MENTAL HOSPITAL REFORM

Evening Post, Volume CIII, Issue 77, 1 April 1922, Page 11

MENTAL HOSPITAL REFORM

DRASTIC PROPOSALS BY EXPERTS

SUGGESTED CHANGES IN LUNACY LAW. s

; (ritOM OUR OWN COMKSPONDENr.) . ' LONDON, 26th January. ', 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 reueiv--ing- the attention which evidently it haslong merited. A conference on lunacy administration, which was called by Sir Frederick Willis, the chairman of the Board of Control, has just ended its sittings, and some important recommendations respecting early treatment and certain consequent alterations of the law have been made. The Minister of Health (Sir Alfred Mond), in his opening address, mentioned that the chance of getting legislation would be very much increased if there was unanimity as-to the alteration of the law which was desired, so as to permit of the treatment of eaj-ly cases without certification. This subject was very fully discussed and the conference arrived at the following- unanimous conclusions: That early treatment without certification should be legalised; that by early treatment verymany cases would be prevented from suffering- permanently from mental breakdown; that such early treatment should 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 a.ny hard-and-fast lines should be laid down as to where early treatment should be provided. Sometimes it might be best if' provided at h general hospital; som?----j times at a public mental hospital; and sometimes in an approved home. The essential thing was* to secure the best j arrangements possible in a.ny area. VOLUNTARY BOARDERS. It. was also unanimously agreed that the law sliould be altered so as to allow of the reception of- voluntary boarders in public mental hospitals, and that local authorities should be empowered to contribute towards' the expense of early treatment when it was carried out by ' some one other, than themselves. Another subject discussed was the great importance of research-and pathological work. The amount of this work which is at present being conducted is not realised by the,general public, 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 visiting committees, ; b.ut there was no unanimity on the suggestion that every institution in which there were women patients should have, women doctors on the staff. -A number of speakers, however, urged this. „As to the medical staff generally, a strong feeling was expressed that the medical superintendent should delegate his non-medical duties as far as practicable, and that visiting committees should be prepared to provide medical superintendents with sufficient lay staff to carry out the business arrangements for the institutions. The general view was expressed that the position of an assistant medical officer should be made more attractive, and that these officers should be encouraged to take up post-graduate courses and to take . the diploma in psychological medicine. PRESS CAMPAIGN. Several of tho London dailies have j taken the matter up, and on the prin- j ciple .of forecasting that the Ministry j of Health will do nothing towards improving the law as it stands, are* attempting to force the Government's hands. "The public," says The Times, "has watched with indifference the setting up of the committee a few days ago' 'to investigate and report on lie charges made by Dr. Lomax in his book, and to make recommendations as to any medical or administrative improvements which may be necessary and practicable - in respect of the matters referred to by Dr. Lomax without amendment of the existing lunacy laws.' It. .watches with hardly more enthusiasm. the conference of asylum superintendents and others which met to consider in what direction lunacy administration and the treatment of persons suffering from mental diseases might be improved. For both committee and conference are busy with ' the same matter—the treatment of mental sickness after the patient has been branded'as a lunatic, and herded 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 arvindication of the lines of debate, little need be hoped from this fact. BRAND OF LUNACY.. "Sir Alfred Mond's 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 we conceive it, there is no answer to these questions. With some notable excep-. tions, asylum superintendents have consistently opposed tho reform we are now advocating. We do not for a moment question their motives, which we believe to bo entirely 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 layman feels." EARLY TREATMENT UNAVAILABLE. v "All mental specialists declare," says the Evening News, "that whereas confirmed lunacy may be incurable, many forms of incipient lunacy are definitely curable. The mania can be caused by. the action on the brain cells of virulent bacilli. If so, the appropriate vaccnio treatment, allied to healthy surroundings, is likely to bring the sufferer back to normality. In other instances the same happy result may be achieved by modern developments of psycho-therapy —sympathetic, suggestion, ab-reation, and the scientific usages of hypnosis or psycho-analysis. Yet, unless the patient is wealthy, or can obtain access to a , homo controlled by the Ministry of Pensions, such treatment in a mental hos-. pital is denied him. The urgent need is not so much reform of "lunacy administration as for reform of the lunacy laws, so that patients whose mental abnormality is only incipient can bo treated in a mental hospital as apart from an asylum. Sir Alfred Mond's . Committee of Reform, however, is 'to. make recommendations without amendment of the Lunacy Laws.' In this respect the Minister of Health has missed a great op--portunity." MENTAL OUT-PATIENT DEPARTMENTS. Dr. Ifnrold Dcarden, in an article in the Daily Mail, suggests the lines on which reforms could be made..'/ One suggestion is the ratablishinwit of mental fHit-patieii.t dep.-j.rtrtH'nts at ffeneml hoy. pit»k, "These," he says, "would form

tho second lino of defence in our system for the prevention of mental instability. By their means doctors would be trained to diagnose much earlier conditions, which called for advice and treatment by specialists, r.nd no stigma whatever j would be attached to patientsf attending such departments. This would make for early treatment and thereby many could uiidoubtedly.be rescued from that initial error ' of thought which, like a will o' the wisp, leads them from -the firm ground of common sense to lose themselves out of earshot in the impenetrable fogs and marshes of insanity. Oatpatient departments such as these would be quite 1 inexpensive to work, and their value, in reducing the incidence of mental disease would, I believe, more than justify the outlay. I commend the suggestion to the very earnest consideration of the Ministry of Health and governing bodies of hospitals." THREE STAGES. In a special article to the Evening Standard, Dr. Albert Wilson also contributes his suggestions. "When a patient shows the first symptoms of mental disease," he writes, "the family.doctor should register or report the case, as we do measles. This certificate should go at once before a standing medical committee of experts. All lawyers and lay officials should be rigidly exciuded. The patient should be visited by an expert, whose advice at the critical moment 'might save the patient. But if it was necessary for further treatment, then the patient should go into a sanatorium free from any stigma. There would be no prejudice or opposition to such a procedure. There the patient would be thoroughly examined, inside , and out, and who knows but that a rapid euro would be effected. This should be under medical control; no lawyers, no committees. There should be no distinction between rich and poor. "Tile second stage of treatment would bo the hospital, also equipped in the latest scientific methods for completeanalysis physically, mentally, and psychical. It would be a true hospital; not an empty label. After the sanatorium and the hospital would come the equivalent of our asylums, but to be renamed the Retreat. Here would be collected chronics and hopeless cases, all sorted out and placed in the pleasanteat. surroundings. Some would doubtless reside en famiHe in villas or cottages. Home life would be the object. But what about the paralysed, the dements, and bedridden cases? What about early relief? Have we the courage?"