§ Postponed Proceeding on Question, That the Bill be now read a Second time, resumed.
§ Question again proposed.
§ 9.58 p.m.
§ Mr. Ross
I think it more than a little hard, in view of all that has happened—we lost about an hour for this debate after half-past three, and now three hours have been taken for the debate on Cyprus—to be asked, as I was by one hon. Member representing an English constituency, "How long are you Scots going to keep us tonight?"
We are dealing with what the Government have described as the most important Scottish Measure in this Parliament. Certainly regarding the subject of mental health, one must go back to the year 1913 to find a parallel in importance. I think I speak far everyone in the House when I assure the Secretary of State for Scotland that we welcome the Bill, the provisions of which are the outcome of studies by expert committees which have laboured long on this question and taken into consideration not only the problems in Scotland but related legislation already passed for England and Wales. Our thanks are due to those committees.
Undoubtedly we shall express differences of opinion regarding certain problems, and I am sure that the committees will appreciate that it is mutual concern being expressed in a different way regarding the problems which worry us all. It is a difficult Bill. It could not be anything but a difficult Bill technically, because we wish to make absolutely certain about this question, not only in connection with the admission, but the detention and continued detention of persons in metal hospitals or homes, people whom we are depriving of their liberty or people who are giving up their liberty in certain respects. In making sure about this Measure, in assuring the public that what we are doing is right and assuring the people who may be treated in such hospitals that what we are doing is right, it is inevitable that we have Clauses which are technically difficult and complex, and, indeed, which may be repetitive, as I have noted when going through the Bill.
368 I wish to congratulate the Secretary of State for Scotland—I am sure that shakes the right hon. Gentleman—on giving us a clear and lucid explanation of the Bill. He was coherent and very skilful. I began to wonder whether we were on Third Reading and that he was explaining what was in the Bill, with certain omissions, of course. I should have thought that during the Second Reading debate the right hon. Gentleman might have spread himself a bit and given a little more of the background to the problem; a greater indication of how the Government saw the whole question of mental health, not purely in relation to the provisions necessary for administration, quite apart from Part II referring to the powers of local authorities, because in that respect it is an enabling Bill, although it is not all new. I should have thought he would have given an indication of what was the programme of the Government in order to make this thing live. But the right hon. Gentleman skated skilfully right through the Bill. He avoided the bumpy bits of Clause 6, and, my goodness, how bumpy it is. There is this whole framework of over 102 Clauses dealing with the question of mental health, and the only definition we get isIn this Act 'mental disorder' means mental illness or mental deficiency however caused or manifestedWell, well! Yet on that rests everything, such as the provision of hospitals and the depriving of nearly 2,000 people of their liberty every year by certification. The right hon. Gentleman could have explained why he did not go further in relation to the definition and why he limited it to two categories. It may be that he was following the English line. We are entitled to point out that the whole history in Scotland is different in respect of this, and I think we ought to have been given a better explanation.
The right hon. Gentleman skated speedily over Part II relating to the local authorities. I was glad that my hon. Friend the Member for Lanarkshire, North (Miss Herbison) pointed the direction of our darts in indicating that this could mean a great improvement, or it could mean nothing. That will depend entirely on how the local authorities accept the challenge of the enabling powers which the Minister has given them. The right hon. Gentleman knows, 369 in fact his expert committee has already told him, that what will determine their ability to act will be the availability of resources. I am, indeed, sorry that he did not explain that a little more. Then there are the important questions in relation to the admission and detention. It may well be that the Bill was so large that the Secretary of State spread himself too thinly over it. I think that he could have given us some indication of what will be the effect of this on the mental hospitals in Scotland. We hope that it will have considerable effect. But that will affect the present resources, and what concerns me is whether those resources will be able to meet the modern challenge that is enshrined in this legislation.
I wish that he had dealt with the question of voluntary patients a little more fully. When I went through the Bill and came to the miscellaneous provisions, I thought that they were not terribly important—just miscellaneous provisions—but Clause 100, under the heading "Miscellaneous Provisions", states:Section thirty-four of this Act shall apply in relation to any patient who is receiving treatment for mental disorder in a hospital, having been admitted for that purpose but not being liable to be detained therein, as it applies in relation to a patient detained in a hospital under Part IV of this Act.That means that the application is exactly the same for a voluntary patient under Clause 34 which deals with the power to withhold correspondence. I think that the right hon. Gentleman could have explained that a little more. This is quite a controversial point. Is he aware that a person who is in that hospital is entitled to stay for a night and walk out the next day? Indeed, to my way of thinking, he can walk down to the post office, collect any mail posted to him there and go back to the hospital to read it. In the hospital itself he is denied, in the same way as a certified patient, the right to receive correspondence.
It would be interesting, too, to have had a few remarks on Clause 102, in view of the definition, or lack of definition, of mental disorder, whereby a constable or some such authority can deprive of his liberty for seventy-two hours in a mental hospital anyone he finds wandering about and whom he thinks is in need of such care.
370 The Bill is packed full of human interest. That is why I think that we have to be so terribly careful about it. I am glad that the right hon. Gentleman spoke as he did about the support which he hoped would be provided in Committee and that he would be prepared to look at Amendments. I hope that he will look not just at technical Amendments, but Amendments of substance in relation to the admission, detention and treatment of patients.
Mental illness—I think that the country is at last facing it—is one of the major causes of human suffering as well as of economic loss. It has the power to disrupt the orderly life of the family probably more than ordinary physical illness and it affects the orderly life of the community as well. Mental illness and mental deficiency when taken together form a force of unique significance. It strikes at all levels and all sections of the community. When we appreciate that the highest rate for suicides is in one of our university towns and is nine times that of a similarly large group of the population, we appreciate how grievous this question of mental illness can be. When we look at the statistics in relation to Scotland at present we have to draw some grim lessons.
More than one hon. Member has remarked on the astounding growth—which we can commend—of voluntary patients and the turnover in hospitals. The last available statistics show that in Scotland in 1958, 11,407 people were admitted to mental hospitals. As many as 8,700 of them entered voluntarily and only 2,622 were certified.
I have heard people talk about the advance that seems to be indicated by this change-over of patients. The assumption was, in an otherwise excellent maiden speech, on which I want to congratulate him, by the hon. Member for Aberdeenshire, West (Mr. Hendry), that everyone who goes out is cured. I wish that were true. Unfortunately, I think that within these figures we have the same person appearing more than once. There is a coming and going in many cases. We tend to over-emphasise the question of voluntary patients and the turnover and to forget that in Scottish mental hospitals at any time during the year 75 per cent. of the patients are not voluntary patients 371 and that the bulk of them have been there not for two or three months, but for years.
There is the problem of the short-stay voluntary patient and the short-stay certifield patient. Then there is the problem of the continuing lag of the long-term patient to whom most of the time of the staff has to be devoted. When we come to patients in residence, we find that 20,671 were certified and of those discharged last year—9,428–7,616 were voluntary and 1,812 were certified. We find with this development of the voluntary patient that we still have the certified cases remaining more or less on the same level and the discharges more or less the same. It would be wrong to lead anyone to think that we have found the cure. What is outstanding and from what lessons must be drawn is that a great many people who go in for voluntary treatment can be cured if they go in at the right time and there certainly is an amelioration of their condition.
That points to the fact that in our administration under this Bill and whatever services are set up, we want much earlier diagnosis of mental illness and treatment of mental illness. In that way probably we shall get a larger percentage of cures. It also points out, since we have the greater number of people leaving mental hospitals every year, that in order to prevent a recurrence we must have some form of after-care. Have we got it at present? I am sure the Secretary of State will agree that it is not there. We already have powers and this is where we must not blind ourselves with the provisions of this Bill. If hon. Members turn to Section 27 of the 1947 Act they will read:A local health authority may with the approval of the Secretary of State, and to such extent as the Secretary of State may direct shall, make arrangements for the purpose of the prevention of illness, the care of persons suffering from illness or mental deficiency, or the aftercare of such persons …A circular was sent out by the Department of Health which read as follows:Section 27 of the 1947 Act also gives local health authorities a wide general power, applicable in the mental health field as elsewhere, to make arrangements for the purpose of the prevention of illness,—they have never done it—the care of persons suffering from illness or mental deficiency372 —the provision has been meagre—or the aftercare of such persons.—and I think that that has been even less.
Here we have a duplication of the power within this Bill. Let us not consider ourselves satisfied that it necessarily means that something will be done. The power existed twelve years ago. One of the points made by the Sub-Committee considering mental deficiency was that we must take great care that in increasing our ascertainment of the problem we back it up with the resources to deal with the problem, because if we are limited to our existing resources and we ascertain a greater number of cases, it means that there will be less treatment than there is at present.
I am glad that my hon. Friend the Member for Glasgow, Craigton (Mr. Millan) raised the question of mental deficiency. I recognise that 40,000 are suffering from mental deficiency in Scotland, that between 10,000 and 12,000 of them are in need of institutional care and that we have institutions available to take only about 5,000, or half of them. I know that our present building is concentrated on meeting this problem, but we must face the fact that at the moment we are stretching our resources to the limit. I said that there were nearly 21,000 patients in mental hospitals, and the Report of the Department of Health almost exactly a year ago pointed out that we have beds in our mental hospitals for 21,000 people. But here we have this lag in relation to institutional treatment for mental deficiency.
It is not good enough merely to talk about this. The Secretary of State failed to give an indication of his programme and how he will help the local authorities with this immense problem. The failure of local authorities to meet it has not been a failure of will. They have been held back, as in many other projects, by lack of capital development. The Secretary of State is the man who has held them back. He had power under the 1947 provisions to compel them to do things.
My hon. Friend the Member for Lanarkshire, North was right to point out that the power in the Bill is purely permissive and that if the Government and the country seriously meant it, we should insist on the Government doing 373 these things. Let us make these responsibilities mandatory.
This is the great weakness of the Bill. What are we doing about voluntary patients? We are making it easier to get them into a mental hospital without the formalities. I disagree profoundly with the instance which the Secretary of State gave. He talked about old people who could not write. In order to have them enter these hospitals they have to be certified. Surely this is one of the things to which we object. The old people should not be in these hospitals at all. The Secretary of State said it would be much better if we got rid of the formalities of signing forms. But where will this lead? I hope that it will lead to a greater number of people submitting themselves voluntarily for treatment in our mental hospitals. Have we the hospitals, the beds, the doctors or the equipment?
They are doing wonderful things in mental hospitals, certainly in Ayrshire. I am very glad that the hon. Member for Ayr (Sir T. Moore) remembered the Ailsa Hospital in Ayrshire. An astounding transformation has come over that place since the days of old. I can remember it very well. My father used to be a governor of the hospital in the bad old days. Today it is an amazing place. People come from all over Europe to see it. They even come from the other side of the Atlantic.
We have made changes and introduced new methods which go well beyond the treatment of voluntary patients. The changes made in the treatment of long-staying patients must be seen to be believed. I refer to such measures as providing them with work and letting them go out to farms to do some work. A completely new spirit has been effected in relation to these people, which is the hardest thing to achieve in relation to people who have been tied to a mental hospital for years. I hope that the Secretary of State for Scotland will take steps to provide regional hospital boards and local authorities with the necessary finance to enable them to deal properly with these problems.
I want to deal specifically with only one problem. I shall then end, because I am discarding most of my very learned and erudite speech. I will leave my 374 hon. Friend to quote suitably from the World Health Organisation Expert Committee on Mental Health. I want to deal with the proposal to transfer to local health authorities junior occupational centres presently administered by local education authorities. There has been a certain measure of confusion about this. As I read Clause 12, there can be no confusion at all. I thank my hon. Friend the Member for Lanarkshire, North for drawing my attention to this. There is not very much in education that escapes her notice. Clause 12 (1) says specifically:It shall be the duty of the local health authority to provide or secure the provision of suitable training and occupation for—(a) persons under the age of sixteen who have been reported by the education authority under section fifty-six of the Education (Scotland) Act, 1946, as having been found unsuitable for education or training in a special school.The important words are "in a special school".
Local authorities have set up special schools. I have come across cases in my own constituency and in my own town of children who were not acceptable in these special schools. It started with dedicated and devoted parents who were determined to have some form of training for their children. They started it on their own—not just in Ayrshire, but in many places elsewhere. Eventually the local authority took the work over for them, and we have seen the development of junior occupational centres being administered under local education authorities. These are not special schools.
§ Mr. Millan
According to the Education (Scotland) Act, 1946, the words "special school" include by definition the term "occupation centre". There does seem to be some confusion.
§ The Joint Under-Secretary of State for Scotland (Mr. T. G. D. Galbraith) indicated dissent.375
§ Mr. Ross
It is all very well for the Joint Under-Secretary to shake his head. A scheme was going on for the proper training of staff for these centres, and that was stopped. As far as I know, it is not going on now. It was stopped because of doubt about whether the work would come under the Health Department or the Education Department.
I shall certainly continue my argument on the basis that these occupational centres should continue under the local education authorities. That is justified from the point of view of the area alone. Taking Ayrshire as an instance, is it not better that this should be dealt with by the education area, which is wider, than by three separate authorities—the local health authorities in Ayr, in Kilmarnock and in the county?
When we appreciate that these local health authorities have already had statutory responsibility for those over the age of 16 and have done little or nothing—the figure quoted for the whole of Scotland showed that 339 were being catered for in this way—it does not exactly give one any feelings of confidence that we shall get the local health authority measuring up to the demand that has been made by the parents and met by the local education authority. I sincerely hope that in Committee we shall get complete confirmation that the responsibility will continue to be with local education authorities.
The local health authorities have not the experience and the trained staff for the work. They have not got the experience of the work—they have not done it—and training is educational. The staffs have already been guided and aided by teachers and teacher-training colleges, and where there is training of any kind the competent authority is the education authority.
It would be wrong to cut the numbers of these children presently under the ægis of education authorities, and say that they would not benefit from educational training. That would be a disservice to the parents and to the teachers. It would most certainly be a disservice to the children. The medical and social element does, of course, enter into consideration, but it is outweighed by the educational aspect of these occupational centres. Sensory and 376 physical training, handwork, the appreciation of art and the like all add up to educational training, and they must all continue to be the responsibility of local education authorities.
There is no doubt that the danger feared by parents of handicapped children is that far too many of these grades will be put in one establishment. When too many grades are mixed, the training comes to a standstill. Under the present schemes—I wish there were more, but I believe that there are 49 throughout the country—the children feel that they are at school just like their brothers and sisters, who are at the ordinary schools. Psychologically, that is very important for both the children and the parents, and I hope that we do nothing by this Bill to undermine what has been done.
The service is new—it has been running for only a few years—but, thanks to the work of the parents and the teachers, it is now established and developed, and it would be wrong to disrupt it. The children have been upgraded from these occupational centres into the special schools. It is true that they have been downgraded, too, but without the kind of upset that we shall get if it is a case of going from one authority to another.
I would like the Secretary of State to tell us whether it is true that no Scottish occupational centre was visited by the Committee before the recommendation was made. If that is true, it is rather serious, but it has been pointed out to me and, I believe, to the right hon. Gentleman, in the form of a memorandum from the association of the parents interested in the work. First-hand knowledge of the achievements should have been sought by the Committee before the recommendation was made, and the opinions and experience of the parents themselves considered. I hope it was not done in order to achieve uniformity with what is happening in England and Wales. Let us remember what the Committee said:We approached the problem with which we now deal with the wish, firstly, that Scottish law and practice should be as similar as possible to the law and practice in England and, secondly, that the best traditional features of Scottish law and practice should be preserved. 377 These two objectives proved to be not entirely compatible, and as our deliberations progressed we formed the view that certain features of the law in Scotland were—for Scotland—more satisfactory than their English equivalents, and that we were not justified in seeking uniformity by sacrificing provisions which have worked well in Scotland and in which the public have confidence.The people most concerned in relation to the junior occupation centres are the parents of these children. They have confidence in these centres. The 378 Committee itself said that they are working well, and I wonder that the Committee made the recommendation that it did. I hope the Joint Under-Secretary will give us the assurance that, if it is not crystal clear in the Bill, he will make it clear that these centres have got to remain under the education authority. On the whole, I welcome the Bill and I look forward to the exchanges in Committee.
§ 10.32 p.m.
§ Commander C. E. M. Donaldson (Roxburgh, Selkirk and Peebles)
Early this afternoon, because of a change in the business of the House, it was thought that perhaps this Bill might pass rather quickly through its Second Reading stage and thereafter in due course reach its Committee stage, there to be considered in more detail. I recall when, having sat here for two or three hours earlier this evening, the hon. Lady the Member for Lanarkshire, North (Miss Herbison) said that this might be a shorter debate than had originally been anticipated. But the hon. Member for Kilmarnock (Mr. Ross) then said something and went out of the Chamber to ascertain how matters stood. It was obvious, therefore, to me, as it was perhaps to other Members, that whatever had been suggested for the expedition of the Second Reading, the hon. Member for Kilmarnock had something to say and wished to say it in considerable detail.
§ Miss Herbison
There were no arrangements whatever between the Front and back benches to expedite the Second Reading of this Bill. I was considering some of my own hon. Friends who might wish to get into the debate and might have transport difficulties.
§ Commander Donaldson
I accept what has been said by the hon. Lady—or perhaps I may be allowed to say "the hon. and charming lady". I heard what she said, and I appreciate the inference. She made it clear that she did not wish to inhibit the debate, but that some of her hon. Friends might wish to speak, and by inference she said she hoped that others would not speak at too great length and deprive her hon. Friends of an opportunity to contribute to the debate, in view of the time limit.
The point I am trying to make, in following the hon. Member for Kilmarnock, is that there have been occasions when the hon. Gentleman, who is gifted to speak in a manner in which I shall never be, has carried a debate for about 6½ hours, as he did one night two or three years ago in the Committee stage of a Scottish Bill. He has the ability to understand Bills, and I am sure that whatever might be said on the Front Bench, he was determined to speak at some considerable length. In any case, he has done so.
380 I should have liked to follow the hon. Member for Fife, West (Mr. W. Hamilton). That may seem odd to some hon. Members, because he and I in general principle seldom agree. But he spoke with a human note in a speech which impressed me very much, and also my hon. Friend the Member for Fife, East (Sir J. Henderson-Stewart). They followed my hon. Friend the Member for Aberdeenshire, West (Mr. Hendry), who had made his maiden speech.
The Bill is one which ought to be, and I think will be, in general terms a non-controversial Bill at this stage, in Committee, on Report or on Third Reading. As time is now a little more free to us, I should like to add to the congratulations to my hon. Friend the Member for Aberdeenshire, West. A maiden speech is a difficult speech, but he made it, and he made it in the context of human relationships. My point is that human relationships are really the basis of the Bill, and they will be the basis of the consideration when we come to the more controversial stage, the Committee stage.
I have had, as other hon. Members have, instances of the difficulties in family life resulting from, whether it be in childhood or in adult life, mental illness and other matters which form the basis of the Bill. I could, but will not, give a number of illustrations. I have had a number in my constituency, and in some ways they work one against another. When in this House we consider these matters of human relationships in relation to mental illness and mental disability, we should think of them in human terms.
In the past I have been in contact with constituents of mine who had a child in the Gogoburn Hospital, Edinburgh. The child, by the process of the educational ideas and modern thought of those in charge, reached a stage where it was, in their opinion, ready to return to its parents. The tragedy of this case was that the child was adopted. The couple who adopted it were not able to have children of their own, and they deeply and sincerely and in love wanted the child returned to their home. For a time it was not possible for the child to 381 return. However, after inquiry and suggestion and, perhaps, a little argument and pressure, the child was returned, and the joy the household was great. The child, which I have seen, is now evolving into a useful personality in the community in which it lives.
I have seen the converse of that in a family of another of my burghs. The family had five children. The third child was a mental defective, was the subject of cerebral palsy and was afflicted with epilepsy at the same time. The hon. Member for Greenock (Dr. Dickson Mabon) will appreciate the tragedy of the case from his medical knwoledge. For five years the mother never left the door of her house to go anywhere, and by reason of his work her husband was away most of the time. At the end of that time, she asked, in desperation, whether something could be done, and the child was removed to the home for epileptic children at Bridge-of-Weir. The tragic thing was that, after I had had a letter saying what a relief it was to the other children, the mother and the father, about six weeks later the child was returned, the hospital stating that it could not control it. What did the mother think?—"If the hospital cannot control the child, how are we expected to control it, and what about its brothers and sisters?" That was a tragedy. However, by the efforts of the predecessor of the present Under-Secretary of State some quick action was taken. That child was admitted to the Gogoburn Hospital in Edinburgh and is now with others of the same mental capacity. It is becoming a happy child and the parents are rid of that terrible fear and difficulty, and its brothers and sisters are happy little boys and girls because the child has been removed. That is the sort of remedial treatment which would unite the House in relation to the Bill although we may disagree on some of its contents in Committee.
I would like to take the matter a little further, and apart from these individual cases. It so happens that in the whole of Scotland there is one hospital—we are dropping the term "mental hospital"—that has open doors. It is in my constituency. The medical superintendent is a man whom I have come to understand after ten 382 years of knowing him and visiting the hospital.
This institution accepts all types of mental illness cases—schizophrenics, mental depressives and paranoics—and it has no locked doors. I have pleasure in visiting the hospital and my agent is even more happy because he knows that when I go into the hospital I shall be able to come out again because the doors are unlocked. The hospital caters for some 460 people of all classes of mental illness. It is situated adjacent to the Burgh of Melrose. The people of Melrose had to accept the proposition of having within their compass and in their orbit a hospital with open doors catering for various types of mental illness. They accepted it. The fact is that there has never been any trouble or difficulty. There have been instances of patients wandering out of the hospital, but never any trouble.
I do not believe that Dr. Bell, the medical superintendent of the hospital, has yet received the praise due to him. I have followed his work and his career. He is known throughout the world—not just in Scotland—as a man with a new idea who has kept it going without difficulty for many years. He went recently to America to lecture on his system. People come from New Zealand, Switzerland and other countries to study the methods used in this hospital which, as I have said, happens to be in my constituency.
It is wonderful to think that although when we come to the Committee stage of the Bill we may differ on the minutia of certain parts of it, to which no doubt my hon. Friend will refer when he winds up the debate tonight, we all in principle accept the Bill. I do not think that we shall divide on ifs Second Reading. We may argue the difficult cases, the finances or whatever we may, but I believe that all of us in the House are interested in the very difficult cases of mental illness of whatever form, starting from the youngest children and, as has been said in the debate, ending with those who are committed to these institutions because they are old and are suffering from a mental state which afflicts elderly people.
When in Committee we come to discuss finance and other things I hope that we shall keep in mind the backcloth that 383 all these cases are cases of human relationships. Young people may be suffering from cerebral palsy and other mental illnesses which afflict the young. They are the responsibility of their parents. But when older people are afflicted with illness of the mind to which the elderly are prone, they are often the responsibility of the younger members of the family, sometimes their daughters and perhaps their grandchildren.
We should approach the Bill in an atmosphere of compassion and understanding. I do not think that there is a Member of the House who has not had knowledge of these cases. I hope that when we come to the Committee stage, whatever the differences may be, the backcloth will be human understanding, the relationship of family with family and individual with individual, and that we shall support the Bill in large measure even though disagreeing, perhaps, in small measure on the intricacies of the debate.
§ 10.45 p.m.
§ Mr. William Small (Glasgow, Scotstoun)
One would have expected an adventurous effort in major legislation on mental health in Scotland to do something for the patients, for the mentally ill, but, from a study of the subject matter of the Bill, one finds many cross references to previous legislation and provisions to modernise what is already on the Statute Book, so that it is really more a Statutory Instrument than anything else.
I am particularly concerned with the provisions of the Bill which affect the liberty of the subject. Almost the first words of the Explanatory and Financial Memorandum tell us that the Billprovides that patients may in future be treated in hospitals or nursing homes for mental disorder without any formality.On a commonsense approach, that does not seem to take into account the fact that, with the advance of senility, in ten years or so, we shall have a growing pro- portion of old people in the population for whom no provision is made by the local authorities under the presently existing restrictions.
The result today is that the only place for those with failing mental powers is the mental hospital. This is something which most of us object to very strongly. 384 Whether certification is necessary or not, the fact remains that the mental hospital should not be the only place provided by the Government for the old. This is really the central problem, to my lay mind, and I am not altogether without experience, after serving for seven years on committees dealing with mental health.
Further, we are told in the Memorandum that the Billprovides for registration of private hospitals and residential homes for persons suffering from mental disorder.In my view, such registration would be desirable, but I wonder whether, after registration, the local authorities, through the medical officers of health, or the new Mental Welfare Board, will be able to watch the standards of treatment and care provided in such private institutions. Will it be within the province of a local medical officer of health to see that standards are maintained within a private hospital, after registration?
I have another question on that matter. If registration is to give the stamp of approval by the Secretary of State or the local authority, will this affect the opportunity of the private institution to obtain drugs via the National Health Service? It is important to know whether the stamp of approval is given at that stage and access to drugs will be provided for in that way I am asking these probing questions so that we may be informed about the actual effect of the Bill.
My hon. Friend the Member for Kilmarnock (Mr. Ross) dealt very adequately with the implications of the proposal to give the local health authority a duty to provide suitable training and occupation for mentally defective children. In most local authorities of which I have had experience, there has always been a contest between the health and education departments. On the weight of the evidence, I have come to the conclusion that the duty should be given to the education authority, since it already has most of the other facilities under its control, including the school dental service. This activity should be added, in that sense.
As for people or children unsuitable for education, my experience has taught me that members of hospital managements boards or committees are always 385 plagued by appeals from parents who cannot get their children into institutions today. There is a contest here, too. I have in mind the position of the doctors and the recommendations they make. There is no reference in the Memorandum to any raising of the status of the doctor through the Diploma in Psychological Medicine.
The Bill provides for detention on the signature of two doctors. When dealing with mentally disordered persons, however, one must be able to be satisfied concerning the qualifications of the doctors. I will quote a practical example. Previously, when a matron was resident in a home without a resident physician, she was in control night and day and was responsible for the classification and grading of all the mentally defective patients. If, however, she decides that two or three are ready to go out into the world and are socially competent, she must consult a general practitioner who lives in the nearby village but who is unfamiliar with the mental state of the patients. Frequently, such cases give rise to dispute and representations are made and there is always a contest whether the matron or the G.P. is better qualified to decide a patient's release.
My main interest is in what happens to a person who comes before the court and is sent to, for example, Barlinnie, where men are certified by the prison doctor as distinct from a general practitioner. The Explanatory and Financial Memorandum to the Bill states that there are to be'State hospitals' for patients who require treatment under conditions of special security.The existing hospital at Perth is not specifically mentioned, although the State Mental Hospital and the State Institution for Defectives at Carstairs is designated. Is the transfer of Perth Prison to State mental hospital status a change in name only?
The Explanatory and Financial Memorandum states thatThe Bill provides for the appointment of one or more committees to manage State hospitals.In Committee, I should like to discuss the appointment of committees for this new task. On the broad issue, there is much in the Bill that is good and real in character concerning the right of appeal by patients. One of the amazing features 386 is in Clause 34, concerning the correspondence of patients. They may write to their nearest relative, the Lord Advocate, any Member of Parliament, the Mental Welfare Board, any sheriff or sheriff clerk and the board of management of the hospital, but there is no suggestion that they may write to the doctors who recommended their admission to the mental hospital for their assistance to get out.
Always at the back of a patient's mind is the thought of the doctor who sent him to hospital. He has a sensitivity that the doctor should watch his progress and that he should be able in due course to appeal to him when he wants to be discharged. It is usually a general practitioner who introduces these services to parents. These doctors are, however, omitted from the category of people to whom a patient has authority to write.
I anticipate introducing a number of Amendments in Committee to help to strengthen the Bill. I assume that the setting up of committees for the State mental hospitals will be done on a local basis so that the members of a committee will be in close proximity to the hospital for which they are appointed, rather than that the membership of the committees should be distributed over Scotland as a whole. I welcome much that is in the Bill, but I am concerned about the liberty of the individual, and particularly the prison offender.
§ 10.55 p.m.
§ Mr. William Baxter (West Stirlingshire)
I have listened carefully to the speeches that have been made this afternoon. The humanitarian speeches made by hon. Members on the Government benches impressed me greatly, but when they were making those speeches and talking about the great transformation that had taken place in the hospital services, especially in the mental hospitals, they failed to point out that that transformation had been brought about by the National Health Services Act, 1947, and the National Assistance Act, 1948, which gave great powers to local authorities to help in this respect, both of which were passed by a Labour Government.
As one who had the privilege and opportunity of being a member of the board of management of the Larbert 387 District Hospital Board before the introduction of those two Acts which I have referred, I know of the great problems that confronted the committees which tried to bring about some alteration in the things that had existed for many years. It was only when the Labour Government brought those Acts into being and set up new boards of management and regional hospital boards that this transformation to which hon. Gentlemen opposite have paid glowing tribute came about.
I had the good fortune to be a member of the West of Scotland Regional Hospital Board at its inception, and I can speak of the excellent work that was done by regional hospital boards and the board of management of various hospitals to try to bring mental hospitals to the peak of perfection and give the results which have been so highly praised this afternoon by hon. Gentlemen opposite.
During the recent election not many hon. Gentlemen paid tribute to the work that had been done. They did not then pay the tributes that they have paid this afternoon. On many occasions I have heard hon. Gentlemen speak of the great wastage caused by the National Health Service Act and the National Assistance Act. It is a pity that only on occasions such as this do we hear tributes to the work that was done under those Acts.
I should have thought that when the Secretary of State for Scotland introduced this Bill he would have apologised to the House, and to the people of Scotland, because neither he nor his predecessor tried to do what the Acts to which I have referred gave them power to do. They could have helped considerably by giving local authorities assistance to enable them to bring about a better state of affairs for our mentally sick people.
I listened in vain for the Secretary of State for Scotland to refer to the power that he has for setting up health centres throughout Scotland. Unlike his opposite number in England who has no power to set up health centres, the Secretary of State for Scotland has power to set up health centres in Scotland. Since this power was vested in the Secretary of State for Scotland, three 388 health centres have been set up in the whole of Scotland to try and combat in some small way the terrible disease of mental health. If such health centres had been built, clinics could have been established for treating the unfortunate people about whom we have heard today.
If the past is a criterion of what is to be done by the right hon. Gentleman in future, then we cannot have any great hopes that the promises of the Bill will be fulfilled. The Bill has not come by chance. It is a natural follow-on to the legislation which I have mentioned. Irrespective of the complexion of the Government of the day, a Bill of this character would have had to be introduced. The great folly of right hon. Gentlemen opposite is that they did not introduce it earlier.
The right hon. Gentleman said that certain powers were to be vested in local authorities, which is true, but those powers already exist. I have been a member of numerous deputations to the right hon. Gentleman asking him to permit the building of health centres by local authorities if the Government were not prepared to undertake the work themselves, But we have had the greatest difficulty in getting such permission and it is only in the last 12 months or so that there has been a relaxation in that attitude.
If the right hon. Gentleman is sincere—and I hope that he will be in future—and if he is to do anything drastic, he will have to encourage and assist local authorities. One tangible way would be by £ s. d. There is no doubt about that. Progressive local authorities wanting to start schemes for this or that find that they will have to increase rates considerably. The Government have said that they will permit local authorities to go ahead with schemes suggested in the Bill, but they have not indicated what money will be available.
With many others, I believe that a grant, not on the present basis, but a special grant for a special purpose, is required. If the right hon. Gentleman is sincere, he should have no hesitation in demanding that the Treasury make available to local authorities a special grant for these purposes.
Stirling County Council recently had plans for going on with occupational schemes for the mentally handicapped. 389 Lo and behold! A great opportunity came along, an opportunity to acquire a building meeting the requirements of the local authority and originally owned by the county council. That was Camelon Hospital in Falkirk. The regional hospital board had taken over that hospital from the local authority, but then decided that they no longer required the building. It wrote to the health committee of Stirling County Council, of which I have the honour to be chairman, saying that it was prepared to hand over the hospital to the original owners, from whom it had taken without compensation.
We said that we would be delighted, but we were told that we could take back the hospital only if we were prepared to pay the valuation fixed by the district valuer. Is that the way to reap the rewards offered by the Bill? That is the most stupid thing in the world. Here was the county council taking back its own hospital at the district valuer's valuation and yet, if the implications of the Bill are implemented, without that hospital the county council will have to spend public money on a similar building. It means the negation of progress. The Secretary of State tells us that he is prepared to do all that is humanly possible to carry out the implications of this Measure. Let him meet his words with actions. Let him prove his words by giving special grants to local authorities, and giving back to the local authorities the hospitals which are no longer required by the Department of Health or the hospital boards.
Under the provisions of this Bill an interesting new committee is to be formed, the Mental Health Committee. I have no doubt that it will be a valuable body, but only if its members include a proper proportion of elected local authority representatives. I ask the Secretary of State to look at what he has put in the Bill and consider whether he should not make clear that a certain proportion of elected local authority representatives should be appointed to this committee.
If time permitted, I could say something about the great mistake of the National Health Services (Scotland) Act, 1947, in not utilising local authority representatives to the fullest extent in 390 the administration of that Measure. I suggest to the right hon. Gentleman that he should not repeat the mistake made in the past in taking the whole of the hospital and curative services from the local representatives. There will be a great danger if this new committee is deprived of the wisdom of the elected members of local authorities.
Many authorities are dabbling in the question of mental health. I wonder whether the time has arrived to insert a provision in the legislation setting up a committee to co-ordinate all the activities pertaining to mental health. I make that suggestion for the consideration of the Minister.
§ 11.8 p.m.
§ Mr. John Rankin (Glasgow, Govan)
The hon. and gallant Member for Roxburgh, Selkirk and Peebles (Commander Donaldson) told us that we no longer use the words "mental hospital" in the Bill which he regarded as a sign of progress. It is perfectly true that a name, or a change of name, can represent a form of progress. I am reminded of when I was a member of a parish council which controlled a mental institution and also an institution for those who were physically destitute. These places were known as the "Poors' House". The council decided to call them combination hospitals, and that was regarded as an advance. But the inmates still went on calling them the "Grubber". The real test is whether there is a change in character. Will there be an improvement in the accommodation, in the treatment and in the attitude to the patients?
Surely these are the important things we have to be asking about this Bill? Are these other changes to take place? As my hon. Friend asked, will more money be spent on the hospitals than was spent on the mental institutions? It does not look like it for a reading of the Bill tells us that no further demand will be made on local or central finances. That is rather a brake on the progress which many of us would hope to see taking place as a result of this Bill.
There is another sign, not of progress, but in my view and the view of many on this side of the House, of retrogression. Clause 12 deals with the power to compel attendance at training centres. If a child is unsuitable for 391 training in a special school, the local authority will have to establish a training centre for that child. We are to certify that child as ineducable. We are to decide that for practically its whole future life that child will remain separated from the rest of its little community. This is one of the causes of bitter grievance which I have discovered time and again in neighbourhoods and in homes.
We are taking a small group of children and separating them from the rest of the child community. We are defining them as a different lot and they become differently regarded. Parents do everything in their power to get friends to believe that their child is no different from other children. Now in the Bill we are to mark that child by taking it away from the educational community and putting it into another environment altogether. I think that is fundamentally wrong. I think it impossible for anyone to examine a child and come to the conclusion that that child is ineducable. No one can say the changes which may occur in the years which lie ahead, yet because of a decision at a particular phase in its life, it is marked for the rest of its earthly sojourn.
The hon. and gallant Member for Roxburgh, Selkirk and Peebles seemed to indicate that there was a large measure of agreement about the Bill and that there was no controversy whatever. I assure him that if the Government are not to have another thought about Clause 12 there will be controversy, bitter controversy. It is already plain that in its general aspect in regard to the mental hospitals and mental illness there has been advance.
Today I looked at the Lunacy Act, 1857. It gives three categories of persons subject to treatment in what used to be called the asylum—the insane person, the idiot and the person of unsound mind. These groups have disappeared and the categories are no longer mentioned. One might call that a sign of progress.
In the 1913 Act there were four categories—idiots, imbeciles, the feeble minded and the morally defective. These four identifications have disappeared, too. Kindlier descriptions have taken their place. Now we talk about those 392 who are mentally disordered, and we put them into two groups—those suffering from mental illness and those who are suffering from mental deficiency.
All four groups in the Lunacy Act, 1913, had one common feature: they were all mental defectives. Will the Joint Under-Secretary of State tell us the difference between mental deficiency in the Bill and mental defectiveness in the Lunacy Act, 1913? In the 1913 Act we tried to define the mental defective as a person who showed a condition of arrested or incomplete development of mind. Is that definition to be applied to the mentally deficient, or are we abandoning definition altogether, and simply leaving it to the two doctors, to determine the fate of the person who comes before them?
After all these Acts and all the treatments which have accompanied them, we are no nearer to knowing organically the cause of mental defection, idiocy, imbecility or any of these other illnesses which demand institutional treatment. We are dependent solely on behaviour as our guide in determining whether a person is to have hospital treatment or not. Will the psychopath come within the definition of mental deficiency or mental illness? He exhibits strange behaviour at times, does he not? Many people might think that he is suffering from some form of mental illness or deficiency, if behaviour is to be our guide in determining his future. Will the Minister tell us whether people of that type will come within the scope of the Bill.
If we look again at the three Acts we find a common purpose running through them. In the 1857 Act we had the General Board of Commissioners in Lunacy for Scotland. That was the name of the Board which looked after the lunatics and the private asylums which mostly obtained in those days. Its function was the supervision, management, direction and regulation of all matters under the 1857 Act in relation to lunatics. It had very wide powers. It could hold inquiries, summon and examine witnesses and so forth.
On 15th May, 1914, under the 1913 Act, the General Board of Commissioners in Lunacy disappeared and we had the General Board of Control in Scotland. Once again let us note 393 its functions. They were to supervise, protect and control defectives. The trend to which my hon. Friend the Member for West Stirlingshire (Mr. W. Baxter) referred ran through all these changes. There has been a common aim—the desire and the need to protect, the mental defective. We come to this Bill, and again that fact is emphasised. Its purpose is to provide protective functions for those persons who are suffering from mental disorder. We have now got description down to one single group; but the purpose is still there.
What was the chief protective function that the General Board of Control had? Surely it was to safeguard the liberty of the subject. We are dealing with people who are subjects, and we should remember that. I believe this Bill makes it easier to get a patient into hospital compulsorily whenever this is found to be necessary. Whether it makes it easier to get the patient out of hospital I am not sure. It is a point that may have to be examined very closely in Committee. But of this I am certain, that the Bill makes no advance whatsoever in fitting the patient back into society. If I am wrong in that, I hope the Joint Under-Secretary will say so.
This problem of safeguarding the liberty of the individual becomes very important, because, wily hilly, old people have been put in these institutions which we now call hospitals. They are there because there is no other place to which they can go, and that is a terrible accusation to launch against the Government, who are primarily responsible.
The aged come into the new definitions very easily indeed. Is not senility an example of mental illness? Many old people become senile. They are not able adequately to fend for themselves. Sometimes we describe them as "doddering"; as people who have to be cared for, and when they get to that stage of what is called senility they can very easily be categorised as suffering from a form of mental illness. Because of that danger, certification becomes a matter of the gravest importance. Therefore, we should resort to certification only in the very last resort.
The procedure gives the two doctors enormous power, power as great as some dictators. We are told that the sheriff has to give his sanction. If two 394 doctors, separately, dealing with an individual come to the same conclusion and utter a certificate to the effect that the patient is suffering from mental illness, what sheriff in the land will disregard a decision reached in that way?
There is the further point that there is now power under the Bill to detain a person in the interests of his own safety. No Secretary of State could seek for wider powers than that in any Bill.
§ Mr. John Brewis (Galloway)
What alternative suggestion has the hon. Members to two doctors and a lawyer in the form of a sheriff carrying out certification?
§ Mr. Rankin
If the hon. Gentleman had been in the Chamber when I began speaking he would have heard me say that there were many points in the Bill which at this hour it is not convenient to pursue and that there would be controversy when we reached the Committee stage. I am dealing with some of the points on which there will be sharp controversy. Had the hon. Gentleman waited a second, I should have come to the safeguard which I want to put to the Secretary of State.
I am asked what safeguard we have against the two doctors. I am looking for such a safeguard. I seek protection for the patient. The primary thing is to look at this from the point of view of the liberty of the individual. The two doctors are a great advance on the 1857 Act under which a person could be committed on the certificate of one doctor. Nevertheless, it is enforcing and promoting authority; it is giving still greater power.
The Mental Welfare Board, like the boards under all the other Acts to which I have referred, is primarily concerned with the protection of the patient. Therefore, I suggest to the Secretary of State that, instead of bringing the Board into operation after the patient has been certified and taken to hospital, the Board should be brought into operation at the time when the two doctors are dealing with him. That is the one authority which can protect the patient, and if it is to protect him, it must do so not after certification, but when certification is being considered. I hope that the Secretary of State will very seriously consider that remedy.
395 There is the danger that the present method of certifying and detaining is creating a community of dependent persons. Only this evening I received a letter from the right hon. Gentleman dealing with one of them. I will not mention names because it would be unfair to do so, but the Minister knows the case to which I am referring. It is that of a patient at present in detention who could not on any conceivable excuse be allowed out. He has also been so long in detention that he is absolutely dependent upon the institution. He knows nothing but the hospital. Were he allowed out he could not, in all probability, sustain the normal process of living. As I say, he has become entirely dependent upon the institution. He has in addition reached an age when he would find it difficult to start afresh.
There is something wrong with a system of that type, and that is the system with which we are dealing tonight. We have been talking about the doctor, who will have a powerful function under the Bill, but is there going to be any scope for the psychologist and the sociologist, because here we are also dealing with a social problem? I must confess that I may have missed that point in the Bill because it is a long Bill to read and hard to grasp. I was not able to settle down to it until this morning, and I confess that I have read an immense amount of it in the course of the day. That is why I am speaking so late in the debate. I admit quite frankly that I was not quite ready to speak earlier. I wanted to talk about some of the things which I thought might not already have been mentioned, and that, to some extent, kept me out of the Chamber in the earlier part of the debate.
The hour is late and one does not wish to speak too long. I hope that I have touched on some matters of importance, matters which in my view must be attended to, and that in Committee we shall have a better opportunity of going into the Bill. I think that it is essentially a Committee Bill. As I have indicated, it is a Bill about which there will be sharp controversy concerning many of its Clauses, but if one looks at it generally and in the historical sense I am sure it can be regarded as a big step forward in what I hope will be a great curative mission in the interests of 396 people who have in years gone by received far too little attention from the community and from the Government. I hope that the Bill will bring these people a greater hope than they have found in the past.
§ 11.34 p.m.
§ Mr. A. C. Manuel (Central Ayrshire)
I do not intend to detain the House very long, but I also wish to associate myself with the welcome given to this attempt to bring up to date the old Acts dealing with mental health and to give that attempt my full support. However, before finally committing myself to doing that, I want the Joint Under-Secretary of State to devote some little time when replying to the debate to the one aspect of the Bill with which I propose to deal. It is the issue of prime importance which will determine whether we shall have real success in implementing the very many Clauses which go to make up this Bill.
At first sight, it seems that the Secretary of State is writing into the Bill—he has certainly written it into the Explanatory and Financial Memorandum—that there is not to be and will not be additional expense over and above what is now being spent on mental health in Scotland.
§ Mr. T. G. D. Galbraith indicated dissent.
§ Mr. Manuel
Paragraph 2 of the Memorandum says:The Bill does not involve any substantial new net charges upon central or local funds".If the hon. Gentleman can satisfy me about this, he will perhaps save a great deal of time being spent on the point in Committee in an effort to write something into the various Clauses so that we may be certain that there will be the expansion which is necessary.
Paragraph 3 of the Memorandum says:The Bill provides for the payment of fees and allowances to members of the Mental Welfare Board, and for the provision of officers and other staff and accommodation for the Board. The expenditure will be offset by savings consequent upon the dissolution of the General Board of Control.If it is envisaged that, as a result of an expansion of head office staff, there will be more field work and more time will be spent generally on mental health and the prevention of mental illness, that will be money well spent.
397 Paragraph 5 of the Memorandum tells usThis duty has hitherto been exercised under Part V of the National Health Service (Scotland) Act, 1947, now to be repealed, so that no new charges to central or local funds are involved.The Secretary of State seems to be taking every opportunity to assure his right hon. and hon. Friends that there will be no greater call on taxation than there has been hitherto Otherwise, why should there be this reiteration of the statement about no new or substantial new expenditure being involved?
In her excellent speech, my hon. Friend the Member for Lanark (Mrs. Hart) referred to the fact that welfare workers concerned with mental health were spending too much of their time doing book work or office work—call it what one likes. She said that as high a proportion as 40 per cent. of their time was devoted to office work. This is deplorable. Of course, records must be kept, and the people doing field work must maintain their notes and records, but there should be sufficient office staff to ensure that there is not this waste of valuable time through their being tied for too long to a desk.
My hon. Friend dealt also with psychiatry and sociology. I hope that these two sectors of mental health will not be cramped in their usefulness by a lack of clerical staff and that those who do the work will not have their activities curtailed by being tied too much to an office stool. It would be deplorable if the skills acquired by these people were virtually wasted because they were doing work which should be done by somebody else.
The Joint Under-Secretary who is to reply to this debate is virtually responsible for general welfare work in the Health Service in Scotland. We have been advised by circular to address our correspondence and questions on various aspects to him, and it will be to him that we take our constituency cases that arise under the Bill. I hope, therefore, that he has taken every precaution to equip himself with the necessary mental skill, although he once told me that he did not begin his education until the age of seven. I hope he recognises that in the modern society in which we live, this is regarded as an ever widening and more important subject. Because more of it is being discovered and it covers much 398 wider spheres than was hitherto thought, it is something about which we must be realistic.
Among the work which is placed upon them by the various Clauses of the Bill, local authorities are to deal with children who cannot attend ordinary school or even special school. These are the most anxious and worrying constituency cases with which we have to deal. We have visited the homes of this type of child, in which the parents, who love their children, carry on for years, but eventually the mother is so overcome by the harrowing existence, not only of herself but of the other children in the home, that the mentally sick child has to be accommodated elsewhere, not only for its own benefit, but for the welfare of the others. We have all had experience of this type of case. Unless a great deal of money is made available to the local authorities to deal with these cases, we shall not get a real solution of the problem.
My hon. Friend the Member for Kilmarnock (Mr. Ross) stated that accommodation was available for only half the mental deficiency cases which needed institutional care and protection. Only half the accommodation that is necessary is available. In the problem cases to which I am referring where the ordinary avenue of education is not available to a child, local authorities must make special arrangements for him. I hope that local authorities who want to do something to help this type of child will not be hamstrung by not being given the grants which they need to carry out their duties.
I have been a member of a regional hospital board for many years. The amount of money allocated to the board and to the local authority for carrying out the work that they have to do is insufficient. They are unable, for financial reasons, to deal with the problems with which they are faced. If they are to carry out the duties which seem to be embodied in the Bill the Secretary of State for Scotland will have to persuade the Cabinet to provide a larger sum of money to the hospital board which is responsible for initiating programmes to deal with mental health.
More accommodation is needed for old people. My hon. Friend the Member for Glasgow, Govan (Mr. Rankin) referred to this. We all know of cases 399 where it has been necessary to get an old person certified so that he can find shelter. Very often such a person is alone in the world and certification is the only way in which he can get a roof over his head. That is deplorable, I think every hon. Member would object to someone being certified because there were some small signs of senility or mental decay due to old age. Local authorities must provide more accommodation for these old people. They must have homes in which they will be looked after and not run into the danger of injuring themselves through falling or other accidents. If we provide more accommodation for old people, we will, in the long run, effect savings in the mental health service.
I want to be assured that the Secretary of State for Scotland, and the Joint Under-Secretary of State for Scotland will do all that they can to ensure that mental hospitals have adequate staffs. In a mental hospital that I know of the governor and the staff are excellent people, but their efforts are sometimes cramped by the shortage of staff.
My observations of hospitals in various parts of the country lead me to believe that during the day-time staffing cover for the inmates is fairly adequate, but staffing arrangements during the night may leave something to be desired. I do not want to highlight the position any more than is necessary, but the right hon. Gentleman may find that there are wards in which there are mental defectives and where there is only one orderly in charge.
That should not be the case in mental hospitals. Anything can happen and has happened where a patient needs attention because he has become unruly and where the orderly has been left without proper assistance. That may be due to shortage of staff, but I should like the right hon. Gentleman to give some thought to the matter. During the hours of the night, the onus should not be placed on one warder—"warden" might be a better word in connection with a mental hospital—to take complete charge of a ward in which there are mental defectives and where anything can happen and where he would find it difficult to quell any outburst through not being able to call on additional help.
400 There are other points, but they can be more, effectively covered in Committee. I hope that the right hon. Gentleman will not close his mind against having some fairly substantial net increase instead of decrease as suggested in the Money Resolution and that when we get to Committee, we shall be able to proceed apace with the Bill, both sides wanting to do the best possible for Scotland and for the poor people afflicted in this way, recognising that it is not only they, but the wider circle of their family and friends who are the sufferers and who look to us for a solution of the problems which are becoming so glaringly apparent in many communities.
§ 11.52 p.m.
§ Dr. J. Dickson Mabon (Greenock)
The last time Scottish business was interrupted was, I think, in October, 1956, during the passage of a miscellaneous provisions Measure dealing with education. That set in train the ill omen of circumstances which we all recall with a great deal of pain and anguish, namely, the Suez adventure. I hope that in having a similar interruption of Scottish business tonight we have not had another omen which will bring about that sort of situation in Cyprus. I am sure that all hon. Members will endorse the sentiment that we do not want anything serious to arise there through the breakdown of negotiations.
Scots are tolerant people and we surrendered the last three hours of valuable debating time willingly. We have not yet managed to recompense ourselves for that lost time, but the Joint Under-Secretary and I will try our very best.
If I may join with my hon. Friend the Member for Fife, West (Mr. W. Hamilton), congratulations are due to the hon. Member for Aberdeenshire, West (Mr. Hendry) who spoke so unusually from his own back benches in such splendid native accents unsullied by the disadvantage of having been educated in an English public school. We were very pleased to hear his sentiments, with which many of us joined. I can assure him that there is no question of having to implore us not to divide the House against the Second Reading. On the contrary, we welcome the Bill, although recognising that if the Government persist in their present attitude towards finance, while we may 401 be no better off with the passage of the Bill, we shall be no worse off. As my hon. Friend the Member for Central Ayrshire (Mr. Manuel) expressed it. We were converts long before the Minister to the idea of reforming the mental health legislation for Scotland.
§ Dr. Mabon
For the very good reason, as the hon. Gentleman must know, that the National Health Service Act—
§ Dr. Mabon
If my hon. Friend does not mind, I will answer the question. Because the National Health Service legislation was in process of being prepared and we were engaged in recasting the whole shape of the medical services in the country. As my hon. Friend the Member for Kilmarnock (Mr. Ross) said if all, the provisions contained in the National Health Service had been operated by succeeding Secretaries of State, including the present one, a great deal of what we complain has not been done would have been done.
§ Mr. Manuel
My hon. Friend did not mention the main point to which I was trying to direct attention. Hon. Members opposite were complaining bitterly in 1946 because there was so much legislation initiated by the then Labour Government that there was no room for anything else.
§ Dr. Mabon
I am pleased to receive the support of my hon. Friend. I do not think hon. Members opposite can genuinely object to the Labour Party having failed to put forward certain items of social reform. We were a great social reform party in 1945 to 1951, comparable only to the Liberal Governments of 1906 to 1914. Only the most biased and prejudiced Conservative would deny us the right to that claim. An enormous amount of legislation was passed in those post-war years. I believe that in one year eighty Bills received the Royal Assent.
Having been distracted from my theme, let me return to the burden of my argument. Hon. Members on this side of the House would like to join with hon. Members opposite in congratulating Mr. John Dunlop, the chairman, and his 402 Sub-Committee which dealt with mental health legislation. We are pleased that he has now become the chairman of the Scottish Health Services Council. That does not mean that we agree with everything that the Sub-Committee produced. In a way, it was a disservice to Mr. Dunlop and his colleagues that the Secretary of State did not argue many of the cases which they tried to explain in the memoranda in justification of decisions taken in the Bill.
I think that my hon. Friend the Member for Glasgow, Govan (Mr. Rankin) raised an important point. He expressed his dissatisfaction regarding the procedure involving the doctors and the sheriff. Most of us, including the National Council for Civil Liberties, are pleased that there is a difference from the English provision, that there is another lay or non-medical authority to which one has to proceed. There is substance in the argument of my hon. Friend, and I give him the point that while there may be the inclusion of the sheriff, the question is, on what does the sheriff base his considerations? There is substance in this when we consider that Clause 6 is, I will not say ludicrous, but axiomatic to say the least. "White is white," say the Clause, and it pronounces something which is self-evident. It does not define any specific categories at all. It defines two medical conditions. Yet all we got from the Secretary of State in his brief reference to the Clause was a twinkle in his bonny blue eyes, and that was the end of it.
There was no explanation of why the Government, as distinct from the Committee, had decided that they would accept paragraph 9 of the Memorandum published in 1958 by the Sub-Committee appointed by the Scottish Health Services Council. Since the Secretary of State has not done the Committee the service of discussing this, I think I might have the permission of the House to go through the four points mentioned.
It says in its first argument that the term "psychopathic" has become meaningless in many ways and is no longer a clinical entity. I believe that the Secretary of State, as a Cabinet Minister, voted for the English Act. Therefore, I presume he thought it good for the English but perhaps not so good for the Scots, for this argument leads us to the point where one might say, as 403 the Committee does in the second part of paragraph 9 of its Report, that this means a stigma. As I think my hon. Friend the Member for Govan suggested, no matter what name we give anything, ultimately it becomes associated with the particular institution, disease or whatever it is, and the name becomes a stigma. There is no point in trying to change names vainly hoping to get ahead of popular prejudice. That is a rather pointless exercise.
The third argument of the Committee was not actually an argument for having no categories but one for having a specific category. It used the words:To deal adequately with the psychopathic group.Note that it actually uses the phrase without inverted commas, implying that there is such a group. Of course there is such a group. The curious thing is that in Clause 23 (1, a and b) we have almost the precise definition, or at least a re-echo of the definition in the English Act, of what of psychopath is. Although the Scottish Ministers pretend that this Bill is a model of empiricism based on a definition which will not involve them in legal obligations, they are obliged to adopt the English definition in Clause 23. In view of the time spent in arguing this point—perhaps it is of a rather remote and clinical nature, nevertheless there are medical men who are interested in Parliament and they are anxious to know why the Government have made this decision—the Secretary of State might have deigned to tell us why this decision has been endorsed.
This is the relevance of it. If there is no definition of insanity or mental disorder, or mental deficiency, in such terms as in the English Act, on what grounds can the sheriff proceed to investigate the recommendations of two doctors? The answer of the Secretary of State is case law and, I think he said, training, experience and judgment. A number of sheriffs may well feel like a number of doctors. This may sound strange to my hon. Friend the Member for Glasgow, Scotstoun (Mr. Small). There are a number of sheriffs who, like a number of doctors, are disinclined to be the sole deciding parties in committing a person to compulsory detention under the mental 404 health laws. That is why the English provision was fought by many doctors who did not like the idea. To use the words of my hon. Friend quoting the aggrieved patient, "It was the doctor who put me there." There would be no resentment felt towards the relative who may have been responsible for initiating the proceedings in the interests of the patient, but it would be felt against the doctor. Often in a little village or small community that means a great deal, and it leads to an unfortunate reflection on the doctor in many ways.
The point which has emerged about defining mental disease in Clause 6 is that it has a reflection in the decision of the sheriff. This was the point which was often raised in England and which sparked off the cry for a Royal Commission—that whenever two doctors appeared, the English J.P. merely endorsed what they said almost without question. The hon. and gallant Member for Ayr (Sir T. Moore) referred to the fact that many people languished in mental institutions in this country who had long been sane. We remember the campaign of my hon. Friend the Member for Erith and Crayford (Mr. Dodds) and of the hon. Member for Carlisle (Dr. Johnson) on specific cases long before the Mental Health Act, 1959, was passed.
Are we confident that under the procedure in the Bill the sheriff will not fall into the same practice as that of the English magistrates which gave rise to such complaints about the operation of the English system? I ask the question even though, not unreasonably, we are congratulating ourselves on the new procedure. Let us not be too anxious to congratulate ourselves on the point. Admittedly, if it works it will be an admirable solution to the problem of how we commit a person, ensuring the balance between the interests of the community and the rights of the person concerned.
As the hon. Member for Galloway (Mr. Brewis) rightly said in his intervention, if we demolish one procedure we must be prepared to offer another in its place, and, frankly, I can see no other, but I want to be sure that the procedure suggested in the Bill will work and that it will not carry the inherent defect of the system which was worked so unhappily in England.
§ Mr. Rankin
Will not my hon. Friend agree that the sheriff stands in danger of being placed in a subordinate position to the doctors, because there are two doctors, one supporting the other, while he has to take a solitary, individual decision?
§ Mr. Brewis
Does the hon. Member agree that all the cases in which there has been scandal in England, such as that of Kathleen Rutty, have been cases not of mental disorder but of mental deficiency? Would it not be possible to use the I.Q. system to find out whether they were feeble minded?
§ Dr. Mabon
A closer reading of Clause 6 by the hon. Member for Galloway will reveal that it embraces mental illness and mental deficiency. The procedure before the sheriff in the case of the mentally defective is similar to that of the case of a person suffering from mental ill health. I agree that it has happened mainly with mental deficiency, but cases have been recorded of it happening to people suffering from mental ill health, and I will come to that in a moment in connection with another part of the Report. As my hon. Friend the Member for Govan said, the sheriff may well be placed in an invidious position. Moreover, he is not only the judge in the case but also the appellate judge in any succeeding appeal, which incidentally is not too precisely defined in the Bill.
It is possible under Clause 6, as drafted, that anybody under twenty-one can be compulsorily detained provided that two doctors are prepared to state that herequires or is susceptible to medical treatment"—Clause 23 (1)—which treatment includes, according to Clause 109,care and training under medical supervision".That seems to me to be an extremely wide proviso which must be justified at the Box by the Government. So far we have not heard an adequate and ample justification of such a serious matter. I know that, quite rightly, the Secretary of State takes Part IV seriously and spent some time on it in his speech, but we are entitled to know a little more about this before Parliament agrees to revise legislation on such a broad basis.
406 The Committee discussed many of these things at length. On page 9 of the same Report, the first Report in 1958, there is a whole section devoted to what is called the 28 days observation period. This is a mechanism by which we might secure the review of cases of persons apparently unreasonably or unfairly involved in certification procedure. At the time when they were affected by their illness or disorder they may have been quite violent and socially irresponsible. In our Bill the 7 days emergency procedure is referred to but there is an implied rejection of there being a 28 days period.
My hon. Friend the Member for Lanark (Mrs. Hart) spoke of the Aberdeen experiment where they were able to observe children for two months and, as a consequence of the experiment—this can be proved from statistical evidence—they had a better prognosis and less sense of hopelessness, because these children could be observed under ideal conditions. The same applies in the case of mental ill health. The English have adopted a 28-day trial period for observation. That is not in this Bill. I presume, therefore, that there are good reasons for its omission, although we have heard none. I looked at the Committee's Report and it argues the case for this omission. There are three arguments, which I will not recite now, but I cannot honestly see how these can be very formidable arguments. Look at the succeeding paragraph, however.
Paragraph 25 of the Report says:On the other hand, although it is not within our remit to make recommendations regarding the criminal code, we consider that in respect of persons who have appeared before the courts and whose mental condition requires observation there would be advantage in the procedure suggested by the Royal Commission for compulsory admission to hospital for up to 28 days' observation and preliminary treatment.That is an amazing argument—"If you have allegedly committed a crime we will give you 28 days' observation. If you are an ordinary citizen who has not committed a criminal offence we will certify for a year." If that is a sensible state of affairs it should be justified at the Dispatch Box. But this has not been done. I do not think any of us should adopt an absolutely inflexible position, but we are entitled as reasonable people to expect some explanation 407 of why the 28 days recommendation was not accepted.
Another minor matter—if it can be called minor; apparently it is, as there are so many of these matters—is the question of the Mental Welfare Board. My hon. Friends the Members for Govan and for Lanarkshire, North emphasised that the Board had one clear, definite function, namely to protect patients. Although the General Board of Control in Scotland had a dichotomy of functions—in one of the Reports it is described as being the centre-forward in the Secretary of State's mental health team and the referee in the question of the patient's interest—nevertheless one of the complaints against the General Board of Control in England and, I believe, in Scotland in a small number of cases, was that this was the Board with whom one had to quarrel in order to get patients out of hospital. This may not be a widespread practice in Scotland—there are so few cases—but I have heard this, not so much from Members of Parliament as from doctors.
This is a curious matter. We are going to have a Mental Welfare Board which is enjoined to perform a function formerly allotted to the General Board, and that Board has been criticised in the past for doing just the reverse of this policy. The Mental Welfare Board will exist to protect the interests of the patient. It must demonstrate that it is free from any influence by the Secretary of State, by any sheriff and by any other persons other than those who constitute the Board. It must be an entirely independent organisation if it is to carry out its duties satisfactorily.
The Board's membership may be five or seven. Two of its members have to be doctors, but there is no provision for there being a lawyer. It is possible that all the members could be doctors. I am a great believer in doctors—they are very fine people—but I would never agree to a board of this kind being made up entirely of medical men, for that would be wrong. The Board should have a legal element and a lay element.
I do not see why this cannot be incorporated in the Bill. Some may say that it is a committee point, but I emphasise it because the whole tenor of the function 408 of the Board is to be changed. We should ensure that there is a proper balance in its constitution. If we can set aside time to ensure that there are two doctors, we can set aside time to ensure that other specific types of person serve on the Board.
To turn to the main bulk of the Bill, the minority of families in this country are fortunate enough to say that none of their relatives, near or distant, has ever been involved in mental ill health. There is a widespread incidence. The social stigma attached to certification and mental ill health is at present almost comparable with the stigma formerly carried by tuberculosis. People are gradually becoming educated and tuberculosis is no longer a vicious social disease because it has been cured by the wonder drugs—not by the Scottish Office—and mental ill health will probably lose its stigma when we are able to see more cures and more preventive advances being made. The stigma can only be removed when we can show that there is no fear. As my hon. Friend the Member for Lanark said, it is the hopelessness, the sense of fearfulness, the sense of permanent blackness in mental deficiency and mental disorder that gives the whole subject the atmosphere of gloom. It is that kind of thing that we have to sweep away.
That can only be done by persuading people to undergo voluntary treatment. That is the reason for the Bill—to revise the process of certification, to make it minimal and to encourage more and more people to go forward voluntarily for treatment. It means that about one-third of patients will be spared the indignity of certification in future. It means that many mental defectives will be released from institutions. The Fyfe Committee said in its Report that there were 5,000 mentally deficient persons awaiting admission to institutions. It is not unreasonable to expect that under the Bill there will be the release of a substantial number of mental defectives. Of the 52,000 National Health Service beds, 20,400 are for the mentally ill, not counting 6,300 for defectives detained compulsorily. Many of these persons will come out of hospital. What will happen to them? When will they come out?
409 My hon. Friend the Member for Kilmarnock made a splendid case when he argued this. For twelve years almost precisely the same powers have been in the hands of the local authorities, and the Secretary of State has been able at any time to direct that they should become duties but at present they are permissive powers. My hon. Friend the Member for Lanark made a first-class speech on this subject. For twelve years the Government have been able to show their mettle. There is this process of not mandating the authorities but of saying "We will gradually nominate authorities and duties one by one, item by item, as the circumstances allow." This is empiricism gone mad, if I may quote the Secretary of State in another context.
The point is that for twelve years this experiment has been tried. Hon. Members opposite have no right to say to us, "Ah, well, you have been very demanding and unreasonable in saying that it ought to be mandatory." We have tried the permissive system with the nominating power of duties. It has not succeeded, and our proof is in the Mental Deficiency Report, probably one of the most astonishing documents ever to come out of a Government office. The Fyfe Committee Report published in 1957 had some damning things to say about the administration of the mental defective services in Scotland, and precious little has been done since that Report was published. Some of these dreadful things were itemised in the speech of my hon. Friend the Member for Glasgow, Craigton (Mr. Millan). In an admirable speech he went over many points, but he naturally had to leave out many of the things that he wanted to say.
On page 13 of the Fyfe Report there are two very pertinent paragraphs—paragraphs 34 and 35—headed "Community Care" and "After-Care". To where do these defectives who are going out go? To the community care and after-care. Paragraph 34 says:The question of the respective financial responsibilities of the National Assistance Board and local authorities for the provision of funds and facilities for defectives should also be consideredThat is totally inadequate. The latter part of paragraph 35 says:The Sub-Committee found little evidence that these obligations with respect to after-care were being fulfilled.410 Of course we have been through all the figures for all the facilities that are available. This really is the crux of the objection which hon. Members on this side of the House have. Of course, we shall not oppose the Bill, but we want to see it become a reality. We do not want to see it become just another Measure on the Statute Book, a Measure without meaning or with only as much meaning as previous legislation has had. We do not want to see precisely no advance being made.
A very excellent booklet has been published by the National Society for Mentally Handicapped Children which talks about the two kinds of centres which can be used for these children, occupation centres and industrial training centres. No attempt seems to be made by the Government to describe the sort of centres which they have in mind or how they are to be financed. Some of my hon. Friends are quarrelling with the Government about the transfer of the occupational centres from the education committee to the health committee. But the industrial training centre calls not only for a combination of health and education, but also for the Ministry of Labour to try and see if we can integrate many of these adolescents who have been so unfortunate into the ordinary society and work of our community.
These are the kind of things that we should like to have heard about. We have not heard very much We impress upon the Government that while we have many reservations on many points our fundamental objection to the Bill is the fact that it does not promise any financial impetus in order to try to discharge these functions.
There are nine parts to the Bill, said the Secretary of State. There are five Schedules, said he, obviously enjoying the fact that there are so many pages in the Bill and so many words. But if he could only have added a paragraph to say that over the next five years, either in this Vote or in some other Vote within the National Health Service, the Government intended to have a financial programme which would build up all the hostels, centres and hospitals and be used to train the psychiatric and social workers, then we could understand that on the skeleton of the Bill it was intended to place flesh and blood. But we have had nothing like that.
411 In the knowledge that behind the right hon. Gentleman lies the Treasury we are not very sanguine about the prospect unless the Scottish Ministers can demonstrate that they have some plan or scheme for bringing up to date quickly the mental health services of Scotland. We shall support the Bill and, in Committee, seek to amend it as best we can.
§ 12.25 a.m.
§ The Joint Under-Secretary of State for Scotland (Mr. T. G. D. Galbraith)
We have had a good debate on what is a rather complicated Bill. The standard of the contributions which hon. Members have made reflects the attention they have devoted to the problems of mental health, and I thank them for the general welcome they have given to the Bill. I congratulate my hon. Friend the Member for Aberdeen, West (Mr. Hendry) on his maiden speech. He has a wide experience of local government, and I hope that he will make further contributions at later stages of the Bill, when what he has to say will, I am sure, be of great value to us.
Inevitably, in discussing a Bill of this kind, several detailed points have been raised. I shall do my best to answer them now, but, as the hon. Member for Glasgow, Govan (Mr. Rankin) recognised, they are really best discussed in Committee because of their very complicated nature. Although the subject of the matter is complicated, the object is a simple one, to enable the mentally sick to have the same informal, easy access to care and treatment which is available already to the physically sick. Simplicity is, however, often a difficult thing to achieve, and, in the process of seeking to simplify and modernise the law on mental health, we have produced a rather long and bulky Bill.
The hon. Lady the Member for Lanarkshire, North (Miss Herbison), together with her hon. Friends the Member for Glasgow, Craigton (Mr. Millan) and the Member for Lanark (Mrs. Hart), drew particular attention to the financial provisions of the Bill. The hon. Member for Lanarkshire, North seemed to think that, because the Explanatory and Financial Memorandum states thatThe Bill does not involve any substantial new charges412 this disclosed a weakness in the Bill which would prevent the development of better mental health facilities.
The attitude of the hon. Lady and hon. Members opposite may spring from a misunderstanding of the nature and scope of the Bill. The Bill is designed to provide the framework within which expansion will be possible. It does not itself initiate any new service, but it indicates the lines along which development should take place. The Bill creates a code. It sets the legal foundation for the things we want to have done in terms of care, treatment and aftercare. It does not itself provide—this was recognised by the hon. Member for Fife, West (Mr. W. Hamilton) who has very courteously explained to me why he could not be here now—the accommodation or recruit the workers essential for the work or support any of the unfortunate people we are trying to assist. These services are all the responsibility of various agencies, and the Bill lays down only the law under which they will work. Therefore, it does not require substantial new charges. I hope that that explanation will make clear to the hon. Member for Central Ayrshire (Mr. Manuel) the meaning of paragraph 2 of the Memorandum.
§ Miss Herbison
All my hon. Friends have made it quite clear that they understand what the Joint Under-Secretary of State is now saying. That is why we referred to the National Health Service Act and the National Assistance Act, since under those Acts local authorities have been quite unable to make proper provision. There ought to be financial provision in this Measure. There was no misunderstanding of it.
§ Mr. Galbraith
I will be coming to that aspect. Thus the National Health Service will provide, at Exchequer expense in the usual way, the hospital and specialist services that are required for mental illness. The local authority services, of which the hon. Lady has just spoken and to which the Bill refers, will be provided under other Acts.
The Bill clarifies and emphasises the provision that local health authorities will be expected to make. It also ensures that restrictions in other Acts that might stand in the way of local authorities giving all the services possible to the mentally disordered are swept away. 413 What it boils down to is that we look to the local authorities to play a large part in the expansion of the mental services where modern medical opinion shows that expansion is most needed—that is, outside the hospitals and in various forms of community care.
This expansion will certainly involve considerable expenditure, a point which the hon. Lady the Member for Lanarkshire, North made. I assure the House that, as far as this expenditure falls on the local authorities, it will be taken into account in the discussions on general grant which will be held later this year.
§ Mr. Galbraith
I recognise, as the hon. Member for Kilmarnock (Mr. Ross) says, that this arrangement does not altogether satisfy all hon. Members and that there may be differences of opinion as to the best way of financing local authority services. As the hon. Lady said in opening the debate, however, we have discussed these differences on many occasions in the recent past, and my right hon. Friend and I do not feel that it would be right in this Bill to put the clock back. So much for the financial aspects.
§ Mr. Manuel
The hon. Gentleman has said that care will be taken by means of a general Exchequer grant to ensure that the money is provided to permit the necessary expansion of the services. Is he giving a pledge that money will be earmarked for mental health care and that the block grant method will not be used?
§ Mr. E. G. Willis (Edinburgh, East)
This is an important matter, because it places a big burden on the local authorities. Can the hon. Gentleman give any indication of what allowance is to be made in the next block grant proposals for the increased expenditure on these services?
§ Mr. Galbraith
As I said only two minutes ago, that will be subject to the negotiations which are shortly to take place. [An HON. MEMBER: "Take it or leave it."]
414 Several hon. Members have, rightly, taken advantage of this Second Reading debate as an opportunity to comment generally on the mental health services, so I would like to say a word about the extent of the problem of mental disorder. The number of those who are mentally ill in hospital today is a little over 20,000, or about one-third of all hospital beds in Scotland. Generally, our resources are able to accommodate this number of patients, although there is a certain amount of overcrowding in some hospitals and schemes for major improvement are in hand. The situation on the mental hospital side is not bad.
Concerning mental deficiency, however, there are at present about 6,300 beds and, as the hon. Member for Craigton pointed out, this is not sufficient, but building projects are going forward which will provide about another 800 beds within the next three years. No final figure of the remaining deficit after that can readily be calculated, because it is not easy at this stage to predict how many of those now in institutions can return to the community under the new policy enunciated in the Bill. Apart from one or two areas, however, and except for some classes of low-grade defectives, we generally expect that when the building programme which I have just announced is complete, we will be within sight of adequate accommodation for the mentally deficient.
As for the old folk, the figures mentioned by the hon. Member for Fife, West have been fairly steady over recent years. The hon. Member asked, and so did my hon. Friend the Member for Fife. East (Sir J. Henderson-Stewart) why the proportion of old people in hospitals was high. The reason is that the incidence of mental illness, increases in old age. We hope, however, that with the provision of more intermediate hostels and more old people's homes, both of which are encouraged by the Bill, the number of old people who need to stay in hostels—
§ Mr. Galbraith
That is the hon. Gentleman's argument, but it is not the argument that I am propounding. I say that the Bill does encourage these things. The number of old folk who will stay in hospital will decline, and I believe that this will meet the point 415 made by the hon. Member for Glasgow, Scotstoun (Mr. Small).
As I have already indicated, a considerable portion of the Bill is devoted to ensuring that all the resources of the local authorities will be available to help the mentally disordered. This does not imply that local authorities are entering this field for the first time. They have for a long time played an important part in the care of the mentally sick and, in particular, of the mentally defective. For example, there are 2,600 mental defectives boarded out at the moment under the responsibility of local authorities.
The proper supervision and visitation of these patients is a matter to which many local authorities have devoted attention. The work that local authorities already do will be preserved and continued, and the particular provisions that we have listed in Clause 7 are designed to allow more comprehensive developments in future. For example, the reference to residential accommodation links up with the development in thought that the proper environment for certain mentally disordered persons is not necessarily within the hospital service. They are more likely to get better if they are able to continue to live in the community, or at least to return to the community soon afterwards.
I should like to say a word about education. Local authorities have devoted a considerable part of their resources to ensuring that the less gifted child is given every opportunity to develop his capacities to the full extent. The House will appreciate that there are some children who, although they are unsuitable for ordinary schools, can benefit from education modified to suit their capacity in a special school. In addition to these, there are other children whose defect of intellect or emotional disturbance is such that their education must be limited to training in occupation centres.
In Scotland the term "special schools" covers not only schools, but occupational centres of this sort and the great majority of children are able to benefit from one or other of these special schools which are provided by the education authority. There remain, however, a few children whom the education 416 authority regards as unsuitable, even for training in one of its occupation centres. I think that the hon. Member for Lanarkshire, North was suggesting that the education authority should be given responsibility for these children too. We think that that would probably be a mistake, and we thought it right to preserve the existing statutory responsibilities as laid down in the National Health Service Act, 1947.
Education authorities in Scotland have not been at all backward. They have provided about 43 occupation centres for training children under 16, and there is no doubt that education authorities in general show a keen interest in these children and their welfare. It seems to us to be perfectly proper for the education authority to be left with the power—and this is the important point—to decide whether a child can benefit from the facilities it provides, subject, of course, to the right of appeal to the Secretary of State for Scotland.
The alternative point of view which was referred to by the hon. Member for Craigton was advanced by the Scottish Health Service Council. This was that to ensure continuity of help for mental defectives all occupation and training centres should be the responsibility of the local health authority and not of the education authority. However, in view of the record of Scottish education authorities in this work, we felt that it would be better to leave the duties to the two types of authorities, as they are at present.
§ Mr. Galbraith
I am glad that the House agrees, but there is one proviso which I hope will not mean that there will not still be agreement between the two sides. It is only when local education authorities consider that they cannot help a child that his training will be transferred to the health authority.
§ Mr. Galbraith
I mean that degree of training which might be regarded as care and which the education authorities feel that they are not competent to give. The present position is to be kept, i.e., the education authorities will deal with 417 children both in special schools and in occupation centres and only when that authority feels that a child is not suited to its occupation centre will the child be transferred to the health authority.
§ Mr. Galbraith
It is obvious that we will have to examine this matter at greater length on another occasion.
One of the most important points which was raised by all hon. Members opposite was that the powers of local authorities to expand the services they provide are permissive only and are not expressed as duties. There are several reasons for that decision. First, not all local authorities have the same potential for expansion and a statutory duty would therefore have to be limited to what the smallest local authority could manage. Further, it would leave no scope for raising standards, which are easily adjustable, as and when required by the procedure envisaged in the Bill.
Secondly, if local democracy is to mean anything, then local authorities must at least be given the chance to exercise their initiative and to carry out developments along the lines which they think best. From this diversity of experience and experiment one local authority can learn from another.
§ Mr. Galbraith
No, but one hopes that gradually the smaller authorities' standards will be worked up. I can best explain the point by giving an illustration. The speed of a convoy has to be the speed of the slowest ship. Equally, if these standards are imposed by Statute, it would have to be the standards of the smallest and least well developed authority—[HON. MEMBERS: "No".]—that is the view I take. We all have plenty of time to discuss this on another occasion.
A third argument in favour of the Bill as drafted is that to single out the mental health services for entirely 418 different treatment from the rest of the Health Service, where the powers are permissive, would be quite contrary to modern thought on this subject, which is that we should wipe out the division between mental and physical health services. We would be doing the very thing we are trying not to do.
§ Dr. Dickson Mabon
Nevertheless, is it not true that the mental health services are not at the same stage of development as those for physical health and that, therefore, that argument is rather unfair?
§ Mr. Galbraith
I do not admit that it is unfair. We are trying to make the mental and physical health services the same and yet the hon. Member immediately says that we must have permissive powers for the one and mandatory powers for the other. We do not agree. We have permissive powers for both cases at a time when one is trying to make the two types of medicine comparable.
§ Miss Herbison
There is something in the hon. Gentleman's argument that both should be treated alike; but, with permissive powers, several local authorities have not provided what they ought to have provided for physical health. If we have to make both the same, could we not have mandatory and not permissive powers in both cases?
§ Mr. Galbraith
I mean at this stage. Everything I say is subject to the proviso that we shall have heaps of opportunity to—
§ Mr. Galbraith
I am only following the feeling of the House. Practically every hon. Member has said that, so I do not except anything else—unfortunately, perhaps.
The hon. Member for Govan asked a question about the so-called psychopaths and the hon. Member for 419 Greenock (Dr. Dickson Mabon) also referred to the class of patients mentioned in Clause 23. These are the high-grade mental defectives, and those mentally ill patients whose illness is displayed only in their behaviour over a long period. We have taken the view that medical treatment under compulsion is most likely to be effective for these patients during their adolescence, and that unless they fall foul of the law, they should not later be subject to compulsory treatment. Accordingly, the ordinary provisions of the Bill will reach these patients only if they are under the age of 21 and they will, subject to certain safeguards, have to be discharged not later than their 25th birthday. It is possible to suggest that any age that is fixed for this purpose is to some extent arbitrary, but we think that by allowing this reasonable period for treatment we are striking a proper balance between the liberty of the subject and the need for the health services to reach those patients who may benefit from treatment.
As to the categories to which the hon. Member for Kilmarnock and the hon. Member for Greenock referred, we believe that we have managed to provide for their proper treatment without making use of the terminology of the English Act with its four categories of mental disorder. We have stuck to two categories because Scottish doctors take the view that psychopaths whom they may be able to assist can always be regarded either as mentally ill or mentally defective. Further, in Scotland there is not the same anxiety as the Royal Commission apparently found in England to get rid of the term, "mental deficiency." No one in Scotland seems to prefer the terms, "subnormality" and "severe subnormality" used in the English Act. Because of this it seemed important to us to provide the medical profession in Scotland with terms in the Scottish Statute which it recognises and accepts. We think it important to do this especially when it can be done at the same time as providing a medium to limit compulsion to the same extent as in England without the complexity of a large number of categories which are apparently found to be necessary in England.
§ Mr. Rankin
And, of course, the treatment, with the definition not stated, will be in the control of the doctors who will certify.
§ Mr. Galbraith
I am not certain that, even if we had not four, but forty categories, we should not still to a certain extent be in the hands of the doctors. It is difficult to get away from that.
§ Mr. Galbraith
One has to have faith in somebody at some time.
During the Christmas Recess, knowing that this debate would be held soon, I took the opportunity to visit various mental hospitals and institutions and I have seen something of the inspiring work which has been referred to and which is being done by many devoted people. The hon. Member for Lanark and the hon. Member for Lanarkshire, North referred to the need for additional staff. They recognised that there are problems of recruitment and training which were examined by the Young-husband Committee.
My right hon. Friend the Secretary of State and my right hon. and learned Friend the Minister of Health are considering the recommendations of that Committee and I cannot anticipate their decisions. We recognise the need for an adequate supply of skilled teachers and I welcome the suggestions of the hon. Member for Lanark and particularly her reference to the possibility of employing married women on this work. As it is, however, local authority workers, hospital staffs and voluntary workers of all kinds are helping to create a service in which men and women can confidently expect to find ever more rewarding work which I hope will do something to stimulate recruiting to this service because we shall certainly need recruits if we are to expand the service in the way in which we hope to expand it.
As a statutory basis of the service, we are confident that this is the sort of instrument Scottish opinion will want to have. I am sure that the general welcome the Bill has received tonight truly reflects the attitude of our fellow countrymen towards this problem. It is a happy coincidence that in Scotland 421 we should mark the World Mental Health Year with legislative reforms that point the way to further practical improvements. I accordingly invite the House to give the Bill a Second Reading.
§ Question put and agreed to.
§ Bill accordingly read a Second time.
§ Bill committed to a Standing Committee pursuant to Standing Order. No. 38 (Committal of Bills).
§ Notwithstanding anything in paragraph (21 of Standing Order No. 57 (Standing committees (constitution and powers)) and Standing Order No. 59 (Scottish Standing Committee), Bill to be considered by the Scottish Standing Committee.—[Mr. Maclay.]