MENTAL PATIENTS.

New Zealand Herald, Volume LXII, Issue 19062, 6 July 1925, Page 11

MENTAL PATIENTS.

NEW BRITISH PROPOSAL. VOLUNTARY ADMISSION SCHEME DIFFERENT POINTS OF VIEW. Proposals for the treatment of inmates of mental institutions on a voluntary basis, under a " provisional " order, it being suggested that by this means some of the stigma attaching to asylum confinement might be removed, were considered recently by the Royal Commission on Lunacy. Tho proposals were put forward by representatives of the MedicoPsychological Association of Great Britain and Ireland, on whoso behalf a memorandum of evidence and recommendations were submitted. The association represented that they were of opinion that the vast majority of tho community, including patients, were grateful for the protection afforded by the Lunacy Acts, and that tho safeguard they provided against, abuses and illegal detention, had on tho wholo proved very satisfactory. Those Acts, however, failed to keep pace with medical progress, especially in regard to the treatment of the initial and more curablo type of mental disorders. They considered that a considerable proportion of admissions to mental institutions should be dealt with on a voluntary basis, so that much voluntary treatment should be extended to the rateaided class for which legislative sanction has already established precedence at the Mandfley Hospital and at the City of London Mental Hospital, and that special legal machinery should be devised for treating early non-volitional cases. " A Provisional Order." A " provisional " order, it was suggested, should be instituted as an intermediary measure before the usual " judicial order " for detention is enforced, and when detention is necessary for the cure or care of patients, medical certification should take place as constituting evidence, but the authority :for detention, discharge, and continuation orders should entail the responsibility of some authorised person not acting in a medical capacity. The poor-law authorities, it was contended, should be superseded by the local authority in regard to the care, treatment and maintenance of necessitous patients suffering from mental disorders. A long discussion ensued between the medical experts and tho chairman, the Right Hon. H. P. Macmillan, K.C., with regard to the clinics. The point at issue was as to how far " voluntarism " was possible, and whether a patient who offered himself for treatment voluntarily was not necessarily so mentally affected as to make his offer legally unacceptable. Dr. Menzies, medical superintendent, Stafford County Mental Hospital, contended that this was a phase of mental treatment growing so rapidly that he guaranteed that if Lord Onslow's bill were passed, in ten years, if he were still alive, 50 per cent, of his patients would be voluntary patients. He further contended that within a measurable period of time tho fact of having had voluntary treatment in a mental institution would leave no more stigma on the patient than would treatment for any other ailment. Point of Difficulty. The chairman said that, speaking for himself and colleagues, he thought ho could say they were convinced of tho desirability of tho establishment of these clinics, of their being associated with, but separated from, the general hospital, of the treatment of patients for some timo without certification, and so on. But the point of difficulty with them was as to what recommendations they could embody in. order that machinery might bo evolved to carry them out. Sir Frederick Mott, consulting physician at Charing Cross Hospital, observed that what they must aim at was to get the patient, and doctors to induce their patients to put themselves under voluntary treatment as soon as possible. He thought the witnesses were very optimistic in thinking that voluntary residence in an institution would leave any less of what was called tho stigma. The public in such matters were very cruel. The fact that a person had been in such an institution would be mentioned against him whether he had been voluntarily or otherwise.