MENTAL HANDICAP VOL. 11 MARCH 1983

Letters Speech therapy in adult training centres

Sir - In the article on The Future Role of the Adult Training Centre Instructor (Gordon Wellard, September, 1982), I was naturally delighted to read the paragraph on “The importance of speech therapy in ATC’s”.

I wholeheartedly agree that, when professional help is available, it should be used to help the instructors rather than as direct therapy with clients. After many years of effort we have, at last, obtained funding to give such an advisory service to some of the ATC’s in Somerset and our hope is that the remaining centres will be covered as increased funding becomes available. Perhaps I should make the point that there is not a shortage of speech therapists, but rather a shortage of funding for extending services. We are very fortunate in Somerset in that one ATC has a weekly speech therapy session which is funded by the local branch of the RSMHCA.

Speech therapists commencing services to ATC‘s have, predictably, encountered problems because of the lack of other professional support to the centres. In our experience it is particularly difficult to obtain visits from audiometricians and many of the clients have not had recent hearing tests. This is obviously a most important area when considering clients’ communication skills, and it has become obvious that the introduction of a speech therapy service to these long neglected centres will bring increasing demands on other services. LINDA TARBOX, Area Speech Therapist, Somerset Health Authority, County Hall, Taunton.

Mental handicap policy in Great Britain

Sir - In their comments on the above article (Mental Handicap; June, 1982), Dr. Douglas Spencer and Dr. L. F. W. Rowe (Mental Handicap; December, 1982) refer to the contributions made by psychiatrists to the development of the services for mentally handicapped people since the advent of the NHS. No one would wish to deny the value of these contributions, least of all MIND.

The article contained a considered assessment of the function and purpose of mental handicap hospitals, and their future. It emphasised the importance of education, care, and treatment provided by well-trained mental handicap professionals in the community. The value of teachers, nurses, social workers, doctors, and others was never questioned. The question posed was why this work

has to be performed within the artificial despite the obstacles. We do not ask for a confines of an institution. decline of services but a replacement of

Instead of addressing the principal services. This is not an inexpensive theme of the article, Dr. Spencer and Dr. government option. Rowe chose to focus on the role of the In a reformed service the consultants, psychiatrist within the mental handicap currently based in the hospital, would services. The article suggested that some have the basis of their authority changed. members of the psychiatric profession Their authority would then come, not emphasise, in accordance with their from their special position, but from the medical function, the primary importance knowledge and skills they deploy. Our of hospital care. This statement was impression is that many consultants in intended to examine the role (as opposed mental handicap have already gone far to the worth) doctors should play in the down this road, and would welcome the reformed services envisaged in the article. change in role the transfer would bring. Is

Bringing mental deficiency colonies the article correct when it suggests that into the NHS as hospitals gave doctors a some senior staff - particularly consultant special role which, in the early 19503, psychiatrists - feel threatened by it? It they were hardly able to perform; this was would hardly be surprising if they do, due primarily to the lack of doctors to because the new policy does mean a staff the hospitals, and to the change in role, and this is never easy. shortcomings in the training of the few There is, of course, legitimate concern. who were available. The last decade has Will patients suffer if the consultant no seen a vast improvement, and there are longer has overall responsibility? Will the now well-trained applicants for the posts, new policy be properly implemented with although still far too few. But while this sufficient resources to provide adequate has been happening, the climate of community care and facilities? opinion has been changing. These are taxing problems, and we

The Education (Handicapped Children) must be attentive to them. However, it Act (1970), for instance, transferred the must not dissuade society from the responsibility for educating severely correct policy of transferring patients handicapped children from health from large sterile institutions to a more authorities to local education authorities. normal community environment with as The fierce controversies over the transfer much care, compassion, and acceptance died as soon as it had taken place. It has that society can provide. never been regretted* It came about LARRY GOSTIN, formerly Legal Director, because of the greater importance given MIND (National Association for Mental Health), to the educational and social, rather than now Fellow in Psychiatry and Law, Oxford the medical, disabilities of the University Centre for Criminological Research.

handicapped. DEREK RUSSELL DAVIES, Emeritus Professor Yet doctors continue to play a vital part of Mental Health, Bristol University.

as consultants, whether as orthopaedic New method of treating deafness surgeons, ophthalmologists, clinical Sir - At the otolaryngology department biochemists, ENT surgeons, or of the Institute of Pediatrics of the psychiatrists. This role is not to develop Academy of Medical Sciences of the the social and educational potential of the USSR a physiotherapeutic method of mentally handicapped child or adult, but restoring hearing in children with to diagnose and treat the accompanying cochlear neuritis and neurosensory physical or psychological disabilities hypoacusis was tested in 1981-1982. which they may, or may not, have. The new method of treatment has been Doctors may go on seeing their patients developed in cooperation with the over many years. Their relationship with specialists of the chair of biomedical them is the same as that which they have systems and technical equipment of the with all their other patients. They do not, Bauman Higher Technical School in or should not, have the special Moscow. Here it is, in a nutshell. responsibility which the consultant has The Soviet-made low-frequency for his patients in hospital. helium-neon quantum-mechanical oscil-

Should there now be a similar transfer lator was used to influence the drum of the care of the mentally handicapped membrane via an intermediate fibre light adult from the health services to the local conductor. The monochromatic red laser authority services, as a result of the light was absorbed by the structural recognition that their problems are social elements of the tissue. The tissue’s energy and educational as much as medical? This potential thus increased and so did its would happen if the buildings in which regeneration. Vascular permeability they are accommodated lost their processes were also affected: the designation as hospitals. Or, preferably, i f congestive hyperemia (that is, the rush of the hospitals themselves were phased out blood) turned into an active process and replaced with a full range of which restored capillary macrocirculation residential and community services. and general metabolism. There are many who believe that, The second procedure is magnetic whenever such a transfer will take place, massage. Earphones are put on the it is too soon. We believe, however, that a patient’s head, and small permanent phasing out of hospitals should take place magnet rods are introduced into his ears.

40 @ 1983 British Institute of Mental Handicap

MENTAL HANDICAP VOL. 11 MARCH 1983 ____

A mains-operated compact electro- magnetic vibrator makes ferromagnetic rods produce something like a roll on the drum membrane.

Then wet electrodes in chlorvynil braid sleeves are introduced into the acoustic meatuses as far as they will go. The MBS- 3M one-channel battery electrostimulator we have designed together with engineers produces pulse voltage, and the patient feels weak rhythmic tingling in his ears (in the drum membranes).

A course of treatment lasts one week. Dr. Tatyana Baklanova, head of the otolaryngology department of the Institute of Pediatrics, said this:

‘Several dozen children have had their hearing restored. We have admitted patients who were most seriously ill. One boy began losing his hearing after suppurative otitis (inflammation of the middle ear) when he was 2% years old. He came to us a teenager, 15 years old. He could not hear the loud sounds of a television set one metre away. According to an audiogramme, the boy could hear no low frequencies. Now his hearing is restored practically completely. ’’ Professor Igor Koshel, deputy director

of the Institute, officially said the results were positive. He said:

“The results show this to be a promising method of treating children with cochlear neuritis and neurosensory hypoacusis. ”

YURI MIRONENKO, Cand. of Sc. (Medicine), c/o Novosti Press Agency, Pushkin Square, Moscow, USSR, and 3 Rosary Gardens, London SW7 4NW.

Editors’ note: We have deliberately left the technical terms in

the above letter unchanged as they will undoubtedly be of interest to specialists in the field. Apologies to readers unfamiliar with them.

Directory of non-medical research Sir - In September 1982 you published

a letter from HPRU requesting researchers to contact us regarding the Directory of Non-Medical Research Relating to Handicapped People which we were compiling. We should like to take the opportunity of thanking Mental Handicap and its readers for helping to make this venture a success. We have received a massive response from researchers all over the country, and the Directory has gone to press at 650 pages. Unfortunately this has necessitated making a charge of LlO - to cover the high costs of producing such a volume - but we hope this will not put it beyond the financial reaches of all interested persons.

The Directory is now being updated for the 1983 edition and we hope researchers will keep us informed of their work, together with new investigations. With funding from the Department of Industry we are setting up a national computerised

database on aids and equipment, and so should also like information on design and development projects, and research into aids.

Once again, many thanks to you and your readers for supporting us. JANE WHITELEY, Project Assistant, Handicapped Persons Research Unit, Newcastle upon Tyne Polytechnic, 1 Coach Lane Campus, Newcastle upon Tyne.

A case of mistaken identity Sir - What a dreadful problem it is

being called JONES. Since you published McEvoy, Megee,

Rowe and Beard’s letter in Volume 10:3 of Mental Handicap, in which they dissociate themselves from the work of Mr. PHXLIP Jones, I have been embarrassed to receive a number of enquiries asking why this group of colleagues is so critical of my work.

Of course, the answer is that there are two “Jones the Psychologist” who have worked for the Spastics Society at Meldreth. I am the Jones who works with severely disturbed handicapped children in Beech Tree House, while Mr. Philip Jones was the Meldreth Manor School psychologist.

I dare say many people are critical of my work as well - but they have yet to put it in writing. I would appreciate it if you would publish this brief letter in order to put the record straight. MALCOLM C. JONES, Head of Beech Tree House, Meldreth Manor School, Meldreth, Nr. Royston, Herts.

Editors’ note:

that no more misunderstandings will arise. We regret the confusion that has arisen and trust

“Portage-type” services - national survey

Sir - The Health Care Evaluation Research Team is presently undertaking a national survey of “Portage-type” home teaching services for mentally handi- capped people as part of a DHSS funded research programme. All such services, including discontinued services, need to be identified.

For the purposes of the survey a “Portage-type’’ home teaching service usually includes the following components: regular visits to the family, assessment of clients with a develop- mental checklist, written instructions and record charts, modelling of the inter- vention by the home teacher, observation of the parent carrying out the teaching, recording of baseline and post-baseline measures, and the home teachers attending regular supervisory meetings.

We would be grateful if readers involved in such services could contact us. Further information regarding the research is avaiiable on request. SUE BENDALL, HCERT, Dawn House, Sleepers Hill, Winchester SO22 4NG.

Colour as a learning aid Sir - In nearly all teaching situations, I

have found colour a useful stimulant. Most people are fascinated by colour, hence the invention of colour TV and photography. A coloured diagram is far more attractive than a “black and white” production.

Mentally handicapped people are attracted to colour. Many enjoy “colouring in”, with crayons, pencils, or paints. I find that colour helps those with severe reading or numeracy difficulties.

For example, the alphabet looks far more interesting presented in bold, bright colours than in black on a white back- ground. Patients can learn the alphabet, and even words, by colouring in the letters that are outlined for them. As reading progresses, books that are well- illustrated in colour have proved more helpful than readers with black and white drawings, or none at all.

In the same way, large numbers that are already coloured, or offered in outline to be coloured in by the patient, can enhance learning. Using coloured blocks can help mentally handicapped people grasp the mechanics of addition and subtraction. G. A. W. PARTRIDGE, Adult Education Tutor, Greaves Hall Hospital, Banks, Southport, Merseyside.

Handbook for occupational therapists

Sir - We have been approached to write a handbook for occupational therapists and allied workers in mental handicap. We envisage that it will include some theory and background information but will be primarily a practical reference text for techniques and treatment mediums.

We are therefore concerned that it should be as widely relevant and useful as possible and so we should be grateful to anyone in this field for any ideas on subject matters they would find relevant. CHRISTINE PECK, Head Occupational Therapist and CHIA SWEE HONG, Senior Occupational Therapist, Chace Village, Enfield District Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL.

Readers are reminded that restricting letters to not more than 750 words enables early inclusion in the journal. Longer letters may have to be held over.

_ _ _______ -____.- - - . - .. __

@ 1983 British Institute of Mental Handicap 41