1980: Edinburgh Settlement; The Need For Psychiatric Day Centres
The Settlement is an arm and hand of friendship which the University, as a community, stretches forth to the wider world of Edinburgh. The University is a tidy and recognisable community in which common interests are readily recognised – not only in learning, and educational matters, organisational and administrative problems, but in preparation for life for some and progress in careers for others.
In contrast the community beyond is a positive jungle. Only times of national joy or disaster – or a sporting event – knits the populace together even in a city which has much beauty and a rich heritage.
Of course this jaundiced view arises because psychiatrists see the community as a laboratory of social pathology – the effects of, or outcome of such phenomena as:-
- Unemployed youth
- Unwanted births
- Mental deficiency
- Physical handicap
- Children in care
- Children in Special Schools
- Electricity disconnected
- Self Poisoning
- Problems associated with
- alcoholism in old, young, men
- and women too.
It is to this environment that many of our recovering or recovered patients are (in the prescribed word for this address) “discharged”. The items which I have mentioned as examples of social pathology are specially prevalent in the Craigmillar and Pilton areas and in the part of the town around this building in the District Ward of St. Giles. Return to such conditions, or to home situations to which I will refer -can obviously mean return to environments which have contributed to the admission, but current legal provision and the various responses to medical treatment tends to pre-determine the pattern and maintain it.
The National Association for Mental Health, under the pseudonym of ‘MIND’ published a booklet in 1978 describing 12 day centres of this type in England and Wales – with detailed programmes of the day’s work and descriptions of the buildings and organisations.
For example, the centre in Monmouthshire was purpose built in 1969 – one of four supplied for a population of about half of that of Edinburgh though in a rural setting of mining valleys and thus defended from the problems of the homeless and inner city life.
It is staffed and maintained and a subsidised meal is provided from social work funds, but all other internal finances come from the sale of centre products. The fund raising is officially audited and is used for buying materials for work, financing day trips and social evenings and other leisure ventures organised on a joint staff-member basis. The full-time staff are a social worker, an occupational therapist and a craft instructor and there are weekly visiting special teachers and advisors for hair care, dressmaking, country dancing etc.
There are about 70 members with a daily attendance of “25 plus”. The criterion for admission is that attendance can contribute realistically to the member’s social rehabilitation and resettlement. There is no waiting list as it is assumed that support must be offered when it is needed. Assessment and re-assessment procedures are continuous.
Each day is structured for the particular groups attending and work fulfils half the day though a whole day working is quite feasible. There is a workshop, printshop and woodwork area and a craftroom, a members’ kitchen, sitting area and formal dining space. Money is not paid to members as emphasis is on support, counselling and re-establishing social confidence and ability to cope with the pressures of ordinary living. Community involvement otherwise is encouraged – members are encouraged to volunteer their help and volunteers to give their services to the centre.
The centres described in the MIND booklet range from one with only one staff member to a centre for mixed ex-mentally ill, mentally handicapped and physically handicapped with 50 staff and 16 volunteers. Staff are generally social workers and occupational therapists and there are links with the psychiatric services both for referrals and professional advice and help. Literacy and numeracy and educational services are often invoked and helpers with language and musical skills can be used.
In my opinion the legal, administrative and organisational system for mental health services in the United Kingdom is in a chaotic mess!
This is inevitable because neither hospital and community health services nor local authority social work services were designed with mental health services in mind. These services have had to fit in with designs prepared for other health and social needs. Having said this, what we have is much better than a separate stigmatised and possibly impoverished and alienated mental health service.
Nevertheless, it is very difficult for the hierarchically organised social work service to find an easy slotting-in with the horizontal clinically-orientated individual type of administration of the health service – and there is no sign that this general pattern is going to change. The essential difficulties of this nature must be completely recognised and positive efforts made to create real administrative bridges.
In my opinion voluntary bodies of various types can provide these bridges and it behoves the public service administrations to build them up, to sustain the appropriate load. This is being done in the case of Housing Associations in order that a new range of accommodation can be provided for groups in need – I believe that Scotland’s share in recent years has been £50 million. To suggest another metaphor, the voluntary bodies could be the glue which would fix together the rather ill-fitting parts of the jigsaw.
I think there is a strong case for expanding the Settlement’s mental health club organisation into a Mental Health Day Centre at Wilkie House. We need experience of new patterns of services. I do not see Wilkie House and the Settlement as covering a multitude of illnesses or even as a permanent institution. The best Day Centre would be convenient for the community which it serves but in the absence of local facilities, a central site could be used.
What Edinburgh needs is about six mental health centres – in Craigmillar, Pilton, Muirhouse, Leith, Craigentinny, Gilmerton, Wester Hailes and Gorgie. The provision of such services is a 7-10 year job if we are lucky – but they are not very expensive organisations and there are plenty of buildings available for conversion. Wilkie House could have a 10 year life – it would take 2 years to be in full operation and the setting positively invites the attendance of Sociology, Social Administration and psychiatric and community minded PhD students to set up and evaluate investigations. Volunteers should be extensively involved and the other Settlement services are very relevant.
The University community could offer to the wider community a dynamic but receptive addition to the community care system. It would cater for the needs of those who are on the brink between illness and health, helping them to be released from their social inadequacies by fostering the more effective elements in their unique personalities.
Dr J W Affleck
From ‘Settlement News’ No.7. Newsletter, 1980. (This is an abridged text of the address given by Dr. J.W. Affleck, Physician Superintendent, Royal Edinburgh Hospital, to the Edinburgh University Settlement AGM at Wilkie House on 12 December 1979.)