The Modern Management of Mental Handicap: A Manual of Practice PDF
Preview The Modern Management of Mental Handicap: A Manual of Practice
The Modern Management of Mental Handicap A Manual of Practice EDITED BY C. B. Simon Director The British Institute of Mental Handicap MTPPRESS LIMITED Illtenzatiolltli Mediml Publishers Published by MTP Press Limited Falcon House Lancaster, England Copyright @ 1980 The British Institute of Mental Handicap softcover reprint of the hardcover 1s t edition 1980 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers. British Library Cataloguing in Publication Data The modem management of mental handicap. 1. Mentally handicapped - Care and treatment I. Simon, G. B. 362.3 HV3004 ISBN-13: 978-94-011-7202-8 e-ISBN-13: 978-94-011-7200-4 001: 10.1007/978-94-011-7200-4 Phototypesetting by SWiftpages Limited, Liverpool REDWOOD BURN LIMITED Trowbridge and Esher CONTENTS List of contributors vii Preface G. B. Simon ix Foreword P. Mittler xi 1. Introduction: some information about mental handicap G. B. Simon 1 2 Causes and prevention J. Jancar and G. B. Simon 7 3 Genetics and mental handicap V. A. Cowie 15 4 Medical treatment of behaviour problems in people with mental handicap J. A. Corbett 29 5 The behavioural approach C. Williams 43 6 Mental illness in the mentally handicapped J. C. N. Tibbits 65 7 Epilepsy B. I. Sacks 95 iii THE MODERN MANAGEMENT OF MENTAL HANDICAP 8 Sensory handicaps G. B. Simon 121 9 Motor handicap D. M. Ricks 131 10 Communication M. Walker 151 11 Education of the severely mentally handicapped N. B. Crawford 175 12 Training, employment and recreational activities for adults M. Phillips 189 13 Parents' needs and how to meet them L. Marks 203 14 Assisting the families of the mentally handicapped E. Jones 229 15 Play, toy libraries and adventure playgrounds E. Jones 241 16 Residential provisions for the mentally handicapped G. B. Simon 249 17 Sexuality and the mentally handicapped A. and M. Craft 255 18 The law relating to mental handicap and to the mentally handicapped offender R. S. Bluglass 273 Index 301 LIST OF CONTRIBUTORS R. S. BLUGLASS N. B. CRAWFORD Professor of Forensic Psychiatry Headmaster University of Birmingham Mary Elliot School Walsall J. A. CORBETT Consultant Physician J. JANCAR Consultant Psychiatrist Hilda Lewis House The Bethlem Royal Hospital Stoke Park Hospital Stapleton, Bristol Shirley, Croydon E. JONES V. A. COWIE Consultant Psychiatrist Consultant Psychiatrist Lea Castle Hospital Queen Mary's Hospital for Wolverley, Kidderminster Children Carshalton MRS L. MARKS Parent M.A.CRAFT Personal Social Worker P. MITTLER Bryn-y-Neuadd Hospital Director Llanfairfechan, Gwynedd Hester Adrian Research Centre for the Study of Learning Processec M. J. CRAFT in the Mentally Handicapped Consultant Psychiatrist and Professor of Special Bryn-y-Neuadd Hospital Education Llanfairfechan, Gwynedd University of Manchester v THE MODERN MANAGEMENT OF MENTAL HANDICAP M. PHILLIPS J .C.N. TIBBITS Associate Director Medical Assistant Development Team for Mentally Lea Castle Hospital Handicapped W olverley, Kidderminster D. M. RICKS M. WALKER Consultant Psychiatrist Senior Speech Therapist The Children's Department Botleys Park Hospital Harperbury Hospital Chertsey Shenley, Radlett Project Co-ordinator Makaton Vocabulary Develop B. I. SACKS ment Project Consultant Psychiatrist Farnborough Enfield District Hospital and Royal Free Hospital, C. WILLIAMS Hampstead Principal Clinical Psychologist Royal Western Counties Hospital C. B. SIMON Starcross Consultant Psychiatrist Exeter Lea Castle Hospital Kidderminster vi PREFACE The aim of this book is to provide parents, staff and others involved with mentally handicapped children and adults with up to-date basic information and advice in their management. Methods of care, treatment and management of a heterogeneous group of people such as the mentally handicapped must of necessity include many disciplines if they are to be given an adequate service. This book is an attempt to bring the knowledge and experience of many people together. The size of the book could have been increased to include more detail on other aspects of the subject but this might easily have diminished its value as a convenient reference to as wide a readership as possible, both professional and non-professional. The contents deal essentially with the needs of the severely mentally handicapped and should have an application in most parts of the world. Much of the information and advice on services, and on treatment and management, is based on the experience of specialists working in the United Kingdom, this now being standard practice in most parts of the world. All the contributors have experienced direct involvement with the mentally handicapped, and have been chosen because of their specialized knowledge of particular aspects of the subject. To meet the needs of this wide readership, the authors have provided explanations which will enable readers to gain an understanding of the subject without previous related knowledge. Despite the intentional simplification the subject has been covered in the vii THE MODERN MANAGEMENT OF MENTAL HANDICAP widest sense, and where more detail was not felt to be appropriate in this book, the lists of references and further reading suggested should provide further information. Mental handicap"and severe mental handicap in particular, are crippling states in a world where increasingly only the fittest can achieve independent survival. Those less able tend to go under. Throughout this book the need for early assessment, treatment and training is stressed; this will not cure the mentally handicapped but it will certainly improve the quality of their lives. The progress made in the last 30 years in developing methods of training for the mentally handicapped, even the severely mentally handicapped, should dispel for ever the belief that these people will inevitably be incompetent, and must therefore be over-protected and without opportunity for development. I would like to thank all the authors for their co-operation in rearranging and modifying their chapters to meet the objectives and aims of what I hope will be a useful and practical text. Finally, I must thank the publishers, MTP Press Ltd, for their tolerance and patience, my secretary, and other British Institute of Mental Handicap staff who have assisted with the typing of drafts. G. B. SIMON Editor viii FOREWORD P. Mittler This is a book by practitioners for practitioners. Its authors work daily with people who are mentally handicapped and their knowledge and commitment spring from every page. A practitioners' manual is badly needed because knowledge of good practice is nothing like as widespread as it might be. We need to disseminate good practice by every means at our disposal-not only by books but by films and videorecordings and, above all, by programmes of staff training in the settings in which people work. Staff training is undoubtedly the key to a better service. This book describes briefly and in simple language what staff actually do in their day-to-day work and it succeeds in conveying a vivid picture of treatment programmes in action. It will un doubtedly be useful to staff working in the service but it should also be read by those outside the service who would like to increase their understanding of recent developments in the field of mental handicap. Since such staff will in future come increasingly into contact with mentally handicapped people, it is obviously impor tant that they should have opportunities to learn about the signifi cant advances that are being made. It is equally important that such opportunities should also be available to policy makers, planners and administrators at national and local level who often determine the resources that will be allocated to mental handicap services. The book could just as usefully be read by parents and families. Although more parents are now working in partnership with ix THE MODERN MANAGEMENT OF MENTAL HANDICAP professionals, they do not always receive clear explanations of the range of treatments that are now being used or the reasons why they are thought to be useful. There are still many bridges to be built between parents and professionals and some of the chapters in this book should prove invaluable for this purpose, just as the chapters on the needs of parents contain important material for professionals. The book also richly illustrates how the treatment of mentally handicapped people demands a multidisciplinary approach. The authors write as skilled practitioners in their own fields but also show a deep awareness and appreciation of the work of their colleagues in other disciplines whose work complements their own. There are still many problems of teamwork to be solved, one of the most basic being that of recruiting scarce professionals into the service and another of ensuring that their skills are available in both health and local authority settings. Here again, the chapters should serve to convey a positive picture of the advances that can be made and stimulate the crossing of professional and ad ministrative boundaries. There can be no doubt that major advances have been made in the treatment of mentally handicapped people during the last ten 'years and that further advances in the next decade are possible. There seems to be a much broader base of agreement about what we should be doing and what a good mental handicap service looks like. But it would be dishonest to minimize the difficulties that lie ahead. The chronic shortage of resources which has affected both health and local authority services seems set not only to continue but to become worse. This is all the more frustrating to staff at the very time when they feel that better methods of care and treatment are within their grasp. It is therefore more important than ever that practitioners present a united front and demonstrate through their work with mentally handicapped people that this long-neglected field deserves a greater share of scarce resources. Too many people in high places still have pessimistic attitudes about the possibilities of achieving results in the field of mental handicap. If we are to make progress in the next ten years, we shall have to convince others as well as ourselves. This book will make an important contribution by showing what can be done. x
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