A more humane approach

Paul Williams on the life and work of Jack Tizard, a pioneer of community services for people with learning disabilities.

Jack Tizard was born in 1919 in New Zealand. He obtained a first class degree in philosophy and psychology, one of his tutors being Karl Popper, the renowned philosopher of logic and scientific method, who had moved to New Zealand to escape the Nazis in Austria. This gave Jack a strong commitment to scientific methodology. After serving in the War in the field ambulance service, Jack came to Britain and in 1948 was offered a post in a research unit newly established by the psychiatrist Aubrey Lewis at the Maudsley Hospital in London: the Occupational Adaptation Unit, later changed to the Social Psychiatry Unit.

Between 1948 and the 1960s, Tizard's work laid the foundations of community care for people with learning disabilities. It's that period I will focus on here: more comprehensive accounts of Jack’s life and work can be found from Clarke and Barbara Tizard (1983), Williams (2005a, b) and his Wikipedia entry [and see also our own archive].

Challenging policy

At the Social Psychiatry Research Unit, the initial focus of the research was on the occupational skills of people with learning disabilities detained in large institutions. In the early years of the 20th century, the eugenics movement had created the scare that many social problems were caused by people with learning disabilities breeding similarly affected children. British policy was enshrined in the 1913 Mental Deficiency Act which proposed the compulsory detention in institutions of people with learning disabilities judged to be a danger to society (English Heritage, 2021). At its peak, over 50,000 people were detained in this way in England alone. 

Jack’s challenge to this policy, with his colleague Neil O’Connor, was to demonstrate through scientifically respectable studies that many of the people detained were capable of work, in open employment or in sheltered conditions. The research began with the more able people but later progressed to the work potential of those with a more severe degree of learning disability. The work was reported in scientific journals (for example Tizard, O’Connor and Crawford, 1950; O’Connor and Tizard, 1951), including some in the American Journal of Mental Deficiency (for example Tizard, 1953a; Loos and Tizard, 1955), which ensured the research became known in the USA. The studies were summarised in the book The Social Problem of Mental Deficiency (O’Connor and Tizard, 1956). The book argued that many people currently detained in institutions could live and work in the community. The research fed into the Royal Commission on the Law relating to Mental Illness and Mental Deficiency which reported in 1957 and led to the 1959 Mental Health Act which completely reformed the 1913 Act.

A research strategy formed in Jack’s thinking that involved four elements: epidemiological surveys of the extent of particular social issues, the setting up of model services to represent a more humane approach, careful evaluation of the effects of these new services against conventional practice, and dissemination of the results to key policy actors (Clarke and B. Tizard, 1983).

Examples of the first of these elements are Jack’s early studies of the prevalence of learning disability (Tizard, 1953b; O’Connor and Tizard, 1954; Goodman and Tizard, 1962). The first major example of the second element that Jack devised was known as The Brooklands Experiment. The Fountain Hospital in South London housed around 600 children under a medically and custodially oriented regime. Sixteen children were moved to Brooklands, a large house away from the hospital, which would be run on principles of child care established for children without disabilities who were unable to live with their parents. Progress of the children would be compared with a matched group who remained at the hospital, and the results disseminated: the third and fourth elements of Jack’s approach.

The Brooklands children showed improved verbal skills compared to the Fountain controls (Lyle, 1960). Equally important, it was shown that children with learning disabilities could be successfully cared for in a more homely, family-like environment than a hospital (Tizard, 1960).

In 1963, Jack published probably the most influential piece of his whole career, the book Community Services for the Mentally Handicapped (Tizard, 1963). In this he reviewed the work on employment from the early 1950s, the Brooklands Experiment, his survey of prevalence with Nancy Goodman, and a study of 250 families with a member with learning disabilities carried out with Jacqueline Grad (Tizard and Grad, 1961). On the basis of these he outlined his ideas for a comprehensive service covering education, health, support for families, residential care services and employment opportunities. Such a service could be planned for population areas of 100,000 enabling services to remain small and to relate to meaningful local communities close to people’s families.

Major projects

In the early 1960s, Jack negotiated funding for three major projects. One was a study of disability in a complete cohort of children aged nine to twelve on the Isle of Wight, a total of 3,500 children. This was reported in a 400-page book co-authored by Jack (Rutter, Tizard and Whitmore, 1970).

Projects of more specific relevance to learning disability were the Wessex Project and the Child Welfare Project. The first of these was the first example of the full implementation of Jack’s four-stage method (Tizard and Kushlick, 1965). It involved an epidemiological survey of all people known to have learning disabilities in the two million population of Hampshire and Dorset. In cooperation with the Regional Health Authority, population areas of 100,000 people were chosen for the establishment of small homes (albeit for up to 20 residents), first for children and later for severely disabled adults, relocated from institutions often far from their family homes. Adjacent areas of the same population size were chosen for comparison with people who remained in hospital. Results showed benefit to residents (Smith et al., 1980; Felce et al., 1980), but again the main finding was the feasibility of this kind of small community-based provision. The research was closely monitored by the Department of Health.

The Child Welfare Project operated in parallel with the Wessex Project. It was a study of management practices in different kinds of residential provision for children, with a focus on those with learning disabilities. These studies were published in the book Patterns of Residential Care (King, Raynes and Tizard, 1971). This documented in detail the findings from 16 residential services on measures of management practice. Children’s homes and local authority hostels were found to operate in a more child-centred and beneficial way than long-stay hospitals. The book included recommendations for improved practice in all residential services.

Jack remained at the Maudsley till 1964 when he was appointed Professor of Child Development at London University Institute of Education. In 1973 he founded and became Director of the Thomas Coram Research Unit at the Institute. In 1979 he died of cancer at the early age of 60.  He had become a highly respected adviser on child and family welfare services. He was a consultant on learning disability to the World Health Organisation and also to the Centre for Educational Research and Innovation, a branch of the Organisation for Economic Cooperation and Development. For the UK Department of Health he was adviser on learning disability, a member of the Chief Scientist’s Research Committee, Chair of the Advisory Committee on Handicapped Children, and a member of the Court Committee on Child Health Services. He was a member of the Social Science Research Council and Chair of its Educational Board. He was adviser to the Home Office Research Unit, and adviser on learning disability to the Association for Child and Adolescent Mental Health.

Jack received several prestigious American awards for his research. In 1973 he was awarded a CBE in the Queen’s Honours List. In 1975-6, he was President of the British Psychological Society. After his death, in his memory a special school in London was named the Jack Tizard School, a research unit at Kent University was named the Tizard Centre, and a Tizard Memorial Lecture was established by the Association for Child and Adolescent Mental Health which is still given annually. 

Sixty years ago, Jack’s remarkable energy, insights and commitment to scientific methodology laid the foundations for the community-based services for people with learning disabilities that we have today.

Photo: Creative Commons / Jenny Tizard

References

Clarke, A. and Tizard, B. (eds.) (1983) Child Development and Social Policy – The Life and Work of Jack Tizard. Leicester: The British Psychological Society.

English Heritage (2021) Eugenics in Britain. english-heritage.org.uk, accessed October 2021.

Felce, D., Kushlick, A. and Mansell, J. (1980) Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: client engagement. Advances in Behaviour Research and Therapy3, 13-18.

Goodman, N. and Tizard, J. (1962) Prevalence of imbecility and idiocy among children. British Medical Journal1, 216-219.

King, R., Raynes, N. and Tizard, J. (1971) Patterns of Residential Care: Sociological Studies in Institutions for Handicapped Children. London: Routledge and Kegan Paul.

Loos, F. and Tizard, J. (1955) The employment of adult imbeciles in a hospital workshop. American Journal of Mental Deficiency59, 395-403.

Lyle, J.G. (1960) The effect of an institution environment upon the verbal development of institutional children: the Brooklands Family Unit. Journal of Mental Deficiency Research4, 14-23.

O’Connor, N. and Tizard, J. (1951) Predicting the occupational adequacy of certified mental defectives. Occupational Psychology25, 205-211.

O’Connor, N. and Tizard, J. (1954) A survey of patients in twelve mental deficiency institutions. British Medical Journal1, 16-18. 

O’Connor, N. and Tizard, J. (1956) The Social Problem of Mental Deficiency. Oxford: Pergamon Press.

Rutter, M., Tizard, J. and Whitmore, K. (eds.) Education, Health and Behaviour. London: Longman.

Smith, J., Glossop, C. and Kushlick, A. (1980) Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: client progress.  Advances in Behaviour Research and Therapy3, 5-11.

Tizard, J. (1953a) The effects of different types of supervision on the behaviour of mental defectives in a sheltered workshop. American Journal of Mental Deficiency58, 143-161. 

Tizard, J. (1953b) The prevalence of mental subnormality. Bulletin of the World Health Organisation9, 423-440.

Tizard, J. (1960) Residential care of mentally handicapped children. British Medical Journal1, 1041-1046.

Tizard, J. (1963) Community Services for the Mentally Handicapped. London: Oxford University Press.

Tizard, J. and Grad, J. (1961) The Mentally Handicapped and Their Families. London: Oxford University Press.

Tizard, J. and Kushlick, A. (1965) Community services for the mentally subnormal: an epidemiological approach and a plan for experimental evaluation. Proceedings of the Royal Society of Medicine58, 373-380.

Tizard J., O’Connor, N. and Crawford, J. (1950) The abilities of adolescent and adult high-grade male defectives. Journal of Mental Science96, 889-907.

Williams, P. (2005a) The work of Jack Tizard – 1: 1950 to 1964. Learning Disability Review10, 7-11.

Williams, P. (2005b) The work of Jack Tizard – 2: 1965 to 1979. Learning Disability Review10, 18-21.

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