Public Business. - Vote 43—Dundrum Asylum.

I move:

Go ndeontar suim ná raghaidh thar £10,260 chun slánuithe na suime is gá chun íoctha an Mhuirir a thiocfaidh chun bheith iníoctha i rith na bliana dar críoch an 31adh lá de Mhárta, 1939, chun Costaisí Coinneáil-suas Geilteanna Cuirpthe i nGealtlainn Dúndroma (8 agus 9 Vict., c 107).

That a sum not exceeding £10,260 be granted to complete the sum necessary to defray the Charge which will come in course of payment during the year ending on the 31st day of March, 1939, for the Expenses of the Maintenance of Criminal Lunatics in the Dundrum Asylum (8 and 9 Vict., c. 107).

The note at the top of this Estimate is calculated to mislead most people who are interested in it. Technically, it is true that inmates of Dundrum are criminals. In fact, they are not. They are only criminals because Queen Victoria wanted them called criminals. They ought to be persons acquitted of the indictments charged against them because they were found to be innocent. As a result of her late Majesty's intervention, the verdict was altered to read "Guilty but insane" and they have become criminal lunatics. They are in Dundrum because the court found that when they committed the breach of the law for which they are held responsible they were not sane and did not know what they were doing. They are really persons of unsound mind who have been more unfortunate than their neighbours. For that reason, I venture to repeat, with special application to this mental hospital, certain representations I made in regard to asylums on the Minister's Vote, which representations he had not time to deal with. I shall elaborate the case.

At present there are large sums of money in the hands of the Minister earmarked for hospitalisation and, with a view to getting the best advice as to how best to use that money, I believe a body is to be set up known as the Medical Research Council. They may recommend the Minister to establish certain specialised types of hospitals here and there for certain specialised types of work. I want to suggest to the Minister that on that council there should be put at least one person who would constitute himself the champion of inmates of the type of hospital we are now discussing so that the question could be examined as to whether it is not desirable at once to take steps to provide an hospital where selected inmates of Dundrum and other mental hospitals could be brought for intensive treatment. At present any person going into a mental hospital in Ireland——

Might I put it to the Deputy that we are not dealing with mental hospitals?

I submit that this is a mental hospital.

The Deputy is dealing with mental hospitals generally.

I include Dundrum in them.

I submit he is not entitled to do that.

I shall listen with interest to the Minister's submission.

I will put it to the Chair.

The Minister's contention is quite right. One of the major rules of procedure is that the same matter may not be discussed on two Estimates. The Deputy should confine his remarks to Dundrum Asylum.

I accept your ruling without hesitation. Discussion implies that two parties take part in it, and if you address a representation to the Minister, and he is so hard pressed when answering that he forgets your representation, you are rather at a loss, and you are tempted to go back on it on the next Estimate in order to try to persuade him.

The Deputy should resist temptation.

I will resist temptation. I submit that in the Dundrum Asylum owing to the nature of the work that has to be done the amount of therapeutic work that can be done on the patients there is limited because there is no adequate staff or equipment primarily designed for the cure of mental disease. Dundrum is more or less looked upon as a place of detention. While I have no doubt whatever that the medical staff, with the resources at their disposal, are doing all they can for the patients, my submission is that they are not sufficiently well equipped nor are there sufficient numbers effectively to attempt to cure persons mentally diseased. I therefore suggest to the Minister that he should use some of the moneys at his disposal for the purpose of establishing a new hospital to which certain selected patients from Dundrum might be removed for the purpose of attempting their cure. I can well imagine the medical superintendent picking out a dozen patients——

Can he legally do that?

I think so.

I think they are committed to Dundrum.

You have a perfect right to establish another asylum. It would restrict the debate too much, I submit with great respect, if you wish to make a proposal in such a form as to bring it within the rules of order. I suggest that the Minister should use some of this money——

I am not raising a point of order, but the legal point.

I think that can be easily overcome administratively, because one hospital might be an annexe of Dundrum, and in that way the medical superintendent could transfer patients from the main building into the appropriate annexe. The new mental hospital should be equipped with all the most modern apparatus available for the treatment of mental disease and should have at its head a really distinguished neurologist and psychologist, who might be found amongst the graduates of our universities or amongst the graduates of foreign universities. My object would be to establish an institution here which would compare favourably with the best to be found on the Continent of Europe or in the United States of America; that from Dundrum there would then be transferred a dozen selected patients, who would be submitted to intensive therapeutic treatment for a reasonable period of time in the knowledge that perhaps only three of them would yield to treatment and the remaining nine, when proved hopeless, would unfortunately have to be returned to the institution as chronic and incurable to be looked after so long as they survive. Then another dozen could come forward and a similar course of procedure might be embarked upon.

I believe that out of that would grow a system whereby the Minister would see his way to take small lots of patients from all the mental hospitals in due time to give them the same chance of being cured. I go so far as to suggest that unless something of that kind is done it is going to be impossible to get any curative work done in Dundrum or any other mental hospital, not for want of good will on the part of the staffs of the institutions, but because they have too much to do looking after the daily requirements and the patients' normal health. There is nothing to restrict the Minister, in dealing with the Dundrum establishment, from subdividing it if he so desires.

I suggest to him that it would be desirable, in the event of his adopting my plan, to keep these new institutions, subsidiary if need be to Dundrum, very small, comparatively speaking, for two reasons. One, because I think the therapeutic treatment of mental disease requires the personal attention of a highly-skilled physician for each individual patient and so it is desirable to avoid having a very large number of patients in them. Secondly, I believe, if we are to develop the plan, we might have two or three of these hospitals and there would be a friendly and desirable rivalry amongst them to see which of them could secure the greatest percentage of successes amongst the patients committed to their care.

A good deal of work on these lines is being done in America and in Great Britain at present. Some work on these lines is being done in our mental hospitals by enterprising medical officers who, struggling with great adversity, are managing to make time to experiment in the most modern methods of treatment of the mentally afflicted; but they are not getting half a chance, because they have not the equipment and the time to give this matter the attention I believe they would wish to give it. I think it right to direct the attention of the House to the fact that this is a matter which should engage the perennial and very special personal care of the Minister in charge of this Department, because, in respect of every other branch of his administration, affected parties can make representations to him, or they can get someone to speak for them. The mentally afflicted, of course, cannot. While, on the whole, I have no doubt that they are well looked after, it should be the Minister's daily care to watch their interests himself, and to regard the mentally afflicted as his particular charge, because he is not likely to get the same kind of representation on their behalf that he will on behalf of any other section of the community.

This is a matter of very considerable importance. In other countries horrible abuses have grown up, and no attempt has been made to remedy them, until they became so blatant and horrible that they created a public scandal. I do not believe there is any serious danger of that arising here, but it would be a scandal if we allowed every other country to pass us out in the matter of treatment of mental disease, and left the mentally afflicted simply to lie in an institution like Dundrum without making any attempt to cure them. Now is the time to act. It has been done everywhere else, and we ought to be doing it here. This is the place to make representations and to stir public opinion in the matter, and if the Minister constitutes himself the champion of this cause, he will find public opinion very glad to co-operate with him. It is for that reason that I direct his attention to it on this Estimate, and also for the purpose of giving the Minister an opportunity of stating his view as to the desirability of advancing on the lines which I have suggested.

Before the Minister replies, I should like to ask Deputy Dillon what he intends to do with the patients of the criminal mental hospital who have been cured?

Let them out. What else? If they are cured they ought not to be kept in Dundrum. They ought not to be kept there if they are sane.

Somebody suggested that in certain eventualities the Minister should be locked up in Dundrum. I would suggest that if anybody wants to punish the Minister it would be a better arrangement to give him a job as attendant in Dundrum for a while. The conditions of employment of the attendants in Dundrum are extremely unsatisfactory. In 1920 the attendants there were doing a 48-hour week. About 12 months subsequently, it was found that when attendants retired it was almost impossible to replace them, the job being a very unpopular and a very unpleasant one. The result of a reduction in the staff has been that at the present time the attendants are required to work a 64-hour week. Nominally, it is a 64-hour week, but in fact it means more than that, because some of the attendants who are married and who are living outside the institution are on occasions, because of the necessities of the case, required to stay in overnight. I understand that at the moment the intention is to recruit eight additional attendants, and that as a result of that it may be possible to reduce the working hours. I should like to hear from the Minister what progress has been made in that matter, and when actually those additional attendants will be employed so as to enable the staff to work reasonable hours.

There is another matter affecting the staff in Dundrum to which I want to refer, and that is the question of rent allowance. The remuneration of the staff makes provision for a rent allowance for members who are not living in the institution. I understand that the minimum allowance is 6/6 per week, with a maximum of 10/6. Some of those attendants are living in ex-British soldiers' houses, and some time ago, as a result of a decision of the courts, those houses were made free of rent. They still, of course, have to pay rates, and they are still liable for the cost of repairs and maintenance of the houses. It seems unreasonable that, in such circumstances, rates and maintenance should not be regarded as being the same thing as rents. Apart from that, while this matter has been under consideration by the Department of Finance, payment of rent allowance to those men has ceased altogether, although they should at least be entitled to the minimum. I should like if the Minister would indicate when this matter will be finally determined, and when those attendants will have their rent allowance restored.

I take it that Deputy Heron refers to British ex-service men who are attendants?

That is a very important point, because it arises in a lot of other cases as well as that of Dundrum Asylum, but while we are on the question of Dundrum I should like to reinforce Deputy Heron's plea. In the case of British ex-servicemen who came back here to this country after the Great War, and who by reason of certain legislation in the British House of Commons are in receipt of gratuities or small pensions, or who, as in this case, live in British ex-servicemen's houses, it seems to me to be the general policy to take that into consideration and make a deduction from any small wages or salary which they may get in Government employment. In this particular case, those British ex-servicemen who are attendants in Dundrum have a free house, which they rightly earned by their war service during the horrors of the 1914 to 1918 period. It is most unfair that on that account their rent allowance should be stopped, and I think the matter is deserving of the consideration of the Minister.

I am pleased that Deputy Dillon has raised the matter of the patients in the Dundrum Asylum. Here you have an Estimate of £13,000 for officials alone, and we find that the Estimate for the cost of the patients in the institution amounts to only £2,099. I ask the Minister is it fair that the clothing for a patient in Dundrum Asylum should cost only £1 15s. per annum? Deputy Heron talked about the attendants. We see here that the clothing for the female attendants costs £4 per annum. There are 40 male attendants, and the cost of clothing is £4 11s. each. In the case of institutions such as this I think it is up to the Minister to see that the patients receive proper treatment. In the old days those patients were put in there to be detained during His Majesty's pleasure. Later, it was the Governor-General who could give them a pardon. I do not know who it is that releases them at the present time, but I think that if those people got proper treatment and their minds were kept occupied their release would probably come much earlier, and the cost of the running of those institutions would not be so heavy. I think anyone who has acted on the committee of management of a mental hospital—there are several Deputies here on the Minister's side— will bear me out in that. It hardly seems right that, where you have an expenditure of £13,000 for officials alone, the cost of the 115 patients should be only £2,099. The cost of clothing is £201 for the 115 patients, and the cost of the patients themselves, given here in a number of items, amounts to £1,898, bringing the total to £2,099. I would appeal to the Minister, as Deputy Dillon has done, to try to provide in such an institution some means by which the minds of the patients will be kept active, so that when they are released they will be of some use to themselves.

The Minister to conclude.

The general question of treatment of persons mentally afflicted was raised by Deputy Dillon on this Vote. That matter of the patients in Dundrum, including the question of therapeutic treatment for people mentally afflicted, is having the active and careful consideration of the officers of the Department. In the last two or three years a special professional organisation of the officers of mental hospitals has been established. Most of the medical officers of mental hospitals in the country are active members of that organisation, and they are discussing amongst themselves and with the officer charged with looking after this particular aspect of the work of the Department of Local Government and Public Health methods of improving the treatment of mentally afflicted people in this country.

Now, despite the fact that it is true —Deputy Dillon says it is true—that the resources of our medical officers. in mental hospitals in general, including Dundrum, have been very limited, there has been a considerable amount of work, and very creditable work, done by many of our medical officers in mental hospitals. I do not know if Deputy Dillon is aware—perhaps he is—of the work that has been done in the mental hospitals of this country. The number of cases sent out cured, or, at any rate, temporarily cured, in proportion to the number of patients generally, is very creditable indeed, and that arises from the care and attention and treatment, therapeutic treatment as well as other kinds of treatment, given to these patients by the medical staffs of our hospitals. It has been brought to my notice in the case of two or three hospitals that the record certainly is most creditable to everybody concerned in regard to the therapeutic treatment administered to these patients even under the conditions, bad as they are, that at present operate in many of the mental hospitals.

Since the sweepstakes were established within the last few years, a great deal has been done to improve the conditions in mental hospitals, but the most pressing problem was the problem of overcrowding that existed in every mental hospital.

Is this in order, Sir?

It is not strictly in order, but I shall give the Minister at least as much latitude as the Deputy who raised the question, and perhaps a little more.

It may not be in order, Sir, but I am only answering the points that have been raised. However, if the Chair thinks I am not in order, I shall not continue with it.

I do not think there is any objection to the Minister continuing.

We would like to hear the Minister, anyhow.

I am just answering the points that have been raised, Sir. A considerable improvement has been achieved in a number of mental hospitals all over the country in connection with the question of the condition of the inmates. Undoubtedly, a number of these hospitals—in fact, most of them—were overcrowded, and there has been a tendency, not in the last four or five or six years, but in the last 20 or 25 years, to put mentally afflicted persons into institutions to a greater extent than was the practice heretofore. The people in these institutions, generally, are well treated, well cared for, well looked after, well clothed and well fed, and, as I have already said, even taking into account the very restricted resources from the point of view of staffs and other respects of these institutions, in some of the institutions, in particular, very considerable and creditable work has been achieved from the point of view of curative treatment.

Now, with regard to Dundrum Asylum and the conditions that exist there, it must be remembered that the institution is small, and that the number of inmates there is small; but an institution of this kind, nevertheless, must be kept up, and it must also be remembered that, because of the comparatively small number of patients the overhead charges are high. In connection with an Estimate of this kind, and other similar Estimates, of course we usually have to meet complaints of the growing costs of these services. Well, our efforts have been directed towards keeping, within reason, the costs of such institutions down as much as possible, and that applies to the cost of the upkeep of the institution itself as well as the cost of the inmates and of the staff. I think, however, that it can be said that so far as the staff of this institution in Dundrum are concerned, they are much better off than the staffs in other hospitals.

Does the Minister not know that they have had to work 64 hours a week as against 48 hours a week in other places.

They do not now.

But they were working that number of hours.

They do not work that number of hours now. There has been an agitation, and I think it has resulted in better hours.

That applies to people who are going to be appointed, does it not?

Well, if they are not actually appointed, they are on the road to being appointed. I understand that they will be appointed within the next few weeks.

By the Civil Service Commissioners?

Yes. They have better conditions generally, and an easier time than many of the attendants in similar institutions all over the country. I do not think they are badly off. That is my opinion. Now, with regard to the other points such as the introduction of an improvement of therapeutic service for Dundrum people, that matter is being attended to also. We hope when the efforts that are now being made to improve conditions generally in all these mental hospitals have been brought to a satisfactory state—and even without waiting for the conditions of all the hospitals to be improved—that as a result of the recommendations that have been made and that are being actively considered, improved opportunities for therapeutic treatment of patients will come into operation. At any rate, it is not a matter that is being lost sight of. It is a matter upon which our medical inspector who is in charge of this part of the work and who is an enthusiast in his subject, who uses every opportunity to press forward the claims for progressive treatment of the mentally afflicted under his charge, is doing all he can to bring pressure to bear, and certainly I hope that before long his efforts will result in considerable improvements of a medical nature for these patients as well as the other improvements that as a result of the money that has been made available through the Hospitals Sweepstakes have been brought into operation within the last few years.

There is one thing to which I should like to call the Minister's attention. I refer to the question of criminal lunatics in Dundrum Asylum and the question of dangerous lunatics generally. What I have in mind is the question of the release of these people after a certain period of curative treatment. I should like to know from the Minister under whose control and under what conditions are these people released? Are they released under the control of their relatives and friends after a certain period of curative treatment, or are they released, so to speak, ad lib? I think that is a very important matter.

I do not control the releases.

I appreciate very much the Minister's review of what is being done, but might I ask him, categorically, has he any personal opinion on the desirability of the establishment of a separate institution to which selected patients might be brought from the general institutions, with a view to submitting them to intensive treatment in the hope of curing them, and so gradually dividing the mental hospitals —or perhaps I should say, eventually dividing each mental hospital into two divisions: One, where you have the incoming patient who would be examined with a view to sending him for curative treatment, and the other part consisting of a hospital for chronic patients who might be regarded as incurable. My object is to get the Minister's view as to whether he would approve the idea of a separate curative hospital, a therapeutic hospital, to which patients might be sent from all the mental hospitals in Ireland in restricted numbers with a view to putting them under intensive treatment in the hope of curing their mental affliction.

I would like the Minister to say definitely—it is a matter of very great importance to the staff at Dundrum—when these additional attendants will be appointed.

I will say no more to anybody; I have said all I am going to say.

Are we to take it that the Minister will not answer?

No, because if I answer Deputy Dillon I will have to deal with half a dozen other questions.

But, surely——

The Deputy asked a question by permission of the Chair.

There is no need to introduce asperity into these proceedings, but if the Minister is going to take up the position of "I am damn well not going to answer," then they will sit here for the next three weeks.

The Deputy realises that by permission he was allowed to ask a question. He discussed the general question and the Minister replied. It would be out of order now for the Minister to reply to other matters that might be raised.

If the Minister cannot be civil, he will find it will not pay in the long run.

I was not uncivil. The point is that advantage was taken of the fact that I was answering Deputy Dillon to raise other matters.

Question agreed to.