Mental Treatment Bill, 1960— Committee Stage (Resumed).

Debate resumed on the following amendment:
In subsection (2), page 9, to delete "subsection is" in line 15 and substitute "subsections are" and to insert the following subsection after line 16 as a subsection added to section 190 of the Principal Act:
"(4) Where a request for a recommendation for the purposes of subsection (3) of this section is made to the authorised medical officer, that officer shall examine the person in respect of whom the recommendation is requested and shall give the recommendation if he is of opinion that such person will benefit by the proposed reception."
(Minister for Health)

In view of what has happened—the Minister was not able to tell us about it last Wednesday—would the Minister agree to recommit Section 18?

Not today, if the Deputy does not mind. We might recommit it on Report Stage.

Amendment agreed to.
Question proposed: "That Section 19, as amended, stand part of the Bill."

The purpose of this section is to relieve a person entering a hospital as a voluntary patient of the necessity of having a recommendation from an authorised medical officer stating he has examined the person concerned and that he would benefit by the treatment. In future, this statutory requirement will only remain for persons under 16 years of age.

Question put and agreed to.
Question proposed: "That Section 20 stand part of the Bill."

The purpose of this section is to remove the requirement on a person who is 16 years of age or over entering a hospital as a voluntary private patient to have a recommendation from a registered medical practitioner. It is the same principle as that in Section 19.

Question put and agreed to.
Question proposed: "That Section 21 stand part of the Bill."

This is to validate the reception of a person received as a voluntary patient where the place of residence shown in the application is not the ordinary place of residence of the patient.

Question put and agreed to.
Question proposed: "That Section 22 stand part of the Bill."

The purpose of this section is to transfer from the mental hospital authority, who at the moment is the manager, to the resident medical superintendent of a district mental hospital power to release a patient on trial. That is subsection (1). The other one runs the same way.

What about subsection (3)?

That is to permit the recall of a patient on trial before the expiry of the period for which he has been released.

If a patient is now released for three months, he may not be readmitted?

If he is released on trial——

Question put and agreed to.
Question proposed: "That Section 23 stand part of the Bill."

The purpose of this section is to permit the recall of a patient who is absent on parole from an institution before the expiry of his parole.

Question put and agreed to.
Question proposed: "That Section 24 stand part of the Bill."

This is to provide thatbona fide applicants may be supplied by the mental hospital authorities with certain information about persons detained in mental hospitals. There is also provision for an appeal to the Minister against the refusal of a mental hospital to furnish the information concerned. These provisions will replace similar provisions in Section 200 of the 1945 Act which is being repealed by Section 42 of this Bill.

I cannot find "appropriate person" defined. I do not follow in whose discretion lies the determination as to who is or is not an appropriate person.

It is not defined.

Should there not be some sort of yardstick?

The difficulty is that there are 19,000 patients in our mental hospitals, many with no relatives. Yet there might be a person with a traditional interest or a person who would not be a close relative but a connection—a business associate, for example—with an interest in knowing how the person came to be detained. The only question that would arise if he made an application stating that a person had been improperly detained would be that there should be somebody to decide whether the information should be given to him as a person who had either a charitable interest or business interest in the patient concerned.

The request for particulars or information may, in fact, be known to the mental hospital authority to be antagonistic to the authority inself. It may be embarrassing, inconvenient and, possibly, potentially troublesome to the authority, to have to give the information. In those circumstances, it seems to me undesirable to give the mental hospital authority, which is the country manager or whoever he appoints to act on his behalf, the right to refuse entirely on the grounds that the person asking is not a proper person, without saying who is or is not likely to be regarded as a proper person.

Of course, there is an appeal to the Minister.

I see that, but the Minister, in dealing with the appeal, has no guidance under the statute.

No, he would have to act on his own responsibility on the facts before him. It would be very difficult. What could we say? That he must be within a certain degree of kindred? The applicant would have to satisfy the manager in the first instance, and the Minister afterwards, if necessary, that an application was madebona fide and that would lead to an investigation of the person's right to obtain the information. I think we will have to leave it at that.

Question put and agreed to.
Question proposed: "That Section 25 stand part of the Bill."

Broadly, this provides that if a person detained in a district mental hospital is charged before a district justice with an indictable offence and there is aprima facie case that he has committed the offence but, if placed on trial, would be unfit to plead, he will be detained in the institution or may be transferred to Dundrum, according as the Minister, after considering a report from the Inspector of Mental Hospitals, decides.

He may be transferred to Dundrum?

He can either be detained in the local authority institution or, if that is not appropriate, he can be transferred to Dundrum. The whole point is that he must be charged with an indictable offence and there must be aprima facie case against him.

If he recovers, under the parent section he is to be discharged and his fare home is to be paid. I take it he then faces the full consequences?

Yes; I assume so, anyway.

Question put and agreed to.
Question proposed: "That Section 26 stand part of the Bill."

The purpose of this section is to transfer from the mental hospital authority to the R.M.S. of a district mental hospital the power to approve of the discharge of a person detained as a private patient on the written direction of the person by whom the last payment for the patient was made or, if such person is not available, on the direction of the nearest of kin of the patient who is available.

Question put and agreed to.
Section 27 to 30, inclusive, agreed to.

I move amendment No. 5:

Before section 31, to insert the following new section:

"31. The following section is hereby inserted after section 222 of the Principal Act:

‘222A. A mental hospital authority may, subject to the sanction of the Minister, arrange for the provision of preventive or after-care services for any chargeable patient ordinary resident in their mental hospital district.'"

This is a drafting amendment. The original section imposed a limitation on after-care services to patients detained in a mental hospital. It is considered essential that such after-care services should be available to all classes of chargeable patients.

After-care is to be provided in accordance with a general authorisation given by the Minister. I should like to know in what way it is proposed that such general authorisation shall be given: and, secondly, I should like to know what is meant by "after-care"?

First, it would be done entirely by general authorisation. Quite frankly, we have not worked that out. To some extent, we may have to await the report of the Commission, but I do not think we shall. I think we will start an after-care service as soon as we have the requisite personnel. Patients released will be visited in their own homes to try to get them to avail of the rehabilitation services and generally to adjust themselves to ordinary civilian life.

It will be a medical matter?

Medical, nursing and psychiatric, if I may put it that way.

What I am concerned about is this. It may be the exceptional case but I can certainly imagine the type of person who, if subjected to after-care of an ill-considered kind, might find that that was the worst kind of treatment for him. Having been discharged from hospital, anything that might bring back into his mind his period of hospitalisation might have a harmful effect on him. All I am concerned about is that whatever will be done will be done under medical advice.

Yes, certainly.

I assume that this scheme of after-care will be more or less standard throughout the country. Quite frankly, I am afraid of these phrases. I believe as much as anybody in regard to the autonomy which these authorities should have but I think there should be some attempt at co-ordination by the Minister or the Department in endeavouring to get a uniform scheme. That is being done successfully in respect of general treatment and especially in the after-care treatment of T.B. patients. In respect of T.B., a national campaign was initiated by the Minister for Health at one period. If this business of mental health and after-care treatment were tackled in the same way and if standards could be laid down which could be adopted by every local authority, much more good could be done than by leaving it to the discretion of the local authorities. I trust that the Minister will try to have introduced and established some uniform scheme of after-care treatment. Has the Minister some views in relation to the word "may"?

There will be uniformity. It will be under the control of the appropriate medical personnel.

Amendment agreed to.
Section 31 deleted.
Question proposed: "That Section 32 stand part of the Bill."

The purpose of this amendment is to clarify who is responsible for the repayment to the Minister for Justice of expenses incurred by the Garda in re-taking a patient who escapes from an institution other than a mental institution, e.g., from a general hospital to which the patient had been transferred for treatment there. Under the existing provisions of Section 229 of the 1945 Act, expenses incurred by the Garda in re-taking a patient who escapes from a mental institution are repaid to the Minister for Justice by the person carrying on the institution—in the case of a district mental hospital, by the mental hospital authority. There is, however, no provision for a case where a patient escapes from any other type of institution. The amendment will make it clear that where a patient escapes from an institution other than a mental hospital expenses incurred by the Garda in re-taking him will be recoverable from the person carrying on the mental institution to which the patient belongs, in the case of a district mental hospital, from the mental hospital authority.

Question put and agreed to.

I move amendment No. 7:

In page 13, between lines 11 and 12, to insert a new paragraph as follows:——

"(h) enquire as to the staffing arrangements."

The appropriate section in the 1945 Mental Treatment Act provides for an inquiry by the Inspector of Mental Hospitals into staffing arrangements. The White Paper says that the present duties of the Inspector of Mental Hospitals are set out in the Mental Treatment Act, 1945. The purpose of the new amendment is to specify in more detail the duties of the Inspector. Indeed, to a large extent that is done very well. The reason this amendment is moved is to re-introduce what was in the 1945 Mental Treatment Act. There was provision for an inquiry into the staffing arrangements. As far as Section 33 is concerned, the duties of the Inspector are specified in greater detail, but I am also concerned about the staffing arrangements, especially in respect of the staff itself. The staff of mental hospitals were always pleased to know that one of the Inspector's duties was to inquire into staffing arrangements and consequently into their wellbeing as mental nurses. Perhaps the Minister would begin by telling us why this particular subsection, providing for an inquiry as to the staffing arrangements, has been deliberately deleted from this Bill?

I think the reason really is to be found in the phraseology of subparagraph 2 of paragraph (e) which says: "ascertain whether or not the care and treatment provided for the patients is adequate." That would seem to cover, among other things, the staffing of the institution. Perhaps the Deputy might feel it would be more satisfactory if the amendment were accepted? I do not think it is necessary but I am prepared to accept it.

I would prefer if it were included. While the Inspector of Mental Hospitals is primarily concerned with the care and treatment of the staff, it is rather important that the Inspector should be empowered to inquire as to the general staffing arrangements with emphasis on the staff. If the subsection is phrased in that way, it would be very desirable.

I think the Deputy is carrying it a little bit further than I would be inclined to go. He would be entitled to inquire as to the adequacy of the staffing arrangements but I do not think he should inquire as to the care and treatment of the staff.

I did not mean——

If it were a question of satisfying himself that the staffing arrangements are adequate to provide proper care and treatment for the patients, I would be quite prepared to accept the amendment. While I am accepting it, it must not be taken that an obligation is laid upon the Inspector of Mental Hospitals, when he visits a mental hospital, to investigate any grievances the staff may have. That is a matter more properly to be dealt with by the staff organisation and the authority of the mental hospital.

Amendment agreed to.
Question proposed: "That Section 33, as amended, stand part of the Bill."

Why is an inquiry as to the facilities in respect of patients attending religious ceremonies now excluded from the responsibility of the Inspector?

Because in present circumstances we do not think that is necessary. Its inclusion in the earlier Act, I think, was a mistake. I feel it was a mistake. It implies that there was an absolute need to ensure that these facilities would be given. As far as I know, the patients are afforded every facility and given every encouragement.

Question put and agreed to.
Question proposed: "That Section 34 stand part of the Bill".

As the law stands at the moment, whenever the Inspector visits a hospital, he must be presented with a detailed list of patients as well as registers, books, records and other documents. He is required to certify that these documents have been produced to him. We think that it should be left to the discretion of the Inspector of Mental Hospitals what documents he should require to be produced. The existing provision is not of any great practical value and in view of that, we can dispense with the requirement, which is obligatory, that all these documents produced to him are to be certified by him as having been so produced.

Question put and agreed to.
Question proposed: "That Section 35 stand part of the Bill".

The purpose of this, I think, is clear. It is to make certain that the reference to ill-treatment which appears in Section 253 of the Mental Treatment Act, 1945, will include a reference to striking.

I should have thought that it would.

It was held not to; at least, on one famous occasion, we were advised that it did not.

Question put and agreed to.
Question proposed: "That Section 36 stand part of the Bill."

This is to give a patient the right to send a letter unopened to the visiting committee of a district mental hospital. As it stands at present, the patients have a statutory right to send letters to the Minister, the President of the High Court, the Registrar of Wards of Court, a mental hospital authority and the Inspector of Mental Hospitals. This is to add a visiting committee.

I am sure if Deputy Sherwin were here, he would ask: why not members of the Oireachtas?

Well, there is no reason but that some members of the Oireachtas would not welcome it. I would try to meet the request which Deputy Kyne made, that they should be sent to members of the Oireachtas, but I would like to try to meet it in another way. The requirements provide that all correspondence or letters to or from an intern patient shall pass through the person in charge of the institution. I would hope to provide in the revised regulations that in future this will operate only where a person in charge considers it essential, in relation to a particular patient, that they will be opened and that the majority of the letters will be sent out without scrutiny. Accordingly, any members of the Oireachtas who may care to receive these letters will probably receive them unopened.

We try to keep the members of the Oireachtas out of all the local bodies.

Of course the number of cases in which patients write letters which are opened are comparatively few and I think this is a better way of approaching it.

Question put and agreed to.
Question proposed: "That Section 37 stand part of the Bill."

The purpose of subsection (1) of this section is to enable the Minister to make regulations governing the payment of a fee of two guineas payable by the Mental Hospital Authority to the authorised medical officer for examination of a person whose reception is sought as a person of unsound mind and a chargeable patient, a temporary chargeable patient and a person who is under 16 years of age. Subsection 2 (1A) is to provide for the payment of two guineas to any registered medical practitioner who has examined a person whose reception is being sought in any of the categories I have mentioned. The purpose of the amendment in subsection (2) (1B) is to provide that the Minister shall have power to decide any dispute which may arise as to which mental hospital authority is to pay the fee.

Question put and agreed to.
Question proposed: "That Section 38 stand part of the Bill."

The purpose of this section is to ensure that persons who are criminal lunatics who are undergoing sentence will be regarded for treatment on the expiration of their sentence as if they were received under the normal procedure of the Mental Treatment Act as persons of unsound mind.

That means after-care and all the other provisions will apply?

Question put and agreed to.
Question proposed: "That Section 39 stand part of the Bill."

This section provides that the institution which is now properly known as the Dundrum Central Criminal Lunatic Asylum shall in future be known as the Central Mental Hospital.

Is there no Irish name for it?

Well, I suppose——

Better ask the Minister for Defence—he has an Irish word for everything.

Well, perhaps that is an oversight on my part but I think we will let it stand.

Question put and agreed to.
Question proposed: "That Section 40 stand part of the Bill."

This is the special section which provides that an established civil servant, who was for any period a pensionable officer of a mental hospital authority, shall be entitled to reckon for the purposes of superannuation the whole period which he was entitled to reckon whilst he was with the authority.

Question put and agreed to.

I move amendment No. 8:—

To add to the section the following subsection:

"(6) Where—

(a) an allowance under Part VIII of the Principal Act is, on the commencement of this section, in course of payment in whole or in part,

(b) the person to whom the allowance was granted was granted it by reference to his having been an officer who ceased to hold office on reaching an age limit, and

(c) it was not a condition of his having been appointed to be such officer that he should so cease to hold office,

the body paying the allowance may, subject to the sanction of the Minister for Health, grant—

(i) an increase of the allowance, the increase being of such amount as the body may consider proper subject to the restriction that it shall not exceed one-eighth of the salary by reference to which the allowance was computed and,

(ii) an increase of the lump sum granted with the allowance, being an increase of such amount as the body may consider proper subject to the restrictions that it shall not exceed one-third of the salary by reference to which the allowance was computed and that it shall be such that the lump sum as increased shall not exceed four-thirds of the said salary."

The purpose of this amendment is to make provision for the addition of years in a very limited number of cases where people had to retire without full pension and their retirement was due to an age limit order which was not in operation at the time of their recruitment. The amendment limits the addition to a number not exceeding ten to the number of years on which the pension is based. There was no provision under the 1945 Act for the addition of years for any person who had to retire under an age limit order which was not in operation at the time of appointment. In that respect the 1945 Mental Treatment Act was more restricted than the 1948 and 1956 Local Government (Superannuation) Acts. The lack of provision has created some hardship in a small number of cases and it is desirable to rectify the position.

Amendment agreed to.
Section 41, as amended, agreed to.

Amendment No. 9 is out of order.


Question proposed: "That Section 42 stand part of the Bill."

This is a repeal section.

Question put and agreed to.
Section 43 agreed to.

Amendment No. 10, in the name of Deputy Corish, is out of order.

Question proposed: That the First Schedule be the First Schedule to the Bill.

One of the effects of this Bill is to transfer for superannuation purposes the staffs of mental hospitals.

May I suggest that the Chair permit us to take the Schedule paragraph by paragraph? There are paragraphs 1,2,3,4 and 5. Then we come down to where the operative part begins, paragraph 6.

The Schedule is a unit and I shall have to put it as a unit.

It would suit me better this way because I have to make some general comments. It has been impossible, as has been pointed out by the Leas-Cheann Comhairle, for any member of the House, apart from the Minister, to attempt to make any effective change. Any change that might be proposed from this side would be in the form of an amendment that would impose a charge on the State or on the local authorities and for that reason would be ruled out of order. It should be said straight away that the Bill does make some improvements in superannuation for staffs of mental hospitals, while, on the other hand, there will be some disadvantages for future entrants.

The Minister should recognise the special position of mental hospital staffs, mental nurses in particular, which was recognised 15 or 16 years ago when the 1945 Mental Treatment Bill was introduced. I do not recall the discussion but the Minister, or it may have been a Parliamentary Secretary, on that occasion justified the superannuation provisions embodied in that Act on the ground of the difficult and trying type of occupation that mental hospital staffs have.

It has been difficult for a layman to tease out the difference between the superannuation provisions of the 1945 Act and those in this Bill but I think I am right in saying that any mental nurse who does not opt out will automatically come within the scope of this Bill and will be eligible for all the provisions in addition to continuing to contribute at the rate of three per cent. and being eligible for widows' and orphans' benefits, as in the 1945 Act. The Minister will probably tell us that it will be done by regulations, that there will be a specified time within which the existing members of mental hospital staffs will be allowed to opt out.

I do know that there was quite an amount of confusion in the minds of officers and servants of local authorities in regard to the 1948 Local Government (Superannuation) Act. I do not think that tight arrangements were made to ensure that what the officer or servant wanted to do was done and many of us have had cases where there was a loose method of notification to the officer or servant as to what his right was, as to whether or not he should remain under the 1925 superannuation code or whether or not he should opt for the provisions of the 1948 Local Government (Superannuation) Act.

Therefore, I would urge the Minister to try to provide that there will be proper arrangements and that these arrangements will be made known to the officers and servants of mental hospitals, that they will know what their rights are with regard to opting in or out,

I gather—I regard this as an improvement also—that the allowance and lump sum at retirement will be calculated on remuneration at the date of retirement. That is to be welcomed.

I had put down an amendment—I do not want to pursue it in any detail, Sir—in respect of the death of an officer or a servant in the employ of a mental hospital. The present position seems to be that if, within seven years, a male nurse, for example, dies in the service of the mental hospital, an allowance may be paid to a widow and children. That should be stressed. It does not mean that he dies as a result of injury incurred in the service of the mental hospital. If he dies from natural causes and has had a period of service of seven years or over, his widow and children are entitled to a gratuity or allowance.

The present proposals mean that it is only in circumstances where after seven years' service a mental nurse is injured in the course of his employment with a mental hospital that a gratuity or an allowance can be paid. There is a difference in that whereas heretofore only a widow and children could receive a gratuity or allowance, under the present proposals, if the mental nurse dies as a result of injury in the service of the hospital and has had seven or more years of service, a gratuity or allowance may be paid to his widow or her widower, a dependent father, mother or children.

My amendment was ruled out of order but I must confess that in that amendment I had attempted to get the best of the 1945 proposals and of the proposals in this Bill because I believe that in view of the special type of work and most trying work that is involved, any advantages that could be given with regard to superannuation should be given.

On the other hand, it is an improvement that a short service gratuity will be payable after one year's service where retirement arises from illness in service, illness, I assume, contracted and proved to have been contracted in the service of the hospital. In the 1945 Act the minimum period of service was five years and it was an improvement on the 1909 Act which provided for ten years. We can also agree that it is a substantial improvement to see that the service after which a gratuity can be paid where illness is contracted has been brought down to one year.

I assume the addition of the years of service—I forget in what particular section it is done—is generally in accordance with the ordinary provisions of the Local Government (Superannuation) Act of 1956. I mention these as improvements and it might be said that they are not the entire list of improvements in the matter of superannuation for mental hospital staffs. There are also disadvantages, of course. The existing salary contribution for the purpose of superannuation is three per cent. In the new proposal, to come into operation on 1st April this year, it seems that there will be four and one-sixth per cent. for a servant and five per cent. for an officer. I assume, and if I am wrong perhaps the Minister will correct me, that this four and one-sixth per cent. and this five per cent. are the contributions ordinarily paid by local government servants and officers.

That is so. It applies only to new officers.

Yes, new officers or those who do not take the option. I have dealt with the advantage in the matter of the death of a servant due to injury but may I mention it again as somewhat of a disadvantage that there will be no gratuity or allowance in the case of death from ordinary causes? There are no such gratuities or allowances for a widow or children but there is a provision for the payment of a gratuity or allowance in certain circumstances to other people besides the immediate members of the family.

The retirement provisions are such now that a mental hospital employee, a mental nurse, may retire at 55 years of age. That is the age at which a member of a fire brigade may retire. It is ten years sooner than the retirement age for the ordinary civil servant or for any officer or servant of a local authority. I wonder has the Minister considered reducing that retirement age in the case of mental nurses particularly? I believe that the age at which members of the Garda Síochána retire is 52. They may, if they so desire, continue in the service until they are 55 and, in some cases, until they are 60.

Does the Minister not consider that there is a special case to be made for mental nurses, those who go into the service at 18 or 19 years of age and who serve in that capacity for 34 years? It is a rigorous type of employment and one that is very trying. There is no necessity for me to describe in detail the nature of the duty of a mental nurse. The Minister and his officials are well conversant with the nature of their duties. It affects them physically and in many other ways. I think the Minister would be doing a service to mental nursing and to nursing personnel if he decided that retirement was possible at the age of 52 years. If a special case can be made for the Garda Síochána a much stronger case can be made for mental nurses.

I would like, in conclusion, to refer to a particular problem. The Minister may not be aware of it as of now but perhaps he would inquire into it. There is a proposal in the Bill to the effect that it will come into operation on the 1st April this year. On that day new entrants will be subject to new conditions. I have in mind people holding temporary positions as trainee nurses. They are not regarded as officers. They have been in a temporary position for some time and will not be deemed to be officers till 1st April this year. I would like to know if these temporary trainee nurses will be subjected to the new provisions in the Bill. I am informed that in one particular mental hospital there are 19 such persons and perhaps special consideration could be given to them. They might be given the option of electing to work under the 1960 Act or under the 1940 Act.

By and large, I think it would be right to say that there has been some improvement in the superannuation codes for mental nurses. There are some disadvantages. It has not been possible to attempt even to amend the Schedule in any way for the reasons stated by the Ceann Comhairle. Perhaps the Minister would consider some of the things I have mentioned, especially those in regard to the early retirement age and also to the position of the temporary trainee nurses who will not be deemed to be officers by the time the Bill comes into operation.

I cannot concede what Deputy Corish has asked in respect of the mental nurses. After all, in the prison service and in the case of the Central Mental Hospital, the officers may retire at 55 but they may also serve up to 60 years if they so wish. A Garda may retire at 50 if he has 30 years' service. Anybody below the rank of superintendent can normally retire at 60. That is running contrary to the direction in which Deputy Corish would like us to go in relation to mental hospital nurses. I think, after all, that they are being fairly treated if they can retire, having the necessary service, with full pension at the age of 55.

On the matter of the trainee nurses, I think there is a point there all right, that they should be regarded as having entered the service. I will look into it and see what can be done on the Report Stage.

Question put and agreed to.

I move amendment No. 11:

In the third column, in the repeals specified in respect of the Mental Treatment Act, 1945, to insert "223" before "226".

Section 233 of the Principal Act was to be amended by Section 31 of this Bill as introduced. The purpose of the amendment was to enable mental hospital authorities to provide after-care for discharged patients who had been detained but the new section provides that it will not only deal with such patients but also with voluntary patients.

Amendment agreed to.
Second Schedule, as amended, agreed to.
Title agreed to.
Bill reported with amendments.

Could I put it down for Report Stage on Thursday to enable me to look into this question of the trainee nurses?

There are a few other earlier points?

That is so.

It had better be next week.

My anxiety is to get the Bill through, if I can, before the 1st April.

I think the Minister will.

Through the Seanad? That is the only point. I shall look into the other matters and if we do not meet them we can put it back to Tuesday.

Report Stage ordered for Thursday, 9th March, 1961.