ASYLUM REFORM.

Press, Volume LVIII, Issue 17401, 11 March 1922, Page 14

ASYLUM REFORM.

DRASTIC PROPOSALS BY EXPERTS. SUGGESTED CHANGE IN LUNACY LAW. (raosi our own cobkispokdekt.) LONDON, January 26. Probably "as a result of the widespread publicity given to Dr. Lomax s book, ''The Experiences of an Asylum Doctor,'' the subject of asylum reform is receiving tho attention which evidently it has long merited. A conference on lunacy administration, wluci was called by Sir Frederick W' illis, tho chairman of the Board of Control, ha- s just ended its sittings, and some important recommendations respecting earlv treatment and certain consequen alterations of the law, have been Tho Minister of Health (Sir Att Mond), in his opening address, n.entioned that the chance of getting I©=, - lation would bo very much incxeaße there was unanimity as to the al J era ~ tion of tho law which was desired, so as to permit of the treatment of early cases without certification. , Thia subject was very fully discussed and tho conference arrived at the following unanimous conclusions: Anat early troatment without certification should be legalised; that by early treatment very many cases would be prevented from suffering permanently, from mental breakdown; that such early treatment 6hould only be given in institutions or homes approved for the purpose by some Government Department; that the Government Department upon whom the duty of supervising this work should be placed should be the Board of Control, . The conference did not desire that any hard-and-fast lines should bo laid down as to where early tivsatment should be provided. Sometimes it might be beet if provided at a general hospital ; sometimes at a public mental hospital, and sometimes in an approved home. Tho essential thing was to secure tho best arrangements possible in any area. Voluntary Boarders. It was also unanimously agreed the law should be altered so as to allow of the reception of voluntary boarders in public mental lfospitals, and that local authorities should be empowered to contribute towards the expense of early treatment when it was carried out by someone other than themselves. Another subject discussed was tho great importance of research and pathological work. The amount of this work which is at present being conducted is not realised by tho general publio, but a strong desire was expressed by various speakers that it should be still further extended, and that local authorities should be authorised to combine for this work wherever it seemed to them desirable, It was generally agreed that there should be women members on all committees, but there was no unanimity on the_ suggestion that every institution in which there were women patients should have women dootors on the staff. A number of speakers, however, urged this. As to the medical staff generally, a strong feeling was expressed that the medical superintendentshould delegate his non-medical duties as far as practicable, and that visiting committees should be prepared fo provide medical superintendents with sufficient lay staff to carry out the business arrangements for. the institutions. The general view waa expresesd that the position of an assistant medical officer should bo made more attractive, and that these officers should be encouraged to take w) post-graduate courses and to ■(;ake the diploma in psychological medicine. Press Campaign, Several of tho London dailies have taken tho matter up, and on tne principle of forecasting that the Ministry of Hcilth will do nothing towards improving the law as it stands, are attempting- rtQ force the Government's hands, Tho public, says ''The Times," "has watched with indifference the setting up of the Committee a few days ago' to investigate and report in the charges made by Dr. Lomax in his book and to wake recommendations as to any medical or administrative improvements which may be necessary and practicable in rospeHi of the matters referred to by Dr. Lomax without amendment of the existjng lunacy laws,' It watchea with hardly moro pnthusiasra the conference of asylum superintendents and others which met to consider in what direction lunacy administration, and the treatment of persons suffering from mental .disease* might be impro/ved. For both oommittee and conference are busy with the sftiTie matter—the treatment of mental sickness after tho patient lias been branded as a lunatic and horded with other lunatics in an asylum. The conference, it is true, has placed the subject of treatment without certification on its agenda. But if we are to take Sir Alfred Mond's opening speech as an indication of the lines of debate, little need be hoped from this fact. ',' Sir Alfred Mond'a claim that medical opinion is unanimous that 'permanent mental disease can be-prevented by early treatment' condemns the present attitude of his Department unequivocally. For if this be true, why send these cases to an asylum,at all? "Why brand them with the mark of lunacy? Why force them to live in the dread company of the insane even for a day? As wo concorve £fc, tbere is no answer to these Questions. . . With some notable exceptions asylum superintendents have consistently opposed the reform we are now advocating. Wo do not for a mo- ! inept question their motives, which we believe to be entiroiy honest and disinterested, but we feel that most of them have lost touch with the public mind. Long association with lunacy_ administration no' doubt tends to mitigate the sense of horror which the lajman feels." Early Treatment 1 Unavailable. j "All mental specialists declare," says j the "Evening News," "that _ whereas j I confirmed lunacy may be incurable, many forms of incipient lunacy are definitely curable. Tho mania can be caused by the action on the brain cells of virulent bacilli. If eo,_ the appropriate vaccine treatment, allied to nealtny surroundings, is likely to bring the sufferer baek to normality. In other instances the same happy result may be achieved by modern developments or psycholo-therapy—sympathetio suggestion, ab-reation, and the scientific usages of hvpnosts or psycho-analysis. Yet, unless the patient is weaithj _or can obtain access to a home contro.ictl by the Ministry of Pensions, suca treatment in- a mental hospital is denied him. The urgent need is n ®t 60 much reform of lunacy administration as> for reform of the lunacy laws, so tha patients whose mental abnormality is only incipient can be treated m a mental hospital no apart from an asylum. Sir Alfred Mond's Committee ot Reform, however, is 'to mok® dations without amendmentof the Lunacy Laws.' In this. respect the Minister of Health has nussed a great opportunitv." . „ ,• , Dr. Harold Dearden, m an article in the VDaily Mail," suggests the lmes on which reforms could suggestion is the establishment of mental out-patient a an ,?„ general hospitals. ' c f defence "would form ° u !" WetemfoT t n |/ their doXl wS b d J t>^^4^much earlier for advice and treatmen * s » cb

This would make for early treatment »** thereby m«u« could andoubtcdly be rescued from that initial 2Xr of thought winch, .like a will 0 ' X wisp, leads them from the firm cround of common-sense to lose themselves out of earshot in .the impede--3a fogs and niarshes of insanity. Out. rfniicnt departments such as these would bo quite inexpensive to work, and their value m reducing the incidence of mental disease would, I believe, moro-tlian justify the outlay. I commend to tho veiy earnest consideration of tho 'Ministry of Health and governing bodies of hospitals. jjirao Stageß. In a special article in tho "Evening G+onrlard " Dr. Albort Wilson also contribnt£h« suggestions. "When a patient shows the first svrantonis ot mental disease," hj« writes, '.'the family doctor should register or report tho case as wo do measles. lhis certificato'should go at once before a standing medical committee .ot experts. All lawvers and lay officials should be ngtdlv excluded. The patient sliould bv visited by an expert, whoso advice at the critical moment might save the pw tient. But if it «'« s necessary for further treatment then the patient shoula co into a sanatorium freo from any stigma. There would bo no prejudice or opposition to each a procedure- Thero the patient would be thoroughly examined, inside and' out, and who knows but that a rapid cure would be effected. This should be under medical control; no lawvers; no committees. There should to no distinction between rich stage of treatment would be the hospital, also equipped in the latest scientific, methods, for complete analysis physically, mentally, and psychical, It would be a true hospital- not an empty label. After the sanatorium §nd tho hospital would eotiie the equivalent of our asylums, but to bo renamed the Retreat. Hero would be collected chronics and hopeless cases, all sorted out and placed in the pleasanteat surroundings. &omo would doubtless reside en famine in villas or cottages. Homelife wouul be the object. But y'hat about the paralysed, the dements, and bedridden cases? "fl|hat about early relief? Have wo the courage?";.