Dáil Éireann debate -
Friday, 1 Dec 1944

Vol. 95 No. 10

Committee on Finance. - Mental Treatment Bill, 1944—Second Stage—(Resumed).

Seán Mac Cárthaigh

Ba mhaith liom, maraon leis na Teachtaí eile a labhair arú inné sa Tigh seo, an Bille nua so um shláinte phoiblí do mholadh; agus ina theannta san comhgháirdeachas do ghabháil leis an Rúnaí Párlaiminte dábharr. Ar nóin, is céim bhreágh thábhachtach ar aghaidh an Bille seo, go mór-mhór do na daoine a dtuiteann galar meabhrach ar dtúis orthu; agus im thuairim féin nuair a cuirfear an Bille seo i bhfeidhm mar dhlí, coimeádfaidh sé éalang áirithe uathu amach má thárlaíonn go dtagann biseach nó feabhsú orthu taobh istigh de thrí nó sé míosa agus tabharfar sólás agus dóchas dá muintir chomh maith leís sin.

This new Bill has many excellent progressive features, more especially in relation to the diagnosis and treatment of early symptoms of mental illness. It is, I think, readily admitted by all sides of the House that it is an excellent measure and the Parliamentary Secretary in introducing such an admirable measure deserves our heartiest commendations. Roughly speaking, this measure will affect four sections of people. In the first place, we have the administrative bodies responsible to the Minister for the provision and administration of proper institutions for the treatment of mental disease. One of the splendid features of the Bill is the section dealing with the possibility of a number of such administrative bodies co-operating for the purpose of establishing research laboratories—a much-needed provision, I should say, in the preliminary work for the adequate treatment of this disease. I think it was Deputy O'Higgins who referred to the fact that there were no post-graduate courses for those who intended to specialise in this particular branch of national health but, as far as my knowledge and experience go, I think the medical men who were admitted to the mental hospital departments had first to undergo a postgraduate course in the study of mental diseases. In addition—probably the matter would not arise under this Bill —there is the provision of travelling studentships, and so on, in countries where this particular branch of medicine has received special attention for years.

Regarding the patients threatened or afflicted with mental illness, what I may call the early treatment period will save them from what is commonly regarded as a stigma. Mental disease is not more remarkable than any other disease, but in the public eye some stigma attached to those who were afflicted with mental disease.

Under the Bill, those who may be affected will now have a better chance of retaining their property, until the course of the disease is definitely established. The Parliamentary Secretary told us that about 33? per cent. of the patients recover after three to six months. There is a danger of relapse if they recover after three to six months and find themselves amongst people who for long years have been affected by this disorder. That danger is largely obviated by the provisions in this new Bill.

These provisions will relieve relatives of many natural anxieties. They will now know that special care and attention will be given patients in the early stages. The only part of the Bill likely to cause any difference of opinion will be the section dealing with the staffs in the immediate charge of the institutions and of the patients. We admit that the employment is not a very congenial one, involving as it does years of care and continued vigilance. The staffs look forward to getting two-thirds of their pay and emoluments as the basis of pensions. They will not get that under this Bill, even though many improvements have been made, for which full credits must be given to the Parliamentary Secretary. Instead of calculating on ten years previously as the basis of the pension to be granted, it will now be on the last three years. In addition, it is proposed to give one year's salary and emoluments. The staffs state that this is a contributory scheme. Many of them have been contributing since 1910. Even when the emoluments are included to their advantage, they would prefer two-thirds as the basis of pensions if the Parliamentary Secretary could see his way to grant that request. The easiest way for the substitution for what is in the Bill would be to put in one-sixtieth where one-eightieth occurs, and two-sixtieth where two-eightieth occurs. That means something in cash and a small rectification of the Bill.

When female attendants engaged in those institutions leave to get married after a number of years' service they were entitled to receive a certain salary and emoluments. Under the Bill they simply get back contributions paid towards pensions. I suggest to the Parliamentary Secretary that he should consider restoring the other provisions. After all, when attendants leave after ten years' service, they have an accumulation of rights towards pensions, and it is only right that, in addition to the restoration of the premiums they paid, some additional sum should be given. Those who are looking for two-thirds of their salaries as pensions are not looking for everything, but are prepared to give something. I believe they are prepared to pay 4 per cent. instead of the 3 per cent. they are now paying, if that concession were granted. There are other small items that affect pensions. One is that those in these institutions feel that they are prematurely aged and that there should be some provision for the continuation of the payment of portion of their pensions to widows. The Parliamentary Secretary has a very admirable provision in the Bill for the payment of moneys in certain circumstances to the legal representative of members of the staffs. That provision in the Bill is an improvement. One fear in that regard is that it may be too closely interpreted. A person entering the service has to pass an examination and if disabled afterwards by heart disease or digestive trouble, due perhaps to anxiety and the nature of the work, there is a fear that the provision may be too closely interpreted. I congratulate the Parliamentary Secretary on introducing this measure which, I am sure, will be sympathetically received by the entire community.

Mr. M. O'Sullivan

I join with other Deputies in welcoming the introduction of this Bill and, in particular, in congratulating the Parliamentary Secretary on the distinction of having his name associated with the removal of what might be described as a very degrading clause so far as the treatment of mental diseases is concerned, particularly in the incipient stage. I venture to say that when the Bill becomes an Act it will, at least, have removed a very serious blot from our social life. As far as voluntary patients are concerned we welcome that proposal. That regulation was simply archaic and absolutely retarded anything in the way of curative treatment. It certainly did not tend to induce patients to seek treatment at the early stage before being committed. There were also restrictions inside such buildings for the treatment of patients of that class. I am glad that all these regulations are being swept aside and that we may look forward to the plan enshrined in the Bill producing good results.

Having paid a tribute to the Parliamentary Secretary, it is well that it should be recognised in the last analysis, that the practical solution of this problem will rest on the shoulders of local authorities. In so far as the treatment of mental disease is concerned I am sure the Parliamentary Secretary will agree that the problem has always been approached by local authorities on the basis of practical sympathy, and that everything has been done in respect of accommodation and medical attention in the various hospitals. I have no doubt whatever that whatever extra financial commitments will follow the passing of the Bill, will be borne by local authorities in the same spirit as they have manifested up to this. Because of that, it is, perhaps, regrettable that this excellent Bill, which obviously calls for enthusiasm and co-operation from those who will be in charge of the administration of the Act, should incorporate the terms of the County Management Act. It is obvious that a certain amount of enthusiasm, personal attention and supervision will be wanted on the part of local authorities.

The Minister, I am sure, will agree with me when I say that, as a result of the operation of the County Management Act, the work of mental hospital committees has very seriously deteriorated within the last six months or so. I have personal experience of the main hospital committee in the country, that is, Grangegorman Mental Hospital Committee. It is a very large committee, consisting of over 40 members, and, if the Dublin County Council had its representation, the membership would run to about 47. Members of the House who were members of that committee prior to the change-over under the County Management Act will agree with me with regard to the excellent work done and careful attention given by that exceedingly large committee in respect of patients and the general working of the institution, but it is regrettable that, even recently, it has been exceedingly difficult to get a meeting of that committee and that meetings could not be held for lack of a quorum. Obviously there is something radically wrong, when a committee which was active, enthusiastic and co-operating with the heads of the institution suddenly falls down as this committee has. I suggest that an examination of the position even at this stage would be well worth the while of the Parliamentary Secretary rather than that the opportunity which this Bill gives for bringing about the active co-operation which we desire should fail to be availed of.

Deputy Roddy referred to one point in regard to which I very gladly support him, that is, the question of the capitation grants. I have already referred to the part which local authorities will be called on to play. The main financial burden arising from this Bill will fall on their shoulders, and they are not objecting, as I say, to that, in any way, but the Parliamentary Secretary is aware, because the point was brought up in the House here even since I became a member, that the origin of the capitation grant is an old British Act of somewhere around 1875. The régime at that time was apparently anxious that a distinction should be drawn between a patient in a poor law institution, a workhouse, as it was then designated, and a mental hospital, or an asylum, as it was then described, and were anxious to encourage a patient to be treated in a mental hospital or asylum rather than in a poor law institution. A grant was given at the time covering the difference in the cost of maintaining a patient in a poor law institution and in an asylum, the amount being based on a differential of 4/-. The strange thing about it is that, down through the years, that figure has not changed, or where it has changed, it has changed to the detriment of the local authorities.

The Dublin Corporation is not getting the 4/- differential at the moment. The figure is even less. I understand that the fund originally came from certain licence duties, and whether the fund has dried up or not, I do not know, but true it is that the figure is not what it was 60 years ago. The difference between the cost of a patient in a poor law institution and a mental hospital at the moment is best illustrated by the fact that, in Grangegorman, the over-all cost is £2 2s. and for the Board of Assistance, roughly 25/-, or a differential of 17/-, while the local authority still gets only 4/-. I suggest to the Parliamentary Secretary that the opportunity provided by this Bill might be availed of to rectify that anomaly which has existed so long and to which attention has been drawn on several occasions.

The question of chargeability is pretty well defined in the Bill, but I am not quite clear as to whether a particular case which has been brought to my attention is covered. Mountjoy Jail is regarded as the receiving jail for practically the whole country, and if an individual there becomes insane, he will naturally be taken to the local hospital, which is Grangegorman. If he were a chargeable patient, I should like to know if there would be recoup-ment so far as his local authority is concerned. There are other matters, including the matter of superannuation referred to by Deputy McCarthy, which arise on the Bill, but we will obviously come back to them at the appropriate time on Committee Stage.

Mr. Murphy

Any Bill of this kind, tending, as this does, to give more care and to provide improved methods of treatment and more humane administration so far as one of the most afflicted sections of our population is concerned would be assured of a very sympathetic hearing in this House from all sides, and consequently it is natural and proper that some welcome changes made in the Bill should receive appreciation and welcome in the House. Powers are sought in the Bill to repeal, partly in some cases and wholly in others, a long list of previous enactments dealing with lunacy. I have not had the opportunity of finding out to what extent they alter the position, but I am willing to believe that, having regard to the fact that there is in many respects a progressive spirit manifested in the Bill, the repeal of such enactments is in accord with that spirit.

With other members, I very warmly welcome this new and up-to-date method of getting admission for patients to mental hospitals. The former system was one of the most hideous deformities of our social system. The fact that people had to be paraded in public in the custody of police officers before their admission could be secured was a dreadful deformity and everybody interested in the development of a more humane and up-to-date treatment of the afflicted sections of our population will give a very warm welcome to this new proposal. In the words recently uttered by a very distinguished ecclesiastic in this country, it was something which deserved to be blotted out from the Statute Book of the country and from the memory of the people. I sincerely hope it foreshadows developments of a similar kind in regard to other services. The people would certainly warmly welcome an extension of that policy in regard to the poor law system generally and in regard to other matters appertaining thereto.

I am glad to see that provision is being made in this Bill for the closer supervision of private and semiprivate institutions dealing with mental disorders. The fact that the system will accordingly become more uniform and that the question of supervision, inspection and general control will be brought into line is another welcome feature of this Bill. On the question of superannuation, I do not want to say anything at present, but I am sure the Parliamentary Secretary must be aware that, for a number of years past, there has been a sustained agitation amongst employees of mental hospitals for the betterment of their condition. I think he will recognise that it is in the interest of the people committed to the care of attendants in mental hospitals that those who perform the arduous and, very often, unpleasant work of caring for such patients should not have any ground for discontent. In so far as these provisions will bring about an improvement, and in so far as they may be revised again on the further stages of the Bill, they are a very important feature of the whole measure.

I join with my colleague, Deputy O'Sullivan, in his statement in regard to the control of mental hospitals. The term "board" is used in this Bill and there is also a provision for the repeal of a certain section of the County Management Act. I had not the advantage of hearing the Parliamentary Secretary's opening statement and, if I am in the dark in regard to this matter because of that, the fault is my own. But, if this matter has not been adverted in his opening statement, the Parliamentary Secretary might, perhaps, indicate how far the repeal of this particular section and how far the use of the term "board" in connection with this measure indicates any change in the present position or the giving of any additional executive functions to the people's representatives on the mental hospital committees. Not alone in Dublin, but in other parts of the country, mental hospital committees are falling very largely into disuse because of the fact that there are no functions that they may usefully perform, except the function, which, of course, is an important one, of paying periodic visits to the institution. That is a function, however, that could be exercised by any public representative without any closer relationship with the mental hospital. I think the Parliamentary Secretary will find on examination of this matter that there is a case for taking the elected representatives of the people more fully into confidence and putting them in a position of responsibility in regard to the administration of the mental hospitals and that that change will be for the benefit of the people concerned and of the service as a whole.

There are distinctions made in this measure between certain sets of employees in a mental hospital, registered and non-registered employees. I rather understood that, in the case of a considerable number, if not the overwhelming majority of the employees of mental hospitals, they were attendants in the sense of being officers of the institution and that, in addition to that work, they discharged up to a certain point other functions in connection with a particular craft or calling in regard to the upkeep and maintenance of the institution. I should like to know exactly how far this proposed change will alter the position in regard of such persons.

Dr. Ward

It does not make any effective alteration.

Mr. Murphy

I am satisfied with that. This Bill, as I said, does afford an opportunity of saying something that I think the Parliamentary Secretary is aware of, namely, that there is a feeling amongst people who have tried to associate themselves as much as ordinary lay people can with the question of the treatment of mental disorders in this country about what may be done in the immediate future towards making substantial progress in that direction. If a very inexperienced layman may venture a suggestion in a matter of that kind, my suggestion would be that a number of prominent officials, such as resident medical superintendents in various mental hospitals, should be given facilities, as soon as conditions approach anything like normal, to go abroad and find how far more up-to-date curative methods of treatment could be applied in this country in regard to this particular disorder. There are many strange things said from time to time, I do not know with what degree of accuracy, with regard to mental disorders.

I saw a statement some time ago which seems to me a very strange contradiction in itself, namely, that during periods of war and terrific unrest, when everyone would expect mental disorders rapidly to increase, that in fact the contrary is the case, and that during periods of terrible unrest an examination of statistics in various countries has disclosed that there has been a rather marked decline in the incidence of mental disorders as shown by the records in regard to people admitted to institutions for the treatment of that type of disease. I do not know whether that is a fact or not but, if so, it is an extraordinary statement. I only mention it in order to press on the Government, through the Parliamentary Secretary, the viewpoint that in this particular matter there is a great field for developing a programme that will ultimately result in more up-to-date curative methods being employed for the treatment of mental disorders in this country.

I am very glad to notice that provision is being made in this measure for gratuities to the widows and dependents of people who die in the service of mental hospital authorities. There is just one fear lurking at the back of my mind in connection with that matter and it is whether there will be much difficulty, having regard to the provisions of the Bill, in establishing in applications of that kind a particular connection between the death of the persons concerned and the service in which they were engaged for a certain number of years; whether, in the case of a person employed in a mental hospital, who dies from pneumonia, for instance, there would be any difficulty for any person who sought to establish a claim under this measure in showing that that was due to service in the mental hospital. The Parliamentary Secretary is aware, or at least some of his colleagues are aware, that with regard to people who die while serving in the National Army there is very often great difficulty on the part of dependents who make a claim for gratuities or pensions afterwards in connecting the deaths of those persons with service in the Army or causes arising out of that service. I feel, therefore, that in connection with a measure of this kind, the spirit of which has already been commented upon favourably, the Parliamentary Secretary should keep that matter in mind so that disappointment and disillusionment will not be created in regard to the operation of this provision when the Bill becomes law.

I endorse on behalf of the local authorities and the people of my county the plea of Deputy O'Sullivan that this out-of-date computation of the grant payable to mental hospitals should have the Parliamentary Secretary's attention and be dealt with before the Bill is finally passed. While I always have had, and still have, reservations and considerable doubt as to the wisdom of the plea that has been put forward in many quarters for many years that mental hospitals should be a national charge, I think it would probably bring us very considerable difficulties if that proposal were adopted. I think, however, that having regard to the long period that has elapsed since this method of calculating the grant was initiated, the time has come for a favourable review of that matter.

There is one point upon which I would like some information from the Parliamentary Secretary. There are certain very unpleasant happenings, in my opinion, from the social point of view, that formerly took place with regard to persons of unsound mind who were in mental hospitals. Occasionally here and there through the country a patient in a mental hospital became violent and did harm to some person in the hospital, either a fellow-patient or somebody in charge of the hospital. We had in the past what I think was a most unpleasant and, in fact, a most unnecessary proceeding, the formal bringing up of such people in courts of law to go through the form of standing trial for that particular happening. One could not say it was an offence, because the person responsible for it was not in possession of his senses, and the trial was a mere formality. If that method of investigation into such cases has been dispensed with, I am very glad; if not, I think it ought to be dispensed with. The fact that persons in that position were already proved beyond yea or nay to be of unsound mind ought to be sufficient, without parading the unfortunate people in a court of law. It is possible that steps of that kind were inevitable in view of the existing law, but I suggest that method is out of date and, if it has not been already changed, it ought to be.

There is another thing that has occurred to me in my association with local affairs. I have seen a number of people discharged from mental hospitals completely cured. One is very glad to know that that does happen. I wonder if any attention could be devoted to such people for a certain period, say 12 months after their discharge from the mental hospital? I feel it would be necessary in many cases. I suggest that, just as people who are recovering from an attack of tuberculosis have means by which a certain amount of after-care is available for them, it would be a very useful auxiliary to the treatment and the ultimate cure of people afflicted with mental disorders. I have seen people in very poor circumstances—and there can be no doubt such circumstances very often have a great deal to do with mental disorders—following their discharge, and I felt there ought to be some provision by which there could be a following-up examination from the point of view of their circumstances and a building-up of their general health. That procedure would be very advisable.

It seems to me that there are certain districts where there is a very high incidence of mental disorders—certain parts of the country yielding a vastly higher proportion of cases than others. It may be due to heredity or other causes, but these are matters that I do not wish to discuss now. However, there does seem to be a very large number of admissions to mental hospitals of young people almost on the threshold of their lives and it appears to me that any money spent in securing for such people good health and the full possession of their senses would be very well spent. I feel that the Parliamentary Secretary and his advisers, knowing more of the facts of such cases than I do, will devote all the attention they can to that particular aspect of our problem.

I feel sure the Parliamentary Secretary is aware of the fact that the incidence of mental disease may, to a large extent, thank God, in view of the up-to-date treatment and the developments we may expect in the future, be reduced, very considerably. There is one thing he will not need to be convinced of and that is that prevention is very much better than cure. Mental disorders must, inevitably, have their roots in economic conditions and as long as there is a good deal of destitution and fear in the minds of the heads of many households as to what the future has in store for them, there must always be a strain on such people that very often becomes unbearable and results in additions to the numbers afflicted with mental trouble.

I feel sure that this measure, good in itself, will do a great deal more good if it is followed by other measures of social reform for the purpose of rooting out the economic evils that contribute very largely to the incidence of mental disease. I welcome this measure as a progressive step in that direction and I hope I may have the opportunity before the new year becomes very old of expressing a further word of congratulation to the Parliamentary Secretary on the advent in this House of other proposals along the same progressive road.

Mr. Allen

I must congratulate the Parliamentary Secretary on the introduction of this progressive measure. He has brought in no half-measure to remedy the problem that has confronted us for such a long time. It could be said that our legislation with regard to mental treatment lagged behind the legislation of many other countries in the world, but I believe that this measure when it becomes law will put us in the forefront in the treatment of mental disorders. There is no doubt that it is recognised in the medical profession as a revolutionary step in the right direction.

The question of the mental hospital board was dealt with pretty fully in the Local Government Act or the County Management Act in 1939 or 1940. As Deputy Murphy pointed out, the board of the single mental hospital has no function whatever and it is not proposed to change that in this Bill; at least, I see no change giving them any more functions than they have. I suggest that this is an opportune time to make an alteration in the County Management Act or the Local Government Act of 1939 or 1940. I do not suggest giving them control over the staff, but rather something to interest them in the work of the committee. Their functions and duties are so few at present that the members are not interested in attending the meetings. For some extraordinary reason, the joint boards have wider powers and functions and I suggest that the mental hospital boards be given the same powers, which is the least they might expect. If the Parliamentary Secretary cannot go as far as that, I suggest that he at least give them control over the finances of the mental hospital so that, like the county council, they can decide the estimate.

Dr. Ward

They have that control.

Mr. Allen

No.

Dr. Ward

No? Then you must know more about the Bill than I do.

Mr. Allen

They were not allowed to function.

Dr. Ward

The House should be addressing itself to what is in the Bill.

Mr. Allen

They had not got them up to this.

Dr. Ward

There is no use in talking about what has been. It is what is in the Bill that should be discussed.

Mr. Allen

If they are getting them in the Bill, I am glad to know that there is some improvement, and to know they will have control over the finances in future. That is a step in the right direction. This means that once a year, at any rate, when they decide the estimate, the members will have at least one interesting meeting of the committee. They should be given other functions in addition. I suggest that the Parliamentary Secretary should provide a medium through this Bill whereby these committees could function effectively, so that they would be kept interested in the work of the mental hospital, without in any way impairing the powers of the county manager. Otherwise, the Bill is a good one and will meet with the full approval of all members of the House.

The staffs are being provided for and their conditions are being improved. It will give general satisfaction that the widows and dependents of the officials of mental hospitals are being provided for. That was a very big grievance in the past. I would ask the Parliamentary Secretary to make that provision retrospective over a number of years. I have in mind some widows who were very badly hit as a result of the loss of their husbands while on duty. They were young men with 15 to 20 years' service who left large families totally unprovided for. They got the small amount the husband had put into the funds, though in one case even that small amount could not be paid to the widow, for some reason or other. There are a number of cases in every mental hospital district, where husbands have died in the service for the past ten or 12 years, and I suggest that the Parliamentary Secretary make the provision retrospective.

Dr. Ward

How far back?

Mr. Allen

I would go back a dozen years, at least.

Dr. Ward

What about the husbands who died 13 years ago?

Mr. Allen

I suggest that, where there are children under 16, the same provision should be made retrospective for them.

Dr. Ward

There should be a retrospective provision in all our social legislation?

Mr. Allen

There are special conditions arising in this legislation that may not apply in other cases. I would suggest that the Parliamentary Secretary give that matter consideration.

Mr. Byrne

I welcome this Bill as a step in the right direction. I would ask the Parliamentary Secretary if there is any possibility of increased accommodation being found for children who are slightly mentally defective.

Dr. Ward

That does not come under the Bill.

Mr. Byrne

There is a long list of children waiting to go into various homes in and around Dublin and their education is being sadly neglected because there is no place for them to go. I would ask him to speed up the accommodation for such children.

Dr. Ward

Perhaps I might reply first to the point made by Deputy Alfred Byrne, inasmuch as it is one of the few points which has no relation to the Bill. The Bill does not make any provision for mental defectives. I do not know if the Deputy was here during my Second Reading statement, when I drew a distinction between mental defect and mental disease. The Bill is intended to deal with the problem of mental disease, mental disorder, mental ailment, the various disturbances of mind of people who at one time possessed their normal faculties and subsequently became ailing in mind. In the case of the mental defective, it is a hereditary condition and the unfortunate people afflicted have never been in possession of their full mental faculties. That is another problem and, in fact, is more an educational problem than one of mental treatment. Beyond trying to develop their limited faculties, so as to make life somewhat easier for them, the prospect of cure in the case of the mentally defective is almost negligible, so it is merely a matter of education rather than of mental treatment.

It has been pleasant to listen to Deputies of various Parties paying tribute to me and to my advisers and assistants in the Department, on the introduction of what has been very properly described as a revolutionary measure in our approach to the whole problem of mental disease. I appreciate all that. I realise how difficult it sometimes is for people to rise above political affiliations and give credit to their political opponents where credit is due. That has been rather generously done in relation to this Bill and I appreciate it.

Some Deputies spoke about our having lagged behind neighbouring countries. That is so: we certainly have lagged behind neighbouring countries, but one could reply, if one were so inclined, that if the neighbouring countries had not interfered so much in the affairs of this country, perhaps we might not have lagged behind so far in this matter, as in many other social matters. While we have been considerably behind the most recent legislation in neighbouring countries in dealing with the treatment of mental disease, it is true to say that, when this Bill comes to operate, we shall have substantially passed them out. I think it is no exaggeration to say that the mental treatment code before the House is the most advanced and, though I say it, the most enlightened code in any country in Europe. That is a very big thing to say, but I think it is true; and those who have an opportunity of discussing this Bill with medical experts outside the House will, I think, find general agreement with that interpretation of it.

Deputy Roddy mentioned the matter of better segregation. I presume he has personal experience of these institutions, as he comes from a constituency where there is a mental hospital. While we have not, in fact, the degree of segregation we should like to have and which this Bill aims at securing, I rather think the Deputy conveyed the misleading impression to the House—I am quite sure he did not mean to do so—that, for all practical purposes, we have no segregation at all. Of course that is not so. The Bill gives us power to provide different institutions for different classes of mentally afflicted people and, if the local authority fails to make such provision, the Minister is armed with the necessary power to enforce his authority and to prescribe the institutions which are to be provided. Deputy Roddy also complained about the appearance of these institutions. I do not deny that they are not very inviting. It has to be borne in mind that, by reason of the type of patient that these institutions have to deal with and accommodate, they have to follow a certain type of architecture. In that way, while they might be brightened up perhaps considerably, still they cannot be made as inviting as institutions for the treatment of physical disease. These institutions are provided particularly for such disordered patients as may require restraint or may be dangerous to themselves or others. I am sure Deputy Roddy appreciates that as well as I do. If we were able to bring about a further segregation of the less dangerous patients, the temporary patients and the chronic patients, they probably could be accommodated in more attractive surroundings, if we had the necessary finance to provide the more attractive surroundings.

There was a good deal said by various Deputies on the question of the compulsory acquisition of land by mental hospital authorities. Deputy Roddy and Deputy Hughes and a number of other Deputies seemed to feel strongly that mental hospital authorities should not be given power for the compulsory acquisition of land, particularly for farm purposes. That attitude of mind represents the layman's outlook in relation to this particular problem. In fact, land, particularly for farm purposes, is as necessary a part of a mental institution as the building itself. The farm is used, of course, for therapeutic purposes. These people's minds and bodies are occupied in the cultivation of the land which also serves the useful purpose of providing the food requirements of the institution. Apart from that aspect of it, it is not a new position even in relation to mental hospitals. Right down the ages we have had compulsory acquisition powers vested in the county councils. They may not have been exercised to any great extent, but the fact remains that they were there. Similarly, we have compulsory powers of acquisition in relation to housing, and, under the public assistance code, in relation to hospitals and similar institutions. So that it is not by any means an innovation, and more particularly, in relation to mental hospitals than to any other institution, is it necessary to have the powers of compulsory acquisition.

A suggestion has been made that we should take power in the Bill, if we are going to adhere to this power of compulsory acquisition, as we are, to acquire land for the purpose of exchange. I do not propose introducing any amendment to meet that point of view. It would be a very difficult type of compensation to operate. If we found it necessary—let us take a hypothetical case—to acquire a farm of land convenient to a mental hospital and we were under a statutory obligation to provide alternative land for the owner of that farm, I do not know how we would satisfy him that the land that we proposed to offer him was, acre for acre, as valuable as the land that we had taken from him. In fact, it would never be as valuable in his eyes, even if you were to give him two or three acres for every acre that you took from him. Apart from that, if you were to follow that suggestion to its logical conclusion you would have compulsorily to acquire land in order to give land for the land that you compulsorily acquired. On a full examination of the matter I do not think that much criticism can be found with the proposal in the Bill. We are driven back to the policy of compensation by way of money.

Mr. Roddy

Adequate compensation.

Dr. Ward

It will be fixed by arbitration under the law. Deputy Hughes, in the course of his welcome to the Bill, described this as the first effort of the Fianna Fáil Government to codify our social legislation. Other Deputies seemed to be equally forgetful. I think that one of the most comprehensive codifying Bills, indeed one of the most revolutionary Bills, from the point of view of historic background anyhow, that passed through this House was the Public Assistance Act of 1939, which I also had the honour of piloting through the House, under which we got rid of all that pauper law that was as old, as out of date and as unsuited to the conditions existing in this country, and as incompatible with the dignity of our people, as the mental code that we are now proposing to replace by this Bill.

Deputy Hughes also mentioned the question of some protection for the medical profession in relation to certification. I do not propose to delay the House in dealing with that. The Deputy will find the protection set out in Section 248 of the Bill. In the new setting, and under the new system of admissions to mental hospitals, dispensary medical officers will, in the first instance, merely recommend a patient for admission. The patient is not admitted, and the reception is not completed, until the expert in mental diseases, namely, the R.M.S. or his deputy, examines the patient and decides whether, in fact, the patient should be received. So that, so far as the protection of the patient is concerned, and indeed the protection of the medical certifiers, the position is much better safeguarded than it had been before.

Many Deputies, from virtually all sides of the House—and, surprisingly enough to me, some of the Labour Deputies—advocated the transference of the cost of mental treatment and of the provision of mental institutions to central funds. A good deal of criticism has been levelled at the line of policy under which the 4/- per head voted by Parliament in 1874 still remains the capitation grant. I could say a good deal on the social policy represented by that line of thought but I do not propose to go into any great detail now. There are just a few points I should like to make. This grant was paid for the purpose of inducing the local authorities to take the mentally afflicted out of the workhouses and the jails. As I pointed out to the House in my Second Reading statement, under the laws of more than 100 years ago, which we are repealing in this Bill, people mentally afflicted were arrested, charged before a justice of the peace and put into jail. The next advance was to put them into houses of industry or into workhouses. The further advance was the payment of this 4/- per head to induce local authorities to provide special accommodation for them outside the workhouses. Until comparatively recently, the huge grants in relief of rates now being paid out of central funds were not being made available to local authorities. In fact, in 1891, about £250,000 was the amount of the entire grant in relief of rates from central funds. In the year 1941-42, the total amount paid in relief of rates in one way or another was £4,807,294 10s.

Mr. Roddy

The Parliamentary Secretary is forgetting the difference in the rates.

Dr. Ward

The Parliamentary Secretary will make his case fairly completely and fairly convincingly because he has a strong case. Deputy Roddy, Deputy Hughes and other Deputies say that the charge should be transferred to central funds, that the State should pay for everything. Even last night, it was urged that the £20,000 which was being made available for the provision of free, or cheap, footwear in addition to the £170,000 already provided for assistance in kind, was not enough. It is never enough. The Minister for Finance had another motion before the House to-day and he was told that he was not making sufficient provision from central funds. In my judgment—and I am surprised that members of the Labour Party do not take this line, from a purely social point of view—a system of taxation based upon valuation of the property a man actually holds is much more equitable than the central system of taxation. If we were to raise this sum of £1,500,000 or £1,250,000, necessary for the maintenance of mental institutions, by way of central taxation, and if we were to impose taxation upon some of the necessaries of life, is it not as clear as noon that the poor would pay a greater proportion of that tax than if it were raised by way of local taxation under which a man pays according to the valuation of his property? I cannot understand why there is not clearer thinking on this subject, even on the part of members of the Farmers' Party. They are not all enthusiastic about the policy of derating advocated by other Parties. Any representative of the small farmers who has thought out the economic consequences of derating would agree that he did not want it, because, so far as the small man is concerned, derating would be no boon; it would give the maximum relief to the man with the high valuation.

Mr. Donnellan

It is a long time since you promised to give it to him.

Dr. Ward

I never promised any such thing.

Mr. Norton

You have a few pals who did.

Dr. Ward

If Deputy Norton or anybody else says that this charge should be transferred to central funds, will he tell me what item should be taxed——

Mr. Davin

You advocated it as a Party.

Dr. Ward

Shall we tax tea, sugar or tobacco? Where will we get the money in a more equitable manner than the way we propose to get it—by taxing a man on the basis of his actual property?

Mr. Donnellan

Tax the men over £1,000 a year.

Dr. Ward

Did the Deputy ever make a calculation of the amount he would get by taxing salaries of over £1,000 a year? Did he ever make a calculation of the amount he would get if he took the whole of those salaries?

Mr. Donnellan

When you made the calculation in 1925 what did it amount to?

Dr. Ward

It was so negligible that we dropped it.

Mr. Davin

You dropped it when you went over on those benches.

An Ceann Comhairle

It is a far cry to 1925. Deputies should get back to the Bill.

Dr. Ward

We have been here a long time and it looks as if we will be here longer, notwithstanding the things we dropped. Deputy Cogan advocated the substitution of the term "nervous disease" for "mental disease". I do not want to be critical but I do not think that there is much in that point. It is not so much what the diseases are called that counts as the provision for treatment and the general approach to the problem. What we require very badly is a more intelligent understanding of these problems. If we could get the people to realise that no greater stigma attaches to disease of the mind than to disease of the body, we should be advancing along the right lines but I do not think it would help to use the term "nervous disease" rather than "mental disease". In fact, there is nothing objectionable in the term "lunacy". It is what the term has come to denote in the public mind that gives rise to objection. In fact, the word is derived from an ancient belief that mental disease was associated with changes in the moon, so that the term itself is comparatively harmless.

Deputy Dockrell spoke about the supervision of persons boarded-out. The Bill is very comprehensive and it is a big task to read it, so I do not blame the Deputy for the slips he made. If the Deputy is particularly interested in the provisions for boarding-out and the selection of persons with whom patients will be boarded-out, he should refer to Section 201. I do not think that any possible consideration is left out in that section. If there is any omission I shall be glad to hear from Deputy Dockrell at a later stage. Deputy Dockrell also spoke about the "new departure" set out in Section 219—the liability of a child to maintain its parents, the liability of an illegitimate child to maintain its mother, and so forth. So far from that provision of the law being new, it is just 106 years old, has remained in our code, and has been operative all the time since. It has been recently re-enacted by this House, under the Public Assistance Act, and, accordingly, I think that if Deputy Dockrell will refer to these other enactments he will be satisfied that there is not anything new about it.

Deputy Seán McCarthy would like to see the two-thirds pension rate either restored or, at any rate, preserved for the present staffs who had been contributing over a long period and who looked forward, on retiring, to two-thirds of their salary and emoluments as pension. The Deputy, on a closer perusal of the Bill, will find that existing members of mental hospital staffs can accept the terms provided under the 1909 Act or the terms provided under this Bill. He will find that they need not accept the terms provided under this Bill, but I rather think that, when they get time to examine the superannuation provisions provided for in this Bill, they will agree that the provisions in the Bill are much better. At least, I shall be very much surprised if they do not accept the provisions of this Bill in preference to what was provided in the Act of 1909, because, in many respects, this is a substantial advance on the provisions of the 1909 Act. Of course, there is the big difference that, if we are to give a lump sum on retirement, naturally, the pension accompanying that lump sum must be proportionately less. This, in fact, is based on the Prison Officers' Superannuation Code, and I think it is designed to meet, in a rather generous way, the case of staffs of mental institutions, in full recognition of the fact that the staffs of such mental institutions have a very difficult life and are following a very depressing occupation. I am fully aware of that fact, and I can say that the Government are also fully aware of it. That is the reason why they agreed to embody in this Bill the superannuation provisions that are provided for here.

Deputy Murphy, of Cork, mentioned the question of an improvement in the conditions of service. I think the Deputy was referring to the salaries and emoluments of the employees of mental hospitals. Of course, the Bill does deal with the question of salaries and emoluments of employees, but for a considerable time past I have been negotiating with representatives of the staffs, in the hope that we might get an acceptable, uniform scale. So far, we have not reached agreement, but the position is not unpromising.

Deputy Murphy also mentioned the desirability of providing more up-to-date methods of treatment for mental patients. Well, the Deputy speaks as a layman, and I am sure that he did not intend to criticise the professional competence of our medical specialists in this country, particularly in relation to the treatment of mental diseases. I think that our medical men, and particularly those specialists who have to deal with the mentally afflicted, are as well equipped as such specialists in neighbouring countries. In fact, I might say that they are probably better equipped than the specialists in other countries. If more money is being devoted in other countries to research in that direction, then that is all to the good, and if in any other country new discoveries should be made in the diagnosis and the treatment of mental disease, then I am sure that our alert specialists in this country will avail themselves of such research work and, very shortly, will give the benefit of such treatment to our patients here.

I might point out that, in fact, the treatment of mental disease has advanced much more rapidly in recent years than the treatment of some other ailments. Statistics prove that there has been a downward trend in the case of mental diseases, and that is the best evidence of the services given to such patients by our medical experts. I think it was Deputy Murphy, also, who mentioned the case of the aftercare of mental patients. The Deputy will also find that that is dealt with in Section 212 of the Bill.

I think, Sir, that I have dealt with most of the questions raised in the course of the debate, and I hope that Deputies will take the opportunity, between now and the next stage of the Bill, of giving a close examination to its provisions. I admit that this is a very comprehensive Bill. In fact, it is almost frightening for anybody to attempt to wade through the sections and examine every feature of it. One would need to be very enthusiastic to do so, but, at any rate, Deputies will have time between this and the next stage of the Bill to consider its proposals and submit amendments that may improve it, and I can assure Deputies that if they put forward any amendments that would be an improvement in the Bill, or calculated to improve it, I shall be only too glad to welcome such suggestions.

Question put and agreed to.

Committee Stage ordered for 24th January, 1945.