HC Deb 11 December 1968 vol 775 cc486-96

In the Representation of the People Act 1949 for section 4 (3) there shall be substituted the following subsection:—

(3) A person who is detained as a patient in any establishment maintained wholly or mainly for the reception and treatment of persons suffering from mental illness or mental defectiveness under section 26 or section 60 of the Mental Health Act 1959, or who is the subject of an order made by the higher courts under section 65 of that Act, or who is the subject of an order made by the Secretary of State under section 71 or section 72 of that Act, or who is detained in legal custody at any place, shall not by reason thereof be treated for the purposes aforesaid as resident there.—[Mr. Lubbock.]

Brought up, and read the First time.

Mr. Lubbock

I beg to move, That the Clause be read a Second time.

I was relieved to hear the Secretary of State say at the beginning of the speech he made on new Clause 6 that he rarely relied on the argument that Amendments have not been correctly drafted. I am certain that the Clause is not correctly drafted, although I have spent some time thinking about it. In a few moments I will explain to the Committee what the difficulty has been.

The Clause seeks to amend Section 4 (3) of the 1949 Act, which says: A person who is a patient in any establishment maintained wholly or mainly for the reception and treatment of persons suffering from mental illness or mental defectiveness, or who is detained in legal custody at any place, shall not by reason thereof be treated for the purposes aforesaid as resident there. To put it in rather more simple language, this means that a person resident in a psychiatric hospital is not entitled to use that hospital as his address for the purposes of registration.

The difficulties which arise from this provision in the Act of 1949 have been drawn to my attention by the National Association for Mental Health, which wrote to me on 29th November about the consultations which it had had with the Home Office in the past year. The Assistant General Secretary said in her letter: The Royal Medico Psychological Association and ourselves have had some correspondence with the Home Office in the past year and, perhaps as a result, have been pleased to note that householders were reminded this year on their return for the electoral roll that they should include informal patients in psychiatric hospitals who normally reside at their address. However, we know that many informal patients have no home or other settled address outside, and we are anxious that they should have the same voting rights as the others. When it actually comes to voting, the final decision as to whether a patient or, indeed, any other person is in a fit state to vote rests with the presiding officer at the polling station. Of course, that power of the presiding officer is dealt with in paragraph 36 of Schedule 2, which enables him to ask an elector who is applying for a ballot paper," Are you the person registered in the register of Parliamentary electors for this election, as follows"—and then the presiding officer reads out the name, and the person has to reply "Yes", Obviously, if that person is not in a fit state to understand the question, he will not be able to exercise his vote, and the presiding officer has to have the answer "Yes" before allowing the person to proceed.

We have a situation where the Home Office, very wisely, has issued a reminder to householders that if they have relatives or friends normally resident at their addresses, but who are in psychiatric hospitals for the moment, they may be included on their returns.

The difficulty arises with patients who have no such relatives or friends, who are permanently resident in psychiatric hospitals and who, because they have nowhere to be registered, are not entitled to exercise their votes.

In this Clause, I suggest that, to the extent that these people are what are called informal patients, they should be entitled to register as being resident at their hospitals. My difficulty is that nowhere in the Mental Health Act, 1959, is there a definition of the word "in formal". It is used in the sidenote to Section 5 of the Act. I suppose that one could have said that any person who is in an institution as a result of the provisions of Section 5 of the Mental Health Act, 1959, shall be entitled to register at that address. However, I have done it the other way round and excluded from the right to be registered at such an institution all those who are admitted other than as informal patients.

I have tried to go through the Sections of the 1959 Act to which this consideration applies. It has not been necessary to deal with them all. For instance, Section 25 allows a person to be detained for only 28 days. Section 29 deals with observation in the case of emergency, and the period is limited to 14 days. Section 51 refers to children and young persons. Section 73 concerns prisoners in custody. Finally, there is the Sixth Schedule, which refers to patients who were legally detained prior to the 1959 Act. The other Sections of the Act which I have mentioned apply to people who are not in formal patients, and I propose amending Section 4 (3) so that those persons should not be treated as resident in the hospitals for the purposes of registration.

The number to whom my Clause applies is quite considerable. If one refers to the last Annual Report of the Ministry of Health, which is that for the year 1967, one sees that, on 31st December, 1966, there were 175,186 patients in psychiatric hospitals.

6.15 p.m.

Mr. James Dempsey (Coatbridge and Airdrie)

Would the hon. Gentleman be good enough to define what he means by "psychiatric hospitals"?

Mr. Lubbock

The phrase used in Section 4 (3) is slightly different and refers to … any establishment maintained wholly or mainly for the reception and treatment of persons suffering from mental illness or mental defectiveness … I have not modified that phraseology in putting forward this new Clause, because I think that it is well understood by the Home Office and others who are concerned.

I was discussing the number of patients in psychiatric hospitals and giving the Committee the figures which I have taken from the last Annual Report of the Ministry of Health. In a further letter to me from the National Association of Mental Health, the Assistant General Secretary says: … some informal patients, even those who are in hospital for quite long periods, have a settled address which they use or can use for voting purposes. However, at one hospital with about 700 beds of which we made inquiries, only about 200 patients came into this category. Of the remainder, about half were regarded as too old and/or confused to vote, leaving about 150 who had no settled address other than the hospital and were capable of voting. At another hospital of similar size we were told that more than half the patients had no settled address outside the hospital. In yet another hospital, about twice the size of the first two, an even smaller proportion of patients had no address which could be used for voting purposes. The Assistant General Secretary goes on to say: As detained patients form such a small proportion of all patients in psychiatric hospitals"— I do not think that it is necessary for me to go through the figures, but they make up a minute number in comparison with the 175,000 informal patients— … it is clear that the vast majority of those who have no settled address outside the hospital are informal patients. Many of them will be as fit to vote as those with a family or landlady prepared to put their names on their householders' returns. It seems reasonable to argue that, if one is entitled to exercise the vote and is fortunate enough to have a relative or friend at whose address one can register, equally one should be entitled to exercise the vote if one has no other address than the hospital in which one is being treated as a patient.

The wording of Section 4 (3) of the Representation of the People Act, 1949, is too narrow as it stands. The Under-Secretary of State would be both logical and democratic if he agreed to this Clause.

Mr. Sharples

I want briefly to sup port what the hon. Member for Orpington (Mr. Lubbock) has said. Until he spoke, I had not realised the extent of the problem. It is clear that a good many people who are informal patients in psychiatric hospitals normally reside at those hospitals. The problem is a real and difficult one, and I am quite sure that the Under-Secretary of State will consider it sympathetically if he feels able.

The hon. Member for Orpington pointed out realistically the great difficulty in drafting a new Clause to cover such a point as this. I doubt whether the Under-Secretary of State will be able to accept it as it stands. I think that there are deficiencies in it. However, if he could give the Committee an undertaking to look sympathetically at the general problem to see whether, on Report or while the Bill is passing through the other place, it was possible to meet the point, I am sure that hon. Members on all sides would be grateful.

Mr. Merlyn Rees

I shall look at the question very sympathetically and consider what we can do to help. So that discussion shall not take place simply in the Department and among people who already know the facts, it may be helpful if I say something about the situation. That may throw a new light on the matter for some people, as one or two of the remarks of the hon. Member for Orpington (Mr. Lubbock) did for me, which is the purpose of debate.

Section 4 (3) of the Representation of the People Act, 1949, as amended by the 7th Schedule to the Mental Health Act, 1959, reads as follows: A person who is a patient in any establishment maintained wholly or mainly for the reception and treatment of persons suffering from mental illness or other form of mental disorder, or who is detained in legal custody at any place, shall not by reason thereof be treated for the purposes aforesaid as resident there. That is the starting point.

When I am dealing with the general principle, it may be a small point to add that the words "… or other form of mental disorder, …" apply to England and Wales. In Scotland, the words used are "or mental deficiency", and in Northern Ireland they are replaced by the words "or arrested or incomplete development of mind". I do not know whether that leads to any profound differences between the three parts of the United Kingdom.

The new Clause would prohibit the registration of a patient legally detained in psychiatric hospitals under the Mental Health Act, 1959. I think that the inference of the way the hon. Gentleman has worded the Clause is that it would permit the registration of an informal patient at such a hospital, that he is concerned with the informal patient alone.

Mr. Lubbock indicated assent.

Mr. Rees

An informal patient—in general terms, that means one who is free to return home—in a psychiatric hospital may be registered as an elector at his home address under the law. He may have been registered before becoming a patient, or may be registered while a patient. A legally detained patient may also have been registered before becoming a patient, but after becoming a patient he is not entitled to be registered any where.

The registration of patients in psychiatric hospitals was considered by Mr. Speaker's Conference, which recommended that steps should be taken to bring to the attention of persons completing Form A in Schedule 1 to the Representation of the People Regulations, 1950, that a patient free to leave a psychiatric hospital from time to time may be included on the form.

That recommendation has already been implemented, and Form A pre pared for the canvass of the 1969 Register, the form which has recently been filled in, asked occupiers to include … those who normally live at your address but are temporarily away, e.g. on holiday, as a student or in hospital (including informal patients in psychiatric hospitals). The law, to some degree, makes a differentiation between the legally detained patient and the informal patient, a term which includes the voluntary patient.

I have been putting some facts on the record so that we have something on which to work. We are left with a smallish group of informal patients who may have been missed out because they were in hospital at the time of registration. Surely they should be covered because there is somebody to register them? The narrow point that we come down to is: what happens when there is nobody to register them?

Mr. Lubbock

The point I made was that the number of such patients is surprisingly large. According to the inquiries made by the N.A.M.H., in one hospital with 700 beds only about 200 patients had an address which they could have used outside the hospital for registration purposes. Of the remaining 500, 150 patients were perfectly fit to vote, in the hospital's judgment, but were not capable of being registered. It is quite a big number.

Mr. Rees

I shall certainly look at the question.

There is one other point—one always finds interesting twists to the curious little problems that arise on Bills such as this. If patients in psychiatric hospitals were entitled to be registered at the hospital address, the register for constituencies and local government electoral areas in which the hospitals were situated would be swollen by a considerable number of persons having little connection with the area, and suffering from varying degrees of mental disorder.

This would raise a problem in Surrey, in parts of which there are large numbers of psychiatric hospitals. One figure I have had is that there are a total of 179,000 informal patients in the county. In some areas, if informal patients were all registered at the hospital their number would be such as to enable them to elect candidates from amongst themselves if they wished. I do not say that that would necessarily be unusual, judging from what one sometimes sees in politics. But there are curiosities in this matter if we take it too far.

I have thought aloud in an attempt to be helpful. It was my inclination to resist the Clause, and I ask the hon. Gentleman not to press it. But if we can help with this marginal problem in some way, without opening up an avenue that would lead to other difficulties, we shall do so.

[Mr. SYDNEY IRVING in the Chair]

Mr. Dempsey

The Clause raises a vital matter of principle. My hon. Friend described it as marginal, but I think that validity is a much more descriptive term. It raises the vexed problem of whether a person detained voluntarily or statutorily in what we in Scotland call a mental hospital should have the right to decide which candidate should represent him in Parliament, when the patient is mentally disordered or mentally deficient but has sufficient faculties to make that decision.

That is the vital point. We should not talk in terms of whether there are scores, hundreds, or a few thousand people involved. In our democracy, of which we are very proud, such people should be given every encouragement.

Therefore, what we are discussing is the limitations that might be set on the Clause if its intent were accepted by my hon. Friend. One comes across various questions when dealing with the problem. For instance, there are people who have no domiciliary residence and are resident in mental hospitals in my part of Scot land. I know someone who has been nearly two years in such a hospital. His residence has gone, but he has many faculties.

This is the type of person whom the psychiatrist would say was capable of exercising his vote, but, under present legislation, there is no hope of his being able to do so. However, he might be given that opportunity if my hon. Friend would consider whether, on Report, we could introduce a new provision. It is certainly worth looking at.

6.30 p.m.

In my part of the country, we have in many instances to say to persons who have left council houses to enter the hospital for treatment," We are sorry. We cannot keep your home going indefinitely. You are likely to be domiciled in the hospital for some time and we are taking away your home. But should the day arrive when your medical practitioners recommend your release, we will provide a home for you at that stage."

I hope that my hon. Friend will grant that this means that, for an interval after a man is released from hospital, he has no home and, therefore, although quite capable to taking part in community life and in elections, does not have the right to vote if an election takes place. This arises because he was not registered, having no domiciliary residence. Yet he could not have had a residence because his local authority took it from him when he entered hospital. It is unfair that persons of that calibre, no matter how few, should be deprived of the right to vote.

There are other persons who spend long periods in hospital. I knew a lawyer who worked in his office during the day, but stayed at nights in hospital for treatment. He had no domiciliary residence because he was really domiciled in the hospital. Yet he was capable of attending to his legal duties during the day. It gives a good deal of credit to lawyers when they can practise in this way and give people advice. That gentle man lived to a ripe old age.

It is clear that, if there are individuals who are capable of voting but are pre vented from doing so by a technicality, the Government should consider introducing a suitable provision on Report. We have a duty to these people. They are citizens. They probably smoke and pay tax on their tobacco or cigarettes. They pay tax on their sweets. If they are capable and it is said by their psychiatrists that they are fit to exercise their responsibilities to the State, they should be given every opportunity to do so.

I hope my hon. Friend the Under-Secretary of State will seriously consider this situation and earnestly study what has been said in the debate and that, on Report, he will bring forward a provision giving these individuals the same right as others in the United Kingdom—the right to vote.

Mr. David Steel (Roxburgh, Selkirk and Peebles)

This has been a constructive and useful debate and my hon. Friend the Member for Orpington (Mr. Lubbock) is to be congratulated on raising the subject. Since we have had such a good reception from the Under-Secretary of State I only want to add one point. I face this problem in my constituency and my hon. Friend the Member for Bodmin (Mr. Bessell) tells me that, at St. Lawrence's Hospital, in his constituency, he has had a similar experience.

At Melrose, in my constituency, I have a large hospital, Dingleton. It is a very progressive mental hospital which, at election times, invites the candidates to come and meet the staff and address a meeting. I have been there at each of three elections and on each occasion it has been pointed out to me that the majority of those who have come to listen would have no vote, although, in the main, they were voluntary patients and were not detained. This was felt to be a grave injustice, but I never thought that we would have the opportunity to put it right because so often one hears complaints and all one can say is," Perhaps one day this will be put right."

I hope that the Government will look at this case sympathetically. I think that we are going through a welcome revolution in our treatment of mental illness and in our attitude to the stigma attached to it. It is curious that psychiatric patients admitted to a general hospital would be qualified to register and vote at an election whereas the law says," If you are in an institution recognised as a psychiatric hospital, you may not have the vote."

But the psychiatric hospitals are opening up. There is much more involvement with the local community. The Under-Secretary of State suggested that it would be wrong, for example, if a large number of people with no local community or constituency interest residing in a mental hospital registered and thereby swamped the register. My reply to him is that long-stay patients, with the development of psychiatric hospitals, are becoming more and more involved in the community and are encouraged so to do. This proposal, therefore, although small, would be a consistent and significant step in helping to remove the stigma illogically attached to mental as against physical illness.

That is the sole point I wish to represent. No one suggests that the vote should be given to those detained or certified in mental hospitals. I think that we are all agreed on that; but I hope that the Government will look at the question as it involves voluntary patients very sympathetically.

Mr. Merlyn Rees

I repeat that I shall look at this matter extremely sympathetically. As the debate has gone on, it has grown on all of us that there are more problems than perhaps we felt at the be ginning.

The hon. Member for Roxburgh, Selkirk and Peebles (Mr. David Steel) has made it clear that we are talking about informal or voluntary patients. I would not like anyone to think that, in talking about the effects of a large number of people being registered in a locality, I would not have said the same in the case of, for example, university students or anyone else. I was not referring specifically to the problem as it concerns people having to be in hospital.

I want to leave the matter in this spirit. I agree that there is a new attitude to the problems of mental illness. It is not per haps that mental illness is growing, but that our understanding and treatment of it becomes more civilised. Perhaps, in this civilising attitude the Committee will accept my undertaking to look sympathetically at this question and consider what can be done.

Mr. Lubbock

In view of the helpful reply by the Under-Secretary of State, I beg to ask leave to withdraw the Motion.

Motion and Clause, by leave, with drawn.

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