HL Deb 22 July 1914 vol 17 cc89-92

EARL RUSSELL rose to call attention to difficulties in early treatment of mental eases, and to present a Bill. The noble Earl said: As your Lordships are probably aware, there is a great growth apparently of lunacy. I say "apparently," because some critics think that the growth is partly due to more cases being certified. I think it is the opinion of practically all medical men that there are a great many cases in which symptoms of mental instability, if treated at an early stage by proper supervision and care, might never develop into certifiable insanity. Of course, every one of your Lordships would agree that if such treatment could be given, and if it should achieve the result of curing a lunatic, if I May put it so, before the person becomes a lunatic, and prevent the person from being under the stigma of having been certified a lunatic, and also save the consequent expense, it would be a very desirable result.

Under the present state of the lunacy laws people who are well-to-do who find themselves in a condition of mental instability are able to go as voluntary boarders to licensed houses and mental institutions, and from figures which have been supplied to me I understand that 400 of this class did so last year. But that course is not easily open to poor people. There is also a very great difficulty, which applies both to rich and poor, with regard to placing any one in that condition under the care of a doctor or some suitable person in a private house. The reason for that difficulty is Section 315 of the Lunacy Act, which makes any person subject to prosecution who harbours in his house an uncertified lunatic. Your Lordships will understand that if any one is treating a case which is on the borderland, which one doctor might hope would not develop into certifiable lunacy but which some other doctor might think was certifiable lunacy, the medical man who treats such a person with a view to preventing his becoming a certified lunatic runs a risk of prosecution tinder Section 315. That naturally makes doctors very unwilling to receive such patients, and when they do receive them they always run a considerable risk.

This matter has been considered, I may say, by a Committee on which there was represented the Medico-Legal Society, of which I had the honour to be president last year, and there were also representatives upon the Committee from the British Medical Association and the Medico-Psychological Association, and they considered and drafted this Bill, which is really for the purpose of avoiding the difficulties entailed by Section 315 of the Lunacy Act, which, as I have said, makes it difficult for a doctor to treat such cases as are on the border-line. In the treatment of these cases at the present moment one of two things has to happen. Either you have to let the persons in this condition go on until they become worse and are really certifiable lunatics and are henceforth under that stigma—and who are put to the very considerable expense consequent upon removal to an asylum, and so on—or the persons have to be treated by some one who takes the risk to which I have referred.

I have some figures showing the possibility of early treatment producing a good effect in these cases. In the London asylums last year, of all those who were discharged as recovered, 7½ per cent were less than one month under treatment, and 33 per cent. were less than six months under treatment. So it is obvious that, even in the cases of people who have been certified, treatment may produce very good results, and treatment which is adopted at an early stage may altogether prevent its ever being necessary to certify these people at all. I might mention to your Lordships that in the course of discussion we spoke of this as a Bill to deal with "incipient insanity," but Dr. Mercier, a great authority on these matters and perhaps also somewhat of a purist, objected to that, expression, holding that a person was either sane or insane. As a matter of fact, whether a person is sane or insane is one of the most difficult matters that doctors have to decide, the dividing line being so fine.

The Bill is now called a Mental Treatment Bill. I am sorry to say that this title also was objected to by the same authority, because he said that it conveyed something in the nature of a Christian Science treatment. The effect of the Bill amounts really to this, that such cases as those I have indicated may properly be treated in licensed houses by approved persons where a doctor is given an authority for mental treatment. It will be a kind of preventive treatment. It will be entirely voluntary—that is to say, the patient will be under no compulsion to remain, and may leave or give up the treatment at any time. I do not say from the legal point of view that that is exactly a good feature. Of course, in this matter I speak as a layman, though not without some experience of asylum treatment. But it was generally thought, I think probably rightly, that lawyers and Parliament, and probably the lay Press as a whole, would not stand any question of compulsion in these cases and would be afraid of anything like compulsory confinement. Therefore the Bill is purely voluntary. But where a medical practitioner is prepared to give this authority for the reception of such a patient in houses which would be under the inspection of what is now called the Board of Control—probably more familiar to your Lordships as the Lunacy Commissioners—then the patient may be treated safely without the doctor being under the danger of a prosecution under Section 315. That is to say, if at a later stage it turns out that the patient is in fact certifiable, it will be a sufficient answer to say, "I had an authority to treat the patient as a case not mentally certifiable." There are provisions for the proper ways of reporting the reception of patients, any change of address, and so on.

It is hoped that this measure may be the means of keeping out of our asylums a very large number of people who, under the law as it now exists, have to be certified for want of any adequate treatment without such certification. As it was put in one of the discussions which were held on this subject, the present law leads to the same sort of result as would happen if no medical man were allowed to treat scarlet fever until the patient had reached the stage when the scaling particles were being thrown off. I think that really covers the whole of the provisions of the Bill, beyond the fact that there is a power included for local authorities to make provision for treatment of cases of this sort in licensed hospitals and in public asylums. I need hardly say that at this stage of the session I do not propose to carry the Bill any further. It is merely desired by those interested in it that it should be presented to your Lordships in order that it may be printed and discussed in and out of Parliament. Medical men, of course, differ to sonic extent as to the details. Therefore I propose merely to lay it before your Lordships and the public in order that it may be considered. I beg to move that it be read a first time.

Moved, That the Bill he now read 1ª (Earl Russell.)

On Question, Bill read 1ª, and to be printed.(No. 187.)