HC Deb 21 December 1956 vol 562 cc1692-702

3.5 p.m.

Mr. Norman Dodds (Erith and Crayford)

The debate which has just concluded has been on dentists, and I cannot fail to recollect that I have this morning been in the dentist's chair. If I do not now feel full of the Christmas spirit, hon. Members will, I hope, appreciate that it is the dentist who is to blame.

Mrs. Thornton was recently discharged after 3½ years in a mental institution. My many months of investigations have revealed a state of affairs under the Lunacy and Mental Deficiency Acts which give cause for deep concern and which. I believe, would cause a great public outcry were the facts known to the people. As I see it, provision is made for a person going into prison, no matter how heinous the crime, to be made aware of his or her rights in prison, but for the person who goes into a mental home it seems to be like going into another world, where, if there are any rights, the patients are left in ignorance of them.

When it is realised that certifications take place with no public hearing, no rules of evidence, no disclosure of allegations to the patient, and no opportunity to challenge or cross-examine the evidence, it will be seen how terribly dangerous the procedure can be. To be certified is, in itself, whether justified or not, a terrible thing, and I submit that with our slapdash mental laws a mistake can easily he made. I commend to the Minister the Dutch laws as being infinitely better. I am also shocked at the consequences of being certified. Even when patients are discharged, the frustrations which they eventually meet are enough to send them insane and back once more into the mental home.

I should like to make it clear that I am convinced that the present Minister of Health is desperately anxious to improve the situation, but I have seen enough to know that he is in an exceedingly difficult position, because of vested interests and the ganging up that goes on to prevent unpleasant facts becoming known. At this stage I should like to correct the facts as stated in HANSARD, when I raised Mrs. Thornton's case at Question Time on 19th November last. This gives a little idea of what one has to contend with in searching for the truth. The OFFICIAL REPORT reads: Mr. Dodds asked the Minister of Health why a box of important documents taken by Mrs. Harriet Thornton to Cane Hill Mental Hospital was allowed to remain in a ward for three-and-a-half years despite correspondence on the subject from the official solicitor appointed to look after Mrs. Thornton's affairs; and, in view of the fact that this is a breach of the lunacy law, what action he proposes to take. Mr. Turton: My information is that Mrs. Thornton did not bring the box with her on admission, and it was therefore not included in the inventory of her belongings. Later she asked the ward sister to put it in the ward store room saying that it contained private letters; and she did not mention it when the medical superintendent subsequently asked her about the whereabouts of certain documents required by the official solicitor. She did not ask for it until after her discharge, when after a search it was found still locked away. Owing to the lapse of time the box had been overlooked, but I am not aware that there was any breach of the law. Mr. Dodds: Is the Minister aware that this lady, when she was forcibly taken to a mental home, took these important documents with her? When persons are certified, surely the authorities want to know what certified patients are taking into mental homes, and is not there some degree of slackness if they were unaware that these documents were there the whole of the time? Mr. Turton: I think the hon. Gentleman is under a misapprehension? She did bring in certain documents on her admission. They were included in the inventory, and in due course those wanted by the official solicitor were handed to him. The other documents in this box were brought in later, I am informed, by a visitor."—[OFFICIAL REPORT, 19th November. 1956; Vol. 560, c. 1364–5.] I knew that the Minister was being misled, and I therefore supplied evidence and asked that an investigation should take place.

Yesterday I received a letter from the Minister as follows: With regard to the box of documents, I said in the House on 19th November when replying to your Question that my information was that Mrs. Thornton did not bring it with her on admission to the hospital. I regret to find that further questioning of the stall concerned has resulted in some evidence that she might in fact have brought the box and parcel with her, as a nurse remembers her having them shortly after admission. I submit that that is as near to an apology as it is possible to get in a case of this sort.

I cross swords with the next extract from the Minister's letter: You doubtless appreciate the difficulty of actual inventories being made in all cases when admissions are heavy and the nurses are necessarily preoccupied with more pressing matters. What could be more important than for a woman to be forced to go into a mental home, having collected her marriage and birth certificates, war loan certificates and bank book—in fact, all the important documents—as well as any jewellery, and with other things which she will badly need when she gets out? Is it not an awful state of affairs that those articles can lay about in mental institutions? It happened in this case, and I believe it happens quite frequently. What an awful system it is that allows all sorts of wrong things to happen.

I shall have something more to say on this aspect of the matter on a future occasion. I have been advised to leave well alone now that Mrs. Thornton has been discharged, as I was told that I would only be knocking my head against a stone wall. But I have seen and heard enough, and I am determined—indeed, it is my resolution for 1957—that I will tackle this subject with far greater vigour than I have done in the past. I would add that there are other hon. Members who are deeply concerned, and I believe a lot more will be heard on this subject in 1957. Although I know that a Royal Commission is sitting on these matters, that by itself does not mean that we should keep quiet in the meantime.

On the subject of "ganging up" to which I have referred, I appreciate that a temporary advantage can be obtained by the Government Front Bench, in the form of briefs supplied to Ministers containing information from the various vested interests, but I would like the Ministers concerned to know that this will be only a temporary advantage because these briefs will be scrutinised with a tooth comb and more will be heard about them in the future if they are not in accordance with facts. I am going to use the case of Mrs. Thornton as a yard-stick to show what can happen so easily to any normal person under our slap-dash mental laws when an evilly disposed person is concerned.

There are important facets to this case, but owing to the limitation of time today I can deal with only one of the main facts, and I should like even more time for that. The others will follow in due course. My case is that Mrs. Thornton should never have been certified, and would not have been but for the determination of her husband to get rid of her. Our slap-dash laws and the slapdash way in which they are all too often carried out make this sort of thing so easy.

It may be asked how I know that the husband was determined to get rid of his wife. I interviewed him for 3½ hours with two witnesses. What he said—and with other substantial evidence there can be no doubt of it—was that he had tried other means to do this, and then turned to the possibility of a mental institution. My concern, however, is not with the husband but with the law and with the way in which it is carried out which makes it so easy for these things to happen.

The first attempt to get Mrs. Thornton into a mental home failed. On 30th December, 1952, she was certified by one general medical practitioner, by no means an expert in mental illness. It seems that the confidence of the husband did the trick, and a justice of the peace also co-operated. Fortunately, on this occasion she was taken to an observation ward of a mental hospital to be watched by experts for fifteen days. At the end, she was discharged and advised to see a lawyer to deal with problems between husband and wife.

Every person should go into an observation ward before being put into a mental hospital, because once one is in a mental hospital it is a devil of a job to get outside, and we have been told in the House that roughly 60 per cent. of the people who go into mental homes do not have the advantage of going into an observation ward but go straight into the mental hospital.

The second attempt succeeded. Three months later, on 30th March. 1953, Mrs. Thornton was certified. On this occasioin, she went not to an observation ward but straight into a mental institution, a mental institution which also housed lunatics and imbeciles. Mrs. Thornton described that experience as "absolute hell," and it must be hell to a sane person, no matter how the authorities strive to make a mental home a heaven upon earth.

While she was a patient, no reasons for the certification could be obtained. These can be obtained only when the person has been discharged and applies to the Board of Control for a copy of the reception order. On some other occasion I shall have some strong comments to make about the Board of Control, but for the present my only comment will be that the Board of Control was set up primarily to safeguard the interests of the individual. My experience indicates how completely it fails to do this, and a searching inquiry into its activities—or, better still, its lack of activity—is long overdue.

After discharge, Mrs. Thornton applied for and received from the Board of Control a copy of the reception order, have the copy in my hand, and it is an interesting document. There are three sheets. The front sheet is headed: Summary reception order The first page gives the name of the justice of the peace and of the one and only doctor—I repeat, the one doctor, because most people, even doctors, are under the impression that two doctors are needed; but not in a summary reception order, and in this case only a general practitioner was responsibile. Is it not amazing that the J.P. and the doctor saw Mrs. Thornton only once and for no more than five minutes? During those five minutes, the J.P. asked not a single question before the awful deed was done. It is true that they spent about half an hour with the husband, but since the husband was not a true advocate for his wife, that is not good enough. I have checked on these facts.

On the second page of the reception order, we get down to business, because it is here the doctor gives the reasons for declaring Mrs. Thornton insane. I quote: I am a person registered under the Medical Act, 1858, and I am in the actual practice of the medical profession, … I personally examined the said Minnie Harriet Thornton and came to the conclusion that she is a person of unsound mind and a proper person to be taken charge of and detained under care and treatment. I formed this conclusion on the following grounds … Then there are seven reasons, only one of which cannot be checked—that she was unco-operative and excited. Who would not be in that state on knowing that an effort was being made to put her into a mental home?

There are, however, six reasons given, each one of which can be completely destroyed. Had anyone taken the trouble to get evidence other than from the husband, of course they would have been destroyed. For instance, it is said that Mrs. Thornton had delusions of persecution. She said: 'My husband nearly killed me. He tried to push me over the banisters'. That is not a delusion—it is a fact. Luckily, another doctor, whose name and address I have, was passing at the time and saw it all happen and called the police. The son had to fight with his father for ten minutes to prevent Mrs. Thornton from being thrown over the banisters, but the son, who knows more about what happened in the house than anyone, and from whom I have evidence, has never been asked by anybody to give a statement.

The second reason is that Mrs. Thornton was hallucinated. She said: 'I get messages about people from the spirits. I can't help it if God has ordained it'. For years she had been an ardent spiritualist. In the middle of the twentieth century, it is not a sign of insanity because a person believes in that. I could go on in the same way with every one of the six reasons. I charge this doctor with making mis-statements without which this woman would never have gone for certification.

On the third and last page there is a statement by the "duly authorised officer" of the London County Council, and I wish I had time to say a lot about it. It seems to me that the duly authorised officer fixes all these things up, arranges transport, collects the magistrate and, while they are on their way to the house, gives the background to the case: and that is the way in which a person can be put away for years.

Of course, people will say—I only wish had time to go fully into it—that there are safeguards when people are in mental hospitals. What a farce that is. The safeguards might look wonderful on paper, but when it conies to reality they do not work out that way. Of course, Mrs. Thornton had the right to have an independent medical examination, but if anyone did select two local practitioners, can anybody expect that they would go against the evidence of the physician-superintendent? In this case—I have evidence of it—the independent medical examination was an absolute farce, because shortly afterwards the physician-superintendent gave testimony that Mrs. Thornton was all right, just before she came out of the home. I have that testimony with me.

Even if the best man in the country is obtained, there is no guarantee and no hope whatever that the Board of Control would accept it. I have had a case with the physician in charge of the Psychiatric Department at Bromley Hospital, one of the greatest authorities in this business. In the Mary Betteridge case, he has given a complete indictment against keeping the girl in a Birmingham hospital, but one cannot get from the Board of Control the reason for keeping the girl.

I would also say that there are vested interests. I refer the Parliamentary Secretary to the article in The Lancet by a great expert, Dr. Bickford, who makes quite clear the vested interests which keep people in mental homes long after they should be there, for cheap labour and other purposes.

Finally, I recommend the Parliamentary Secretary, against whom I have no complaint, to read the editorial in Wednesday's Manchester Guardian on mental patients. I am sorry I have had to rush my speech and cannot do the case justice, and I am sorry for the Parliamentary Secretary that I give her so little time in which to reply.

3.25 p.m.

The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)

This is the second time I have risen to reply to a debate on the Motion for the Adjournment, and I must seek the indulgence of the House to speak now.

The hon. Member for Erith and Cray-ford (Mr. Dodds) has put this case on many occasions, and I regret the many and very grave accusations he has made against officers of the London County Council, the Board of Control and the hospital, and that he has left me so little time to give as full a reply as I should wish to do and could do. I would like to give the history of the case in order to put it in its proper perspective.

On 1st April, 1953, Mrs. Thornton was removed from her home and admitted to Cane Hill Hospital, Epsom, on the authority of a summary reception order made on 30th March by a justice of the peace under Section 16 of the Lunacy Act, 1890. The summary reception order was founded upon a perfectly properly made medical certificate, made in statutory form, and given by a medical practitioner unconnected with the mental hospital. I would ask the hon. Member how he expects judgment in medical matters to be made except by a medical man.

Mr. Dodds

In only five minutes?

Miss Hornsby-Smith

It was accompanied by a statutory form of statement of particulars signed by the duly authorised officer of the local health authority, whose statutory duty it was to bring the case to the notice of the justice. The lady's medical attendant did not also sign the statement of particulars, but his name was given, as is customary, at the foot of the statement, and was included for information only.

The length of time taken in the medical examination of a person alleged to be of unsound mind is a matter for the discretion of the doctor concerned. In many cases the patient is in a very sick condition, and it does not take long for that reason. There is no legal requirement that he should have seen the person previously.

The documents for the lady's reception into care were examined by the Board of Control and found to conform to all statutory requirements. It was, however, for the justice alone to decide, after examining the lady and on consideration of the evidence in the statutory medical certificate, whether a summary reception order should be made. Neither the Minister nor the Board has power to investigate the circumstances in which the justice's order was made, since such an order can be quashed or set aside only by the courts. If, therefore, the lady considers that she was wrongfully certified, it is open to her to seek legal advice.

As the hon. Member is aware, the Court of Protection, which is the authority responsible for the management and administration of the property of persons who are deemed to be incapable of managing their affairs, made an order on 10th June, 1955, appointing the Official Solicitor as Receiver of the lady's estate.

Mr. Dodds

Two years afterwards.

Miss Hornsby-Smith

The hon. Member has said on many occasions that the relatives have been fighting for two and a half or three years to get her out. I would put the facts in their true order. An uncle first applied to the medical superintendent of Cane Hill Hospital on 14th March, 1956, for his niece's discharge to his care, she having been admitted in April, 1953. In arranging an interview with him on 24th March, it was explained that the current arrangement was that his niece should be sent on trial to a mental after-care home to afford the hospital authorities a better opportunity of judging her mental state and reaction to different surroundings. It was also pointed out that if she made satisfactory progress there would be no objection to her being discharged to her uncle's care afterwards.

On 20th March, a sister wrote her first and only letter to the Board of Control asking for the lady to be examined by that department, though she had had correspondence with the hospital since November, 1955, regarding her sister's going to a home for mental after-care. Her sister was informed on 11th April of the intention to test Mrs. Thornton's fitness for discharge by arranging to send her on trial in the near future to a mental after-care home.

On 24th April, 1956, the uncle made application to the Board of Control for an independent medical examination of his niece, giving it as his view that she had been wrongfully certified as a person of unsound mind. It is no good the hon. Member making wild accusations against honourable members of the medical profession. He wants them chosen independently for this work. He wants them to be independent of the Board of Control and the hospital. That was done in this case, but then the hon. Member repudiates the independent medical men's findings on three occasions because they do not happen to suit the point he wants to make.

Two independent medical practitioners were given an opportunity of examining the lady because the law requires that two practitioners shall visit a patient together on two separate occasions with not less than seven days intervening between the two visits. They were not required to have a report from the hospital for the purpose of their investigation. So as to "ganging up in advance", that can be repudiated. It is for the doctors alone to decide what facilities they need for further examination.

If, after the second examination, they certify that the patient may, without risk or injury to herself or the public, be discharged, and their certificates are produced to the Board, the Board may order the patient to be discharged. This is an important fact. No certificates were, in fact, produced to the Board in respect of the quite independent medical examination of the lady in question, and the leave on trial granted to her was extended by members of the Hospital Management Committee on 23rd August, 1956, for a further period of thirteen weeks.

Thus the independent inquiry for which the hon. Member persisted in asking in this House was not pursued to its logical conclusion, for reasons known only to the uncle and the practitioners, and the hon. Gentleman has made extremely grave allegations against those practitioners when he accused them of ganging up. I cannot accept the allegations made by the hon. Gentleman.

Mrs. Thornton was visited and interviewed by the medical superintendent on 12th September. On 26th September, in reply to the hon. Gentleman's inquiry about the discharge of the lady to the care of her uncle, he was informed that it was open to the uncle to make application for this to the Hospital Management Committee under Section 79 of the Lunacy Act, 1890. Under that Section members of the committee may discharge a patient upon the undertaking of the person making the application, to their satisfaction, that she will be properly taken care of and will not do injury to herself or others. Application was made by the uncle for his niece's discharge, and this was granted on 25th October, 1956.

There are mane other items in the case raised by the hon. Gentleman which should have liked to take up, but he had twice as much time as I have, so I will deal only with the question of the box. The normal procedure on admission of a patient is to make an inventory of belongings, and any valuables or documents are handed in at the clerk's office for safe keeping. Personal letters and small articles of sentimental value are generally left with the patient. In the case of Mrs. Thornton, the only possessions handed in were twenty-six books of National Savings Certificates and two Post Office Savings Books. One Savings Book was later ascertained to belong to her son and was returned to him. The other was sent to the Official Solicitor.

Mrs. Thornton claimed that she had also brought a tin box with her, and the evidence regarding this, when the hon. Gentleman first took it up, was inconclusive. In the Minister's reply of 19th November to the hon. Gentleman he said that he was informed that she did not bring the box with her on admission, and it was therefore not included in the inventory of her belongings. It is not disputed that the box existed, but, at some stage, Mrs. Thornton asked the ward sister to take charge of a box which was amongst her personal belongings, which she had taken into the ward with her, and it was put into the ward store for safe keeping.

The box was transferred with Mrs. Thornton to another ward in which she spent the rest of her stay in hospital. Early in 1956 the Official Solicitor wrote to the hospital asking for the deposited documents and was informed of the official documents which had been deposited at the clerk's office in the first instance, but was not informed about the box.

When Mrs. Thornton went to the aftercare home a fresh inventory was made of all her property which she took away, and at that time she made no request for the box and its existence was overlooked. A few days after her discharge she came to the office, a search was made, and it was discovered next day safely locked away in the ward store room. An inventory was made of its contents, which comprised purely private letters, a number of documents, including a building society pass book and personal documents which were of no concern to the Official Solicitor.

Whatever the truth of the statement that she brought the box with her on admission, there is no suggestion that any of the contents were lost. The box was safely cared for and it was not handed over as an item of value to be cared for by the clerk, but was evidently retained by Mrs. Thornton as part of her personal possessions in the first instance.

In view of the wide publicity and the many unfair allegations made in this case, I regret that I have not the time to deal with many of the other points made by the hon. Gentleman.

Mr. Dodds

There are a lot more.