HL Deb 09 July 1959 vol 217 cc948-54

3.30 p.m.

Amendments reported (according to Order).

Clause 3 [Mental Health Review Tribunals]:


My Lords, this Amendment deals with the point that the present wording, which consists of the word "fees", would enable, for example, the chairman of a regional Tribunal to be paid in that way. But as he may well have a considerable amount of administrative work, in addition to dealing with particular cases, it is desirable that it should be possible for him to be paid an annual inclusive salary for those services. The word "remuneration" will clearly allow this, which may well be the most suitable method of remuneration when the amount of work is known. I beg to move.

Amendment moved— Page 2, line 24, leave out ("fees") and insert ("remuneration").—(The Lord Chancellor.)


My Lords, I rise to ask whether the term "remuneration" is rather wider than the word "fees", and whether it might not be more desirable to include both words. It may be advisable in some cases to pay by way of fees and in other cases by way of remuneration. I would suggest that, even now, we might consider having both words in the Bill.


My Lords, I should be pleased to consider that point. As at present advised, I think that "remuneration" would include payment either by salary or by fees. But I will look into it again, and if there is any doubt about it at all I will take advantage of the noble Lord's suggestion and put down a further Amendment.


My Lords, may I ask one question—namely, does this refer only to chairmen? As I read it, it refers both to chairmen and to members, and one hopes that it would so refer.


My Lords, the noble Lord, Lord Taylor, is quite right. The clause gives complete discretion as it is framed at the moment, and that is our desire. I quoted chairmen because they are obviously the most likely example, but it does leave us free.

On Question, Amendment agreed to.

Clause 4:

Definition and classification of mental disorder

(2) In this Act "severe subnormality" means a state of arrested or incomplete development of mind which includes subnormality of intelligence and is of such a nature or degree that the patient is incapable of living an independent life, or will be so incapable when of an age to do so.

(4) In this Act "psychopathic disorder" means a persistent disorder of personality (whether or not accompanied by subnormality of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the patient, and requires or is susceptible to medical treatment.

THE LORD CHANCELLOR moved, in subsection (2), after "life" to insert: "or of guarding himself against serious exploitation". The noble and learned Viscount said: My Lords, this Amendment makes it clear that the definition of "severe subnormality" is intended to cover persons whose arrested or incomplete development of mind is of a nature or degree which makes them incapable of protecting themselves against serious exploitation. The Amendment arises from the debate in Committee on Lord Stonham's Amendment to Clause 26, which would have had the effect of removing the 21 age limit on the compulsory admission of "subnormal" (as distinct from "severely subnormal") patients under that clause. The intention of the Amendment is to make it abundantly clear that the more severely retarded of the patients at present classified as "feeble-minded" are intended to fall into the "severely subnormal" category. This has always been the intention of the Bill, based on the explicit recommendation of the Royal Commission. The Amendment should provide a useful reinforcement of the phrase at present in the subsection describing such patients as being "incapable of living an independent life".

In Committee the noble Lord, Lord Stonham, expressed himself as satisfied with this proposal. The only qualification he made was that it should be made clear that the revised definition would apply to severely subnormal patients of any age. This, of course, it does. No age limits apply to severely subnormal patients in Clauses 26, 33 or 44.

I notice that the noble Lord has an Amendment down later, but I hope that this present Amendment will meet his point. I ought to make clear that the phrase "serious exploitation" is intended to cover, for example, sexual exploitation of severely subnormal girls and women, and also economic exploitation by an unscrupulous employer: for instance, a person might employ a patient as a domestic servant and take advantage of her condition by expecting her to work excessively long hours without proper time off. A patient who is severely subnormal might not realise that there is anything wrong in this, nor be able to prevent it. If a patient who is an adult is incapable, as a child would be, of withstanding this sort of exploitation, he or she would come within the definition of "severely subnormal". The test for a child is that he will be incapable of withstanding this sort of exploitation when he comes of age. I beg to move.

Amendment moved— Page 2, line 46, after ("life") insert the said words.—(The Lord Chancellor.)


My Lords, I am extremely grateful to the Lord Chancellor for finding this solution to a very real problem. This method of meeting the difficulty is a practical and satisfactory one. When the time comes I shall certainly not move my Amendments, which would not have been either practical or satisfactory, if they had been acceptable. But they have served to illustrate the need. The kind of person that I particularly had in mind was the subnormal, or perhaps severely subnormal, person who had been living at home and was adult, whose parents were no longer able to care for him or her. As the Bill stood originally, such persons might not have been able to be admitted to a hospital in later life. I am quite sure that this Amendment covers the point satisfactorily. It is most helpful, and I am extremely grateful to the Lord Chancellor for his manner of dealing with it.


My Lords, like my noble friend Lord Stonham, I greatly welcome this change. In effect, it converts the subnormal patient who is in danger of exploitation, into a severely subnormal patient who can, in his own interests, be dealt with compulsorily by detention. I think it fully meets the point we have made.


My Lords, I am grateful to both noble Lords for what they have said.

On Question, Amendment agreed to.

3.39 p.m.

THE LORD CHANCELLOR moved, in subsection (4), to leave out "of personality" and insert "or disability of mind". The noble and learned Viscount said: My Lords, in the definition of "psychopathic disorder", in subsection (4) of Clause 4, the Amendment would substitute the phrase "persistent disorder or disability of mind" in place of "persistent disorder of personality". This arises from the discussion in Committee on the Amendment of the noble Baroness, Lady Wootton of Abinger, to substitute the new definition of "psychopathic disorder" This Amendment meets one of the two points which she particularly asked me to look at in withdrawing her Amendment. The noble Baroness suggested that it was necessary to import into the description of the underlining disorder the words "mental" or "mind", so as to emphasise that psychopathic disorder is a form of mental disorder. She suggested that if this were not made clear a diagnosis might be made without any symptoms other than persistently anti-social behaviour.

I agree that psychopathic disorder is a form of mental disorder. Very often the patient's behaviour provides the main symtoms on which the diagnosis is based; but anti-social behaviour of the sort described in the later words of the definition is not in itself enough to establish the diagnosis unless the pattern of behaviour shows other abnormal features which indicate that it is the result of an underlying mental disorder. I think we were all in agreement with that as we developed our earlier discussion. I agree that the introduction of the term "mind" instead of "personality" helps to make this clear, and I am therefore willing to make this Amendment. I ought perhaps to explain that the phrase "disorder or disability of mind" is used to make it quite clear that permanent defects of mind are covered. The same phrase occurs in subsection (1) in the definition of "mental disorder" itself.

The second point which the noble Baroness, Lady Wootton of Abinger, stressed in withdrawing her Amendment concerned the words "requires or is susceptible to medical treatment" in subsection (4). The noble Baroness suggested that "or" should be amended to "and". I pointed out that it should be possible to apply the definition to a patient for whom there was a hope of benefit from medical treatment, even if there could be no certainty of cure. The noble Baroness stressed that "there should be a real prospect of amelioration", and the noble Lord, Lord Taylor, pointed out that the treatment of psychopaths is a training and educative process rather than a strictly medical process.

To take the noble Lord's point first, "medical treatment" is defined in Clause 146 (1) as including care and training under medical supervision, in addition to nursing. The sort of training which is given to psychopathic patients in mental deficiency hospitals and elsewhere under the general direction of a doctor is therefore included within the meaning of medical treatment in the definition of "psychopathic disorder" in Clause 4 (4). But after full consideration of the points made in Committee, I feel that it is necessary to retain the words "requires or is susceptible to". The two main reasons are, first, that if the phrase "susceptible to" were used alone it would not be possible to apply the definition except where improvement could confidently be prophesied, and that would cut out many cases where benefit is expected. Secondly, it is often possible by training to benefit the patient by improving his conduct and behaviour, even if the underlying mental condition remains. In that sense it can be said that the underlying disorder "requires" treatment, but not necessarily that the disorder itself is "susceptible to" it. I am satisfied that these words will not lead, if I may use the language of the noble Baroness, to indefinite detention in circumstances in which the doctor does not expect that the patient will benefit", but I feel that the words are necessary to allow such cases to be treated. I said on the last occasion that there was a certain metaphysical aspect of this problem, but I should like the noble Baroness, Lady Wootton of Abinger, to believe that I have considered it carefully, and I hope that she will take some small comfort from the fact that I have at any rate met one of her points. I beg to move.

Amendment moved— Page 3, line 7, leave out ("of personality") and insert ("or disability of mind").—(The Lord Chancellor.)


My Lords, I greatly appreciate the consideration which the noble and learned Viscount has given to the points which were raised by my noble friend Lord Taylor and myself in connection with this matter. Speaking for myself, I feel that the shift in emphasis from conduct to mental condition has been made very much clearer by the substitution of the words "mental disorder or disability of mind" rather than "disorder of personality". We are very grateful for the substitution of those words. We may still feel that the application of these definitions in practice will be an extremely tricky matter, and possibly the more tricky because it is still open to include in the psychopaths those who are not demonstrably susceptible to medical treatment. That can remain, but we accept the noble and learned Viscount's statement that he has given that matter, too, very serious consideration and we are most appreciative of his action.


My Lords, may I join in expressing our appreciation to the noble and learned Viscount the Lord Chancellor for his consideration of this matter? The new definition brings our law closely into line with Danish law in this matter. Under Section 17 of the Danish Criminal Law of 1930 the Danes attempt a definition of "psychopath". In Section 16 they say that persons suffering from mental disorder who are irresponsible shall never be convicted of a criminal offence. They are sent straight to a mental hospital. Section 17 deals with those suffering from—and I quote: mental underdevelopment, mental weakness or derangement of mind not sufficient to produce irresponsibility. In Denmark the court can send such people to a mental hospital, a home for inebriates or a psychopathic prison; but I think I am right in saying that in Denmark they cannot, as we shall be able to do under this Bill, when it becomes an Act, commit psychopaths for treatment without due process of law. I think the Amendment emphasises once more the need for psychopathic prison hospitals, or psychopathic hospital prisons, in which these patients—for "patients" is what the noble and learned Viscount the Lord Chancellor now makes them—can be treated. We thank you.


My Lords, again I am grateful for what the noble Lady and the noble Lord have said. I ask the noble Lord, Lord Taylor, to note a rather interesting partial advance along the same road as that which he mentioned in his quotation from the Danish law, in the shape of the Amendment which I put down in response to a request by my noble and learned friend Lord Denning, to avoid these mental cases being sent to prison. It is a very short advance but it is along the same road and will, I think, interest the noble Lord. We shall come to that matter. In the meantime, I am grateful for his remarks.

On Question, Amendment agreed to.