schools f o r Mental Defectives Act, 1953, already makes provision for such a plan, subject to the drawing up of Regulations, which Is presently being done. The operation of a family care program from The Woodlands School w i l l place additional heavy responsibilities on i t s Social Service Department. The social worker w i l l be required to carry out home-finding and evaluation duties with much community interpretation of the new program. The worker w i l l be active i n the selection of pupils,, and their preparation for foster home living,. Then w i l l come actual placement and continued follow-up services to pupil and foster parent. These w i l l Include help with the pupil's adjustment to the new situation, financial matters, and use of cossmunity resources i n -cluding occupational guidance where applicable. Through this program many pupils could be placed who are incapable of supporting themselves, while the hose can also be used as a stepping stone for some towards p a r t i a l or complete economic self sufficiency. Such a program, as can be seen, makes heavy de-mands on the services of the soeial worker and appropriate additions of per-sonnel to the Social Service Department are imperative. An additional financial resource may be the provisions of the Federal Disabled Persons Act, 1955, which pays pensions to the tot a l l y and permanently disabled, who are over eighteen years of ag© and ere not patients i n an i n s t i -tution. The medical requirements include, for the mentally deficient, the need for constant care or supervision, and i t i s suggested that their.I.Q.*s 1. Interview with Dr. C. E. Benwell, Medical Superintendent, Woodlands School, 2. - - - - "Schools for Mental Defectives Act"} 1953* Chapter 26, Section 17 (2), Province of B r i t i s h Columbia, Victoria, 1953. 102. i would seldom exceed sixty-nine. It would appear that these pensions,, with the Provincial Bonus according to eligibility, would be mainly applicable to those of the mentally deficient who were cared for at home, away from the jurisdiction of the institution. The pensions are becoming widely used for this group. The vocational rehabilitation of the patient is a much needed service both for the child in the home and the one who would be able, possibly, to leave the institution and earn his living. At present such services are in a rudimentary stage in British Columbia and, have not yet become a function of the Provincial Co-ordinator for Rehabilitation. It was noted earlier that the special classes and residential schools offer some occupational training but that much more is yet to be done. However, for those who are ready to work there are the job placing services of the National Employment Service, Special Placements Section. In Vancouver this section has found that most referrals of the mentally deficient were made by Children's Agencies, and 2 the School Counsellors for the special class pupils. At the end of March, 1956 the mentally deficient men made up 14 of the total of 151 men who were listed as unplaced or about 10 percent, while the women d efectives accounted for about 5 percent of women who were not placed. The Section has no clinic facilities and occasionally has used the Youth Counselling Service for eval-uation of an applicant. In addition to this lack of available diagnostic services, the Special Placements Section finds that a higher standard of basic training in preparation for employment is a prerequisite to successful placement. The mentally deficient should receive training which is geared to 1. . Interview with Mr. E. W. Berry, Chairman, Disabled Persons Act, Vancouver. 2. . Interview with Mr. H. McKay, Supervisor, Special Placements Section, National Employment Service, Vancouver. 103. the requirements of local industry. The Special Placements Section at Vancouver has found that the mentally deficient generally can carry out the job satisfactorily once the i n i t i a l employer-resistance is overcome and the man is hired. Types of employment include kitchen help, janitor work, and domestic work. The National Employ-ment Service considers the placement of the mentally deficient to be one of its functions but officials point out that this agency also suffers from personnel shortages. Because of this, the placement officer is restricted in the number of personal'; interviews with both applicant and employer that can be done, yet these are most important in the placement of the resntally deficient. At the present time there is no full-scale sheltered workshop in oper-ation for those who cannot compete on the open labour market. The need is being made known by the Parents' Association, whose medical advisors recently went on record as strongly supporting such a project. There is one part-time experimental project in operation by the New Westminster Association, with young adult pupils from the Woodlands School. Similarly, there are no fac-i l i t i e s for social and recreational activities for the mentally deficient, except what is being provided by the Associations. When compared to countries which are more advanced in this area, the facilities for rehabilitation of the mentally deficient in British Columbia are in the barest beginning stages. The family care program projected for Woodlands School is a step in the right direction but would have to be greatly .expanded in services before i t could compare, for example, with the nationwide British scheme for care of mental defectives in their own homes, or foster homes. Vocational training and placement have reached a high level of performance in the United States both in residential schools and in the 104-public school system and could well be applied to the British Columbia scene. Similar gaps are evident in the provision of sheltered workshops or the British equivalents of Occupational Centres and Industrial centres, and also in social activities for the mentally deficient. One of the most striking omissions in the British Columbia scene is Supervision or Guardianship provisions, especially for those who are away from their own homes. Supervision carries with i t the responsibility for continued interest in and protection for the individual throughout his l i f e . Around this guarantee of continued responsibility the whole framework of ser-vices to the mentally deficient should be built, with each section designed towards helping the individual to function at his best throughout his l i f e . Personnel Training and Research In nearly every section of the British Columbia program shortages of trained personnel have been noted as a limiting factor in doing the job. This has been true for such skilled personnel as nurses, teachers, pshycol-ogists, social workers, vocational counsellors, occupational therapists, and physio-therapists, and speech and hearing therapists. This serious d i f f i -culty in training and maintaining the required special personnel has been prevalent in a l l the programs studied. Probably financial aid for the long training courses, and generally better opportunities and salaries, would help the situation. It s t i l l remains, however, as a field which requires consid-erable research before the solutions will be found. In British Columbia some medical research is being done vith the help of Federal Health Grants and this will aid in the continued search for the prevention and the better care of mental deficiency. 105. A Co-ordinated Program The needs of the mentally deficient person change in their characteris-tics as he progresses through l i f e . So, similarly, the kinds of services available must be of wide variety and focussed to meet these needs. In order to accomplish this, a l l the many complex services must be linked to-gether in one overall program to ensure common goals, maximum efficiency, and a truly continuing service to the individual. Perhaps this could best be done by a representative Board, bringing together Mental Health Services, Education, and Parents Associations for broad planning of services and policy. The actual administration could be through the Woodlands School, which would be giving many of the services. A program which is inclusive of the needs of the mentally deficient would begin with diagnostic services which would be made available to a l l in the province. This requires a new Clinic at Woodlands School and travelling clinics for more sparsely populated sections of the province. An agency such as the schools would have the duty by law of seeking out the mentally deficient and registering them with the Crippled (Handicapped) Children's Registry. Parents would be helped to understand their child's condition and there would be r esources at hand which would enable realistic planning. Visiting teachers and social workers would, wherever possible, help the parent in training the child at home, and in meeting the many problems of the child, and those of a family nature. Home care would need to be streng-thened by financial provisions, supervision where needed, and health services-. Relief for the family and child should be provided by day centres and summer camps. 106. The new Education Act would be extended to make provision for classes for the educable and the trainable children equally across the province, with attendance of the educable being required by law unless otherwise arranged with the school board as with normal children. The classes would extend into high school and provide vocational training and guidance, and preparation for employment. The Woodlands School would expand its facilities for the treat-ment of those mentally deficient children who were emotionally disturbed, and improve its vocational training and employment preparation. Rehabilitation would occupy a more important place in a comprehensive program, A Family Care program would be offered throughout most of the province with adequate financial arrangements and f u l l Social Services to the home and pupil, centred in the Mental Health Services at Woodlands, The pupil who was ready for employment would have job-finding and counselling services readily available at an expanded National Employment Service, Sheltered Workshops would be established with government support where others others of the mentally deficient could partially earn their living or obtain further confidence and training. In addition to his basic needs for family ties and a worthwhile occupation, there would be facilities for recreation, social clubs, camps, etc., where the mentally deficient could share enjoyable experiences with others of a similar level of interests and abilities. The future prospects for his group would be enhanced by active programs of personnel training and research into problems of a medical nature and into the social aspects of the program as well. The individual would be assured of supervision continuing throughout his lifetime with services available for any particular phase. The interests of the g roup as a whole would be safeguarded by a continuation of the strong 107. leadership and faithful services of the parents, acting together through their local groups. The implications of such a scheme are particularly great for the profes-sion of Social Work. Many highly skilled and strongly motivated workers will be required to carry heavy portions of the programs from the early diagnostic process, through training, personal and family services, rehabilitation, family care program, supervision, community interpretations and eocial-recreational programs. The program outlined above is realistically based on successfully oper-ating programs here, and in other countries. It will be noted that this does not require a building program but instead is designed to keep the child in the home or to return the child as soon as he is ready, where i t is least expensive to care for him and best for his own happiness and achievement. Wherever possible he will be earning at least part of his keep, to the benefit of a l l . The money for the program would be expended where i t is most effective, namely, on trained personnel who, however, will be difficult at f i r s t to obtain. The overall savings will be considerable, and the bene-fi t s to the community great, in having provided a proper life for the mentally d eficient. APPENDIX A BIBLIOGRAPHY SPECIFIC REFERENCES B o o k s Burt, Cyril; The Backward Child: University of London Pressj London, 1937. Burt, Cyril; The Subnormal Mind: Oxford University Press, London, 1937. Deutsch, Albert; The Mentally 111 In America: Columbia University Press} New York, 1949. The Handicapped Child: White House Conference on Child Health and Protection; The Century Co.} New York, 1933. Jervis, G.A.; Medical Aspects of Mental Deficiency: Vocational Rehabilitation of the Mentally Retarded; U.S. Government; Washington, 1950. Noyes, Arthur P.; Modern Clinical Psychiatry: Saunders Co.; Philadelphia, 1953. Penrose, L.A.} The Biology of Mental Defect: Grune and Stratton; Mew York, 1949. Social Work Yearbook,; Rus3e*ll Sage Foundation, Hew York, 1949. Tredgold, A.E.} A Textbook of Mental Deficiency; Bailliere, Tindall and Cox; London, 1952. Zilboorg, G.; A Historyiiiof Medical Psychology: Norton and Co.; New York, 1941. Articles. Reports and Other Studies, An act Concerning Mentally Handicapped Children; Public Act 432 of 1953, State of Connecticut, Sections 1 and 3. Assistance in Payment of Cost of Education of Retarded Children; Ontario Regulations 114/53, June 1953-Badham, J.H.; "The Outside Employment of Hospitalized Mental Defective Patients as a Step Toward Resocialization"; American Journal  of Mental Deficiency: Vol. 59 #4, April 1955. 109. Baumgartner, B.j "Study Projects for Trainable Mentally Handicapped Children in Illinois"! American Journal o f Mental Deficiency: Vol. 60 #3, January, 1956. Benson, F.; "Problems Faced by an Institution in Placing Mentally Deficient Patients in Family Care"; American Journal of Mental Deficiency; Vol. 57, #4, April 3953. Bishop, E.B.; "Family Care: the Institution"; American Journal of Mental  Deficiency: Vol. 59 #2, October 1954. Black, H.K.j "Saskatchewan Training School, Mcose Jaw"; Mental Hospitals; Vol. 6 #11, November 1955. (Washington, D.C.) Bostock, Norma L.j "How Can Parents and Professions Co-ordinate, etc."; American Journal of Mental peficiency; Vol. 60 #3, Jan. 1956. The Canada Year Book: Dominion Bureau of Statistics; Ottawa, 1955. Children in Britain; Central Office of Information, London, May 1953. Cianci, V.; "Home Training"; American Journal of Mental Deficiency; Vol. 60 #3, January 1956. Clapper, C C ; "A Study of Mentally Retarded Students in San Diego City High Schools"; American Journal o f Mental Deficiency; Vol. 59 #1, July 1954. Clark, R.J.; "Care of the Mentally 111 in British Columbia"; Unpublished Thesis, School of Social Work, University of British Columbia, 1947. Crippled Children's Registry, Third Annual Report, 1954« Mimeograph, Vancouver; and Mimeographed Information Sheets, Feb. 7, 1956. DiMichael, S.G.; "Principles and Methods of Establishing a Sheltered Workshop"; Sheltered ¥orkshops; National Association for Retarded Children; New York, 1954. Dudley, Lois P.; "Home Care Program"j American Journal of Mental Deficiency; Vol. 60 #3, January 1956. Education in Britain; Central Office of Information; London, July 1955. Ekdahl, H.; "The Placement Program for the Aged at Walter E. Fernald State School"; American Journal of Mental Deficiency; Vol. 57 #3, January 1953. Feder, Nathan, "The Clinics of the Association for the Help of Retarded Children"; Inc." American Journal of Mental Deficiency; Vol. 56 #2, October 1951. 110. Fried, Antoinette* "Report of Four Years of Work at the Guidance Clinic for Retarded Children, Essex County, N.J."j American Journal of  Mental Deficiency; Vol. 6 #1, July 1955.. Garber, R.S.j Discussion Leader, "Outpatient Clinic Services for the Mentally Deficient"; Mental Hospitals; American Psychiatric Association, Washington, D.C.j Vol. 7 #2, February 1956. Gilberty, F.R. and Porter, E.L.H.j "Beginnings of a Home Training Program"; American Journal of Mental Deficiency; Vol. 59 #2, October 1954. "Important Basic Background Understandings for Counsellors, Relating to the Mentally Retarded"; Mansfield State Training School, Connecticut, Mimeograph, 1956. Ingram, V.M. and Popp, CE.j "A Public School Program for the Severely Mentally Handicapped Child"; American Journal o f Mental  Deficiency: Vol. 60 #2, October 1955. Jolly, D.H.; "Where Should the Seriously Retarded Infant be Institutionalized"; American Journal of Mental Deficiency: Vol. 57 #4, April 1953. Kallman, F.J.; "Recent Progress in Relation to the Genetic Aspects of Mental Deficiency"j .American Journal of Mental Deficiency: Vol. 56 #2, October 1951. Katz, Sidney; "The Lonely Children"; Maclean's Magazine; Toronto; Vol. 69 #2, January 21, 1956. Macdonald, John D.; "A Study of Three Cases of Functional Feeblemindedness"; Monograph III; The Ryther Child Centre, Seattle, 1947. Martin, M.F.; "The Role o f State Legislation, etc."; American Journal of  Mental Deficiency; Vol. 59 #2, July 1954. McBride, R.j Kaplan, J.j Hall .,M. j "Community Planning to Meet Some of the Social Needs of the Mentally Retarded Adult"j American Journal of  Mental Deficiency; Vol. 58 #2, October 1953. Mental Health Services Annual Report; Province of British Columbia, Victoria, 1953. Mental Health Services Annual Report, 1955J Province of British Columbia, Victoria, 1955. Mental Health Services in Canada; Memorandum #6, Department of National Health and Welfare, Ottawa, 1954. »; Mickelson, Phyllis; "Minnesota's Guardianship Program as a Basis for Community Supervision"; American Journal of Mental Deficiency: Vol. 56 #2, October, 1951. 111. News Notes; American Journal of Mental Deficiency; Vol. 60 #2, October 1955. "Objectives of the School Program"; Mansfield State Training School, Connecticut, Mimeograph, 1956. lister, J.; "Scientific Problems, Progress, and Prospects"; American Journal  of Mental Deficiency; Vol. 59 #3, January 1955. "Parents"; "American Journal of Mental Deficiency; Vol. 59 #4, April 1955. Penrose, L.S.; "The Supposed Threat of Declining Intelligence"; American  Journal of Mental Deficiency; Vol. 53, July 194-8. Pollock, H.M.; "Family Care of Mental Defectives in Scotland"; American  Journal of Mental Deficiency; Vol. 52 #2, July 1957. Pollock, H.M.; "Requisites for the Further Development of Family Care"; American Journal of Mental Deficiency; Vol. 50 #2, October 1945. Rowers, G.F.; "Research and the National Association for Retarded Children"; American Journal of Mental Deficiency; Vol. 59 #2, July 1954. Public Schools 83rd Annual Report, Province of British Columbia, Victoria, 1955. "Pupils with Mental or Educational Disabilities"; A Report of the Advisory Council on Education in Scotland; H.M.S.0.; Edinburgh, 1951. Roselie, E.N.; "New Horizons for the Mentally Retarded: When a State Looks at the Problem as a Whole"; American Journal of Mental Deficiency: Vol. 59 #3, January 1955. Roselle, E.N.; and Powter, E.L.H.; "A Procedure for Study, Care and Training of the Mentally Retarded in a State or Other Residential School"; American Journal of Mental Deficiency; Vol. 60 #1, July 1955. Roselle, E.N.; Chairman, "Report of Committee on administration, American Association of Mental Deficiency; May 2 4 , 1955"; American Journal  of Mental Deficiency; Vol. 60 #3, Jan. 1956. Roselle, E.N.; "Some Principles and Philosophy in the Planning and Develop-ment of Institutional Plants with Particular Reference to Institutions for the Mentally Retarded"; American Journal of Mental Deficiency; Vol. 58 #4, April 1954. Sloan, W; Chairman, "Progress Report of Special Committee on Nomenclature, A.A.M.D."; American Journal of Mental Deficiency; Vol. 59 #2, October, 1954. Social Services in Britain; Central Office of Information; London 1954. 112. Social Work and the Social Worker in Britain"; Central Office of Information; London, October, 1951. Thomas, E.; "Family Care"; American Journal of Mental Deficiency. Vol. 60 #3, January, 1956. Training and Supply of Teachers of Handicapped Pupils"; H.M.S.O.; London 1954-Vital Statistics Report for 1953; Province of British Columbia; Victoria, 1955. Whitney, E.A.; "Current Trends in Institutions for the Mentally Retarded"; American Journal of Mental Deficiency; Vol. 60 #1, July 1955. Willoughby, R.R.; "Rhode Island's Experiment in Registration"; American  Journal of Mental Deficiency; Vol. 50 #1, July 1945. Wirtz, M.A.; "The Development of Current Thinking about Facilities for the Severely Mentally Retarded"; American Journal of Mental Deficiency; Vol. 60 #3, January 1956. GENERAL REFERENCES Books Carr-Saunders, A.M.; Eugenics; Williams and Norgate Ltd.; London, 1926. Hobhouse, L.T.; Social Evolution and Political Theory; Columbia University Press; New York 1911. Maclver, R.M,; Community^  a Sociological Study; MacMillan and Co.; London, 1928. Maclver, R.M.; Society, a Textbook of Sociology; Farrar and Rinehart; New York, 1937. 

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