17 - Mental Health, Community Care, and Medical Education

Summary

Introduction

Titmuss was concerned, from the 1930s onwards, about the psychological effects of modernity. This informed his approach to social medicine, given its aspiration to see patients and their families in their total contexts, and not just as clinical entities. In turn, this suggested there was more to individual, and social, wellbeing than simply the provision of medical services. Consequently, Titmuss was a critical supporter of community care which, although not a new idea, had nonetheless expanded in scope with the advent of the ‘welfare state’. Although community care can take a number of forms, here we are especially concerned with its relationship to mental health, an area with which Titmuss directly engaged. He was also a critic of what he saw as the overweening ambitions of ‘welfare professionals’, including medical doctors. The training of the latter, he argued, paid too little attention to the patient as a psychological and social being. Social workers, too, could behave in an overbearing way, but Titmuss was keen to defend their role as ‘front line’ workers in the ‘welfare state’, and to see their numbers expanded. This chapter examines Titmuss's approach, in the 1960s, to mental health, community care, and medical education. These activities should be seen in the context of both his critique of ‘The Affluent Society’, and his contribution to the debates over the future of local authority social services, discussed in Chapter 19.

Mental health and community care

In his input to Labour's Working Party on the NHS in the late 1950s, Titmuss had, as we have seen, raised concerns about proposed changes in mental healthcare, non-medical staffing in health and welfare settings, and the need for an enquiry into medical education. He further expressed such concerns more broadly around this time. So, for instance, in spring 1959 he wrote to The Times commending a recent letter from Lady Hurtwood, encountered in Chapter 6 when she sought Titmuss's advice on her campaign for what was to become the 1948 Children Act. Hurtwood was right, Titmuss argued, to call for an end to the Ministry of Education's ban on the extension of nursery school provision.