The Mental Deficiency Act 1913, A Foundation To The National Health Service And Community Care Act 1990
NHS and Community Care Act 1990
During my studies with the Open University's Health and Social Welfare diploma, it was a requirement to complete a project. I chose to study the Mental Deficiency Act 1913. I wanted to compare and contrast this act with the National Health Service and Community Care Act 1990. You can learn more in depth about these acts in the links at the bottom of this article.
I asked the permission of an older lady with learning disability to help me. 'Lillian' was old enough to remember her earlier life and would have been assessed under the criteria of the 1913 Act. Furthermore, during the time of the interview, she was cared for under the terms of the National Health Service and Community Care 1990 Act.
With all I had learned during the analysis of both the NHS and Community Care Act 1990, the Mental Deficiency 1913 Act and my attempt at making sense of a transcripted interview with 'Lillian', I came up with some profound conclusions. This article is a summary of what I had found during my research.
The Silent Minority, The Effects Of The Mental Deficiency Act 1913
The Mental Deficiency Act 1913 In Brief
The Mental Deficiency Act 1913 came into force because of firm beliefs in Eugenics. This was formulated from Charles Darwin's 'Origin Of Species' which looked at genetic inheritance. The Eugenics Society, which was committed to improving human stock and eradicating what society considered as poor human traits, was fundamental in implementing this eradication. One of the forefront men within the Eugenics Society, apart from Adolph Hitler in Germany, was Dr Barnado.
The idea was to sterilise and deter all people in society deemed to be socially unacceptable, including those who were drinkers, those with learning disability and people who were not prudent. They were to be institutionalised and segregated from mainstream society.
It was a very common thought before, during and after the first World War that human stock should be purified. It was no real wonder, therefore, that Hitler managed to get away with all he did as the rest of the world turned a blind eye to his 'institutionalisation' of what he considered poor human stock: Jews, Gypsies, the sick, people with learning disability and mental health issues.
Dr Barnado instigated and actively encouraged, as a result to the Mental Deficiency Act 1913 for which he and the Eugenics Society campaigned for, small homes and institutions for parents to hand in their children. Many of the children were sterilised so as they would not breed more unprudent human stock for generations to come. These were the foundations to the famous Dr Barnado homes that we are all familiar with in the UK.
Under the Mental Deficiency Act 1913, many single mothers were forced to hand over their babies because it was socially unacceptable to keep them. It wasn't really until the film 'Cathy Come Home' that there was more social empathy toward these people. This was televised in 1966, so the effects of the1913 act was pretty much thought of as acceptable and a social norm. Institutionalisation of poor human stock was well integrated into the society of the Western world.
The Mental Deficiency Act Flourished
The effects of the Mental Deficiency Act, therefore, continued to flourish in the form of social services, mental health services and national health services. These ranged from small adoption homes to huge institutions.
These H-Block Prison type institutions, like Leavesden Hospital in Hertfordshire for example, were dehumising. They consisted of two class of in mates: the highers and the lowers. The highers used to assist staff with the daily chores of the lowers. The process was a regimented, cruel and disempowering.
As someone who has had personal experience of the effects of the Mental Deficiency Act 1913 - I was a day care therapist for people with severe learning disability and challenging behaviour pre and post NHSCC 1990 Act - I can say conditions, as far as human rights were concerned, were not far off of Theresienstadt (What's this? Click on the link at the end of the article!).
Pioneers of Health, Social Welfare and Community Care Change: John O'Brien and Dr Wolf Wolfensberger
John O'Brien developed the concept of person-centred planning as a model. His 5 principals or 'accomplishments' considered the following as core concepts for people:
- Ordinary places
Wolfensberger's principle of normalization was defined,
"as much as possible, the use of culturally valued means in order to enable, establish and/or maintain valued social roles for people" (Wolfensberger & Tullman, 1982)
The National Health Service And Community Care Act 1990 In Brief
Change had been long overdue. The Mental Deficiency 1913 Act had some minor adjustments and add ons but was pretty much the same by 1990 as it was in 1913.
There were different forms of sterilisation, for example, with drug intervention. The pill wasn't as evasive and was cost effective.
The influence from the likes of John O'Brien, his ideas on the principals of living an ordinary life, and Dr Wolf Wolfensberger's 'normalisation' made great contributions to the rejection of the ideas on institutionalisation, now claimed social role valorisation.
This was about a person centred approach (see link below) as opposed to a 'mother knows best' approach to health, social services and community care.
In brief, they were pioneers in empowerment and enabling people to live an ordinary life, whatever class, creed or ability.
NHSCC 1990 Act, Cost Containment
It is not surprising, however, that cost containment had a great influence on the development of the National Health Service and Community Care Act 1990. In fact the prelude to the act - the green paper - was developed by the Director of Marks and Spencers, Sir Roy Griffiths. This provided the fundamentals to the NHSCC 1990 Act.
The vision was to integrate health, social welfare and mental health into one - to be partners in care. Care services, therefore, were decentralised and made into trusts that ran independently, enabling agencies to purchase the best care at the most competitive price. The principals ran on competitive market forces.
The Patient is, therefore, the customer of care as well as the centre of care services. He or she is the active participant rather than a passive reciever (someone enabled, empowered and active in the services received).
He or she, therefore, just like a customer of Marks and Spencers, has consumer rights in their care package. The customer, afterall, comes first with all agencies and is always right.
The ethics ran on efficiency and, by care services focusing upon the 'client first' whilst keeping within the bounds of cost containment, it was hoped that savings could be made. The NHS and care services were in crisis and something had to be done to control the bottomless pit of expenditure.
The National Health Service And Community Care Act 1990 was born. People came out from large institutions into, what some would argue, as small institutions embedded within communities - often on housing estates.
Summary of Lillian's Case Under The Mental Deficiency Act 1913
- Lillian's family had a choice to send her into institutionalised care when she was a child. However, this was a restricted choice because she had to attend an institution on a part time basis, rather than residentially.
- Lillian had a role within her family and local community. She lived, as Wolfensberger and O'Brien highlighted, a normal life - as far as possible for her individual capacity - albeit with institutionalised support (her family were strong enough to query institutional abuse, should it arise).
- Eugenics was a firm belief within the social construction of reality. Western culture believed in survival of the fittest to improve human stock. This was shown in the example of open air Hospitals that used fresh air to 'kill or cure' their patient's diseases.
An Interview With Lillian
The interview with 'Lillian' surprised me. She was brought up as someone classed as 'imbecille'. She satisfied the criteria outlined under the Mental Deficiency Act 1913 and, although her family were advised to send her into institutionalised care, her parents felt it best that she stayed with them. She loved her parents very much.
They lived in the rural location of Abedare, Wales, in a two up, two down Victorian terraced house. Her father worked in the local coal mine and was partial to the odd bet or two to alleviate the hum-drum of poverty. Her mother stayed at home, keeping house.
There was provision for specialist education for which she attended some miles away in an 'open air' hospital with a varander. Many of the 'patients' were put on this balcony for treatment. Fresh air was deemed to be good for patients and many were left overnight outside with the hope that it might eleviate their conditions.
The thought was that if it didn't kill you, it would make you stronger - you were good human stock - a great Eugenics belief formed from the ideas of 'survival of the fittest'.
As a contributory thought, germs wouldn't harbour in the outside as opposed to the warmth of the inside and, taking into consideration that antibiotics were not even invented when Lillian was a child, people only had their own immunity to fight disease. In fact, in 1913, the average life expectancy of people was 42 years of age.
Sterilization - Improving Human Stock
During the interview with Lillian, she told me that she had been sterilised. I asked her why and she said in regard to the birth:
"The Doctor said I wouldn't stand the pain."
Some would say that Lillian was given an informed choice, but this would be questionable in terms of how the information was packaged to Lillian. However, this was done, the end result was sterilisation.
It seems that Lillian was not an exception when it came to birth control in the form of sterilization. Formulated from the ideas of the Eugenics Society, the social norm was to dissuade unacceptable human stock from giving birth to more of the same. This idea was a big one from the Mental Deficiency Act 1913.
Lillian had the support of her family. However, was very much a victim of the 1913 Act, although to a lesser degree than her peers
Institutionalisation, Times Now - Times Past
Later in her life, Lillian's family passed away. She came into the realms of the National Health Service and Community Care Act 1990 and was placed within a social services run home for people with learning disability.
Under O'Brien's principals and Wolfensburger's ideas on 'Normalization', it seemed that Lillian became further from these ideas than when she was with her parents. Far from living and ordinary life, she lived in a home with other people with learning difficulties where her choices were restricted.
Again, her informed choices were packaged to her in a way that was the convenience of the staff and the overall running of the home.
She could go out whenever she wanted, but there was always a reason given as to why she shouldn't.
She could have whatever she wanted to eat, but it was very rarely available.
She could wash whenever she wanted, but only when the staff was available to assist her. It would never cross her mind not to shower in front of others because she knew not of dignity - she had been institutionalised and was accepting of decisions made for her.
National Health Service and Community Care Act 1990, the Fundamentals of the Mental Deficiency Act 1913
The point I want to highlight here is, even under the great health reforms in the guise of the National Health Service and Community Care Act 1990, the fundamentals have always been written from the shadow of the Mental Deficiency Act 1913. How can we move away from something that has evolved and changed from it's foundations? How can a battery chicken know happiness when for generations upon generations they only know the cage? The battery chicken might think he is happy, but he, like Lillian, has been institutionalised.
© Shazwellyn 2011 - This work is covered under Creative Commons License
Further Reading Relating To This Article
- Survival of the Fittest - Darwinism
- Community Care - The Griffiths Report
- Mental Deficiency Act 1913 Search
- Criteria For Institutionalisation - This article states that the 1913 Act was abolished. What I discovered is that it was reinvented with only a change in labels, the criteria stayed the same and people that were not deemed socially acceptable were still placed in large institutions.
- The National Health Service and Community Care Act 1990
- Person Centred Approach
- O'Brien, J. and Lyle O'Brien, C. 1988. A Little Book About Person Centred Planning. Inclusion Press, Toronto.
- O'Brien, J. and Lyle O'Brien, C. Make a difference: A Guidebook for Person Centred Direct Support. Inclusion Press, Toronto