MENTAL HANDICAP VOL. 11 DECEMBER 1983

encouraged and supported. This may be because, in the world of family or community, where meaning is local and may be made up of shared and warm understandings, the expert with his highly-trained capacity to abstract and d y s e is no longer hero. Nevertheless, in separate chapters, both MacConkey and Woods seem to advocate just this simplicity: that good order in its essential form, for people with special needs, as for others, is sometimes just people doing things together with a shared purpose and understanding.

JOHN HALE Reference Arms, Schon, Organisational learning: a theory

of action perspective. London: Addison-Wesley 1978.

Working towards independence West-Central Jewish Community Development Centre London: WCJCDC, 1980 Pbk S2.50 72pp

Working towards independence is described as a manual for self-help groups, for parents with difficult or special children, and for workers in the community. It would be more accurate to refer to the “children” as “adults” since David, who is repeatedly mentioned as an example of an individual whose needs were partly realised through the activities of the Community Development Centre, is a 22-

The book is about organising self-help groups and individual programmes on social and leisure skills with mildly mentally handicapped adolescents and adults. The restricting of this work to the Jewish population may be considered a drawback in a society in which facilities such as social clubs for mildly mentally handicapped people are limited enough, without making them unidenominational. However, the manual does offer guidance to parents and community workers which might be useful irrespective of religion, culture, or handicap.

The manual is less about handicap than about the organisation of groups and the mobilising of resources in the community to meet identified needs. It describes the development of a social club and an independence training programme, emphasising issues such as organising meetings, leadership, groupwork, training volunteers, and channelling resources.

The layout of the text is extremely clear, with different type being used to separate the experiences of the group, the main points arising from their experiences, and the general guidelines which emerge for other groups. The illustrations, although plentiful, are less clear. This manual would be a useful guide for parents and professionals working in the community, who are attempting to develop social and leisure facilities.

JUDY SEBBA

yw-old.

Legal Editors7 note Further wrrespondence from readers on the new Act is welcome, either for the Letters section or the new Legal section of the journal.

CLASSIFICATION OF “SEVERE MENTAL IMPAIRMENT”

Sir - The Mend Health Act, 1983 i n t r o d u c e s t h e t e rms “mental impairment” and “severe mental hpairment”. The latter is defined as “a s t a t e of a r r e s t e d o r incomple te development of mind which includes severe impairment of intelligence and social functioning and is associated with abnormally aggressive or serious irresponsible conduct.” The new terminology has the laudable aim of differentiating from the majority of mentally handicapped people a minority group who present particular problems which may require special management or treatment, and who may be the subject of compulsory powers under the Mental Health Act.

At Meanwood Park Hospital an attempt has been made to apply the new criteria of severe mental impairment to the hospital population, to determine how many residents would come within the new category as defined in the Act. Out of the hospital‘s population of 425 adults (216 male, 209 female), 85 (51 male and 34 female) were classified as coming within t h e de f in i t i on of severe menta l impairment; that is, 1 in 5, or 20 per cent of the total number of residents. This result concurs wi th the f ind ing of the

Mike Gunn comments:

Development Team for the Mentally Handicapped - that 20 per cent of mentally handicapped people in hospital show signs of disturbed behaviour.

Mental impairment can be criticised as yet another “label” to be applied to mentally handicapped people. The term has the merit that it is not applicable to all mentally handicapped people purely on the basis of “retarded” or “subnormal” intelligence, as was the category of “severe subnormality” used in the Mental Health Actof 1959.

To distinguish a small minority of mentally impaired patients from the larger population of mentally handicapped people has the advantage of restricting the “medical” and “psychiatric” models of mental impairment to the patients for who it may be most appropriate.

The classification of mental impairment strengthens the argument for the placement of mentally handicapped people who do not come within this definition outside the present mental handicap hospitals, and clarifies the specialist role the services of these hospitals can aim to develop.

DOUGLAS SPENCER, Consultant Psychiatrist, Meanwood Park Hospital, Leeds, Yorks.

Whilst agreeing with Dr. Spencer in most of his comments, a number of points can be made for the purpose of stimulating discussion.

Firstly, the identification of a “minority group” may have a detrimental effect on that group, particularly in terms of staff and public attitudes. Secondly, if a mentally handicapped person cannot express himself adequately in speech and resorts to the use of his body, is that “abnormally aggressive” conduct? Careful consideration does need to be paid to this phrase. It is likely that this suggestion would be frowned upon by the Mental Health Act Commission, which is expected to prevent any such abuses. It is worth considering the workload this expectation will impose.

Thirdly, labelling is legally necessary; on the assumption that certain people do need to be compulsorily hospitalised. This new label should have an improved educative role since the connotations of “impairment” are less derogatory and demeaning than those of “subnormality”. Fourthly, in considering the new terminology sight must not be lost of the need for “treatability” on the initial admission of a mentally impaired person under section 3. This is also a general requirement for continued detention under section 20 unless the patient is severely mentally impaired, in which case he can continue to be detained if he would be at serious risk in the community.

Fifthly, it is always worth remembering that for short term admission the much wider concept of “mental disorder” is sufficient. Part of the defintion of this phrase is that it includes “a state of arrested or incomplete development of mind” simpliciter. Thus, mentally handicapped people can be compulsorily admitted to hospital for up to 28 days for assessment, which may include the provision of medical treatment (section 2).

Finally, will the Act have the laudable effects suggested?

174 @ 1983 British Institute of Mental Handicap