§ LORD SANDHURST asked His Majesty's Government whether they will in the present Session introduce legislation to enable voluntary boarders to be received into public asylums. The noble Lord said: My Lords, I may perhaps remind you that there are three classes of institutions that provide for the treatment of the insane. There are the licensed houses, more commonly known as private asylums, and registered hospitals, and these two cater for those who are persons of reasonable means—some with comfortable means; then there remain the public asylums, which cater for the poorer class of patient. The first two can receive what we call voluntary boarders; that is to say, patients who feeling themselves in danger of mental disturbance volunteer for admission to those institutions. But with two exceptions, which I will mention later, public asylums cannot receive voluntary boarders, and in that respect the poorer classes are placed in a very disadvantageous position compared with that of their more wealthy neighbours.
It is five years since the Mental Treatment Bill of 1923 passed all its stages in this House, and it contained, with, I think, complete approbation, a provision which would have remedied this injustice. It is two whole Sessions since the Royal Commission on Lunacy reported, and reported in favour of this change, and I may perhaps be allowed to
two passages from that Report. One, on page 45, is as follows:—
The evidence given before us indicated conclusively the need for remedying this omission,
and, referring to the Mental Treatment Bill of 1923, the Report contains this passage:—
The reforms to which it is directed are long overdue.
I limit myself to advocating the adoption of this single reform for three reasons. In the first place I realise that Parliamentary time will not admit of any extensive reform of the lunacy law; in the second place, I believe this proposal to be entirely non-controversial, and I feel considerable confidence in this on account of the attitude taken up by my noble friend Lord Russell when he raised the subject more than two years ago, and I think I can rely upon it that his friends, as a Party at any rate, will not offer any opposition to the suggestion that I make: and, lastly. I believe it to be the most urgent of the reforms indicated by the Report of the Royal Commission. Another reason I have for putting it forward now is that the political future of next year is somewhat obscure, and we may have interposed yet a further delay in lunacy reform, which is now, as I have said, long overdue.
§ The principle is not a new one. It is in force in Scotland. In Scotland the public asylums are able to receive voluntary boarders; and in this country, by Private Bill legislation, the London County Council obtained power to entertain voluntary boarders in the wards of their Maudsley hospital as long ago as 1915, and, since the Mental Treatment Bill failed, owing to the Dissolution of 1923, the City of London has obtained similar powers to receive voluntary boarders in their present hospital or in any other hospital they may establish for mental patients. The powers in the latter Bill were granted almost in the same terms as those suggested in the Mental Treatment Bill. There can be no difficulty of draftsmanship, because the matter is all cut-and-dried. The necessary language will be found in Clause 2(3) and Clause 5 (1) of the Mental Treatment Bill, 1923, and further precedents are afforded by the Private Acts of Parliament to which I have referred, and parts of which will 377 be found in Appendices 13 and 13 a of the Report of the Royal Commission.
§ When this matter was raised before by my noble friend Lord Russell, it was pointed out on behalf of the Government that several reforms suggested in the Royal Commission's Report were such that they could not be dealt with apart from the question of Poor Law reform. Now that observation does not really apply to this suggestion that I make. The private enactments to which I have already referred show that it is a matter which can quite easily be dealt with piecemeal and by itself. But it may be possible for a clause to be introduced in the Local Government Bill which is now being discussed in another place. In this connection perhaps I may say it was with very great satisfaction that I read that the noble Earl, who had charge of the Mental Treatment Bill in this House and who made himself thoroughly acquainted with the whole business and knows well the necessity for the reform for which I ask, is going to have the conduct of the Local Government Bill in your Lordships' House.
With your Lordships' permission I should like to read a short, extract from a speech made recently at the Public Health Congress by Mr. H. P. Macmillan, who was Chairman of the Royal Commission on Lunacy Reform. He is reported to have said that—
When he first approached the problem which came before the Royal Commission he was impressed by the cardinal defect in the existing law, that prevention was better than cure, and how this doctrine had not been recognised. He had no secrets, but he was hopeful of legislation. There was no legislation which would be more beneficial and bring more happiness to those who had suffered than an Act of Parliament which would throw open the doors of our mental hospitals to those who desired to avail themselves of their treatment.
I beg to ask the Question which stands in my name on the Paper.
§ THE EARL OF CRANBROOK
My Lords, in rising to support the noble Lord, Lord Sandhurst, I am not quite so sanguine as he in thinking that legislation may be introduced this Session; but I hope that something may be done in regard to this matter. It cannot be too strongly urged that the best chance for the early recovery of a patient suffering from 378 mental disease is the earliest possible diagnosis and treatment. Once the disease has progressed so far that certification is necessary the chance of recovery is infinitely more remote. It is fair to say, I think, that in this country we are very much behind the rest of the world as far as the early treatment of cases of mental disease is concerned. In America they have the great Phipps Clinic at Baltimore. There are similar institutions at Utrecht and other places on the Continent, while the Zurich Hospital is world famous. Under the Lunacy Acts, as the noble Lord has pointed out, local authorities in this country are empowered to deal only with certified cases. The only hospital which can accept voluntary boarders is the Maudsley Hospital of the London County Council, which, by private legislation, has been able to do that, not since 1915, but since 1923. This Hospital was the first of its kind to be established to deal with early cases of mental disorder, and that some provision of this sort was very necessary has been shown by the fact that the demand for beds has greatly exceeded the supply and that there has been such pressure on the out-patients' department that it has been practically impossible to cope with it. The enlargement of the Hospital is very likely to take place in the near future.
Apart from the benefit to the patients themselves, the system of allowing voluntary boarders in mental hospitals will be of great benefit to the medical profession. It will enable observation to be made of cases possessing unusual scientific interest and will do a great deal to bring together the treatment of cases of mental disorder and ordinary general medical practice which now, I am sorry to say, are somewhat widely separated. Although it is rather early yet to draw conclusions from the statistics obtained at the Maudsley Hospital, the figures show that of the cases admitted to that hospital many more recover than of the certified cases which go to the ordinary mental hospitals of the London County Council and other institutions. On the score of economy as well as of humanity I would urge that some such legislation as is proposed should be introduced very soon. It is far more economical to cure these infirm people at the early stage of their disease than to wait until they are certified and 379 then allow them to drag out a dreary existence in some mental hospital as well as being a continual burden on the rates.
My Lords, I am glad to welcome to your Lordships' discussions of this subject a new recruit who is interested in mental treatment. The noble Lord who introduced this subject has, of course, quite a special and extensive knowledge of the matter. I acquired perhaps a more diffuse but even wider knowledge of it in my two years on the Royal Commission in which, I think, we had before us either collectively or singly practically the views of every alienist in the country. This is really a matter both of humanity and of common sense. All those who are interested in this matter, the late Chairman of the Board of Control, the whole of the medical profession who have to deal with it, all those who administer asylums, have their hearts really wrung all the time by realising that there is in the country a large class of persons mentally unstable, and becoming more mentally unstable, for whom there is no treatment available until they reach the final stage of certification.
It is unlike any other disease. You are practically, in the present circumstances, unable to treat it in its initial stages and in the stages where you might prevent it ever becoming the subject of certification. All of us on the Royal Commission were tremendously impressed with the weight of this evidence, and I hope that the Government's spokesman, even if he does not make a very favourable answer, as, indeed, he did not when I addressed your Lordships on this subject some two years ago, will say that some thought will be given to accepting even this one very simple proposal which is now put forward by the noble Lord. The well-to-do are able to obtain from private doctors, or from private asylums, treatment as voluntary boarders under the voluntary system before they are certified. The only place where the poor can obtain adequate treatment of that character is the county asylum, and the doors of the county asylum are now closed to any one who does not come there with a certificate of insanity; that is to say, such asylums cannot take in and cannot treat people in the early stages, however much they 380 may wish to do so. I told your Lordships before, and I think it is worth repeating, that we actually had evidence of people who had said that they wished to go there and be treated but they could not go, and had to wait until some months later they got worse and were taken there as certified lunatics.
So much for the side of humanity. Now let us look at the side of common sense. If you can avoid certification, if you can arrest mental disease at an earlier stage and turn the person out a sane citizen and useful worker it is surely all to the good of the country. It reduces the upkeep of asylums, it will reduce the total certified population, and it is really a measure of sound economics. It is a very small matter, but I cannot help thinking that either by a single-clause Bill, which I do not think would meet with much opposition from any quarter, or, as is suggested, by a mere amendment to that very voluminous Bill which is now being dealt with in another place and which I can quite understand there may be hesitation in further encumbering, or in some other manner this subject could really be dealt with in this Session of Parliament. I appeal to the Government to do what everyone who knows about these things is most anxious to see done, and what everyone feels it is folly not to be doing—to start at once by giving the opportunity for voluntary treatment to those who feel that they are ready to submit to it, and who by that treatment may be saved from the much more expensive and much more troublesome compulsory treatment afterwards, which by the stigma of certification sometimes destroys their chances in the world when they are released after cure and their chances of remaining cured. I only rose to impress upon your Lordships the fact that this is really a matter of very considerable importance.
THE PAYMASTER-GENERAL (THE EARL OF ONSLOW)
My Lords, you have listened to speeches from two noble Lords who are peculiarly qualified to deal with this question. The noble Lord who raised the matter has very great experience, and my noble friend opposite [Earl Russell] served upon the Royal Commission and has great experience and knowledge of the subject. The noble Lord, Lord Sandhurst, mentioned the fact that 381 the Royal Commission reported some two years ago and issued a very comprehensive Report upon the whole matter. It is certainly the hope of the Government to lay before Parliament a measure to deal with certain aspects of the recommendations of the Royal Commission and to deal with the subject as a whole. The noble Lord, Lord Sandhurst, the noble Earl opposite and also my noble friend behind me expressed the hope that it might be possible to deal with the subject separately, but there are considerable difficulties in bringing in a Bill dealing with one side only of the question, and dealing with it separately. We feel that the proper way of dealing with this important matter of lunacy and mental disorder is by treating it as a whole under one Bill.
THE EARL OF ONSLOW
I will come to that in a moment. The noble Earl suggested, if we did not bring in a one-clause Bill, that we might introduce some addition to the Local Government Bill. I dare say your Lordships have studied the White Paper which was issued to accompany that Bill on the First Reading, and those of you who have done so will see that the Minister of Health stated that the reason why certain recommendations of the Commission regarding lunacy law were not dealt with in that measure was that it was proposed to deal with the whole matter separately. That being the intention of the Government, it would, I venture to think, in spite of the weighty arguments which have been brought forward by noble Lords, be inconvenient to deal with this question of the admission of voluntary boarders into public mental hospitals separately. Although this question is a very important one it is only one of those which were before the Royal Commission. Another very important consideration was mentioned by the noble Lord, Lord Sandhurst, and it is this. At the present stage in the life of Parliament, with the numerous commitments that the Government have, it is impossible to bring in a comprehensive Bill dealing with the whole of this subject. If you deal with one part of it, it is difficult to see why other parts should not also be dealt with. Although I am afraid I cannot give a satisfactory answer to what 382 noble Lords have asked me in regard to dealing with this matter in the present Session, I can say that the Government hope to introduce a Bill dealing with lunacy and mental disorder as soon as possible, and when that is done I can give an assurance to noble Lords that provision for the admission of voluntary boarders into public mental hospitals will certainly find a place in the Bill.
The noble Lord alluded to the Mental Treatment Bill of five years ago which I had the honour of introducing to your Lordships. The noble Lord opposite, Earl Russell, has supported this proposal of voluntary boarders, and I think, judging by the experience we had at the time of the Mental Treatment Bill, that this particular proposal of the Royal Commission is likely to meet with support from all sides of your Lordships' House. In order to indicate to your Lordships the importance which His Majesty's Government attach to this question, I would like to quote what was said by my right hon. friend the Minister of Health. In another place a short time ago, he said—I fully realise the great importance of improving the facilities for early mental treatment; and, as I have frequently stated, I hope to be able to take the necessary action as soon as it is practicable to introduce legislation.We regard extended facilities for the treatment of incipient mental trouble as one of the most important features to be included in any lunacy legislation, and though, for the reasons I have stated, we are unable in the present Session to introduce legislation as suggested, the matter will certainly be dealt with when a Lunacy Law Reform Bill is introduced, and we hope that such a measure may be brought before Parliament at no distant date.