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Dáil Éireann debate -
Thursday, 2 Mar 1961

Vol. 186 No. 8

Committee on Finance. - Mental Treatment Bill, 1960—Committee Stage.

Section 1 agreed to.
SECTION 2.
Question proposed: "That Section 2 stand part of the Bill."

Section 2 proposes to amend Section 108 of the Mental Treatment Act, 1945. The purpose of the amendment is to provide for the transfer of patients who become chargeable patients during a period of detention in hospital. At present, by Section 19 of the Mental Treatment Act, 1945, a mental hospital authority is obliged to provide mental hospital assistance for persons being chargeable patients who require such assistance by reason of mental illness and who are ordinarily resident in the mental hospital district. Normally, chargeable patients are received into a district hospital for the district in which they ordinarily reside. Occasionally, when people are received into a hospital, it transpires they are ordinarily resident in a different district. The purpose of the amendment is to regularise that situation and make it much more flexible than it is under the 1945 Act.

Question put and agreed to.
SECTION 3.
Question proposed: "That Section 3 stand part of the Bill."

This is the section which provides for the making by all or one or more mental hospital authorities of payments to patients in respect of work done. Speaking on the Second Stage of the Bill, Deputy Corish seemed to be concerned that patients would be used to displace tradesmen. In most hospitals, patients are and have been accustomed to work with tradesmen in carpentry, gardening, farming, etc. It is a form of occupational therapy which it is essential should be carried on in a hospital of this sort. That situation is clearly visualised in the original Act which makes provision for special superannuation terms for persons such as tradesmen who for portion of their time have charge of patients. I do not imagine that the Deputy would want that practice stopped. I think I will suggest to him that where patients are employed, it is desirable in their own interest that they should be employed on useful work. In fact, I am advised it is very important from the patients' point of view that they should be made feel they are doing something useful.

I agree entirely with what the Minister has now said, but I think it must be said that, when the Second Stage was being discussed here and in the Minister's opening speech, there was just a mere reference to the fact that patients could now be paid. When speaking on the Second Stage, I assumed that this was part of the treatment side of occupational therapy and was engaged in for very many years. I do not think I was, as the Minister described me, very annoyed or worried.

I did not say worried.

I was concerned. In any case, it will not do what the Minister says it will not do. If it does not extend the practice now being engaged in in the treatment of patients, I am quite satisfied. I wanted to get an assurance from the Minister, as I have now got, that this could not be a method to get what might be regarded as cheap labour.

In what manner will the patients be paid? Will money be put to their credit or will they get goods or cash? If they are so mentally deficient, will they be able to appreciate money? Has the Minister anything to say on that score? A person could be paid and somebody could relieve him of the money.

As to the manner in which payment will be made, I think we shall have to leave that matter to the discretion and the responsibility of the hospital authorities.

I had complaints from patients. Things are being legally stolen—sometimes by those who are supposed to guard the patients. At least, that is their allegation.

That is a serious allegation.

It may be but——

When allegations are made by patients who are unfortunately mentally ill, I think the Deputy should treat them with a great deal of reserve. It is a characteristic of certain conditions that the patients feel they are in some way being injured or victimised. I suggest to the Deputy that he should not take these allegations as being well founded until they have been fully proved.

I accept that but advantage can be taken of the fact that they are mentally ill.

In relation to the whole of this matter, regulations will be made in due course. It is proposed to stipulate that the primary consideration in all this matter should be the welfare of the patients and not the advantage of the hospital authority.

It ought to be said at this stage—I thought the Minister would say it—that there are well-defined regulations and a well-defined practice in respect of patients and money so that I think it would be wrong even to suggest that mental hospital nurses to any extent engage in the practice described. The mental hospital nurses to any extent engage about money. The Minister, as Minister for Social Welfare, knows that in respect of their allowances, whether pension or sickness benefit, the authorities are very careful about the persons to whom they should give this money and in what amounts.

Question put and agreed to.
SECTION 4.
Question proposed: "That Section 4 stand part of the Bill."

Is it necessary to explain this? I think it is quite clear.

I understand the purpose of this section and the next section. I am not happy about the phrasing—the way it is put. Even though we can understand what is aimed at, I think it is unfortunate that the draftsman should so phrase the section that temporary patients and voluntary patients are to be regarded as persons of unsound mind. I think that the purpose aimed at in the section could be provided for in a better way.

I shall look into the matter. The difficulty has been to try to amend this and preserve so far as possible the phraseology of the original Act. I shall look into the matter between now and Report Stage.

It is important not to discourage people.

Question put and agreed to.
SECTION 5.
Question proposed: "That Section 5 stand part of the Bill."

The same applies to this section.

Question put and agreed to.
SECTION 6.
Question proposed: "That Section 6 stand part of the Bill."

This is a desirable amendment.

This gives effect to a principle, which is carried all the way through the Bill, of providing, first of all, that a person may be received as a chargeable patient in any district mental hospital under the control of a mental hospital authority. Secondly, it provides that he may be received under certification of any medical practitioner, whereas previously he was received as a chargeable patient only under certification of an authorised medical officer who was the dispensary doctor for the district.

Up to this, could a private practitioner certify a non-chargeable patient?

Yes—not a chargeable patient, a non-chargeable patient. I should perhaps mention, although it does not matter on this section, but would arise on another section in relation to where an additional duty is imposed on a district medical officer, that that is for the purpose of preserving his superannuation rights in respect of fees.

Question put and agreed to.
SECTION 7.
Question proposed: "That Section 7 stand part of the Bill."

This is consequential?

Yes. Section 163 of the Mental Treatment Act provides that an application for a recommendation for reception must be made in the prescribed form and the authorised medical officer is obliged to visit and examine a person to whom the application relates within 24 hours after the receipt of the application. I have some reason to believe that the general practice is that the doctor examines the patient first and the application form is completed afterwards. We have no objection to that procedure but, as the law stands, the examination must be made after the application and the purpose of the amendment is to obviate the necessity for further examination if a doctor has examined a patient within 24 hours before he is presented with a formal application for the recommendation for reception. If the doctor who receives that application happens to be the authorised medical officer, he is obliged to visit and examine the person if he has not done so before in the previous 24 hours. No such obligation, however, is placed on the private practitioner, but the reason why the obligation to see the patient within 24 hours is there is that he is under a similar obligation at present. It is desirable that some registered medical practitioner should see the patient in respect of whom the reception order is being sought and the placing of the obligation on the authorised medical officer to act when he is presented with an application of this kind will preserve the existing position whereby fees paid in respect of the examination of such persons are classified as pensionable emoluments.

There is only one point I should like to raise on that. Again, it may be a drafting matter but under the section as it stands the practitioner who makes the reception order, acting on the application, has now carried out a statutory function. He is protected in relation to what he does but he is concerned with the medical condition of the person he is examining. That is his primary duty and his primary concern but, in the reception order which he makes, he has to decide first of all whether the medical condition is such that the reception order should be made and, secondly, he has to decide whether the person concerned is or is not a chargeable patient. If, in fact, he has not come to any proper opinion with regard to whether the patient is a chargeable patient or not, and later on a question arises in relation to that and the doctor had not made proper inquiries in that regard, it might be suggested that the reception order which he made should not have been made.

I am concerned under subsection (1). The reception order can be made only if the doctor is satisfied that it is proper to make it and is of the opinion that the person concerned is a chargeable patient. A chargeable patient is defined as a person who cannot meet the entire cost of maintenance. I think that is the definition in the 1945 Act. If, in fact, the medical practitioner concerned certified a person who was in a position to meet the entire cost of maintenance, and did so bona fide, being of the belief that the person's mental conditions were such that he should be certified, but did not make proper inquiries as to his chargeability, that medical practitioner might subsequently be in some difficulties. Perhaps the Minister can satisfy me.

I think I can. Section 260 of the 1945 Act provides that no civil proceedings shall be instituted in respect of an act taken in pursuance of this Act, except by leave of the High Court, and such leave shall not be granted except the High Court is satisfied there are substantial grounds for contending that the person against whom the proceedings are to be brought acted in bad faith or without reasonable care. I think that meets the point.

It says "reasonable care." I know the safeguard that is intended by the Oireachtas, and would be intended in this measure but, in another place, good intentions are irrelevant and regard must be had to what is written down. Under Section 7 of this Bill the recommendation order can only operate if the medical practioner is of the opinion that the person is a chargeable patient. I am only taking an improbable case, but if the doctor is faced perhaps with a raving lunatic and can get no clear information as to background and means, but is satisfied that medically this person should be committed straight away, he does not make any inquiries because he cannot and it might be held afterwards, in regard to whether the person was chargeable or not, that he had not exercised reasonable care. I am concerned as to why that duty should be cast on the doctor. The doctor's concern initially is a medical one. Obviously the person concerned has to be got into a mental hospital quickly; let him be brought in and let the question of chargeability be discussed subsequently.

There may be a point there and I shall look into it but I think if we refer to the wording of the proposed amendment itself, in subparagraph (a) (i) of subsection (1) it reads: "If he is satisfied that it is proper to make the recommendation." That is the point—as to whether the person should be admitted to a mental hospital—"and is of opinion that the person to whom the application relates will, if received, be a chargeable patient.""Is of opinion"—that does not impose a very onerous duty upon the doctor. He does not have to make any investigation beyond that of the circumstances, shall we say, in which he finds the patient. But, I shall look into it.

We do not want to complicate the situation further and if we can simplify this procedure and ensure that the medical practitioner concerned is not likely to be faced with legal proceedings, we shall try to do what we can but it would seem to me that it is fairly fully covered by the words "is of opinion," having regard to Section 260 of the Principal Act. I assume that if legal proceedings were taken, unless they had some evidence to show that the person was not bona fide of the opinion necessary to commit the person as a chargeable patient they would not hold him liable. I mean, would it not be incumbent upon the person taking proceedings to show that the doctor had acted in bad faith and contrary to the circumstances as they were plain to be seen?

I do not like to keep pressing this matter. It may be an improbable set of circumstances but I can imagine a doctor saying: "There is only one thought in my mind. Here, we have a raving lunatic. I made no inquiry as to who he was, what his means were or anything like that". A doctor may be asked: "How then could you form an opinion as to whether or not he was a chargeable patient?" The protecting section says: "acted in bad faith or without reasonable care." It might be contended that the words "without reasonable care" would suggest and imply a duty to the medical practitioner that he had to have regard both to the medical condition and the question of means. Everybody knows that the concern is to get a person, whose medical condition is such that a recommendation order has to be made, under medical care as quickly as possible. That is clearly the intention in the Bill and in the original Act. I think that can be achieved if we remove this question of chargeability from this section and provide for it otherwise. Once the person is in, then the question of chargeability can be considered properly and carefully by those who have the responsibility.

I will have a look at it. We are both concerned to ensure that the medical practitioner will be able to act with full security, that if he does anything in good faith he will not be held responsible.

Question put and agreed to.
SECTION 8.
Question proposed: "That Section 8 stand part of the Bill."

This amendment to the Principal Act is merely consequential on the extension to registered medical practitioners of the power to make a recommendation or sign a certificate in connection with the reception of chargeable patients.

Question put and agreed to.
SECTION 9.
Question proposed: "That Section 9 stand part of the Bill."

The amendment to the Principal Act which is proposed by this section is to remove a doubt regarding the right of entry of a member of the Garda Síochána to a house or other premises when he has reasonable grounds for believing that a person believed to be of unsound mind is for the time being therein. I have been advised that the right of entry for a Garda is inherent in Section 165 of the Principal Act but it is desired to establish this beyond any doubt.

Is there any difficulty in the use of the definite article there—"the person believed to be of unsound mind is for the time being therein?" In subsection (1) of the original section it is "a person believed to be of unsound mind". Is there any possibility that somebody may say that that has got to be a defined or particular person?

No. Wait. There is an addendum there to subsection (1) of Section 165. We started off by saying "a person believed to be of unsound mind" and so on. Then we go on and particularise that person by saying "the person", meaning the person who in the preceding sentence was supposed to be of unsound mind.

Yes. In regard to subsection (4) I notice there is a repetition of what is defined as a disqualified medical practitioner. That is subsequently repeated throughout the page of the Bill.

Is it necessary to keep repeating that?

I think so. We have been so advised.

If you notice, they are used in different contexts relating to different classes of patients. If we were to specify these disqualifications in relation to one class, we would ipso facto be supposed to specify the disqualification in respect of other classes, would we not?

Question put and agreed to.
SECTION 10.
Question proposed: "That Section 10 stand part of the Bill."

The purpose of this section is to enable an appropriate assistance officer to apply for a recommendation for reception to any registered medical practitioner, having approved the principle that in future any registered medical practitioner may grant a certificate on the application of any properly interested party.

Question put and agreed to.
SECTION 11.
Question proposed: "That Section 11 stand part of the Bill."

This is consequential on the extension again to registered medical practitioners generally of the power to make a recommendation or to sign a certificate in connection with the reception of chargeable patients.

Question put and agreed to.
SECTION 12.

I move amendment No. 1:—

In paragraph (c) (ii), line 32, before "escort" to insert "competent" and after "necessary" to add "and where such escort consists of a member or members of the Garda Síochána, such member or members shall wear civilian clothes while acting as escort".

The amendment in effect seeks to ensure that where a Garda escort is provided for a mental patient the member or members of the Garda should not appear in uniform.

No. The first one is the insertion of the word "competent". Amendment 1 is to insert "competent".

"In paragraph (c) (ii)"—have I got the wrong list?

It is a composite amendment, which makes it rather difficult to dispose of.

I was prepared to talk on the first part first.

Take the first part first.

I was going to make a point in relation to the section itself as it stands and the Deputy's amendment might fall in with it. This is in relation to clause (b) of Section 12.

Would it be better to discuss the section?

It is relevant to the section.

I have moved the amendment.

The wording there is "to arrange for such escort as may be necessary." The Minister can correct me but I do not find "escort" defined and my concern is in relation to questions that may be raised in relation to the administration of the Act.

It is not defined in the original Act, either.

I have looked at the original Act. Therefore, you have an undefined escort but the only right the Guard or the R.M.S. has to imprison the person concerned is the right laid down in Section 12 that he must do it by means of an escort, such escort as may be necessary. If in fact it were subsequently alleged that he got 12 nurses where in fact only two were required, the question might be raised as to whether he was acting within the authority laid down in the section. I know how these phrases come into a section of a Bill or an Act of Parliament. I know also how frequently it arises that the words laid down here are the words that have to be interpreted subsequently. I have personally very grave objection to imposing on an unfortunate officer, whoever he may be, the obligation of defining for himself what his duties are to be, unless he is protected in that way. I should like to see the words "arrange for such escort as in his opinion he shall consider necessary." I think that should be in and it was obviously intended it should be in.

As in the opinion of the medical superintendent concerned?

The member of the Garda Síochána concerned, because in this case the R.M.S. has refused to provide an escort or says he is not going to and the onus is on the member of the Garda Síochána to provide an escort. The amendment here is designed to ensure that not alone will the escort be adequate, that is in numbers, but that it will be a competent escort as well. I believe the member of the Garda Síochána can enlist the aid of anybody in the pursuance of his duty. If he has to accompany or provide an escort for a mental patient to a mental hospital, he can take anybody from the side of the street. I suppose the usual practice will be that he will get another member of the Garda Síochána. This amendment seeks to ensure that it will be a competent escort and, as Deputy O'Higgins suggests, that it will be adequate in numbers. How that can be provided for in words I do not know, but the word "competent" before escort is suggested as a safeguard.

In relation to what Deputy Corish has said, I do not particularly like the word "competent" because if it subsequently transpired that the person concerned was not in fact escorted from the place where the person was placed under escort to the hospital, then the people seeking to convey the patient presumably would be held not to be competent and it might mean that the whole journey could be challenged subsequently as being a journey not authorised by the Act.

The whole thing is daft.

Deputy O'Higgins had a point when he proposed to make the opinion of the resident medical superintendent the determining factor, but in everything we do, must we not proceed on the assumption that the courts will interpret the law with a feeling for what is practicable, that they will make a rational approach and will not endeavour to construe what is done by the Oireachtas, the Legislature of the State, in such a narrow way as to make it impossible to enact any statute? I am afraid that is where we are tending to go, particularly in relation to the point which is being made by Deputy Corish. We would have to assume if this matter did come to the courts that where a resident medical superintendent had provided an escort, and that is the first thing we have to consider, he would have to provide an escort of competent persons, persons who, in his view as a person qualified to determine such a question, were competent, and I do not think we need worry very much about what the courts would say——

"Escort" does not necessarily mean a member of the Garda Síochána? It can be any civilian?

That is right.

Yes. It can be any person who—I am proposing to give effect to the suggestion which Deputy O'Higgins has made—in the opinion of the competent medical authority is capable of being an efficient and suitable escort for the patient concerned. I do not think we have to worry very much about that and we will have to leave it.

The other case arises where the medical superintendent indicates that he does not intend to arrange for an escort and then the member of the Garda Síochána must himself arrange for such an escort as may be necessary. There we must assume again that the medical superintendent, having all the facts before him, will decide that this particular person does not require an escort of the special type which he would propose to send and that the patient would be quite safe in being brought to the mental hospital by any escort which the member of the Garda Síochána could himself arrange.

I think we would have to leave it at that. Do not forget that an unfortunate person may have been wandering around suffering from amnesia or under some hallucinations. The first consideration is not as to who will bring him there but how he will be brought as speedily as possible to a place where his condition may be treated by some experienced and expert person. These are the considerations which must guide us in coming to a conclusion as to what type of escort should be sent and who should provide the escort.

I agree we may be pinpricking somewhat, but I do not think anybody visualises a situation where a question of law will be raised here. I am prepared to accept what the Minister has said. I am prepared to assume that when a certificate is handed to a member of the Garda Síochána, he will consult the R.M.S. and will give him the general details of the case, the certificate for which he has. Then between the two of them they will decide whether or not the R.M.S. should provide an escort or whether it would be sufficient for the member of the Garda Síochána to provide that escort. I suppose I would also be safe in assuming—although it is not right to assume too much in respect of the law—that the Garda Síochána and the R.M.S., in consultation, will try to ensure that there is a competent and capable escort, whether it is a member of the force or somebody who is experienced in handling people of the kind we deal with in this Bill.

I know there are two parts to this amendment and I want to treat of the second part. We may well do that as there will not be a division, either on the whole amendment or on any part of it, but I should like to consider the suggestion in the second portion of the amendment. I notice in the section that when a certificate is presented to a member of the Garda—and I quote Section 12 (b)—"thereupon that member shall (i) request the resident medical superintendent of the district mental hospital mentioned in the recommendation to arrange for such escort as may be necessary." Then it says: "or (ii) himself arrange for such escort as may be necessary." I wonder if it is desirable to give a member of the Garda that discretion. He may either consult with the R.M.S. and ask him to provide the escort or he may decide not to consult——

If so, he does that on his own responsibility.

I wonder if we should give him that responsibility and that discretion? To go on, if the R.M.S. decides he will not provide an escort, the Garda may then provide the escort themselves and this amendment asks that in such a case where the escort is a Garda, the uniform should not be used.

I appreciate the necessity for the use of the Garda uniform in certain cases—one might say in many cases. I appreciate the necessity for it in respect of Section 9 of the Bill, the section which gives a Garda right of entry, in a situation in which he must enter a premises uninvited, so to speak. He must have some authority, apart from the fact that he announces himself as a member of the Garda and the uniform does have the effect sometimes of bringing people to heel.

But here is the situation where the proper procedure has been carried out in order to have a person admitted to the mental hospital. The certificate is made out and the whole thing is voluntary, so far as relatives are concerned. I do not say that the patient is willing or that he submits to the hospital without any fuss, but here we are providing for a case where an escort is necessary and I think it would be safe to assume that there would be quite an amount of annoyance to the patient concerned and to some extent some embarrassment for the relatives where a Garda or two appear at the door of a house and proceed to take forcibly— in most cases in such a situation as is envisaged under this section—some person from the house. If a Garda or a civilian in ordinary clothes, or even two of them, go to a house, there is not much risk of a scene but if, in a street of a provincial town or of a city two or three Gardaí appear in full uniform, it is inevitable that a crowd should gather. They may not know there is a mental patient there. They may suspect robbery or violence or something like that and all this serves to embarrass relatives and annoy the patient who may become much more violent as a result.

I do not think there should be any difficulty here. It is not an emergency situation but one in which time has been taken to consult the R.M.S., to enlist the aid of an escort and, because it is not urgent, time could be taken to recruit a Garda who is not in uniform for the reasons I have stated. It is not a very important part of the whole question, but I know from experience— not my own, but from what has been told to me by mental nurses and members of the public—that it would be very desirable, in cases where an escort has to be provided, if the escort comprises members of the Garda, they should be in civilian clothes.

In relation to this whole matter, we must remember that there will be a great variety of cases to be dealt with in which the circumstances will be different and we could not possibly cover these by statute. The section as now worded is designed to put a great deal of responsibility and discretion upon members of the Garda and upon the medical superintendent and upon the authorised medical officer or the registered medical practitioner who issues the certificate, in the first instance.

On the question which seems greatly to concern Deputy Corish, the unpleasant implications, shall we say, of having a patient escorted by men in Garda uniform, I can say that I propose to ask my colleague, the Minister for Justice—and I have some assurance that he will agree—that, where possible, the escorts of mental patients or of persons being brought to mental hospitals will be in civilian clothes, but I think it would be undesirable that we should write that in as a specific statutory requirement because cases may arise in which, for instance, immediate action may have to be taken and in which a Garda himself will have to act upon his own authority and with whatever escort or persons are available to him, without even consulting the R.M.S. and may have to bring the patient along. We want to provide for that.

On the other hand, he may be called upon to bring a patient to a mental hospital where the certificate states that the certifying practitioner feels that an escort should be provided but that might be because some unfortunate individual suffers from a loss of memory to the hospital, he might walk on to the railway lines, in front of a bus or over the quay side. That is the purpose of the provision and I suggest we should make certain that whatever happens under Section 12, there will not be undue delay in getting a person to a mental hospital, when it is certified that he should be admitted and that his condition is such that he should have somebody to take him there, to act as his guardians on the journey—that is the real meaning of the word "escort" used in this context. I can assure the House that I shall try so to arrange, and I am sure everybody else will too, that the people are taken to hospital with the least possible public advertisement.

The Minister will consider the point I raised?

I shall look into that and I shall try to bring in an amendment.

Very briefly, I should like to say I am in agreement with this matter in relation to the quality and attire of the escort. It is wiser to leave this to the discretion of the Garda. The Minister has announced his intention of asking the Minister for Justice to co-operate. It might be that the appearance of a uniform would cause unnecessary distress. There are also cases in which the appearance of a Garda in uniform sometimes simplifies this delicate operation. From my experience of rural Ireland, I can say it can be left confidently to the discretion of the Garda who will discharge this duty in whatever way is least distressing to the patient, his relatives, and himself.

I am quite satisfied. Frankly, I did not expect this to be written into legislation. The Minister's assurance that he will bring the matter to the attention of the Minister for Justice satisfies me entirely. I appreciate there are circumstances in which it would not be possible to do as suggested in the amendment.

Amendment, by leave, withdrawn.

I move amendment No. 2:

To add to paragraph (c) a new subparagraph as follows:—

"(iii) where the resident medical superintendent decides to provide an escort, such escort shall consist of registered mental nurses whose conditions of employment shall be determined in relation to this special duty."

This amendment is designed to secure special consideration for registered mental nurses who are required by the R.M.S. to do escort duty. I have an idea that this is a matter which might best be resolved between the trade unions and the hospital authorities. I raise it because it has been represented to me that mental nurses who are sent on escort duty in the middle of the night are required to turn in to work at the usual time next morning. I do not know what substance there is in the complaint or whether or not it is widespread. I assume, if the complaint is well-grounded, time off would be the solution.

The Minister might consider the desirability of having two male nurses in each mental hospital whose sole duty would be escort duty. I do not know whether they would be fully occupied but it must be admitted that escort duty can be very tricky in the case of violent patients. I certainly would not be competent to handle such a patient. I assume most mental nurses are competent to deal with violent cases. I assume that those who act as escorts are trained in the giving of sedatives. I do not know if there is a case for special treatment for nurses who act as escorts because I am not sufficiently conversant with the duties and I confess that, if there is to be special treatment or compensation for escort duties, that could best be achieved between the trade unions and the authority.

That is so. This amendment would seem to be directed towards conditions of employment. From that point of view, the matter is clearly one to be resolved through the accredited representatives of the nurses concerned. I should like to say that we are labouring under a misapprehension if we think the majority of mental patients are violent. They are not. Violence is the exception rather than the rule. Most are very docile and can be handled and we should not, therefore, base our case for special consideration on the assumption that the majority of the patients are violent. That could create a wrong impression in the public mind and I would prefer that we did not discuss it on that basis. The R.M.S. must carry the responsibility and we must leave him to determine the suitable escort. It need not necessarily be fully trained mental nurses in every case. I am perfectly satisfied that if a qualified mental nurse is essential in the opinion of the R.M.S., he will provide such an escort for his own protection, if for no other reason.

Amendment, by leave, withdrawn.
Question proposed: "That Section 12 stand part of the Bill."

Subsection (b) of Section 12 provides that the Garda may—

(i) request the resident medical superintendent of the district mental hospital mentioned in the recommendation to arrange for such escort as may be necessary, or

(ii) himself arrange for such escort as may be necessary,

The Garda has not absolute discretion. He consults the R.M.S.

He has discretion. First of all, he must have a certificate that an escort is required. An escort may be required because the patient is violent or incapable of looking after himself. Where it is a case of simple incapacity to negotiate the journey the Garda can come to a decision himself. That is the situation which subparagraph (ii) is intended to provide for.

I visualise the case in which a Garda may take it on himself to provide his own escort. Some trouble may occur on the journey and someone comes along and says that if the patient had got a sedative everything would have been all right. It is because of that that I raise the question of discretion.

The appropriate medical practitioner would provide a sedative if necessary. We have to assume that the Garda will discuss the case with the person who issued the certificate and act on his advice.

Question put and agreed to.
SECTION 13.
Question proposed: "That Section 13 stand part of the Bill".

This is simply to validate the reception where a reception order may subsequently be made in relation to chargeable patients where the place of address at which he was received is not his ordinary place of residence.

What, in fact, happens then? Is there an accounting between the districts involved?

There is. It is to make certain that his reception is valid. However he may be accounted for or by whatever authority he may be accounted for afterwards does not arise under this.

Question put and agreed to.
SECTION 14.
Question proposed: "That Section 14 stand part of the Bill."

This section is self-explanatory. Where there are two mental hospitals in a district under one mental hospital authority, the patient can go to one or the other.

Question put and agreed to.
SECTION 15.
Question proposed: "That Section 15 stand part of the Bill."

I think this is quite clear. Where a reception order is made, in respect of a private patient, by two doctors, it ensures that the two doctors are not related to, or connected with each other in any of the ways mentioned in the amendment— not related to each other, or associated or connected by marriage.

Question put and agreed to.
SECTION 16.

Amendments Nos. 3 and 5 are cognate and perhaps they could be taken together.

I move amendment No. 3:

In subsection (3), page 7, to insert the following subsection after line 24 as a subsection added to section 184 of the Principal Act:

"(6) Where a request for a certificate for the purposes of subsection (4) of this section is made to the authorised medical officer, that officer shall examine the person in respect of whom the certificate is requested and shall give the certificate if he is of the opinion referred to in that subsection."

The effect of this amendment is to place an obligation on the authorised medical officer, that is, the dispensary doctor, to examine the patient whose reception is being sought as a temporary chargeable patient and, where appropriate, to issue a certificate. Under the Bill as drafted, no obligation was placed on the authorised medical officer to examine a person in those circumstances. That was a continuation of the existing position. No such obligation exists under the present law. In the past, fees paid to the authorised medical officer in respect of an examination of persons desiring to enter a hospital as temporary chargeable patients and as voluntary chargeable patients were reckoned for superannuation purposes because they were paid by virtue of his office as district medical officer.

In future, these fees will be paid to him as a registered medical practitioner, and not as a district medical officer, unless, as proposed in the amendment, we place an obligation on him as district medical officer to examine these patients. The fees which will accrue to him as a result of these examinations will then count for superannuation purposes.

I want to be quite sure I understand what the Minister is doing. This amendment is consequential on earlier amendments which provided that now, and in the future, any registered medical practitioner may make a recommendation for reception.

Accordingly, the Minister is having regard to the situation in which, in fact, no medical practitioner is willing to examine the patient concerned.

That is true. It would cover the case where an ordinary private practitioner might refuse to examine a patient, but the primary purpose is to impose an obligation on the district medical officer to carry out an examination of patients who wish to become temporary or voluntary chargeable patients. If an examination of such persons is the duty and obligation of the authorised medical officer, any fees he may collect for these examinations may be counted for superannuation purposes.

At the moment it is a dispensary doctor who certifies. He is the only person who may do so.

And any fee he gets is counted for superannuation purposes.

It goes on to his income and consequently ranks for superannuation purposes.

Now there is to be a change, and any doctor may certify.

If I may try to put it this way: In the absence of the amendment, fees payable to the district medical officer would not rank for superannuation, but if we impose an obligation on him and he gets the fees in discharge of his duties, they would count for superannuation purposes. That is the primary purpose of the amendment. There are secondary consequences, but I do not think they are likely to arise.

Does it meet the problem which was raised with the Minister and others by dispensary doctors, following the Second Reading of the Bill? They made the case that, by reason of the change, in effect, their superannuation rights might be affected.

It meets it on the narrow point of superannuation, but it does not meet the other point which they raised, that their income would be reduced by the loss of these fees.

I know the duty is there at the moment, but this is an obligation to examine a person who would be a chargeable patient. In other words, the person concerned with the temporary chargeable reception order may not be in the lower income group. He may not be a dispensary patient.

He may not.

The dispensary doctor is now required to examine a person who may, in fact, be a person of private means, but who may not be in a position fully to meet the cost of maintenance.

The position is that at the present time the only person who can issue a recommendation for reception or a certificate in respect of a chargeable patient whether for a person of unsound mind, a temporary patient or a voluntary patient, is the dispensary doctor. For issuing that certificate, he would be paid a fee of, I think, two guineas, and that, naturally, would rank for superannuation. The change that is being made is that if, for any reason, the patient himself, or a relative of the patient concerned, does not want to go to the dispensarry medical officer of the district, and would prefer to go to the family doctor, to take a case in point, a psychiatrist or a specialist, the certificate can be issued by the family doctor or the psychiatrist. To the extent to which that alternative may be availed of, the dispensary doctor will lose his fee. I do not think there is anything we can do to remedy that situation. It means that he is not called upon to discharge his duty and, therefore, does not draw a fee in respect of it. What we are endeavouring to ensure, and what we will secure, is that wherever he does issue a certificate and draw a fee, the fee will rank for superannuation.

When he does the examination, he does it as part of his duties, and it is associated with his office, even though he may be selected by the people concerned?

Whenever he does it.

Amendment agreed to.
Question proposed: "That Section 16, as amended, stand part of the Bill."

With regard to the disqualification in subsection 3 (a), "if such practitioner is interested in the payments (if any) to be made on account of the taking care of the person," what kind of case is dealt with?

For instance, for a private mental institution.

Could it not be better——

I think it better to leave it that way.

I am thinking of a private mental hospital which may be run by a board of governors or a corporate body, in any event. The medical practitioner certifying is employed by such a hospital. Obviously, the intention is that be should not be the certifying doctor. Is he a person interested in the payments to be made on account of the taking care of a person? Does it exclude him in the way it is phrased there? What interest has he in the fees paid for the maintenance of the patient whom he serves?

He would have an indirect interest. I shall have a look at that. There may be something in it.

Section, as amended, agreed to.
SECTION 17.
Question proposed: "That Section 17 stand part of the Bill."

This section provides that an application for a temporary private patient reception order may not be made by any person under 21 years of age.

Question put and agreed to.
SECTION 18.

I move amendment No. 4:

To add to the section the following subsection:

"(2) Where a person is, at the commencement of this section, detained by virtue of an order or series of orders under section 189 of the Principal Act, the order or series of orders shall, for the purposes of the Principal Act as amended by this Act, be regarded as an endorsement or series of endorsements made by virtue of subsection (1) of this section.”

This is a drafting amendment. In the section as it stands a chief medical officer is given power to grant extensions up to 18 months in the case of a temporary patient other than an addict and up to six months in the case of an addict. This extension is in addition to the period during which, under paragraph (b) of subsection (1) of Section 186 of the Principal Act, he may be detained. This means in effect that he may be detained for the original six months plus any extensions granted by the Minister. If, therefore, the Minister had granted three extensions, and the patient is near the end of the two-year period at the time, as this Bill stands the chief medical officer, in the absence of this amendment, could I think grant three more extensions, thus making the total period of detention up to three and a half years.

Amendment agreed to.
Question proposed: "That Section 18, as amended, stand part of the Bill."

The House knows the purposes of Section 18. They are to transfer from the Minister to the chief medical officer of the institution concerned power to extend the period of detention of a temporary patient but to limit the aggregate of the periods of detention of addicts up to six months. In addition, two new safeguards will be provided under Section 33 (b) of this Bill and under Section 282 of the original Act.

Could the Minister tell us something about the qualifications of the Inspector of Mental Hospitals? I am not questioning his qualifications. I know there is only one inspector.

There is an assistant inspector, as well, who has equal rights.

He has certain qualifications?

He has. I am not giving the specific qualifications now but I think the Deputy may take it that he is qualified as a psychiatrist for the post.

Apart from paying particular attention to patients whose period of detention has been extended since his last visit, and so on, he has other duties besides being a psychiatrist or mental doctor?

He has the full responsibility of ensuring that no person is detained in a mental hospital without due warrant and he has the general duty of inspecting these hospitals.

He has also his departmental qualifications to act as an inspector? I do not mean that there are such in the Department but I take it that he has experience of that?

I assume he has. Do not ask me to particularise.

We test these things by the improbable. When an objection is made by the patient himself, the Inspector of Mental Hospitals must give a report. What does he do? Sub-paragraph (iii) of paragraph (b) provides:

on being required to give such report, the chief medical officer shall give it forthwith and, on consideration of the report, the Inspector of Mental Hospitals shall take such steps as he considers necessary for ascertaining whether or not the detention of the person to whom the order relates should be continued.

What would the Inspector of Mental Hospitals do? He has got the report from the chief medical officer. He has a complaint from the patient that he should not be detained. Does he carry out a medical examination himself or does he have the patient examined by some other medical practitioner? What exactly is done?

I do not know what exactly is done but I know what he is obliged to do. He must ask for the report from the medical officer. On receipt of that report—this is all set out in the memorandum—he must take such steps as are deemed necessary to satisfy himself of the propriety or otherwise of the continued detention of the patient. It means that he himself must either have the patient examined or his assistant must have him examined. If he has any doubt about it he can call in another consultant. I take it the onus is on him to satisfy himself on this matter. What steps he may take to do that, I do not know. As well as that, he may have to visit the patient, possibly several times. There may, in some cases, be no way in which he could arrive at a conclusion on any patient except by this personal examination.

Does he have to report to the Minister?

He does, if he is in doubt.

That is not stated here.

It is stated later.

Question put and agreed to.
Progress reported; the Committee to sit again.
The Dáil adjourned at 5 p.m. until 3 p.m. on Tuesday, 7th March, 1961.
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