Medical and general reports and accounts for the year ended 31st December, 1942 : (from Swaylands, Penshurst, Kent.) Present Address: Ash Hall, Bucknall, Stoke-on-Trent / The Cassel Hospital for Functional Nervous Disorders.

  • Cassel Hospital for Functional Nervous Disorders (Richmond, England)
Date:
[1943?]
Catalogue details

Licence: In copyright

Credit: Medical and general reports and accounts for the year ended 31st December, 1942 : (from Swaylands, Penshurst, Kent.) Present Address: Ash Hall, Bucknall, Stoke-on-Trent / The Cassel Hospital for Functional Nervous Disorders. Source: Wellcome Collection.

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    Stage 2. Convalescence. At Stage 2, when the patient is ready for convalescence, our present provisions are most scrappy and unsatisfactory. The lack of adequate convalescence, as opposed to the mere passive process of exposing oneself to a “ change of air ” in some neutral surroundings, is economically wasteful. A number of patients come to the end of the period when they need to be in hospital under close medical supervision, some time before they are ready for normal life. Not all of them require the same type of convalescence. For some a brisk, active toning-up process with a minimum of medical fussing would be ideal. This would not require to be carried out at a centre specially for psychoneurotic patients. Indeed, it would probably be better to accept all types of convalescent patients capable of benefiting from the regime. A strictly limited stay would be necessary, otherwise the brisk and hopeful atmosphere would be dissipated. No doubt something of this type is envisaged in paragraph 23 of the Tomlinson Report which speaks of “ a course of reconditioning which should include organised games and graduated exercises.” Special Centre for psychoneurotic patients. There are, however, other patients no longer requiring strict hospitalisation but for whom con¬ structive discipline, care and supervision is still necessary. This group contains some long-standing neuroses of all types, certain psychopathic person¬ alities and a few whose home environment is very bad. In many cases these patients are not capable of making an abrupt return to normal life, and for them the process of rehabilitation via the type of convalescent home mentioned in the previous para¬ graph is not suitable. They require some establish¬ ment where they can live for a time under occasional medical supervision, but without the close protection of a resident medical and nursing staff. The Super¬ visor. of such an establishment should preferably be a trained nurse since her training would give her the proper background for her work. She should, however, aim at achieving a role which might best be described as that of “ house mother.” One would visuahse that most of the domestic duties in such an establishment would be carried out by the patients. There should be a sufficiently large • garden to occupy some male convalescents quite fully. Work for these patients should be a condition of residence and should enable the cost of the establish¬ ment to be kept at a minimum. Other patients residing at the home would go out to work, either to their normal occupation in neighbouring towns or to some Government or other training centre. Residence in such an establishment should be limited to a maximum of (say) six months. It could serve a most useful purpose in reducing the pressure upon the available beds of the parent hospital. Stage 3. Re-settlement. Stage 3, Rehabilitation or Re-settlement, is a period during which direct medical contact with the patient is reduced to a minimum. The Tomlinson Report makes a series of recommendations upon which one is not qualified to comment adequately. In the field of neurosis among the civilian population the problem at present resolves itself into one of collaboration with the local officials of the Ministry of Labour and with individual firms to ensure correct placement of the patient, and to prevent undue strain from being placed upon him. Our experience with our local Labour Exchange has been a very fortunate one, and we cannot speak too highly of the skill and thoughtfulness which members of its staff have exercised on behalf of our patients. It is obvious that the conditions of total warfare have caused the Labour Exchanges to assume an altogether new significance in the lives of many individuals who had no previous contact with them. To judge by our experience they have borne their new responsi¬ bilities with great success. It seems altogether possible that with suitable staff they might become the main channels through which re-settlement schemes should operate, collaborating both with employers and physicians to this end. With some employers, too, our experience has been satisfactory, particularly when it is possible to discuss the patient’s difficulty with someone who has authority to see that agreed recommendations are actually carried out. The increased employment by larger firms of responsible welfare officers ought to make this process more efficacious in the future, whilst in the case of smaller firms the more direct personal contact between employer and employee often serves the same purpose. Comparison with Tomlinson Report. These, then, are the three stages of rehabilitation in the neuroses as we visualise them. They correspond quite closely to the stages of medical rehabilitation, post-hospital rehabilitation and resettlement dis¬ cussed in the Tomlinson Report. There is one respect, however, in which we feel bound to differ from the recommendations of that report. Too sharp a division appears to us to be made in the report between these various stages. In paragraph 39 the creation of a Diploma is suggested presumably to qualify those who will endeavour to bridge the gap. In the field of the neuroses, however, our experience leads us to deplore such sharp divisions and to deprecate the creation of specialists in rehabilitation. We have after all'only one patient to consider at all these stages, and the physician who has supervised his passage through Stage 1 should be capable of continuing the work to the end. If he is unable to do so the patient’s treatment must inevitably suffer as a result of the break.