(Cavan-Monaghan): I would like to say just a few things. I know that I am confined in my remarks to talking about what is in the Bill and that means that I can say very little because there is very little in the Bill. It is a Bill that replaces three or four other lengthy Acts, the basic one being that of 1945. This Bill has been a long time awaited by the medical profession and other people, but when it is looked at and studied we find that it deals largely with the admission and discharge of patients who have to be committed to psychiatric institutions, and that is about 5 per cent of the patients that we find in psychiatric institutions. There is nothing in the Bill about improving the standard of care, nothing about improving the standard of treatment, nothing about imposing an obligation on the health boards to modernise the wretched places in which unfortunate people are kept, which are not fit for criminal purposes, never mind medical purposes. There is nothing about that in the Bill; therefore I cannot say a lot about it.
One thing in this Bill which I am very perturbed about is that it is provided now for the first time that voluntary patients may discharge themselves from these institutions on 24 hours' notice. That is a slight improvement on the Bill as it was introduced, because the Bill as introduced provided that voluntary patients could discharge themselves from these institutions without any notice. On both Second Stage and Committee Stage of the Bill I went to considerable trouble to try to impress on the Minister that that was dangerous, and I pointed out to him cases I knew where patients walked out of an institution, with fatal consequences for the patient's wife in one instance. I urge on the Minister to provide that a person going into a psychiatric institution should be obliged to give 72 hours' notice of his intention to discharge himself. That provision, which I sought to get the Minister to put into the Bill, is in accordance with the best advice available from the Association of Consultant Psychiatrists, who thought it was dangerous and unwise that a patient could discharge himself without notice and advised that a period of 72 hours was reasonable to enable the consultant in charge to observe the patient to see whether he was fit to be discharged and whether it was safe in his own interests and in the interests of other people or another person that he should be discharged. The Minister steadfastly resisted a 72-hour notice provision and, under pressure from people other than me, he apparently agreed to provide for a 24-hour notice instead of 72 hours. When he was under pressure from me about the advice given by the Association of Consultant Psychiatrists he said that they were reasonably happy with 24 hours. That is as far as the Minister did or could go.
I am not going to drag out this discussion. The Minister has insisted on 24 hours' notice and he refused point blank to provide a longer notice. The basis of his argument is that he wants to encourage people to become voluntary patients. That could very well mean that many people will go in as voluntary patients who really should not be at liberty to walk in and out as they like. But because they go in as voluntary patients they can discharge themselves on 24 hours' notice. That might not be in the interests of the patient and it might not be in the interests of other people; it might be a danger to the patient and dangerous to other people. I want to go on record as saying that I think the Minister is taking a big responsibility on himself. I hope that he or one of his successors will not live to regret this provision. We are not dealing with normal patients. We are not dealing with patients who can exercise a balanced judgment as to their own welfare or about other people. Still, the Minister proposes to treat them as if they were in a position to come to these balanced judgments. I regret very much that the Minister will not give in to reasonable argument here. There are many other things in the Bill that I could talk about but if I were to pick out one provision of the Bill which I feel strongly about and which I think should be ventilated in public and the public warned about, it is this provision.
