HC Deb 06 November 1945 vol 415 cc1188-204

Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Mathers.]

8.54 p.m.

Mr. John Lewis (Bolton)

In this year of 1945 there are approximately 127,000 mental disorder patients in our hospitals and homes. The majority are treated in wholly or partly rate-aided institutions, and the remainder in institutions under private management. It is an unquestionable fact that the staffs of these institutions, male and female, are working under the most difficult conditions, due to a lack of accommodation and to under-staffing. For that reason it is only possible for them to skim the surface of treatment, because their time is taken up in ordinary routine and giving the patients proper attention and care and keeping them fed and clean. In order to appreciate this problem more fully its social background should be remembered, particularly as it affects public opinion today and therefore the patient. In these circumstances the attitude of mind of those who are brought into close contact with the patient is of vital importance, in view of the fact that very often this is a precipitating factor in the onset of the disorder. I know that among primitive people insanity is regarded with suspicion and fear, and very often is associated with witchcraft, demons or the devil, resulting in maltreatment of the sufferer. [Interruption.] Probably the hon. Member who interrupts knows more about primitive people than I do. We remember that only 100 years ago it was the common pastime to bait the lunatics in Bedlam. We have improved quite a lot since then, but today the whole question of insanity is avoided out of superstition, fear, or ignorance.

It is vitally essential, if we are to do anything about this tremendous problem, that the whole matter should be put on the same plane as other physical disorders, and the public should be taught that mental illness and mental hospitals are just another part of general hospital work. The figures relating to people in our institutions, although vast, are very misleading, because they represent only a fraction of those people who are in need of mental treatment and attention. For instance, we understand that psychoneurotics occur in 2 per cent. of the population, and few of those people receive the care and attention they need. In addition general practitioners advise us that 30 to 50 per cent. of their practice is concerned with people who are suffering from functional nervous disorders in various forms and manifestations. What is far worse, in our general hospitals 17 per cent. of those referred to general medical outpatient departments are suffering from psychological illness without any serious organic component. Some of them will eventually come into hospital as certified patients. Others will carry on, burdens to themselves and others with whom they come into contact, and will live out their lives without happiness and work without efficiency.

It has been proved that the greatest opportunities for recovery lie in early treatment. When we look at our mental hospitals today we ask ourselves what inducement there is for patients to enter voluntarily to receive treatment. I maintain that the inducements we have to offer are few and the drawbacks to which we have to confess are many. Reputations die hard and the reputation of a mental hospital as a place of forcible retention is still with us. The very remoteness of the places, with their high walls, bleak premises with their locked doors, makes it absolutely clear to those people who are sufficiently rational to think that those who enter may never return and the very thing we are trying to effect is defeated. Today 40 per cent. of the patients who enter mental institutions return to their families completely cured, and 20 per cent. return home much improved.

These figures are even more encouraging when we bear in mind that very often these people come to the mental hospitals in a late stage of mental illness and very often in the last stages of senile dementia. If we could only give them early treatment, the prospects of cure would be considerably improved. There is no doubt there is the stigma of insanity which is the predominating feature militating against these people entered for voluntary treatment. There is not the glamour which surrounds the general hospital. People do not mind having an illness like pneumonia, and I believe some people are very proud of any condition which requires surgical interference, but as soon as they are told it is a matter of mental illness the whole matter becomes obsessed with mystery and fear, and people attempt to hide from themselves the fact that that is the illness from which they are suffering.

Most of our mental hospitals are neither beautiful nor cheerful, nor do they radiate that atmosphere which is vital—the hopeful atmosphere of recovery. We find that 70 per cent. of the inmates of these institutions are suffering from chronic or senile dementia and cannot benefit from any form of treatment other than care and attention. That care is lavished upon them by a devoted mental staff to whom we owe very much but, having regard to those facts, it is impossible to imagine all people in need of attention voluntarily entering mental institutions. We should take steps to amend the system and bring to the light of day what is a most urgent and pressing problem, and with this end in view we must educate public opinion. When I say public opinion I include some medical men, because some insanity seems to be regarded by some of them as a crime or slur. Mental illness must be as much a normal aspect of life as a physical disorder, and we must recognise that it exists in its various manifestations and forms to the extent that it does and not avoid the consequences of such knowledge.

When we look at the accommodation in many municipal mental hospitals we find it is hopelessly inadequate. There are approximately 1,000–3,000 patients in the average mental hospital. If we compare the space which is allocated to patients in fever hospitals and general hospitals with that in mental hospitals, we find that fever hospitals have 144 square feet per bed, general hospitals 120 square feet, and mental hospitals only 50 square feet. When we remember that some of the dormitories must be less restricted in space, for example, in sickbays, and infectious wards, it is not surprising that in other parts of the hospital the beds are packed still further closely together so that it is impossible to stand up between them. In many dormitories and airing courts conditions are so bad that if people want sitting room they have to squash together.

Then we come to this most terrible indictment of our present system. Deaths from tuberculosis in 1942 in our mental institutions were 15 times as high as in the normal population. These figures, coming as they do from such a colossal incidence, make our mental hospitals a source of infection. When we remember that approximately 60 per cent. return temporarily or permanently to their normal environment from mental hospitals where there is this high death rate from this terrible disease, we can appreciate the seriousness of the problem. These appallingly high figures have been reduced in instances where the overcrowding has been reduced and where the dietary has been improved. There is no reason why the incidence of tuberculosis in mental institutions should be any higher than among the normal population, and it would certainly be reduced if accommodation and diet were regarded as of essential importance in medical health treatment and if active tuberculosis were isolated. The majority of our hospitals are very old and out of date; some of them are more than 100 years old and they are regarded by people as places of detention and not as places for treatment. When we see how the patients are classified we have every reason to understand why there is this feeling about mental hospitals among the people whom we try to induce to enter for early treatment because patients are not classified according to their type of mental disease, but, as a rule, by their degree of physical infirmity; secondly, by the degree of noise, and thirdly by habits, whether dean, dirty, destructive or violent. Throughout all the wards in these hospitals are many epileptics and potential suicides. They are scattered throughout the whole hospital, the category or classification in which a person is placed depending upon which of the classifications to which I have referred is the dominant feature. It is a most unscientific method of dealing with a vital matter.

In many hospitals true convalescent wards do not exist. Patients who are presumed to be convalescent are usually sent into the admission ward, and there they stay until they have to make way for newcomers. In these admission wards people often come in and die and this is not the best environment in which to place a person in a convalescent stage. Convalescent patients are often sent into the chronic wards where the permanent residents are clean and quiet. They may be profoundly demented or schizophrenics but so long as they are notoutwardly too disturbing convalescent patients are sent in with them. Needless to say this atmosphere is not the most stimulating and encouraging for a patient who is trying to adjust himself to normal circumstances after a most devastating mental experience. So far as hospital wards are concerned, these are utilised to a large extent for the chronically infirm and not for patients who come into the hospitals for treatment. There you may have people who have been bedridden for 50 years, and they are often noisy, excited, wet or dirty. It is quite impossible to conceive that these conditions are the proper conditions which should exist for people in mental institutions who are acutely ill and necessitous of treatment.

The patients are, in the majority of cases, fed from great centralised kitchens and the food has to be transported for long distances. It very often arrives cold and has to be served by the nurses. The people who cook the food do not see it served, which is a very undesirable feature. I believe that an advisory committee of the Ministry of Labour have advocated that in general hospitals catering should be under the control of a catering manager directly responsible to the management committee. I suggest to my hon. Friend that that recommendation should apply also to mental hospitals. The standard of diet in many institutions is at the public assistance level and in my view is too low and unsuitable to those whose history prior to admission and resulting condition make a well-balanced and ample diet an absolute necessity, bearing in mind that an improved physical condition is the first step towards recovery. It is absolutely necessary that they should have an ample and well-balanced diet. The low standard of diet has its origin in the fact that some years ago it was believed that low feeding would keep a patient quiet, presumably for weeks. That system still operates today in some places.

So far as the medical staff is concerned, we find at the present time that the average is one doctor to anything from 300 to 700 patients. That is a quite insufficient number for allowing doctors to spend time on research in psychiatry. They are most generally concerned with general hospital administration. Many hospitals still follow the practice that male patients are nursed by male nurses and female patients by female nurses, whereas it has been quite definitely proved in Maudsley Hospital that that practice is quite unnecessary.

Dr. Morgan (Rochdale)

It is not the general rule.

Mr. Lewis

In very many cases it is so.

Dr. Morgan

It is not the general rule throughout the country now that male mental patients should be nursed by male nurses, and vice versa.

Mr. Lewis

Even if my hon. Friend will not agree that it is the general practice, I think that, in view of the fact that I am advocating that this question should be treated as part of a general health scheme and not be separated from it, we should take the worse conditions that obtain in our mental hospitals when considering this problem. There is also the question of the isolation of mental from general nursing services, for this leads to the impoverishment of both services and a lack of understanding of the tradition and knowledge of either. Colonel J. Ivison Russell, at a recent meeting of the Mental Association, said that 70 per cent. of the patients in mental hospitals who caused the major part of the work, and whom he referred to as settled, were senile dements who only needed care and attention. They are unstable mental defectives who cause trouble at home. There are unstable incurable psychotics who cannot benefit in any way from any form of treatment of any kind. Many of them are bedridden. Some of them are devoid of human faculties. The most depressing spectacle that any one can see are these sub-human wrecks kept alive by the devotion of the nursing staffs and filling our hospitals with an air of unescapable tragedy.

Patients are expected to enter this sort of atmosphere voluntarily to obtain early treatment. Apart from the emotional associations, there are the general architecture and bleakness of these places which make a person fear their ultimate freedom. The first thing he thinks about is that at all costs he must keep out of them. We must help these people by introducing new methods into the hospitals and a new approach to the subject in order to ensure that they shall not be obliged to submerge their already disintegrated personalities amongst our vast numbers of patients. As far as finance is concerned, we are faced with the depressing fact that, whereas to keep a patient in an ordinary general hospital costs £4 10s. a week, only 30s. is required to keep a patient in a mental hospital. There are patients who can afford to pay, and they have more cheerful surroundings and better furniture, but no better treatment, because it is not available. It is depressing to envisage pauper patients in public assistance institutions having no privileges in regard to the standard of their treatment. They cannot afford to go into proper homes to avoid certification. They are sent by the relieving officer into a public assistance institution.

It being a Quarter past Nine o'Clock, the Motion for the Adjournment of the House lapsed, without Question put.

Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Mathers.]

Mr. J. Lewis

Thousands of them are retained in the mental wards of public assistance institutions just eking out their lives without any form of treatment whatsoever. I maintain that if my right hon. Friend is going to give the attention he should to this problem he must budget a great deal more money for improved standards of treatment, nursing, surroundings and research, and at the same time he must make the public understand this need.

In so far as mental hospitals are concerned, I maintain that they should be built in two separate categories. In the first place there should be hospitals to deal with the 70 per cent. of chronic cases which cannot and will not improve, and in the second place there should be hospitals for the treatment of the acute cases with all the most modern scientific methods that can be employed. It will not be necessary to discard our present hospitals, because some of the inmates have been there for more than 50 years, and, as they cannot benefit from treatment of any kind, it is reasonable that they should be left to end their days there. In regard to hospitals for dealing with these acute cases, there must be an entirely different method of approach. They must be regarded as centres for treatment, training and research, and all departments must work together. As far as we know, hope of recovery depends on early treatment, and for that reason we must make our hospitals attractive, we must do away with this fear of entering which exists at present. There must be that atmosphere which is linked with and derived from being a part of the great centres of medicine and science. New hospitals must be built near to universities or medical schools. A medical superintendent should be a teaching member of a university. Where a chair of psychiatry does not exist it may well be that one will be established. There should be teaching hospitals in the vicinity with adequate outpatient facilities and a psychiatrist provided by the mental hospital, because we must recognise that there is a large field for out-patient work among those who need never be in-patients, who, for economic or psychological reasons, must keep on with their jobs and their daily routine at the same time as they are receiving treatment.

In so far as nursing staff is concerned, I feel that there should be quite a different approach altogether. There must be two distinct types of nurses, one type who will look after the chronic patients, kind-hearted women who are prepared to minister to the mind-diseased and to devote themselves to their work knowing full well that they will see neither any gratitude nor be rewarded with the joys of recovery. Then there, must be the double-trained sisters in charge of those institutions and double-trained staff nurses, and every possible means must be taken to ensure that the most scientific methods are employed to deal with this terrible problem. A tremendous amount of research must be carried out, and I maintain that every mental hospital should have a bio-chemist and bio-physicist, because I think that these problems are largely problems of biochemistry and bio-physicists. So far as equipment is concerned, a large sum of money must be budgeted to ensure a general system of treatment throughout the country, employing the latest and most modern devices.

I would like to deal finally with certain matters associated with the general administration of our mental hospitals. If a patient is suffering from tuberculosis and he goes to his doctor who diagnoses the disease, the doctor will send him to the tuberculosis officer, who will send the patient to a sanatorium, or chest hospital as they are now called. If, however, the general practitioner finds that his patient is suffering from a mental disease of any kind, he calls in the relieving officer, who is not a doctor, who places the patient in an observation ward in a county or county borough hospital. There may be an interval of 14 days for certification or discharge and, in the case of a poor patient who, in the view of the relieving officer, is a person in need of care and attention, he may be sent to a Poor Law institution and certified there by bringing in a magistrate, who is not specially empanelled, without the advice of an outside doctor.

I am pleased to say that in some constituencies, particularly in my own, it is the practice for the magistrate to bring with him an outside doctor for the purposes of certification. The mental health of our nation should not be left, as far as local administration is concerned, to a sub-committee of a public health committee. I suggest that there should be a special hospitals committee, which would be a statutory committee, for, dealing with this matter, and that it should be directly responsible to my right hon. Friend. I think it would be a good thing to keep the regional system going, because in each region there is a hospital officer who is responsible for the general administration in the region, and it would avoid over-centralisation and the whole scheme becoming unwieldy. But there is no doubt that the lunacy laws must be amended, and the Board of Control must be swept away, because it is intolerable that merely a lack of means should be the factor which decides whether a person should lose his freedom or not. There is no doubt at all that this is a gross infringement upon the liberty of the subject which should be taken off the Statute Book.

In the time available I have tried to deal with certain aspects of this problem as I see them, and we have been gratified with the announcement that my right hon. Friend is to bring in a Bill early next year to deal with the national health question, but I do hope he will give consideration to this matter and that he will bear in mind at all times that mental health cannot in any way be separated from general health, and that specialist treatment rather than restraint should be the dominant factor in the legislation which he will introduce in regard to this matter. If he does that I am satisfied he will have taken steps to remove from our fair land what I believe to be a blot on our national honour and prestige. Common humanity demands that this whole question receive the immediate attention of all those people responsible for the administration of our health services, and I am satisfied that my right hon. Friend, who is applying himself so assiduously to this matter, will do what is expected of him by so many people.

9.22 p.m.

Dr. Stephen Taylor (Barnet)

While I cannot go all the way with my hon. Friend the Member for Bolton (Mr. Lewis), I can in general agree with him; but in one or two instances he has over-painted the picture a little, for example in connection with tuberculosis. The reasons so many mental patients get tuberculosis, and the reason it is so difficult to treat them, is that it is so extremely difficult to feed mental patients suffering from depression. One is faced with the alternative of persuading them to eat their food or of starting tube feeding, and one is always very reluctant to start tube feeding if it can be avoided because of the dangers of infection of the lungs. One is on the horns of a dilemma. I do not think the high incidence of tuberculosis in mental hospitals can be blamed on either the staff or the facilities. It is part of the nature of the disease.

Mr. Lewis

What about overcrowding?

Dr. Taylor

I entirely agree. The overcrowding has been due in part to the existence of the Emergency Medical Service which has used mental hospital beds for general purposes, but it is nevertheless a serious factor in mental treatment at the moment. The difficulties in mental treatment are less on the legal side, I think, than on the question of the physical facilities for the treatment of the mentally sick. On the whole the temporary treatment section of the Mental Treatment Act does not work badly and it has enabled enormous numbers of people to be treated in mental hospitals without certification, and the more people who can be encouraged to be treated under the Mental Treatment Act the better. In the treatment of mental disease we are, in fact, short of almost every facility that is required. There is a terrific shortage of outpatient or advisory clinics. There is a shortage of in-patient facilities for the neurotically ill; indeed, they almost do not exist. In the recent Hospitals Survey published by the Ministry of Health, in the Eastern region, for example, I think there were under 10 psychiatric beds in the whole of the region, apart from mental hospital beds.

There is one big exception and that is the Maudsley Hospital serving South London, but mostly there are no beds for neurotic patients. I agree that the correct thing to do is to have admission blocks for all types of psychiatric patients in general hospitals, where the people can be treated and put into their appropriate classes. Many of them will recover with modern methods of treatment, including shock therapy, but some will have to be sent to the long-term hospital; however, every patient will then get proper psychiatric attention. What my hon. Friend described about the old-fashioned mental hospitals is true. They are an anachronism. We do not want great mental hospitals like that, and if we are to have mental hospitals, let us have small units, perhaps the size of the Bethlem Royal Hospital, with 250 beds, where a medical staff could properly look after the cases. We should also greatly increase the boarding-out system which has worked in Scotland with regard to the chronically ill with very good results. We can do much more in connection with boarding-out the chronic insane for whom further treatment is not possible. Mental hospitals are very short of nurses of both sexes. And the country is short of adequately trained general practitioners who can make a psychiatric diagnosis. As psychiatrists come from the Forces and get going in medical schools again, this can be made good, but it will take 20 years before every general practitioner can make a good psychiatric diagnosis, unless we get refresher training going for general practitioners very quickly. We are short of research centres. The only main centre with in-patient beds is the Maudsley. There is also the Tavistock clinic which should also be developed.

It is hard to estimate the extent of the shortage of psychiatric services, but a report was made by Dr. C. P. Blacker to the Ministry during the war and I hope that it will be found possible to publish Dr. Blacker's report. It was a survey of the whole psychiatric services of the country showing the difficulty and how it could be remedied. I hope that the report will be published along with other hospital surveys. The national psychiatric service can only be dealt with as part of the main National Health Service, and it needs to be tackled on the same lines as other specialised services, with outpatient services and specialists to visit the home if necessary. There is need for long-stay hospital blocks exactly as for other diseases of a chronic nature. There are also three special types of mental hospital which present peculiar problems which do not exist in any other hospital field. There are the voluntary registered mental hospitals of the Bethlem, St. Andrews and the Retreat at York type; these hospitals are really non-profit making bodies with boards of governors, taking in middle-class patients on a fee-paying basis. I do not know how they should be brought in, but they should be brought into the National Health Service. There are also the private mental hospitals run for private profit. Some of them are all right, but some are very far from right, and they are maintained on a kind of snob appeal. The middle class people feel they do not want to send relatives to the county institution, so they send them to one of these places and pay six, seven or 10 guineas a week because they think they are going to get something better. The real answer there is to make our national psychiatric service sufficiently good to make these places unnecessary.

Mr. Lewis

Does the hon. Member mean compulsorily certifying them? Are there not some places where they can avoid it?

Dr. Taylor

Patients can be admitted to both types under temporary treatment, but they can be certified in both institutions. The third variety of hospital which needs consideration, although it is not a Ministry of Health concern is the psychiatric hospital for criminal lunatics, namely Broadmoor. I think that Broadmoor is an absolute anachronism. It is a fantastic state of affairs to suppose that there is one kind of person who is called a criminal lunatic. Any lunatic may commit an offence against the law, and it just depends on circumstances whether he will end up in Broadmoor or in a place like St. Andrew's Hospital with his relatives paying 12 guineas a week for him. I think we have got to face the fact that Broadmoor is a very bad place for the patient and a terrible strain for the staff, and that the proper way to treat these people is to put them under the ordinary psychiatric service and look after them exactly as one would look after every other psychiatric patient.

One last word about staff. The staff of the mental hospital service, as the hon. Member for Bolton said, are very isolated, not merely spiritually, but physically, out in these great places in the country. The remedy is to bring them into the out-patient service, the psychiatric clinic service, or the psychiatric block service in the main general hospital, and swing them about between the general hospitals, and the epileptic hospitals, the mental defectives' colonies, and even the prison medical service. One would also like to see a general linking up of the psychiatric services with the psychiatric services in the colonies, which are nearly non-existent.

9.32 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Key)

I should be the last to saythat everything was well with the mental hospital services in this country, and, particularly, I have nothing to say in favour of the sort of Poor Law atmosphere that exists around a considerable number of these institutions, but I feel also that one does not do the best, so far as dealing with this problem is concerned, by a serious over-exaggeration of the conditions which really exist. We know some are bad and that they need improving, and a good deal of what has been said tonight will be given very careful consideration in connection with the reorganisation of health services of this country, to which my right hon. Friend is giving very careful attention at the present moment.

But let us get our picture really fair and clear, so far as this service is concerned. The number of people under care on 1st January, 1939, was, roughly, 133,000. On 1st January, 1945, it had fallen to 127,000, which gives a different interpretation of the problem with which we are faced. There has been a decrease of something like 6,000 cases in those years.

Now I know that a part of the explanation is that, since there are a great number of people serving in the Forces, those who become mentally ill in the Services are not counted in the numbers I have given; but I also feel that the general improvement in the social standards of people in this country, due to a real continuity of employment amongst them, has led to an improvement in their general standard and, therefore, to a decrease in this problem of mental illness. One of the real ways of tackling this problem is to maintain the general standard of life amongst the people.

Mr. Lewis

Is my hon. Friend saying that there is now a decrease in the incidence of mental disorder?

Mr. Key

I am saying that the number of people in the mental hospitals has fallen by 6,000 in the six years during the war.

Mr. Lewis

Because there was no room for them.

Lieut.-Colonel Sir Ian Fraser (Lonsdale)

Is not that due to the fact that the lighter cases were sent home in order that these places might be taken over as E.M.S. hospitals?

Mr. Key

I am coming to the question of the accommodation that is provided. What I am stressing is that the very black picture that has been painted to us is not borne out by the experience in the institutions that we have. It is true that during the war a considerable number of beds in these institutions were handed over to the Emergency Medical Service and, therefore, there has been a decrease in the accommodation provided and, as a result, there has been some inevitable overcrowding in the accommodation available. But that is beginning to remedy itself, and between 1st January and 31st October of this year no less than 2,273 beds have been restored to the Mental Hospital service in this country.

There is also the problem, which I admit to be a very serious one, of starring the institutions. In this, and in the general hospital services, together with the general health services of local authorities, we are suffering from a very serious shortage of nursing staff. This is one of the problems to which, in the last month or so, we have been giving very serious consideration at the Ministry, and I think that before the end of this week my right hon. Friend will be making a statement with regard to the things we propose to do to deal with improvements, not only in the conditions so far as the nurses are concerned, but in the conditions of the domestic staffs, which has a very great bearing upon the problem of recruitment to the nursing staff generally.

In the statement which he will make, I think the House will find that we have really got down to very serious consideration of this problem with an idea of so far improving the general conditions of the workers in these institutions that we shall get back into them a great number of the people required. I may say in passing that the number of people at present under training for the nursing profession is greater now than it has ever been in our history, the real shortage of nurses being due not to a decrease in the number of people taking up the profession, but to a very great increase in the demand for nurses because of the great increase in the services which we are providing in the way of day nurseries, radiography, and so on.

Dr. Morgan

What about the wastage?

Mr. Key

Now with regard to tuberculosis, it has been said, and I think quite wrongly, that there is no reason why there should be a more than normal rate of tuberculosis amongst the people in mental hospitals. Surely the very condition of these people leads to their spending too much of their time in institutions. They are not living the normal life that people ought to live, and so they have a pre-disposition towards tuberculosis. It is true that the incidence of tuberculosis did increase in the early years of the war, partly due to overcrowding, and because of a reduction in the number of beds available. But since 1941–42 there has been a decrease, not only in the incidence of this disease, but in its death rate among those in institutions. It was said, wrongly, that there were no proper convalescent wards in the mental hospitals—

Dr. Stephen Taylor

In many.

Mr. Key

The first statement was that there were practically none. Of the 101 public mental hospitals in this country no fewer than 60 have provided separate admission units, and separate convalescent units. With the return of peace, and a greater number of staff, there is no reason to believe that that steady improvement will not be carried on, and that in the days ahead conditions will greatly improve. Again, serious statements were made with regard to the standard of diet in these institutions. It was said that it had been brought down to the public assistance level. With that I cannot possibly agree. One of the factors which, I am sure, has contributed to the steady reduction of the death rate has been the attention which has been given to the diet of those who have been housed in these institutions. Scientific rationing has ensured a much better standard, and the Board of Control and local authorities have been specially vigilant. The Board of Control itself has analysed in detail the diets of more than half of our mental hospitals. As a comment upon the very black picture which some Members have endeavoured to paint, I want to say that of the patients who have been admitted, and who are being admitted now, to our mental hospitals nearly 50 per cent. are voluntary patients. If the black picture that was painted was really indicative of conditions I do not think that anything like that percentage would go to the hospitals. With what I said at the beginning may I end? I do not claim that conditions are what they should be, but I can assure Members that my right hon. Friend will give his best attention to this matter.

It being a Quarter to Ten o'clock, Mr. Deputy-Speaker adjourned the House, without Question put, pursuant to the Standing Order.