asked the Minister for Health the total number of people resident in mental hospitals in this country at the latest available date; the proportion of them hospitalised for the following periods: (1) under one year, (2) over one year and (3) over two years; and if he will give full details of the system of review currently operative to determine whether patients require further hospitalisation.
Ceisteanna—Questions. Oral Answers. - Mental Hospital Patients.
5.
The total number of people resident in mental hospitals in this country on 31st December, 1971, was 15,961, of which 14,922 were in district mental hospitals, and 1,039 were in private mental hospitals.
The other statistics requested by the Deputy are not yet available in respect of recent years but the Medico-Social Research Board has the work in hand and expects to have the figures available in about five months. The figures showing the length of stay of patients discharged during the year ending 31st December, 1970, from district and private mental hospitals are available and may be of interest to the Deputy. Of the total of 20,351 discharged, 18,868 or nearly 93 per cent were in hospital under one year; 284 were there for a period of over one year but under two years; 837 were there for a period of over two years; and 362 discharges were unclassified.
The reply to the last part of the question is necessarily lengthy and, with your permission, a Cheann Comhairle, I propose to issue it with the Official Report.
Following is the information:
The determination of whether patients require hospitalisation is primarily a matter for the authorities of the hospitals concerned, but there are several safeguards to prevent improper detention. Among those are the following:
The maximum period of detention of a temporary patient under the original reception order is six months, but if, towards the end of that period the chief medical officer of the hospital or home is of opinion that the patient has not recovered, he may endorse the original order and extend the original period of detention by a period or by a number of periods. No single period of extension shall exceed six months. In the case of an addict the extensions shall not in all exceed six months; in the case of a temporary patient who is not an addict, the extension shall not in all exceed 18 months. The maximum period of detention of an addict is, therefore, 12 months and of any other temporary patient, two years. A person of unsound mind may be detained until his removal or discharge by proper authority or his death. These periods of detention are all subject to the safeguards mentioned below.
When the chief medical officer of an institution extends the period of detention of a temporary patient, chargeable or private, he must advise the patient and the applicant for the original reception order that either of them can send, to the Inspector of Mental Hospitals, an objection to the extension. On receipt of an objection the inspector will have to take such steps as he deems to be necessary to satisfy himself of the propriety, or otherwise, of the continued detention of the patient. If he feels that the patient should not be detained further, he will report the fact to the Minister who may order the discharge of the patient.
There are several other safeguards contained in the Mental Treatment Acts against wrongful detention of patients. The principal ones are:
(i) Every patient has a right to have a letter forwarded, unopened, to the Minister, the President of the High Court, the Registrar of Wards of Court, the Mental Hospital Authority, a visiting committee of a district mental hospital or the Inspector of Mental Hospitals. The Minister may arrange for an examination of a patient by the Inspector of Mental Hospitals and may direct his discharge where justified. The President of the High Court may require the inspector to visit and examine any patient detained as a person of unsound mind and report to him.
(ii) Any person may apply to the Minister for an order for the examination, by two medical practitioners, of a patient detained and the Minister may, if he thinks fit, on consideration of their report, direct the discharge of the patient.
(iii) The Act specifically requires that a patient who has recovered must be discharged.
(iv) Penalties are imposed by the Act for detention otherwise than in accordance with the provisions of the Act.
(v) The Inspector of Mental Hospitals must visit all mental institutions, at stated intervals, and he has a duty to give special attention to the state of mind of any patient detained where the propriety of detention is doubtful, or where he is requested by the patient himself, or by any other person, to do so. The inspector must also ascertain whether any extensions of the periods of detention of temporary patients have been made since his previous visit. If there have, he must give particular attention to the patients concerned.
(vi) Any relative or friend of a person detained may apply for the discharge of a patient and, if the medical officer of the institution certifies that the patient is dangerous or otherwise unfit for discharge, an appeal lies to the Minister.
Is the Minister satisfied that the system of review currently operating is satisfactory and that no one is detained unnecessarily in a mental hospital? Would he give an assurance to that effect?
Yes. I have had very few complaints. The complaints that have been raised in this House, sometimes without proper inquiry by the Deputies concerned—which, perhaps, is natural under the circumstances— have all been satisfactorily answered as far as I know.
Of course, the case of the lady who wrote the book may have been exceptional but it points to the danger of a person being detained unnecessarily in a mental hospital. As the Minister knows, as he has read about the case, she was quite sane but she suffered from institutionalisation. We should hate to have this arise in other cases and I should like to know that the method of review is satisfactory and that the Minister could give an assurance to that effect.
With the growing activation therapeutic care in mental hospitals, it can be accepted that the patients are examined and they are supervised and taken care of in such a way that it should be easier now than it was ten years ago to ensure that no person is wrongfully in a mental hospital.