Strategic Planning for Mental Health*

By Colonel J. R. Rees, M.D.

It would be hard to imagine a time more unusual or more trying than the present for a discussion such as this. I believe that some people feel that Societies giving time and attention to subjects like the present one, in war, are somehow fiddling like Nero, but I have no sympathy with that point of view. Jut now, at this time, we should, more than ever, be thinking out where we stand and making plans for winning the war and for establishing work for mental health firmly for the future.

My thoughts in this paper may be somewhat at random, but both my first and my last points of emphasis are concerned with the present situation in this country. Our own mental stability, our vision and our practical common-sense, have never bean challenged so much as at present. If we are to pull our weight during the war period we mat be sure that we ourselves have got on to friendly terms with our own personal fear, we mat be clear that whatever happens to us individually the spirit that is in everything true and progressive can never be damaged, and if we believe this we can go quietly and resolutely forward working to the utmost, and demonstrate that mental hearth is a reality. Let us then turn our interest and perhaps some of our aggressive qualifies on to this vast problem of mental health, as one of the adventures of the present day, and see what we personally can plan and achieve.

Many people who have written about this problem of mental health have formulated definite aims. I will not attempt to do that with any exactitude, but it seems clear that we would wish, all of us, to do something to make our race more adventurous, more adaptable, happier and, if possible, more intelligent. I shall barely touch on the remedial side of our work. Medicine has, in any case, been far too much a matter of repairing and patching people up. The real Medicine of the future win be largely prophylactic, and certainly in our field the important thing is to stress the positive aspects of mental health instead of concentrating our interest on ill health. Of the three main branches of psychiatric work-for the detectives, the psychotics, and the neurotics-the third is probably the most important from the national point of view, and certainly here prophylaxis is far more important than treatment, in fact it provides the only road to an ultimate solution of this particular medico-sociological problem.

We can therefore justifiably stress our particular point of view with regard to the proper development of the human psyche, even though our knowledge be incomplete. We must aim to make it permeate every educational activity in our national life: primary, secondary, university and technical education are all concerned with varying stages in the development of the child and the adolescent. Those who provide the education, the principles upon which they work, and the people upon whom they work, must all be objects of our interest, for education that ignores the common-sense principles that have been more clearly evolved of recent years is likely to be of indifferent quality. Public life, politics and industry should all of them be within our sphere of influence. It needs little imagination to see improvements that could be effected in each of them.

Especially since the last world war we have done much to infiltrate the various social organisations throughout the country, and in their work and in their point of view one can see clearly how the principles for which this society and others stood in the past have become accepted as part of the ordinary working plan of these various bodies. That is as it should be, and while we can take heart from this we must be healthily discontented and realise that there is still more work to be done along this line. Similarly we have made a useful attack upon a number of professions. The two easiest of them naturally are the teaching profession and the Church: the two most difficult are law and medicine. Anyone whose memory goes back for even a dozen years can realise how big a change has been effected in the outlook of professional people, while certainly anyone with vision can see how much still remains to be done.

If we are to infiltrate the professional and social activities of other people I think we must imitate the Totalitarian and organise some kind of fifth column activity! If better ideas on mental health are to progress and spread we, as the salesmen, must lose our identity. By that I mean that we cannot help so effectively if speaking for a National Council or any other body as we can when we make a more subtle approach adapted to the particular circumstances of the moment. It really wouldn't matter if no one ever heard of this Council again provided that the work was done. Let us all, therefore, very secretly be "fifth columnists".

At the same time, however, there is no reason why we should not as individuals and in small groups make use of a perfectly open approach to the question of mental health. We have all of us got contacts with men and women who are concerned with the various aspects of life that I have just been mentioning and we could most of us get together small groups for informal discussions on these topics, and out of this might grow definite bodies or committees of persons interested in each of these fields of work, being convinced that it was worth while to work out their own specific problems and their own plans. While a central office can sometimes help in a project such as this, only the determined work that we as individuals can put in will ever provide the dynamic for such activities.

In this field, as in every other, we ought to be thinking ahead and foreseeing events so far as that is possible. We have often been too spasmodic in our work and I feel we need a long-term plan of propaganda. The time is past when we need be in any way apologetic for directing people's interest to questions of mental health. Practically everybody is ready for such ideas. They were before the war, and it is far truer now than it was then. I doubt the wisdom of a direct attack upon the existing state of affairs; even though there is a war on, that would still raise opposition, whereas the more insidious approach of suggesting that something better is needed-"why shouldn't we try so and so"-is more likely to succeed. The evolutionary process is essentially British, and I think that we should make it a fundamental in our propaganda plan.

Parliament, the Press and other publications, are the most obvious ways by which our propaganda can be got across, and it needs the thought and work of every one of us to get this going. Medical Members of Parliament are always ready to help with any well thought out plan of campaign which is clearly for the good of the country, but we need not limit ourselves to them. There are many energetic men in Parliament who are very willing when properly coached with questions and supplementaries, to ask them, and to follow up by personal contact to make sure that points of importance are adequately dealt with. I still live in the hope that some day we shad get Members of Parliament to submit themselves to personality and efficiency tests, for I feel sure that if they did they would then insist upon an candidates for Parliament going through the same elementary routine, and we might later have some chance of its being applied to the Civil Service!

In the past we have made sporadic attempts to provide a Press service which can give statements on matters of topical interest and explain to the reporters, and through them to the public, the meaning of various phenomena which are "hot news" in our morning papers. Actually we have as a group not nearly enough alertness and enthusiasm about this matter of helping the Press and so influencing the times in which we live. Every one of us reads papers and journals but we are often too inert to take action about the points which should so obviously be taken up, whether the subject be politics, local government, social affairs or the decisions of the courts. Whether it be in matters of religion or those of home life, there are points which arise in the papers every day, in some of which we should interest ourselves. The policy of the Press, like that of the B.B.C., is affected by the size of its fan-mail. Even if our letters are not published, they still produce their effect upon the editorial mend, and some of them certainly wig be published and in this way will make people think. Here again we had probably better be secretive and not mention this Council or any other body, but simply write or speak as individuals. Don t let us mention Mental Hygiene (with capital letters), though we can safely write in terms of mental health and common-sense. When we do write it is important to remember that the understatement of a case is much more likely to be effective than its overstatement.

Your attention must not be confined merely to the Daily Press, for there are innumerable weekly and monthly journals and special professional and trade papers, and it is as a rule much easier to get articles, notes, comments or letters-into these papers than into the Daily Press. Orate often, also, they are more carefully read than the daily paper.

I should like to see us go beyond these more obvious points and set out on a campaign to get certain points and ideas which are of importance stressed by well known novelists in their books. Priestley, Morgan, Walpole, and a score of others whose books have a wide appeal-even Dr. Cronin-might be wining to co-operate. I am not suggesting, of course, that they should write propaganda novels it would be surprising if those had any circulation, but in an ordinary human story it should not be difficult to give some emphasis on a point of view, and the gradual building up of a series of such emphases over a period of years would be the soundest kind of propaganda. This Council has recently been co-operating in some experiments with films, and there the same idea has been emphasised that just one point can be got across to the public through this medium. Those of you who know books and their authors, and films and their makers, might be doing some long term planning of the right kind of propaganda.

I have said several times that I believe we should be careful about the mention of the Council or any other body which might be thought to be furthering some particular point. Many people don't like to be "saved", "changed" or made healthy. I have a feeling, however, that "efficiency and economy" would make rather a good appeal because there are very few people who would not welcome these two suggestions. It has even crossed my mind whether we ought not to have a subsidiary company caned the Social Efficiency Board and get Mr. Bevin or someone like that in as Chairman! It seems to me that in approaching national matters, local government and social affairs we should be on much stronger ground if we were constantly stressing our interest in efficiency and economy, and certainly we can "sell" mental health under these headings as well as under any other.

Oldham and Bristol, and possibly one or two other places, have their own committees or councils for mental health, and this is, I behove, an extremely wise move. Government in this country is bung de-centralised in many ways during the war, and for our particular work I believe that the more we can spread the responsibility the better win be our progress. These matters of man s mind and outlook are sufficiently vital and interesting to attract in every area groups of intelligent men and women who wig take on the function of local councils or committees. Let us learn from the Oxford Group and have week-end parties; all over the country we have people to our hand, medical students, teachers, journalists, civil servants, trades union officials, and an sorts of other people, whom we might get together and amongst whom we should find sensible, balanced people who could lead in local activities. Provided we have one such stable person in any group I should feel quite happy in giving that group its head. We all make mistakes, and no doubt it would drop some bricks but on the whole it would stir up interest of the right kind and advance our cause.

I have in this article merely been feeling around in this vast field of policy. I have touched on a few pouts hoping to stimulate people to think of many more, and particularly of those that are within their own particular powers to follow up. I would like to close with fresh emphasis on the fact that we each of us as individuals carry a great responsibility for the mental health of the nation, now during the war and in the much better future that must come. We need vision and courage. We mustn't merely plan and be theorists, but we must also experiment, and it is worth remembering that in a time like this it is much easier to spread sensible ideas or, if you like, to teach in a quiet way, than it ever has been before. "It all depends on me" is quite a good slogan, and Mr. Morrison's "Go to it" is yet another of the dynamic sayings of the moment. We can apply both of these to ourselves in this particular field of work.

In view of the coming defeat of Germany, Rees updates the plan. A new social entrance is needed.

*Summary of an address given at the Annual Meeting of the National Council for Mental Hygiene on June 18th, 1940.


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