HC Deb 30 April 1957 vol 569 cc160-70

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

10.1 p.m.

Dr. Donald Johnson (Carlisle)

I wish to raise this matter for a double purpose. The first concerns the grievance of a former certified mental patient, and the second, which hangs upon the first, is to make the optimum use of parliamentary time, which is so seldom given to problems of mental illness. In the short time available, I want to attempt to discuss its background and to examine the problems which it illustrates. I am considerably strengthened in my resolve to bring this case forward by the fact that it is only one example taken from a considerable correspondence which hangs, rather like the albatross, round the neck of any Member of Parliament who is interested in these matters, as a burden which he has to carry alone owing to the singularly unhelpful replies which he receives when he approaches authority.

It is first necessary for me to define the grievance. It is that this lady, according to her own submission, was arbitrarily and unnecessarily deprived of personal liberty for a period of four or five months. It is possible to delve extensively into political history in order to produce quotations in defence of individual liberty, but I feel that I cannot do better than quote the more recent words of my right hon. Friend the Home Secretary, that deprivation of liberty must always be a punishment."—[OFFICIAL REPORT, 13th March, 1957; Vol. 566, c. 1157.] He made that remark in relation to prisoners, but it surely applies to innocent people as well as guilty ones, and to sick persons as well as fit ones, though in saying that I must make it plain that the lady whom I am representing avers that she was a fit person during the entire time of her detention.

The general application of this case is to illustrate how, under the working of the Lunacy Act, with its various Amendments, the principles of liberty appear to have fallen into disregard in recent years. I have very little time to go into detail in the time available to me, and I must, therefore, summarise the position. It is, naturally, necessary that' powers of restraint should exist in regard to those who are mentally afflicted and are a danger to themselves and to others, but I submit that it is equally necessary that the individual should have the fullest protection against either the misuse or the mistaken use of these powers, otherwise we may find that instead of sane people locking up mad people we shall have mad people locking up sane people. I do not say that this is happening today: I merely say that under existing conditions there is nothing to prevent it happening. As this case shows, these protections have now become illusory.

May I proceed to state the details of the case? I state them in chronological order for the sake of brevity. This lady, "Miss X as I must term her for reasons that will be appreciated, is a lady of some considerable academic distinction and also of considerable personality. She plays an important part in the public life of the district where she lives. She came back in middle-aged retirement some years ago to live with her two sisters in the family home. She was the member of the family who had broken away and achieved success in the outside world while her somewhat less brilliant sisters stayed at home. This fact appears to have been a basic cause of friction and ill-feeling in the family.

Shortly after she came home her mother fell ill, and was attended by a young assistant doctor who was fresh to the district. Miss X was dissatisfied and wanted a second opinion. This was refused by the doctor. The refusal led to a request by Miss X to the local executive council to supply a second opinion and the doctor got to know of this. In fact, I have here a letter which shows— I am quoting from documents in what I am saying— that the council wrote to the doctor, so that he was well aware of this fact. This may or may not have a connection with what happened subsequently. As I have stated I am putting the facts in chronological order and not with a view to connecting them as to cause and effect.

It so happened that four months later, quite unexpectedly what one might term a "posse of authority" descended on Miss X at her home. It included the doctor, local authority officers and a justice. I think there was also an ambulance. Naturally, Miss X took fright and attempted to evade what she thought was her capture, and she went to the house of a neighbour. The party entered the house and I imagine a somewhat angry scene ensued as Miss X resisted what she regarded as her capture. However, she was removed to the local mental hospital where she was detained for four to five months.

She found herself subsequently— I am shortening my story very much— as have many others in similar circumstances, deprived of the customary human rights in respect of this period of incarceration both at the time and also after her discharge. I give only one example. I submit that it is an elementary principle that those who lose their liberty, whether they are sick or well, at least should be notified of their rights under the law. As my hon. Friend knows, this lady is a voluminous correspondent. Yet, in spite her appeals to all forms of authority, including the Minister of Health, the Lord Chancellor, the Board of Control and others, no one saw fit to inform her of her rights under Section 82 of the Act, by which she was entitled to obtain copies of the certificates which sent her to hospital.

The Parliamentary Secretary to the Ministry of Health (Mr. J. K. Vaughan-Morgan)

I am sorry to interrupt my hon. Friend, but this is supposed to be an Adjournment debate on a question of administration. Is my hon. Friend suggesting that the authorities transgressed any of the laws or regulations in not giving that information? Where is it laid down that this information has to be supplied?

Dr. Johnson

I am not suggesting that at all. I am making no suggestion of that kind. I am merely saying that this lady did not receive any help. I am stating that purely as a fact, that she did not receive any help, and I leave it there as a stated fact without further comment other than I have already made. I have not said that the laws were transgressed. I am merely talking about the position in which this lady found herself. She found herself in that position until some three years later, when I was first able to inform her of this right. Then, I fully admit, when she wrote to the Board of Control and asked for these certificates, she received them without delay. There is no dispute on that point.

These certificates arrived. I have them here in my possession, and had time allowed I would have liked to deal with them in full; but I have only three more minutes. The main thing that can be said about the certificates is that they are confirmation to the full of the story which I have already told, namely, of considerable family animosity, on the one hand, and what seems to be outraged professional feeling, on the other. Only time prevents me from detailed comment.

The main point of substance is that I do not see any medical evidence of insanity in any of the statements on the certificates. An insane person could act as the certificate describes, but that is not the point; so could a sane person. The day after I received these certificates I was watching a football match. Behind me were two supporters of the rival teams. I could quite easily have given certificates just as good as the one in this case for either of those gentlemen about the state in which they appeared to be at that match.

As the Minister has said, there was a justice of the peace at this ceremony. A statutory duty is laid on him to make such inquiry as he thinks advisable. He appears to have conspicuously failed in his duty. My correspondent alleges— and I put this forward merely as her allegation— that the justice of the peace said some eight words and they were, "Where are the papers? I will sign them".

I appreciate that the lady was in hospital for five months. The only comment I have in this connection, because of the very brief time availabl,e is that we are sane until we are judged insane, unfortunately by only one doctor, while once we are in a mental hospital we tend, particularly under a certificate, to be judged insane until we can prove ourselves sane. For many people, and perhaps for many or most of us, that is somewhat difficult.

I have put the complainant's side of the case. I do not deny at all that there may be another side, which my hon. Friend the Parliamentary Secretary will present to the House. At the end of it all the matter will be left somewhat indeterminate. That is why I regret that, since the good name of the service is involved and the rights of the individual, my right hon. Friend does not feel himself empowered to appoint an independent inquiry.

He has told me in answer to my Questions that the remedy is at law. I am sorry not to be able to develop my answer to this point, too. I can only state that since the Amendments introduced into the Mental Treatment Act, 1930, there has been no successful case of a doctor being sued— not that I want doctors to be sued — but there is no way in which a patient can restore his or her good name. While we must protect people who have difficult jobs to do, none the less we have to protect the individual also and give him or her, particularly in a case like this, an opportunity to re-establish his good name and bring evidence forward in some form or another.

10.15 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. J. K. Vaughan-Morgan)

May I. first, thank my hon. Friend the Member for Carlisle (Dr. D. Johnson) for his courtesy in giving me full and early notice of all the points he was going to raise in this debate. I realise, and the House realises, the interest which he takes in the problems of the mentally sick. I share his anxiety that the greatest possible care should be taken at all times to ensure that the safeguards which Parliament has provided to protect those dealt with as insane are scrupulously observed. After listening to his speech, I must say with deep regret that he has used this occasion to make these general allegations of maltreatment, and of an abuse of the spirit of medicine. I will deal rather more fully with that later.

My hon. Friend talked about protection for those who are certified and has quite rightly reminded us that we need protection also for those carrying out very difficult duties, but I do not think he has thought of that side of the matter at all in his speech. However, since I am not going to say very much to commend my hon. Friend— I will be quite frank about that, I deplore some of the things he said— I do commend him for one thing; he has kept the name of the patient out of this debate. I think it is quite right that we should not use the privileges we have here to bandy names and reputations about. Incidentally, that applies not only to the patient but to all others concerned in this case.

I cannot agree with my hon. Friend in any way in the case he has raised either as to the facts he has given or the conclusions he has drawn from them. He has ranged over a very wide sphere, and I cannot answer everything he has said in the time left at my disposal, but I have one general criticism which I would apply to most of what he said, and I ask the House to apply it, also. Of all the principal parties in this case— and there are many people involved— my hon. Friend has chosen to believe, and apparently to believe implicitly and unreservedly, the one least likely to be impartial or to judge impartially— that is, the patient herself. In a recent letter he wrote to me, which I hope my hon. Friend will not mind me quoting, he said that he has seen and cross-questioned the lady and believes what she says to be substantially true. All right, I am not denying that what she says may be true, but there is absolutely no evidence that my hon. Friend performed the same service for the doctor— he has taken the word of the patient against the doctor— or for the justice of the peace— he has taken her word that the justice dismissed the whole thing in eight words—

Dr. Johnson rose

Mr. Vaughan-Morgan

No, I am going to finish this— for the duly authorised officer, or for the patient's relations.

He has taken her view against the view of her sister, and there are two sides to that question. He did not mention that the police were witnesses of this "disgraceful scene" which he represented, nor has he taken the trouble to question the neighbours who witnessed the certification. He has done this in other cases. He believes in some sort of conspiracy, whether consciously formulated or not, against Miss X, as he called her, in which her doctor and her sisters took the leading part. I do not doubt my hon. Friend's sincerity. I would accuse him, perhaps, of a certain streak of naivety, but I think it is irresponsible to base so serious a case in Parliament as a court of law on a patient's unsupported story without having the views of others closely concerned.

I want to stress a point which my hon. Friend has mentioned and which I put to him in correspondence. It has always been open to this lady to seek legal redress if she thinks she has been wrongly certified. My hon. Friend pointed out that she was a lady of education and of some standing. I refuse to believe that in what he calls "a friendless world" she did not know that the right person to go to was a solicitor, or at least a citizens' advice bureau.

Despite the voluminous correspondence which she has had with various Government Departments and other authorities, she has always evidently failed to take the legal advice which is her obvious remedy. Could this be because she lacks confidence in the strength of her case? That is the conclusion which I draw and which I think the House would draw and which my hon. Friend himself should have drawn.

My hon. Friend argues that there have been few successful actions against allegedly wrong certification, but I suggest to him that that might be because there have been few cases which have been sufficiently strong to persuade the courts which have tried them. He tries to prove that because there have been no successful actions it is, therefore, useless to use the machinery of the courts; but supposing there were many successful actions, my hon. Friend would be the first person to try to use that to prove how bad the present administration of the law was. He cannot have it both ways. It is not the function of the House to judge cases which should properly be decided in the courts.

Let me turn to a more detailed study of the case and tell the House some of the facts which my hon. Friend omitted. I will not go through all the legal ramifications. The lady was removed and admitted to hospital as a certified patient on the authority of a summary reception order dated 26th April, 1954, made by a justice of the peace under Section 16 of the Lunacy Act, 1890. That was done on a medical certificate in statutory form. Proceedings were initiated by a duly authorised officer, whose statutory duty it was, incidentally, to bring this case to the notice of the justice of the peace— that is under Section 14 of the Lunacy Act of 1890.

My hon. Friend made some criticism of the general practitioner in the case and suggested that he was inexperienced and had no special psychiatric experience. But Parliament has never laid down that the doctor called in by the justice of the peace should have special psychiatric experience. It is for the justice alone to select the doctor to examine the person and then to decide, after his own examination and inquiries, whether such an order can properly be made. There is no doubt that the doctor called in to examine Miss X was, in fact, of reasonable experience and qualifications. Some of what my hon. Friend has said, coming from a doctor, is very definitely to impugn the ethical standards and behaviour of a member of his own profession whom he has not examined.

My hon. Friend commented on another point. At the end of his speech he referred to what, in correspondence, he called the "non medical" nature of the certificate. However, the fact is that the Mental Treatment Act, as he should know, requires a doctor to state the facts which indicate insanity; in other words, the behaviour disorders which cause him to conclude that certification is necessary. It does not fall on the general practitioner to give a psychiatric diagnosis of the patient. The answer to my hon. Friend in his analogy of the football match is not unhappy. What would have happened if he had certified those patients and gone to the hospital? I cannot believe that he seriously suggests that any responsible medical superintendent would have accepted those men. To draw an analogy from a casual contact like that to what has been done by a doctor and justice of the peace in full accord with the law, is highly irresponsible.

My hon. Friend has painted a distressing picture of an unfortunate patient being seized by a posse of authorities from a neighbour's house. My information discloses a very different picture. It comes from the duly authorised officer concerned and it is agreed and approved by the police sergeant who was there. My hon. Friend has the evidence of the patient. I have the evidence of the duly authorised officer and the police sergeant and I cannot seriously think that any disorders within the family could have affected the impartial testimony of either of those two, and I think that my hon. Friend should agree.

I understand that the officer concerned went by taxi to the lady's house, having arranged to meet the doctor there and for the J.P. also to meet him there. When he arrived the doctor was already there and so were some of her relations, but not the lady. It then appeared that she had run over to another house and that the taxi driver driving the duly authorised officer told him where she had gone.

The owner of the house then came up in a very agitated condition and said that he had seen Miss X run into his house, that she had locked herself in the house, and that he was very worried because his wife was there and in a very poor state of health. The police were informed, and about a quarter of an hour later a police sergeant came to the house; that is, to the house of the man where the lady had taken refuge, as my hon. Friend has put it. The husband was there as well.

On the question of forced entry, the police sergeant called through the door several times to Miss X, and eventually the door of the house was opened from the inside. The lady of the house was inside at the same time, and they were both inside when the doctor and others went in. It is denied quite categorically that there was any forced entry into the house. One of the lady's sisters was present and went into the house as well. There was no question of ordering anybody out of the house, or of any unruly, disorderly or illegal behaviour; and I could expatiate on the report which I have received for a very long time.

My hon. Friend also raised the question that the lady had not received all the information she should have had. I would have liked, if there had been time, to draw the attention of the House to the very many safeguards which do exist against improper detention, and I think that, on behalf of those who have to administer this very difficult sphere of the Health Service, we ought to express some resentment at the suggestion that there can be these ghastly cases which my hon. Friend has suggested. I am not denying that there may not be occasions when something is wrong, but surely we want rather more evidence than has been given.

This lady's case was reviewed throughout her stay in hospital, and she was specially visited by a Medical Commissioner of the Board of Control and every step was taken to see that she was rightly and properly treated. On the question of an inquiry, neither my right hon. Friend nor the Board of Control has power to investigate the circumstances under which the justice made an order for this lady's reception into mental hospital care, since such an order can be quashed or set aside only by the courts.

Therefore, I end by repeating what I said at the beginning. Throughout this case, the right course was for this lady to take legal action if she felt that she was wrongly deprived of her liberty; and until she takes those steps, I think that we are fully entitled to say that the case which my hon. Friend has made is not proved.

My hon. Friend suggested that nobody had given the lady the documents which she wanted. I think that my hon. Friend is really asking a little too much. He admits that the documents were given as soon as they were asked for, but does he really suggest— for this is what it amounts to— that the Board of Control should give a copy of the certificate to every discharged patient? That certainly is not the law at present. I am sure that my hon. Friend has a very kind and good heart. As I have said, I think he has a rather naive approach to these matters and I think we want to be rather more responsible in our approach to those who are doing a very difficult task under the law as it stands.

In any case, as the House knows, a Royal Commission has been appointed which will study all the evidence, and I think we can await its Report with great confidence. I am quite certain that if there is anything in the administration of the law which is wrong, it will bring it out into the light of day, and I am quite certain that it will produce rather more evidence of injustice, if it exists, than has been produced to the House tonight.

Queston put, and agreed to.

Adjourned accordingly at half-past Ten o'clock.