Table Of ContentThe 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
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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
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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
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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
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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.
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