§ Captain LOSEBY
I beg to move, at the end of the Question, to add the wordsBut regret that no reference has been made in His Majesty's Gracious Speech to the amelioration of the condition of ex-service men at present confined in lunatic asylumsI move this Amendment in consequence of representations from a part of the ex-service men's organisation which is devoted solely to the task of assisting and relieving all ex-service men whose minds have been affected owing to the stress of war; and on behalf of that organisation, and of hon. Members of this House who have been kind enough to support me, I should like to express my most grateful thanks to you for making place for this Amendment and to hon. Members of the Agricultural Committee who, with great kindness and consideration, have gone out of their way to give this Amendment a place. I am asking hon Members to consider the position of some 6,000 ex-Service men who are at present confined in lunatic asylums. That figure does not include a number, between 20,000 and 30,000, of border-line cases, men under the immediate care of the Ministry of Pensions, many of whom possibly under our present system might have been certified, but have not been certified. I am referring only to this number of men between 6,000 and 7,000 who are detained in lunatic asylums.
There has been an extraordinary increase during the past 12 months of soldiers confined in lunatic asylums. Between January and December of last year the increase was 40 per cent. My right hon. Friend the Minister of Pensions has disputed that figure, but I take it from the official returns issued by the Board of Control and from the answer given in the House by my hon. and gallant Friend the Parliamentary Secretary to the Ministry of Pensions. It is perfectly clear how this huge increase has come about. I do not think the Parliamentary Secretary to the Ministry of Pensions can deny that it has arisen in this way: Owing to the fact that the 545 Ministry found it necessary to close certain Departments, they were positively not in a position to offer any kind of alternative but lunatic asylums to the men who were discharged from what were known as mental homes. But they did something much worse than that. Not only did they say, "We must discharge you and we can offer you nothing better than the lunatic asylum"—I challenge contradiction on the point—they have said over and over again, "Unless you accept this particular institution which we offer to you, and which happens to be a lunatic asylum, we shall not give you your treatment allowances, and you are liable to have your pension cut down or not to receive that treatment which was offered to you by the Ministry." That meant that the particular allowances upon which these men and their families, in certain cases, have relied for their sole means of support would be taken away from them unless they were prepared to accept this particular kind of treatment.
In my own constituency I came across one particular case. It was that of a man who quite wrongly had been assessed at 60 per cent. By going into hospital or to a certain institution of the Ministry of Pensions he was allowed 100 per cent., which was a vital necessity to keep him alive. He was offered a certain institution. He was told it was a mental home, but he knew it was a lunatic asylum and he was appalled at the thought. The Ministry did not tell him, "We shall deprive you completely of your pension," but he was told that it would be the 60 per cent., and not the 100 per cent. which he would have been entitled to had he entered this particular institution. I ask the Parliamentary Secretary to tell me if he can what did in fact become of the inmates of Palace Green, to mention one institution. I know that in numerous cases the Ministry said: "We can offer you institutions," which were lunatic asylums and nothing else, but to several men whose cases are within my own knowledge the Ministry said: "We cannot offer you alternative treatment." The Ministry is obsessed by the idea that it is acting in the only way possible within the law. I am one of those who think that to get this matter right, to get this crying scandal right, it will be necessary to amend the lunacy law. Even with the law as it is to-day, there is no reason for the Ministry of Pensions to adopt this 546 policy which they have undoubtedly adopted. That is a policy which undoubtedly accounts for the number of men who are living under what I would almost call this horrible system. Under the lunacy law as it stands to-day, it is perfectly competent for the Ministry of Pensions to say: "As the next-of-kin you are entitled to take charge of this man. It is perfectly obvious we cannot give you the treatment allowance unless you satisfy the local pensions body or any other body appointed by the Ministry of Pensions that he is receiving adequate medical treatment." If this were met with a refusal, if it were said: "No, I will not provide for him this adequate medical treatment," it is then perfectly obvious that the Ministry would be entitled to say: "We shall deprive you of your treatment allowance." I repeat with the most complete assurance that the Ministry of Pensions say: "You will either enter this particular institution recommended by us—that is, a lunatic asylum—or you shall not have your treatment allowance."
§ Major FARQUHARSON
Will the hon. Gentleman make clear to the House to whom he is supposing these remarks to be addressed? Is it to the patient himself?
§ Captain LOSEBY
Either to the patient or the parent of the patient or the next-of-kin or representative of the patient. I am going to give as briefly as I possibly can one or two quite typical cases. They are not extraordinary cases or cases specially picked out. I ask the House to note that many of the men in lunatic asylums at the present time have become mentally deranged, not only in fighting for their country, but because they have given what I may describe as excess of service, because they have overstrained themselves and risked themselves too much. It is perfectly extraordinary, when you go into the statistics, to find that the military records of these men are infinitely above the average of those of the ordinary soldier. The first case I take is that of a captain who enlisted in the ranks and afterwards became commissioned. I observe that he was mentioned five times in despatches. He gave up an important post in the Far East in order to come to this country and enlist, and broke down and went to an ordinary institution under the Ministry 547 of Pensions. He eventually found himself in a lunatic asylum and he was perfectly conscious of where he was. He saw the notices placed there in accordance with the regulations under the Lunacy laws, and he bitterly resented that, having served his country as he had served it, he had been forced into a lunatic asylum. In every single case I have come upon, the discharge men were perfectly conscious of where they were and most bitterly resented it. The first thing they did to this man when they got him inside was to forcibly remove his clothes. He knocked down an attendant, and for that reason he was clapped into a padded room, and in a padded room, in or out, he was for something like six or seven months. His fiancée came to see him, and she says they were continually interrupted by the screams and shouts of patients after he was let out of the padded room. He was placed in the worst ward, with 60 or 70 longstanding cases, dirty, ill-groomed, and neglected, without any kind of literature or anything to divert his mind. He called his fiancée's attention to certain extracts of the Lunacy law and said, "Is this what I gave all up for?" He eventually came to an institution with which I happen to be connected, which helps to look after these men—not a lunatic asylum, but an institution which has not got anything like it in this country, in regard to which, for cures, there is no parallel, I believe, in this country.
§ The PARLIAMENTARY SECRETARY to the MINISTRY of PENSIONS (Major Tryon)
Are you referring to Chartfield?
§ Captain LOSEBY
The right hon. Gentleman knows very well I am referring to the institution that you have refused to acknowledge, although you have accepted lunatic asylums. I was going to make this point in regard to it, that the Ministry of Pensions refuses to recognise that particular institution, because it says, and my hon. and gallant Friend has said it: "We will not consent to mixing the sane with the insane." He knows perfectly well that we have never asked for 1d. grant in regard to any sane person, but what, I ask, can be the argument? What harm are we inflicting on the insane by compelling them to mix with the sane? If you carry my hon. and gallant Friend's argument to a logical conclusion, of 548 course it is impossible for him to allow him to be maintained by the next-of-kin because the next-of-kin does not happen to be insane, and my hon. and gallant Friend has got some crude idea into his head that he is committing some kind of hardship to an insane man if he allows him to consort with the sane. I am sorry to make this personal. I do not ask, and never have asked, my hon. and gallant Friend to accept any kind of responsibility for any person, other than an insane person, in this particular institution, but I will return to my man. He arrived in a very ill-nourished condition, suffering from septic mouth and severe abscesses in the face. After two months, he was able to do with one attendant only, and he is now well on the way to recovery. That man was not insane. He was diagnosed as suffering from dementia præcox; that means incipient insanity, and in regard to the first five men on my list, medical experts stated that no one single man was suffering from this dementia præcox, but was suffering from a definite lesion, a result either of exposure or of a wound which had not been discovered, for the simple reason that in not one of these places of detention referred to was there anything worthy of the name of treatment at all. I may have got unfortunate cases, but it applies to a very large number. In these institutions the method is restraint; it is not treatment, but I have been carried away.
I cannot now, with the short time at my disposal, deal with my other two cases, except to say this. They were diagnosed as insane. They were not insane. One man had meningitis and they clapped him into a padded room. They were going to cure his wound, his lesion, by restraining him in a padded room In every case it was a distinct lesion, something in the nature of a wound, for which this padded room treatment was awarded. One of the saddest cases was that of a man kept practically without clothes in a padded room. I am not blaming my hon. and gallant Friend. It is the system. That man was kept in a padded room for three or four months, and he died. He never would have died if he had been diagnosed properly; had he not been treated as insane, and become subject to this wrong treatment. This is all I say to my hon. Friend, and this is all I ask him, and this is his sole responsibility I know he has no institution into which he is pre- 549 pared to take men in certain conditions. I do not blame him for that. I do not ask him to spend one additional penny, but I do ask him not to adopt a policy which forces men into lunatic asylums unnecessarily, and which, to many, spells mental torture indescribable. I ask him to say, not necessarily that a man must go into a lunatic asylum, or he will not have his treatment, allowance or pension, but to say to him they can offer him a mental home, and that, under the circumstances, if it can be shown that this institution or that institution is efficient, or that the man can be given this or that medical treatment, he shall not necessarily be deprived of it only because he does not go into this lunatic asylum.
I must mention one other matter, because it is of vital importance. Of course, it is perfectly true that we must go further, and I personally do go further, and say, that if these places are not fit for soldiers, they are not fit for civilians. I do say that. I say that our present lunatic asylum is barbaric and antiquated. Whether you agree with that or not, I say that for these particular men suffering from lesions, and not mentally diseased, it is an impossible and an intolerable treatment. My right hon. Friend the Minister of Health, in order to show that we were quite wrong in our arguments, quoted certain figures. He said that the recovery rate from lunatic asylums is 33⅓ per cent. As a matter of fact, the recovery rate is under 7 per cent., and I do seriously hope my right hon. Friend will take the first opportunity to correct what, I am perfectly sure, is only a faulty mathematical calculation. In 1920 there was 119,193 people admitted, and 7,206 discharged as recovered. Eight thousand five hundred and four died. The death rate was higher than the recovery rate. The Board of Control figures referred to that 8,500 as being 8 per cent. By what method of calculation could that 33 per cent. be arrived at?
Recently a book has been published—as everyone knows—containing as formidable and damning indictment of the system, I should think, as has ever been published. I hope hon. Members who are interested in ex-service men and in lunatic asylums will read that book. It may or may not be true in detail. It is written by a medical man with two years' experience. I know enough of the man to say that what he has written he believes 550 to be true in every word. It is a most damning indictment. I thank hon. Members of this House who have been kind enough to assist me in this protest that I am making to the Ministry of Pensions. It is the only protest that I have to make about their methods and has reference only to this Amendment. My argument is that if you want these men to recover it would not be possible to find institutions where their chances of recovery were less. Having said that, it has been quite impossible, for want of time, to say many things that I would have liked to say; but I trust I have brought out such figures as will answer the purpose that I intended. Unless my hon. and gallant Friend can tell us that he has altered his policy, or can defend it better than I think possible, I hope hon. Members who have supported me will insist upon another Debate.
§ Captain BOWYER
I beg to second the Amendment.
In view of the time, what I have to say must be put in a sentence or two. To my own satisfaction as an ex-service man, and to the satisfaction of a very great number of ex-service men whom I try to represent here and with whom I am often in contact, there has been a primâ facie case established for the most serious investigation as to the treatment of ex-service men in lunatic asylums. It is perfectly trite that with this question is inevitably bound up the larger question of lunacy reform. We have in this House hon. Members—and we are lucky to have them—who are distinguished members of the medical profession. What I have heard from them leads me to think that they may stand up for lunacy institutions, as at present existing; that they may be prompted to treat such cases as that put forward by my hon. and gallant Friend in an easy way; but I would ask them to remember what we heard upstairs in the Committee Room just before Christmas. To those hon. Members who adorn the medical profession who are tempted to treat any such case with tolerance I submit that a primâ facie case for inquiry has been made out, and that in the minds of ex-service men there is very, very grave concern as to what is the treatment of ex-service men in cases of shell-shock, incipient madness, and so on.
§ Major TRYON
I realise that it is clearly my duty to rise now, otherwise I shall not have time to reply owing to 551 the rules of the House. I should like to begin by saying how profoundly I regret that no opportunity will be given to any of those distinguished members of the medical profession in this House of replying to what I believe to be a slander upon the medical profession. There is no duty which the Minister of Pensions takes more to heart than the one he has to discharge in reference to the ex-service men who are unfortunately suffering from some mental affliction. In this matter we owe much to the medical profession for there is no more difficult or trying work than that in which they are engaged in trying to do all they can for those who are mentally afflicted. With regard to the charge which has been made, what are the actual facts? I know the Minister of Pensions will never consent to the mixing up of these cases of neurasthenia with those who are insane.
§ Major TRYON
I acknowledge that we keep the whole of our pensioners as long as we can, and we try to prevent by every means in our power ex-service men being put into asylums, but when these men have gone over the border line we have no choice. We do not crowd them into asylums. Under the law we are bound to put them into asylums, and it is necessary for the safety of others that they should be there. When the hon. Gentleman talks about sending these men off to their homes, let me point out that many of them are dangerous, and might commit suicide and possibly kill others if they were not taken care of. We look after them even when they have gone over the border-line for, even then, my right hon. Friend's care over them does not cease, and he sends inspectors round to the asylum to see how they are going on. We send round highly skilled men to watch these ex-service men who are in asylums, and yet my hon. and gallant Friend has no better phrase to use than that these ex-service men are being subjected to torture, when, as a matter of fact, they are being well looked after to the best of our ability.
Their status is not that of a pauper at all. We treat them as private patients: the only difference between their position and that of other private patients being 552 that we pay the charges for them instead of their relatives being called on to pay. They get not only the care given to all the patients in these institutions, but we are also constantly sending people round to inspect them. We do all we can for them. The hon. and gallant Member talks of their position being hopeless when they go into these asylums. When we find that of 11,600 who passed the borderline 1,575 have died and out of the asylum have come 3,827 either cured or so far relieved that they can be released, 6,198 remaining under treatment, is not that a great tribute to the staff of the asylums, because it is only the worst cases that are certified and go in? In these asylums there are men suffering from every gradation of the disease. We have a very large number of men suffering from various forms of mental disease, and when we find that so large a percentage are cured or relieved so as to justify their release it surely is a very satisfactory result When my hon. and gallant Friend tells us that there is nothing in the whole world like the one small institution he refers to, I would remind him of the figures we found showing that out of 17 cases seven had been discharged. Of these one was a case of mild melancholia, not certified. Three were border-line cases, not certified.
§ Captain LOSEBY
Can the hon. Gentleman tell me why they were diagnosed firstly as dangerous and secondly as suffering from dementia?
§ Major TRYON
The hon. and gallant Member criticised the percentage of cures, but for the purposes of his comparison he included patients certified as insane. Obviously that is not a proper comparison.
§ Major TRYON
I can remember an occasion when my hon. and gallant Friend was telling us of the wonderful work done by a certain institution. I asked him what cures there were. He was able to give no figures, but he spoke of one case in which an immediate recovery was anticipated. I very much regret to tell the House that that man is now dead. The figures of these cases must be made comparable; we must compare like with like. I feel that, while everything must be done that can be done—and I know that the Minister of Health is doing and will do 553 all that is possible—I cannot personally advise upon the legal position, because we as a Ministry are governed by the laws of the land; but we do all that we can, as a Ministry, for neurological cases. When men get worse we hold on to them to the very last, up to the uttermost limit of the law, before they are sent away. When they are sent away we still care for them, and when they are treated as private patients we send inspectors; and we rejoice when we hear of all these thousands of them coming out again.
§ Lord H. CAVENDISH-BENTINCK
How it is that, in spite of all the care that is taken, there has been such a large increase in the number of soldiers in lunatic asylums?
§ Major TRYON
I am very grateful to my Noble Friend for reminding me of that. I ought to have mentioned it before, and meant to do so. The point is this. There were, at the end of last year, over 6,000, showing an increase, as stated by my hon. Friend. I am glad to say that the figure is declining, and the latest figures, which I have received this afternoon, show a considerable and welcome decrease in the number.
§ Major TRYON
My hon. and gallant Friend is suggesting that a number of doctors in lunatic asylums have certified men to be sane when they are not sane, because of the agitation, and I say that he owes an apology to the medical profession. The position with regard to the increase in numbers is very complicated, but I will do my best to explain it. It is due to two causes. We have a vast mass of people in every degree and gradation, from the man who is only suffering from melancholia to the man who is hopelessly and dangerously insane. As these cases are treated, some—a large proportion, I am thankful to say—get better. On the other hand, some get worse, but we hold on to them to the very last. Some, at last, have had to go to asylums, and that creates an apparent increase. In dealing with a large number, it is obvious that many get better some get worse, and 554 these are certified. Again, there are in the asylums a large number of men who have been there a long time, and whose relatives are claiming that they come under Article 9 of the Warrant, which allows people to claim, after the event, that their disability is due to the War. Large numbers of such claims have been accepted. We have stretched the Warrant to the utmost point in order to give every benefit of the doubt in these cases to the ex-service man, and as a result hundreds of them are being treated as private patients and given the better basis upon which acknowledged ex-service patients are put—not because they have just become insane, but because, having served during the War, they are recognised by my right hon. Friend, as service patients, and given all the benefits of that status. I think I ought to say, however, that it is not the case that all these service patients in the asylums have been in the firing line. A great authority on this subject took the trouble to go into the details of one asylum, and he found that, of the service patients in that asylum only 44 per cent. had served overseas in the firing line. That shows that it is not entirely a War measure, but we do our best and count them as service patients and give them the benefit. It seems, therefore, a little hard that, because we have so classed them, the fact that we have recognised them as service patients should be counted as an increase in the number. In many cases it is merely due to their being recognised and given allowances. I do not think I ought to sit down without alluding to a circular sent out by a body called the Ex-Service Welfare Society, to, I think, every Member of the House. The statements in it on one page alone are as follows. It alludes to their being men who fought for the Home-land. That is true with regard to less than half. It says their hope of recovery is very small indeed. I have done my best to show how large and how welcome is the list of recoveries which we are able to report. Here comes the statement that "they are not insane." That is not accurate. These are all men who have been certified by highly-trained people to be insane, and whom we have only lost from our care because they were so bad that we could no longer retain them. That is not a statement which ought to have been made.
§ Major TRYON
It says "they are not insane." I find there no such words. I will read on.They can be influenced by kindness and cured by skilled medical treatment and proper nursing.So they have been. But this pamphlet says:Who cares for them?They are being cared for. What we want is help and practical suggestions. We want everyone who can make any suggestion to do what he can for these men and to come and help. Wild charges and wild statements of that kind cause suffering in hundreds of homes where the relatives think those who are being cared for are not being cared for, and those who have lost their relatives in asylums believe they will never get them back, when this large proportion is being returned. I have spoken somewhat rapidly, for the time is short. I should like to express my entire sympathy with the hon. and gallant Gentleman's anxiety about these men, and I am glad to be able to reassure him and the House.
§ Question, "That those words be there added," put, and negatived.
§ Main Question again proposed.
§ Motion made, and Question, "That the Debate be now adjourned," put, and agreed to.—[Colonel Leslie Wilson.]
§ Debate to be resumed upon, Monday next (13th February).