The Mental Treatment Act, 1945, provides that in suitable cases patients may be received into mental institutions as temporary patients for a maximum period of six months in the first instance. Under Section 189 of the Act, whenever the chief medical officer of the institution becomes of opinion that the patient will not have recovered on the expiration of the initial period a request may be made to the Minister to extend the period, and where the Minister by Order so extends the period the patient may be retained in detention in the institution for a further period, not exceeding six months. The Section also provides for further periods of detention where necessary, each time within a limit of six months, and provided that the maximum period of detention may in no case exceed two years.
Before the 1945 Act was passed, there was no provision for admittance to mental institutions on a temporary basis. Since then, with the gradual recognition by those affected or their relatives that mental illness, like other illnesses, was amenable to treatment and that in many cases complete cure was possible, the number of persons admitted to such institutions as temporary patients has increased very considerably, and in consequence the number of requests from medical superintendents for orders extending the periods for which particular patients may be retained under treatment has also increased substantially. It is now in fact running at the rate of nearly 3,000 a year.
The requests are usually received about a fortnight before the then current period of detention of the patient is due to expire; but it frequently happens that a request is not received until much closer to the current expiry date. Since in the absence of a Ministerial order, there is no legal power to retain a patient after the authorised period of detention has expired, it will, I hope, be appreciated that there is frequently a considerable element of urgency involved in dealing with these requests. Notwithstanding this, no case appears to have arisen until recently in which the relevant order was not made within the due time.
Every application for extension received has to be put through certain processes. I can best explain what is involved by reference to an actual file which I have here for the purposes of demonstration. I have, of course, taken the necessary precautions to ensure that the patient to whom it relates will not be identified. This pink paper is a copy of the primary document submitted in connection with the initial reception of the patient. This document arrives in the Department within a few days of that reception. The green paper is a statutory report furnished by the medical officer in the institution to the medical officer in the institution to the Department within twenty-one days after the patient is received. The white document is the request made, in the form of a letter, by the medical officer of the hospital for an extension of the period of detention.
When such a request as this is received in the Department, a member of the staff extracts and attaches to it the earlier documents in relation to the patient, that is to say the pink document and the green document which I have shown to the House. If earlier requests have been received in respect of the particular patient involved, the white documents containing these earlier requests which cannot exceed two—since not more than three request's for Ministerial orders can be granted in respect of any such temporary patient—will be already on the file and to these the current white document is added.
The file is then referred to the Inspector or Assistant Inspector of Mental Hospitals as the case may be. He examines the reception documents and the application for extension, and advises whether, in his view, there is aprima facie case for the extension. If he so certifies, the name is entered, with other names, in a draft order and the draft order and the documents are referred to a senior officer who certifies that he has personally seen the requests and the supporting documents from the appropriate medical officer in each of the institutions in which the patients to be covered in the order are detained. This certificate is submitted to the Minister with the draft order for signature. When the Order has been signed a separate notification in respect of each patient covered by the Order is sent to the mental institution concerned.
For some time, I have been doubtful and I feel that my predecessors must also have had qualms in this respect as to whether this procedure for the granting of extensions on the order of the Minister for Health constituted any real safeguard for the patient. In fact, with the sole exception that extensions exceeding six months are not normally granted in the case of addicts, a case cannot be recollected in which an application for an extension was refused by any Minister for Health.
Last September, in conjunction with other proposals for the amendment of the Mental Treatment Acts, I went into this whole question and I arrived at the conclusion that, subject to certain safeguards which it is unnecessary for me to mention now, the power to authorise extensions should be transferred to the only persons with full knowledge of the mental condition of the patients, that is to say the medical superintendents of the mental treatment institutions. I recommended accordingly to the Government. On 18th October last the Government accepted my recommendation and the necessary provision was incorporated in the Mental Treatment Bill, 1960 which is now before the Dáil and the text of which was circulated on 29th November last.
In December, it came to the notice of my Department that certain irregularities had occurred in dealing with a number of requests for the extension of the period of detention of temporary patients. It was portion of the duty of a particular member of the staff, on receipt of requests for extensions, to associate with each of them, in the manner which I have demonstrated to the House, the previous papers in relation to the patient concerned and refer the file to the Inspector or the Assistant Inspector of Mental Hospitals as I have described. The officer in question went on sick leave on 13th December and some little time afterwards, it came to light that he had withheld from the Inspector a number of requests which had been received by him and had suppressed them to conceal this fact. In all, 280 requests were suppressed in this way. In most of these cases, all but 22 in fact, the default was further cloaked by the irregular issue of a notification to the hospitals concerned that the necessary Ministerial order had been made.
Unfortunately the period within which extensions could be granted in the case of the 280 suppressed requests had expired by the time these irregularities came to notice. After the initial discovery, on 19th December, full inquiries had to be made to ascertain the full extent of the irregularities. When that was done, consideration had to be given to the further action to be taken.
The situation was that because of the failure to make the necessary extension orders, a considerable number of patients were being illegally detained. I gave consideration in the first instance to informing the institutions concerned of this situation and advising the immediate release of these patients but rejected this course for what, I think, were good reasons. These patients, according to the medical advice submitted to me a short time previously, had needed further detention to facilitate their recovery. Since that time. some had improved in their medical condition to such an extent that they had been discharged. Others would soon be fit for discharge. The majority still required further treatment. It would have been upsetting to these patients and a source of worry to their relatives, to have discharged them and put in train again the procedure for their immediate readmission.
On balance I decided that the best interests of the patients would be served by seeking the authority of the Oireachtas to remedy the situation so far as was possible by legislation and this is the reason for the measure which the Seanad is considering today.
The Bill now before the House aims at remedying the situation by providing broadly that where a request for an extension was duly made, the patient may be continued in detention as if an order had been made extending the period, notwithstanding that no order was made. Provision is also made that no damages shall be recoverable by or on behalf of a person merely by reason of his detention during the period in question.
Of the 280 patients in respect of whom the applications for extensions were suppressed, it has been ascertained that 53 have since been discharged and discharged in the normal course. Included in this figure are seven of the 22 cases mentioned earlier whose period of extension had not been authorised and in which no notifications regarding extensions issued to the institutions concerned. I might mention also that these 22 cases concerned only eight institutions. In the other institutions, the issue of the notifications gave the impression to the staffs concerned that the extension had been properly authorised.
Inquiries were made by the staff of the eight institutions to which I have referred about the non-receipt of notifications and they were informed that the matter was being looked into. So far, however, no hospital authority has been notified of the cases in which the necessary orders had not been made. I took the decision not to have them notified because I felt that if the managers of the authorities concerned were made aware of the position, they would be faced with the obligation of discharging forthwith from their hospitals over two hundred patients whom the competent medical officers of such authorities had advised it was necessary to retain in them for further treatment. I am sure that the Seanad will agree that it would have been unreasonable to have placed these authorities in such a situation.
The requests which were suppressed have been examined by the Inspector of Mental Hospitals. He has indicated that the extensions sought would have been recommended by him in all cases had the requests reached him at the appropriate time. In the normal course and in the normal way, therefore, all these extensions would have been authorised by me. In saying this, I am not seeking in any way to minimise the gravity of the irregularities which have occurred, and I may say that I consider what has happened to be most regrettable.
In asking the Seanad to give this Bill a Second Reading and to allow it to pass through its Subsequent Stages to-day, there are three features of the whole affair, however, to which I am entitled to direct particular attention. These are: (1) No blame attaches to any medical superintendent or other officer of any mental institution in relation to this matter; (2) no patient has been detained in a mental institution whose detention was not justified by medical certificate; and (3) no patient has been detained for a day longer than was justified by his condition, or will be so detained.