§ LORD KILMAINE rose to move to resolve, That all mental homes having over 100 patients, should be required to include a fully equipped gymnasium in their establishment, and that the same provision should also be made in respect of the State prisons and reformatories and county asylums. The noble Lord said: My Lords, I have put this Motion on the Paper in the hope that I may thereby be able to help the many hundreds of unfortunate men and women who are dragging out their lives in the mental homes and asylums of this country. I happen to have very intimate knowledge of the life that goes on in these mental homes, because I have two friends one of whom has been and one who unfortunately still is a paying guest at two of the best known of them. I say without hesitation from what I know that the life of the average patient in these homes can best be described as one of total inertia.
§ It is true that in one of the best known of the mental homes—I refer to one in Sussex—every provision is made for those patients who are able to take part in physical games and exercises to do so. They are provided with a golf course, tennis courts, croquet lawns, putting greens, and pleasant walks that take them along the country lanes. But in bad weather there is practically no exercise whatever which those patients or their attendants can have. The patients are restricted either to spending the day moping in their rooms or walking up and down the corridors, if they are so permitted. There is certainly a billiard room, but it stands to reason that only a few can indulge in this form of exercise. In the more drastic homes the only form of exercise for the patients in fine weather is exercise in what is called an "airing court," which is a courtyard about the size of this Chamber surrounded by high walls, with a plot of grass perhaps in the middle and a few paths round the edge. Here the unfortunate patients have to sit, or walk up and down aimlessly, until they are herded in to meals. The only other form of exercise that they have is going for gang walks round the grounds or along the high roads in the charge of 784 uniformed attendants. In wet weather they have absolutely no exercise at all.
§ I venture to think that if a gymnasium were provided it would be of immense benefit to the patients themselves of both sexes and to their attendants. Many of the Attendants have a most wearying time. They are often in charge of, and responsible for, patients who require constant supervision, and when they get time off there is often nothing for them to do except to flirt with the female staff. The old Latin tag mens sana in corpore sano would, I think, find fulfilment in the case of many mental patients of both sexes—for unfortunately there are more women than men in these places—if they could obtain healthy exercise in a gymnasium. There are, of course, many patients who for one reason or another are quite incapable of taking part in outdoor games or exercises, but any able-bodied patient could take part in some of the forms of gymnastic exercise that could be provided. In the case of violent patients, part of their trouble is due to exactly the same cause as leads the chained-up dog to be savage—the feeling of being confined in a limited space and having no outlet for their pent-up energy. I am firmly of opinion that in many of these places if the patients could get healthily tired out by doing gymnastic exercises, that would greatly conduce to their general health and to their sleeping better at night, and it would probably also lessen their outbreaks of violence.
§ What is needed in most mental cases is to find some means of restoring the patient's self-respect and of arousing his interest, and I believe firmly that if patients could be interested in gymnastic exercises, and especially if they could excel in any particular branch of them, the spirit of emulation and the feeling of being successful would take them out of themselves, help them to forget their own troubles, and would probably conduce greatly to their cure. I do not know whether the State prisons or reformatories are provided with gymnasia. I have heard only of one case of a mental home for naval men where there is a gymnasium. But I cannot help thinking that here, too, the facilities, if provided, would be of the very greatest benefit, especially in the case of reformatories where young people are detained. I 785 hope that none of your Lordships will think this Motion of mine a frivolous one. It is not. From inside knowledge of what goes on in these places I am fully convinced that the proposal which I venture to make would result in vast benefit to many unfortunate people who live therein and would greatly lighten their existence. Surely it is better that patients in mental homes and hospitals should tire themselves out in healthy exercise in the gymnasium than that they should be taken for dull walks along the high roads or allowed to sit moping in "airing courts." My Lords, I beg to move.
§ Moved to resolve, That all mental homes having over 100 patients, should be required to include a fully equipped gymnasium in their establishment, and that the same provision should also be made in respect of the State prisons and reformatories and county asylums.—(Lord kilmaine.)
§ LORD ADDINGTON
My Lords, I must apologise for inflicting myself twice upon your Lordships, but as a member of a Committee which is concerned with this subject I should like to support everything that the noble Lord has said with regard to the benefit—
§ THE SECRETARY OF STATE FOR WAR (VISCOUNT HAILSHAM)
The noble Lord is speaking from the Episcopal Benches.
§ LORD ADDINGTON
I apologise to the House. I had not intended to address the House, but one of the things that the noble Lord said caused me to rise from the place where I was sitting to say a few words in support of his Motion. I want to emphasise, as a member of a committee which is responsible for one of our mental hospitals, the enormous importance of physical recreation and exercise. I think there can be no doubt of its value. The only point upon which I would offer any comment is that the noble Lord has not made clear how in many cases such a requirement could possibly be enforced. After all, a great many even of the county mental hospitals are much restricted both as to space and as to finance. The noble Lord knows that a lot of them are very seriously overcrowded, particularly on the female side; because, as he rightly says, 786 there are many more patients on the female side than on the male side. If they are not able to get more ground and if there is no room for extension, it is very difficult to require the responsible authorities, at a moment's notice, to build a gymnasium and provide the equipment for it, with accommodation for the staff who would have to supervise it. The Board of Control who are the authority in these matters are particularly urgent in pressing the importance of recreation upon committees of county mental hospitals. In our own case we had an extension pending for some time but were unable to move until we had acquired the land which was necessary to permit of the extension. So that while urging that everything should be done to attain the end which the noble Lord has in view, and while agreeing that the attention of the Board of Control and the visitors who deal with even the ordinary mental homes might be specially drawn to what the noble Lord has said in this matter, I venture to suggest that a strict requirement would be somewhat difficult to enforce.
My Lords, I am sure that your Lordships would wish to be sympathetic towards the case of my noble friend Lord Kilmaine, but I must point out that what he is actually proposing is that a law should be passed to compel local authorities and others to provide the gymnastic facilities for which he asks. There is, of course, no reason now why any local authority should not, if it thinks fit, provide gymnasia, and I think the whole point is really whether there is sufficient evidence to support the passing of new legislation to compel them to do it. I think we must consider to what extent the majority of patients in any given institution would be capable of using gymnastic appliances. In any institution there are obviously many who are aged and infirm, and if we take those into account, and also those who physically or mentally are unfit to use gymnastic appliances, I feel that the law might merely have the effect of compelling the erection of gymnasia which could only be used by a quite negligible minority.
We must remember that patients are in these institutions for definite medical treatment, and therefore their course of life must for that reason be directed by-the medical officers not only having re- 787 gard to their mental treatment but also to their physical treatment as well. Properly controlled physical culture is becoming more and more recognised as a suitable and indeed necessary part of this medical treatment; but physical culture of this sort can very largely be provided without apparatus of any kind, and the question as to whether this kind of physical culture is being sufficiently used in the various mental hospitals is one which is engaging the attention of the Board of Control. The Report of the Board on Occupational Therapy in 1933, and their Annual Report of last year, both refer to this question, and indeed they go further and say that there is undoubtedly scope for much further development in this direction; but at the same time the Board emphasise that this form of treatment does not necessarily involve elaborate equipment.
Considering that the use of gymnasia for purely recreational purposes is rather ruled out in the case of the majority of mental patients by reason of their condition, the question seems to me really to be how far these extra appliances would be necessary for proper medical treatment. I am unaware that there is any evidence to that effect, and I am unaware that any medical officers have demanded that for the proper treatment of their patients further gymnastic accommodation of the kind asked for in the Motion should be provided. They may have done so, but I am not officially aware that they have made such demands. Actually, I think the noble Lord himself, when he referred to the absence of exercises in institutions, referred to gymnastic exercises rather than to the kind of exercises that would demand more elaborate equipment.
I must refer perhaps separately to the question of the mentally deficient as opposed to those in the ordinary mental hospitals. To them physical exercises and gymnastics cannot have such a therapeutic value in quite the same sense as can be claimed in the case of patients suffering from mental disorder. Most mental defectives are unlikely to improve mentally; but proper treatment may produce great improvement in conduct and power of adjustment. Moreover, in mental deficiency institutions a considerable proportion of the patients are young and able-bodied, and physical drill and other 788 forms of organised exercise are an essential part of the daily life of these patients. It may be added that at the State institution at Rampton, where a very large number of high grade defectives are under care, a properly equipped gymnasium is provided.
It might be said therefore that perhaps the case for mental deficients is stronger than the case of patients at mental hospitals proper. But even at institutions for the mentally defective conditions are by no means the same everywhere, and it must be remembered, too, that the re-allocation of institutions under the Local Government Act, 1929, is necessarily a slow process, and is by no means yet complete. In all these circumstances I would suggest to the noble Lord that what he suggests is premature. The Government are really alive to and sympathetic towards the facts which the noble Lord has put before the House, but we feel that it would be wrong to put the State and the ratepayers to the kind of expense which I think the noble Lord has in mind, when there is no evidence that the doctors require it or that the local authorities are not properly using the powers they already possess. The noble Lord will understand that we are fully alive to the possibility of improving the facilities for physical training.
In regard to the noble Lord's question as affecting prisons and reformatories, I have been asked to make a statement on behalf of my right honourable friend the Secretary of State for Home Affairs. The institutions mentioned in the Motion for which the Home Secretary is departmentally responsible in a greater or less degree are approved schools (formerly called reformatory and industrial schools), Borstal institutions and prisons. The great majority of the approved schools, particularly those having the custody of boys between fifteen and seventeen years of age, have either fully or partly equipped gymnasia, and skilled members of the staff or visiting instructors carry out instruction in physical training. In the case of Borstal institutions the provision of efficient physical and gymnastic training has always been recognised as an essential part of the treatment of the young persons who have been sent there. As regards prisons, great progress has been made in recent years in improving the physical condition of prisoners, and all 789 but six prisons have either fully equipped gymnasia or workshops which are used for gymnastic purposes and are equipped with apparatus. Of the remainder, one is shortly to be provided with a building which will be available for gymnastic purposes, and in the other five the inmates are, on account of age or physical condition or for other reasons, unsuitable for gymnastic exercise. The staff of every prison includes officers trained in physical exercises.
The Home Secretary fully appreciates the importance of the bearing which physical training has upon the mental and physical welfare of the inmates of the institutions under his care, and the matter is one to which particular attention is paid by the Prison Commissioners as regards prisons and Borstal institutions, and by the Home Office inspectors in the case of approved schools. It will, however, be recognised that there is a difference of opinion among medical and other competent authorities as to whether physical training is best afforded by means of equipment or by what is generally known as physical drill, and as at present advised the Home Secretary is of opinion that the question whether gymnastic appliances should be provided at those institutions which do not at present possess them is best left to the judgment of those in close touch with conditions at the individual institutions. I can, however, assure the noble Lord on his behalf that he will not fail to give the closest attention to what the noble Lord has said. I hope that in those circumstances the noble Lord will be satisfied that the Government are doing what they can to pay attention to the ease which he has put, and will not find it necessary to press his Motion.
My Lords, having regard to what the noble Lord has said on behalf of the Government, I will not press my Motion, but I should like to point out that I did not visualise any expenditure by the State. I was thinking 790 of two mental homes which charge very high rates indeed to the representatives of the unfortunate people who are under their care—as much as £600 or £800 a year each. They are money-making concerns, they are a syndicate, and they could perfectly well afford out of their own profits to put a gymnasium at the disposal of the patients and staff if they wanted to do so.
§ Motion, by leave, withdrawn.