Mental Treatment Bill, 1944—Second Stage (Resumed).

Question again proposed: "That the Bill be now read a Second Time."

In Part XIV of the Bill, there is a chapter dealing with the reception of temporary patients in institutions. The institutions in which temporary patients may be received are referred to in the Bill as "approved institutions", that is, institutions approved by the Minister for the reception of temporary patients. In all probability, a number of the institutions approved will be mental institutions, but they need not necessarily be mental institutions. Some general hospitals may have suitable facilities for selected cases, and if the Minister is satisfied that a particular general hospital can make the requisite arrangements for the care and treatment of temporary patients, it will be open to him to recognise the hospital as an approved institution for the purpose. Provision for the reception of persons as temporary patients is one of the reforms which has been strongly urged by medical experts engaged in the treatment of mental disease. A large number of persons admitted to mental institutions recover after a short period of treatment. It is most undesirable to place such persons in the same class as persons suffering from forms of mental disorder likely to be permanent, or at least to last for a long time.

In this connection, I would like to refer specially to the provision in the Bill for the treatment of addicts as temporary patients. The term "temporary patient" is defined as a person who is suffering from mental illness and believed to require for his recovery not more than six months' suitable treatment and is unfit, on account of his mental state, for treatment as a voluntary patient, or a person who is an addict and who is believed to require for his recovery, at least, six months' preventive and curative treatment. The term "addict" is defined as a person who, by reason of his addiction to drugs or intoxicants, is either dangerous to himself or others or incapable of managing himself or his affairs or of ordinary proper conduct, or a person who, by reason of his addiction to drugs, intoxicants or perverted conduct, is in serious danger of mental disorder. From my experience as a medical practitioner, I have long been convinced that special provision should be made by law for the treatment and cure of persons who are addicted to drugs and alcohol. Addiction to drugs and alcohol is one of the most fruitful causes of mental disorder and, as this Bill is intended to provide for the prevention as well as the treatment of mental disorders, I think that opportunity should be taken to deal with the matter in the Bill. In my opinion, the Bill provides suitable machinery for the purpose. Before, however, extending the provisions of the Bill to cover addicts, I consulted representatives of the Royal Medico Psychological Association and other medical experts engaged in the administration of mental institutions and I found that their views were in accord with my own in the matter. The Medical Association of Ireland were also strongly in favour of my proposals for dealing with this problem. Addicts will very rarely submit themselves voluntarily for treatment or remain voluntarily under treatment for a period sufficient for a complete cure. It is, therefore, necessary to apply in their case some of the detention provisions of the Bill and, in my opinion, the most appropriate part of the Bill for dealing with them is that relating to temporary patients.

The procedure laid down for reception of a person as a temporary patient is simple. Application may be made in that behalf to the person in charge of the approved institution into which it is desired to have the person received. In the case of a chargeable patient, the application must be accompanied by a certificate from the authorised medical officer. Where the person is a private patient, the medical certificate must be signed by two registered medical practitioners. On consideration of the application, the person in charge of the approved institution may, if he so thinks proper, make an order for the person's reception and detention as a temporary patient. The Bill provides that a person may be detained as a temporary patient for a period of six months, but the Minister is given power to extend the period of detention for a further period, or periods, subject to a maximum limit of 18 months to the total aggregate extension.

Another new provision of the Bill is that which enables a person to submit himself voluntarily, or to be submitted by his parent or guardian if he is under 16 years of age, for treatment for illness of a mental or kindred nature. At the beginning of my statement, I mentioned that the failure to make legal provision to enable persons to submit themselves voluntarily for mental treatment was one of the major defects in the existing law. Modern medical science favours the early treatment of mental illness. Before the disease is fully developed, there are greater possibilities of effecting a cure. Patients should, therefore, be encouraged to seek early treatment of their own accord. The failure in the past to provide facilities to enable persons to obtain advice and treatment in the incipient stages of mental disease has contributed to an increase in the numbers who developed the more acute or permanent forms of mental illness.

The institutions approved by the Minister for the treatment of voluntary patients need not necessarily be mental institutions, although it is probable that a number of them will be mental institutions. There may be hospitals, other than mental hospitals, with experts in psychiatry on their staffs and other facilities to render them suitable for the treatment of voluntary patients. Where it is desired to have a person received in an approved institution for treatment as a voluntary patient, application may be made in that behalf to the person in charge of the institution by a parent or guardian if the person to be received is under 16 years of age, and, in any other case, by the person himself. The application must be accompanied by a recommendation from a medical practitioner who, in the case of a chargeable patient, must be the authorised medical officer. Where the application is made and there is accommodation in the approved institution which is not required for a person of unsound mind, the person to whom the application relates may be received in the approved institution as a voluntary patient.

The Bill contains various provisions in relation to persons received and detained in mental institutions in pursuance of reception orders and their discharge on recovery. There is power in Part XVI to enable a patient to be allowed out on trial or parole and to enable a patient to be transferred to an institution other than the one to which he was admitted. Probably, the most interesting provision in Part XVI is that empowering mental hospital authorities to board out in private dwellings persons who are not dangerous to themselves or others and do not require treatment in an institution. Boarding out has not previously been provided for in this country. It has been availed of in Scotland for almost a century and it is stated to be extensive in Norway. There are patients in mental institutions suitable for boarding out who would be much happier living in private dwellings than in mental institutions. The Bill makes detailed provision for the inspection and supervision of persons boarded out and their care and medical treatment in case of illness.

As regards the concluding Parts of the Bill, Part XVII contains provision for the recovery of the cost of maintenance and treatment in institutions similar to those in the Public Assistance Act, 1939. The powers and duties of the Inspector of Mental Hospitals are set out in detail in Part XVIII. They are similar to those already devolving on him. Part XIX deals with offences and penalties and miscellaneous matters. It will be noted from the last two sections that the Bill does not affect the law administered by the courts in relation to lunatics or their property, or the law relating to criminal lunatics.

I might also mention that mental deficiency and mentally deficient persons do not come within the provisions of the Bill. Persons of unsound mind or persons suffering from mental disorder to whom the Bill relates, are, in the main, persons who at some time possessed their full mental faculties, but who through mental disease or illness have become mentally deranged. The mental faculties may be permanently disordered, or they may recover after a period of treatment. They differ entirely from mentally deficient persons who did not at any time posses their full mental faculties.

The bringing into operation of a measure such as this will entail considerable labour, and will certainly take time. It would be true to say that the provisions of this Bill are in advance of corresponding legislation in any country whose statutory provisions have been studied in my Department, and I would assure the House that as soon as the Bill becomes law it will be my immediate purpose to make its terms operative as quickly as circumstances allow.

Everybody will welcome this Bill. It is, as was pointed out in the accompanying memorandum, a consolidation Bill. It is not an example of legislation by reference, and that, of course, is all to the good. It is a subject on which I am very far indeed from being an expert, but I do recognise that the Bill is a genuine, and I hope it will be, in administration, a successful effort to bring our treatment of mental diseases up to the most modern level.

I notice that the Parliamentary Secretary has had consultations with various professional people who deal with this matter, and he has stated on a couple of occasions in his speeches that what is in this Bill is in agreement with what these practitioners desire. There are, from the point of view of the ordinary non-expert person, several things in the Bill which are obviously distinct improvements. As in the case of tuberculosis, one of the important things is to convince people that the disease is curable. It is quite impossible in the case of mental diseases to carry out a campaign in various places like the campaign carried out in regard to tuberculosis, but certainly, if any steps could be taken to convince relatives that this is a curable disease, it would be a great step forward and the Bill does make provision, even in the case of poor people, that in the initial stages a patient may visit a doctor at his private house and, without approaching any institution at all, may receive treatment. That, I think, will be a very great improvement indeed. Improvement is slow. I was reading recently about a report made on Grangegorman Mental Hospital in the early part of the 19th century in which it was recommended that the institution should be called a hospital. I think the word was not applied, however, until 1920 or 1921 when the Sinn Féin Party got control of that particular institution of the Dublin Corporation. The treatment has certainly improved.

I am familiar with one case in Dublin, and one case in a mental home in the country, where an old man in whom I am interested is a patient, and I can vouch for the great interest and sympathy which the medical superintendent in the case has always displayed towards the particular patient. These people have a very enlightened outlook generally.

While I congratulate the Parliamentary Secretary on the Bill, I hope that I will not be misunderstood when I say that I was disappointed in his speech. He took a great deal of trouble to explain the various parts of the Bill and prefaced his remarks by a history of the legislation on the matter, but, for my own part, I would have preferred if perhaps, without taking the trouble to explain so many of the details of the Bill which could be considered on the Committee Stage, he would have told us something of the incidence of insanity in the country—whether there is a difference between rural areas and urban areas, between small centres and large centres of population and whether insanity is on the increase.

The Bill is purely an administrative one, with which we would be all in agreement generally, but the whole machinery is aimed at treatment and cure. One wonders whether there are any steps which could be taken towards the prevention of insanity. What are the exact causes? Most of us get the impression that in certain types of places there is more insanity than in others, and one wonders whether there is anything open, not only to the Government, but to the other institutions of the State, which would decrease the incidence of insanity in these places.

I have no expert knowledge of the matter at all, but I am sure that the Parliamentary Secretary, who has made a deep study of the problem, and who has advisers on these questions, would interest the House if he would tell us something about the incidence of insanity, the regions and types of places where its incidence is greatest, and whether there is any improvement, or the reverse.

The only other thing that strikes me about the Bill is that it imposes an extra burden on medical officers. I think that it is true to say that, when it does impose an extra burden, it makes no provision for extra remuneration for them. That is a tendency which is in all legislation—that is, to take certain people who have professional duties to perform, to praise them and to give them more work and to deny them any extra pay. Apart from the question of justice, that is not likely to make for efficiency. While asking the Parliamentary Secretary to make some statement on the lines I have suggested, I should like to say that the Bill is an entirely praiseworthy effort to deal with this particular problem. It is a consolidation of the law. It is complete in itself, and in that way it is a good example of legislation, and I bespeak for it the support of everybody in the House.

I join with Senator Hayes in extending a warm welcome to this Bill. In the lengthy resumé that the Parliamentary Secretary gave of the legislation pertaining to the mentally afflicted, it is noticeable that in the many Acts passed there was no effort made to aim at the objective which is certainly set out in this Bill —the objective of curative or preventive treatment. In the past people were taken to asylums or what were subsequently known as mental homes or mental hospitals. As far as the majority of patients were concerned, on their entry there it would be a very appropriate notice to put up over the portals of these institutions "abandon hope all ye who enter here." Mental disease has not alone been an affliction for the actual cases concerned, but has to my knowledge been a source of worry and a protracted affliction to the relatives and immediate associates of many of these unfortunate people. I am aware of cases where people threatened with mental derangement suffered in silence in their own homes for spaces from three to four months, during which time their associates suffered mental anguish and were punished in a manner that could not be described in their efforts to keep this affliction a secret, since they regarded it as a kind of slur or stigma on the family. If, in the early stages, legislation such as is provided in this Bill had been available, it would have been possible for these people to take the afflicted persons to a clinic or practitioner who would have the necessary expert knowledge. No such expert people were provided and those afflicted had to suffer in silence until such time as the disease had so developed that the safety of the household necessitated a change, and the publicity that followed was only a prelude to what happened when the police came to take away the person, very often under severe restraint, to a place where he would be examined by a medical officer and committed to an institution.

In so far as the management of these institutions was concerned, no effort was made to offer anything in the way of treatment to those admitted. It was absolutely impossible to do anything of the kind because of the arrangement of these institutions, where there were from 900 to 1,000 and often more patients under the supervision of one or two doctors. The doctors could act only in an advisory capacity. They certainly could not make provision for such observation, segregation or treatment of cases as will be possible under this Bill. I only got a copy of the Bill yesterday, as it came from the Dáil, and I did not give it the necessary study, but I notice in so far as the administration of these institutions which it is proposed to re-model is concerned, reference is made to committees or boards. I sincerely hope that it is the intention of the Parliamentary Secretary to revert to that form of management which was in existence before the introduction of the County Management Act. Before the functions of the mental hospitals committees were transferred to the county manager these bodies did very useful work, and so far as they had power within the legislation under which they worked, they did extraordinarily good work for the care of the patients entrusted to their charge. These bodies, as the majority of Senators know, were composed of a certain number from the elected members of the county, with the inclusion of a number of other individuals, mostly clergymen who were in touch with the circumstances of the people. If they erred at all their error was caused by sympathy with the inmates whose interests they had to look after. Since the advent of the County Management Act the functions of these bodies were completely changed. It is quite true that it is possible for a visiting committee to be set up, but the visiting committees set up have no power. They have no administrative or executive power. I do not even know whether they had power to make recommendations to the medical superintendent. As a result interest in the institutions flagged, and I hold it is absolutely impossible for any one man, even with the large staff at the county manager's disposal, to give the necessary attention to these institutions which could be given by a committee of the kind that was in existence before the introduction of the County Management Act.

The only fly I see in the ointment, so far as this very necessary Bill is concerned, is that it is going to be extremely expensive. Now that a county rate is the rule rather than the exception I foresee, with the setting up of various clinics, the appointment of the necessary extra experts who must be appointed if the Bill is going to get a chance, that a very heavy burden will be placed on the shoulders of the ratepaying community. In that respect I would suggest to the Parliamentary Secretary that he might lend a sympathetic ear to the representations that have been made, even before the introduction of this measure, for a more generous recoupment by way of capitation grant in respect to inmates of these institutions. The figure that has been in evidence since the first Act was passed by which mental patients were taken from the poor law institutions to new hospitals was a figure of 4/-, which represented the difference in the maintenance costs compared with the cost in the workhouse from which patients were removed. Now 4/- 40 or 50 years ago certainly was not a very large figure but it had at least twice the purchasing power that the equivalent sum has now.

The Bill is one of the most important that has been introduced by either of the two Governments that we have had since we got control of our own affairs and I hope, for the sake of the success of the measure, that the Parliamentary Secretary will see his way to give consideration to the recommendations that have from time to time been made in so far as recoupments out of central funds are concerned. He will find that the people generally, when they understand the laudable objects of this Bill and when they realise, as Senator Hayes pointed out, that, like consumption, it is a malady that can be prevented and cured, will certainly be very sympathetic, and that they will make no complaint if they have to bear an increased financial responsibility to give the new system a chance of success. I certainly have no hesitation in associating myself with Senator Hayes in his congratulations to the Parliamentary Secretary on the introduction of the Bill. I foresee the possibility, indeed the certainty, of co-operation generally throughout the country when the people understand what the Bill aims at and what it can accomplish with their co-operation.

I think we can all very heartily join in congratulating the Parliamentary Secretary on the introduction of this Bill. It is a very far-reaching measure. It establishes a completely new code and it gets away from the whole conception of the treatment of mental disease which prevailed in this and other countries during the past century. It does more than that, in so far as the Parliamentary Secretary's work is concerned, because it must have been a most laborious task to bring together the various amendments which are codified and the provisions which are very largely repealed by this Bill. It now consists of 283 sections with a number of schedules. I think probably the Parliamentary Secretary will agree that the Bill has been improved very much since its introduction as a result of the manner in which its consideration was approached in the Dáil. So far as I remember, there were 310 amendments in the Dáil for the Committee Stage, of which I think about 130 or 140 were introduced by the Parliamentary Secretary himself.

That is a tribute to the work that has been done by the various Deputies in the Dáil who interested themselves closely in this measure but it also means, of course, that the Bill is as nearly perfect as it can very well be made, having regard to our approach to the subject with which it deals.

Hitherto people suffering from mental disease were treated more or less as criminals. I have a recollection myself of seeing in the old days the police coming to an unfortunate little house in the country with a warrant to arrest a young man or a young woman, planting the patient on a sidecar and driving him off to a lunatic asylum. It was a very sad spectacle. I have one very early recollection of that kind which never left my memory. That system now disappears. It is now very largely a matter for doctors, trained people, to say whether or not a person is of unsound mind, whether or not his case is such as should be treated in a mental hospital or whether it is a case for detention in a criminal lunatic asylum. That is a big advance and one that must give pleasure to everybody who thinks of human beings as Christians, having to lead Christian lives, beset as they are with all the afflictions of human nature.

In regard to the treatment of persons committed to a mental hospital, because in most cases they will be committed—there will not be very many voluntary patients—I should like to make this suggestion. I make it with all due reserve, because the Parliamentary Secretary, as a result of his professional training, is much more competent to judge on this matter than a layman. My feeling is that the more occupational therapy there is, the more efficacious will be the treatment of mental disease. I had some experience of dealing with people in a sanatorium, people suffering from tuberculosis. It was conceded by the medical profession and those concerned with the management of the particular sanatorium with which I was associated, that occupational treatment, light work or such work as the person was able to perform, contributed very largely to the curative processes of the institution. I suspect that something similar can be said in regard to mental disease. I need not pursue the matter—very probably the Parliamentary Secretary himself has given some attention to it—further than to urge upon him that if we are to have mental hospitals, we should have attached to them pretty large farms.

It seems to me that work on the land is probably the most likely kind of work to which mental patients could safely be put. I know, of course, that in the County Dublin hospitals, mental patients are doing all kinds of work, including attendance on butchers, bricklayers and masons. I imagine that it is quite safe, but certainly work on the land seems to be safer and most suitable in most cases. I mention that mainly because I gather from newspaper reports that the Minister for Local Government has stepped in to capture, if I may use the term, a farm of land which was bought by the Dublin Joint Committee for the treatment of mental patients and proposes to utilise it as a site for a sanatorium. He probably acted wisely in the circumstances, but I would urge strongly that there is also need to provide a farm in conjunction with the mental hospitals in Dublin. There are two of them. The amount of land available in one case would be very small, and I gather that in the other case the farm is not in every respect suitable.

There is one other aspect of this Bill to which I should like to direct attention just for a moment—probably it can be discussed better on the Committee Stage—and that is a tendency which appears to have crept in to enable those in charge of mental hospitals to deprive people of their liberty in circumstances which will preclude the persons concerned from rescuing themselves from the activities of overanxious people. Now, we have got to bear in mind that in this case we are dealing with people who are mentally deranged or, at least, alleged to be mentally deranged, and anybody who has read of the experiences of people in other countries will realise how great is the risk when an authority can say: "Pay no heed to that fellow's complaints; he is a lunatic." Now, that there should be such a risk is a very serious matter, and I would urge that, on the Committee Stage, the Parliamentary Secretary should have regard to the risks to which people in those circumstances are exposed.

One other aspect or, probably, two other aspects, I should like to refer to. First of all, I wish to refer to Part VIII of the Bill, which deals with superannuation. I cannot understand why Part VIII is included in this Bill. It does not belong to the Long Title. There is no reference whatever to it in the Title to the Bill. This is a Bill entitled "An Act to provide for the prevention and treatment of mental disorders, and the care of persons suffering therefrom, and to provide for other matters connected with the matters aforesaid". I would respectfully suggest that anybody construing the Long Title will reach the conclusion I have reached, that the payment of pensions to the employees of mental hospitals is not a matter concerned with the prevention and treatment of mental disorders. Part VIII is quite a long enactment in itself and, in my opinion, should be presented, simultaneously with the other Bill, if you like, but as a separate Bill. It should not form part of this Bill at all. As a matter of fact, one of the effects which has flowed from the inclusion of Part VIII in the Bill is that a very large amount of time, which might more profitably have been devoted to dealing with the kernel of the Bill itself, has been devoted to consideration of the principles set out in Part VIII. I think that at this stage the Parliamentary Secretary might reasonably consider whether it would not be wise to take Part VIII out of the Bill and submit it as a separate enactment.

Why should employees—nurses, attendants, carpenters, farm workers, and so on—in a mental hospital have to carry around in their pockets an enactment of this size, containing 280 sections, in order to know their rights under one particular part of the Bill? I think that the thing is unwise. Apart from that, it is inserted here practically in the middle of the Bill. The first part of the Bill deals with preliminaries in general, the inspection of mental hospitals, the establishment of mental hospitals, and so on. Then, in Part VIII you have this question of superannuation, and you pass on from that to other types of mental hospitals, charitable institutions and so forth. I think it is a mistake to have done that, and one that might be corrected, and that is apart from what I might call the unsatisfactory features of Part VIII. So far as I can gather from any information given to me concerning the Dublin institutions it is unlikely that any of the staffs of the Dublin institutions will avail themselves of the provisions of Part VIII of this Bill. I should like to point out that on the Committee Stage in the Dáil a number of amendments were submitted—some of them, I think, unreasonable, and others reasonable— for the purpose of meeting representations made by the employees. The Parliamentary Secretary met certain of the proposals contained in those amendments and has, in fact, improved the provisions relating to superannuation. I am using that term to cover the whole of Part VIII. He met certain of these proposals reasonably enough, but there are still deficiencies, I understand, though whether the staff is reasonable or unreasonable in the matter I do not profess to know. The intimation given to me was that there is not much sense in endeavouring to amend this part of the Bill because, so far as the existing staffs of the Dublin institutions are concerned, they are unlikely to avail of it; in other words, they will continue to avail of the Act of 1909 which they consider to be, in certain respects, more suitable than this Bill. I think that that is a pity, because I regard the proposals in the Bill in connection with superannuation as desirable and intelligent proposals which ought, in fact, to be included in legislation, generally, relating to all kinds of employments, where it is practicable to do so.

I wish to make some observations on two small points, but before proceeding with them I should like to deal with Senator Ruane's point in regard to expense. It seems to me that those who complain of the expense which will be involved in giving effect to the proposals in this Bill see only one side of the picture. They see the cost of clinics, the cost of curative treatment, the cost of dealing in a decent, human fashion with people who are subnormal; but they omit looking at the other side of the question where very considerable sums of money will be saved to the community by ensuring that mentally defective people will be cured as rapidly as possible, and taken out of the institutions where already their up-keep, their management, and attendance cost a vast sum of money. I think that if Senator Ruane would look at the matter more closely, he would see that the figures on both sides would probably cancel out. He made a case, however, and probably his purpose in drawing attention to the expenses involved was to concentrate on the old case that is being made for transferring to the central authority a larger and larger proportion of the cost of maintaining local institutions. I would urge that this is a matter which requires more consideration than it usually receives. I know it is popular, and has been popular as long as I can remember, for members of local authorities to insist that this charge and that charge falling on the rates should be transferred to the Exchequer. That was an understandable demand when the Exchequer was not in this country, but, once we face the fact that the Exchequer is here in Dublin, and that in the long run it is the same community that provides the funds for the local taxation account and for the Exchequer, I think it is a mistake to keep harping on that line of demarcation. I will even go further and make this suggestion, that in theory, at any rate, the transfer from the local authority to the central government of charges of this and other kinds may, in fact, mean the transfer of the burden from the wealthier to the poorer section of the community. I am conscious of the fact that our rating system is antiquated; that it is a bad system, and one that can hardly be defended in a democratic community. What I would urge is this, that in considering the proposal which Senator Ruane made to-day, what we should concentrate upon is the method of levying local taxation.

Mr. Ruane

On a point of order, I did not suggest for a moment that the cost of the administration of this very praiseworthy Bill should be transferred to the central authority, but it is a custom which has obtained here for a very long time that a certain amount of recoupment comes from the central authority to help the local authorities, and I suggest that what was considered suitable 20 or 30 or 40 years ago in point of amount would not be the equivalent of that amount today. I assure you, Sir, and Senator Duffy, that my interest is to give this Bill a chance to go through. I do not wish for a moment to suggest that the whole cost of the administration should be transferred to the Central Fund, because I fully appreciate the point which Senator Duffy is making.

I did not intend to suggest that Senator Ruane was proposing the transfer of the whole of the cost of this measure to the central authority. What I was commenting on was his claim—which is not alone the claim of Senator Ruane but the claim of very many people, particularly those associated with local government administration—that the capitation grant, which was fixed 60 or 70 years ago at 4/-, is antiquated, and that for the future the capitation grant should bear the same relationship to the total cost of administration as the 4/- did in 1860 or 1870; in other words, that it should be, roughly, one-third, or probably a little more. I am pointing out what a mistake it is to make that case, although I understand entirely the justification for it when we have regard to the rating system, which I consider entirely unjust. I know I cannot go into it now, but in passing I might draw attention to the fact that, if a citizen of Dublin puts a new shop front into his premises, they are revalued, and he will pay 20/1 in the £ on every additional £ added to his valuation because he has improved the city, but the gentleman who draws the ground rent out of the property lives across in England and pays neither rates nor taxes nor anything else. I merely mention that in passing, to illustrate my point that what Senator Ruane and others who are interested in the matter must concentrate on is the revision of valuation principles rather than an attempt, in a rough-and-ready manner, to change the incidence of the charges by transferring from the ratepayer to the taxpayer the cost of those local services.

There are two small points to which I want to direct attention, because if I leave them over until the Committee Stage the Parliamentary Secretary might not be in a position to answer them on the spot. First of all, I want to deal with the classification of officers of the mental hospital authorities. Provision is made in the Bill for the registration of certain grades of officers or servants of the mental hospital authorities, and I was wondering whether that is contemplated as giving authority for a revision of existing classifications. The Parliamentary Secretary, of course, is aware that there are classifications already. I think one group is classified as first class officers. They have pension rights; they have rights under the Act of 1909. I am aware that a number of people are anxious as to what is going to happen under this Bill when it comes to reclassification. I am aware that, under the Bill, once a person's name appears on the register it cannot be taken off the register except with the consent of the Minister, but I am anxious to know how people who have been graded as first class officers for the purposes of former administrative machinery are to be treated in the compilation of the first register under this Bill. Perhaps at some stage the Parliamentary Secretary might tell us what is contemplated in that case, because I think it will be found that people are classified as first-class officers now whose principal job may not be regarded as the care of patients. I do not know whether or not it happens in practice, but I can see that it is possible for instance that the land steward in a mental institution might be regarded as a first class officer, because he has in fact control over the patients for the main part of the day, and it might be that it is not contemplated that a person holding that occupation or the occupation of carpenter, bricklayer or tradesman would be regarded as capable of being registered under the present Bill.

One other point to which I want to refer is the need for some clarification of what is meant by the provision in sub-section (2) of Section 63 regarding the revaluation of emoluments. Upon the answer to that question will depend, I think, to a considerable extent the rate of superannuation which will operate in respect of those likely to retire from the employment of a mental hospital authority during the next three or four or five years.

Would the Senator make that point again? I did not quite catch it.

There is power under sub-section (2) of Section 63 to value the emoluments for pension purposes. The Parliamentary Secretary, I take it, is quite clear as to what I mean—that the cash income plus the value of the emoluments will be the measure of the pension. At least, it will determine what the pension should be. I understand that a valuation has been attached to these emoluments over a period which goes back from ten to 15 years without any adjustment. Let us assume that the emoluments received by a mental hospital attendant were valued in 1935. The figure arrived at then would not represent the value of these emoluments now. I take it that the emoluments would include the value of food. I am endeavouring to ascertain the intention of the Parliamentary Secretary in regard to this provision because I think the way in which the employees of mental hospitals will regard the pension provision will be influenced by it. I do not want to stress the matter, which is familiar to the Parliamentary Secretary. I conclude by saying that, on the whole, this is one of the most progressive Bills that have been introduced into this House for a long time. It represents an enormous task and a very creditable outlook on the part of those responsible.

Nothing could bring home to us more convincingly all that we, in this State, have to be grateful for than the realisation that, through the great mercy of God, we can meet here in quiet peace to help to add another tome to the magnificent corpus of social legislation, beginning with the Public Assistance Act of 1939, which will ever bring honour to the memory of the Parliamentary Secretary. While almost the whole outside world is a victim of the worst form of insanity which has ever afflicted humanity—total war—we are privileged to spend this beautiful spring day planning, at our undisturbed leisure, for the cure and care of our mentally afflicted and for the prevention of mental disease among our people. We have further reason for gratitude in the fact that, at this decisive moment, when we are replanning and extending our social and health services, we have in charge of them a man with the sweeping vision, the untiring energy, the dauntless courage, the forward-looking enterprise of our present Parliamentary Secretary.

One melancholy note resounded in my heart when I read in the newspapers last November the report of the Second Reading in the Dáil of the measure we are now considering. It was that the late Dr. Ada English had not been spared to be present when the Parliamentary Secretary was introducing it. He knows—because he, too, had the privilege of knowing well that great-hearted woman—all that I have in mind when I speak thus. All her life, since she entered the mental hospital service as a brilliant and beautiful girl until she was laid to rest, as she herself desired, in the little God's Acre near Ballinasloe, where many of her poor patients await the Resurrection—she worked for the principles embodied in this Bill. The things that make it memorable and worth while are things for which she tirelessly pleaded. Some of them were accepted, in principle at least, when in 1925 the term "mental hospital" replaced the old, depressing designation of "lunatic asylum". Implicit in the new designation was the acceptance of the thesis that mental disease is not a crime, but a disease, like any other disease, capable of being cured if proper curative measures can be applied in time. A mental hospital is, therefore, first of all, a place for such curative treatment and not merely a place of detention for unfortunates thus afflicted. She always felt that conditions should be such that the physicians in charge should not be so overburdened with administrative detail that they could not spare the time needed for their own proper job—time to study their patients and to give them the undivided care their condition calls for. Another necessity she tirelessly stressed was that of establishing mental clinics, such as are contemplated in the Bill, where incipient mental disorders might be detected, and their progress stayed by expert treatment to which patients might voluntarily submit themselves. This aim is recognised, too, in important provisions of the present Bill.

I noticed that Deputy Alfred Byrne raised, in the other House, the question of mentally defective children, for whom there is a deplorable dearth of provision in this State. I was sorry to learn from the Parliamentary Secretary's reply that he does not seem to regard them as coming within his sphere of responsibility. This Bill, he told the Dáil, deals with people who, at one time, were possessed of their full mental faculties, and subsequently became ailing in mind. Mental defectives are, he said, in another category, and their needs are more properly the affair of the Minister for Education.

Now, I must confess I was sorry to see the Parliamentary Secretary make what to the lay mind seems a rather arbitrary differentiation. There is no more crying need in our country at the moment than provision for mentally defective children, and it is only persons with special training in mental conditions who can be expected to help them to develop whatever mental faculties they have. I trust the Parliamentary Secretary will reconsider his position in respect of them or, at least, bring their needs before his colleague, the Minister for Education.

With this small criticism, I welcome the Bill. It is largely an administrative measure. There are some new principles involved in it, and no doubt, other speakers will stress them, but the real work on this Bill will be done on the Committee Stage as it was so largely done in the other House. I wish the Parliamentary Secretary God speed.

Níor chualas ro-mhaith an méid adubhairt Seanadóir O Dubhthaigh ach ba mhaith liom cúpla foal a rá ina thaoibh. I did not intend to say anything, but on a previous occasion I mentioned the careful manner in which Senator Duffy uses his voice. He seems to take good care not to strain his lungs, but it means that it is very awkward to try to hear him on this side of the House.

Why not come over to this side?

Possibly, I am near enough to you.

Why not get Senator Duffy over?

Senator Duffy referred to the desirability or necessity of having farms attached to mental hospitals and he made some reference to the Dublin Joint Mental Hospital Board. I suppose he is aware—if he is not aware I want to point out to him—that there is an extensive farm attached to Portrane Mental Hospital where the staff are employed and giving a satisfactory return to the board authorities, and a further hospital site has been purchased in Santry Court.

Has not that been taken away from them?

That has not been taken away.

Wait a minute, Senator. Do not be so sure of your ground. It is true that Santry Court was purchased as a central site for a mental hospital, but during the emergency, the military authorities thought it necessary to have a military station convenient to the city, and because of the emergency they took over portion of Santry Court. I think they will very soon relinquish it——

No, Sir.

I know what you are coming at also, but such a transfer has not yet been made nor has it taken place. Let me point out to Senator Duffy—I did not obstruct him or any other speaker—that there are also tuberculous cases among mental patients and that the Grangegorman Hospital Board are endeavouring, as best they can, to see that mental patients, because of their association with other patients, do not spread that disease among them. Is Senator Duffy satisfied with that?

I have not the deciding voice.

Senator Mrs. Concannon referred to the term applied to the Dundrum Criminal Mental Hospital. If that name is objectionable, cannot we change it now to "The Central Criminal Mental Hospital"? Is it not a simple change that will remove the objectionable features spoken of by Senator Mrs. Concannon? I am glad of the introduction of this Bill, and one feature which particularly pleases me is that whereby people, when the Bill is passed, can go for treatment to a mental hospital without having practically the stain of criminality on their character. Hitherto, they had to be certified as if they were criminals. I am glad that they will have access to the hospitals in future without going through any legal formalities.

I am not going to delay the House in a lengthy discussion of this measure. One might say that it is a series of Bills, largely, it is true, of an administrative or machinery character, and I am divided in my mind whether to join with the other people who have been congratulating the Parliamentary Secretary or to be critical of some provisions of the measure. I suppose there can be differences of opinion among us as to the necessity and the moral obligation upon us and the State to make all possible provision for the treatment of mental diseases.

But, while saying that, I have to take note of the fact that of the point of view of the people who will have to pay for the creation and operation of this machine, very little account has been taken at all in any of the speeches, with the exception of that of Senator Seán T. Ruane which was criticised by Senator Duffy. However desirable it may be—and we are not going to question its desirability— there should be a forward move in our policy towards mental diseases. We must ask ourselves if the method which is to be adopted through this Bill is really just, and if it is going to be an equitable measure to all citizens of the State when it comes to be operated.

Frankly, I am afraid I have to put down a note of interrogation about some of the principles in the Bill. Part V gives us the machinery by which we are going to get these new hospitals. Unfortunately, I was unable to be present for portion of the Parliamentary Secretary's statement, and I do not know if he gave the House any estimate of what the cost of this scheme is going to be to the country when it is in operation in full swing in accordance with his plans.

If he has any calculation made, the House will be very glad to have the figures. But Sections 20, 21, 22 and all this Part V of the Bill make provision which gives the Minister power to say that a hospital authority must provide proper and sufficient accommodation, and where, in the Minister's opinion, a mental hospital authority have failed, he may by Order require them immediately to remedy their failure. We come on then to the other and vital issue—how this is to be done, and here the point made by Senator Ruane holds good. This Bill makes it obligatory on the local ratepayer to find the extra money to enable the plans to be implemented. I agree that the plan is, as Senator Mrs. Concannon has said, clear and wide in its conception and necessary, indeed, but I think it is of the greatest importance to draw the attention of the House to this fact, that it is going to add considerably to the amount of the moneys which will have to be expended in the treatment of mental diseases in this country, and there is this further fact that this additional cost will have to be borne by the local ratepayers.

There are people here from the country as well as myself. I do not think there is a county council in the country whose rates have not been increased by many shillings in the past ten or 12 years. In my own county the rates are standing at the highest figure they have ever reached, and to these rates will have to be added further costs arising out of the passage of the Drainage Act through the Oireachtas recently.

There are counties in the country where the rates stand at well over 20/- in the £. I would like to hear from the Parliamentary Secretary, in the first place, what additional costs the passing of this measure will impose on the counties generally, and I would put it to the House that the whole basis— I will pay this compliment to Senator Duffy that he did question the whole basis—on which we make our demands is unjust. Senator Duffy indicated that the basis on which we calculate the charges that ought to be levied on local ratepayers is not just. I think myself that the injustice of our present plan is really so obvious that the whole question of rating demands reconsideration. People ought to make their contribution to the State or local authority somehow or other in relation to their incomes, but take property in the country. You have valuations on buildings and farms and it is on this basis that we are going to levy the taxation which will pay for the implementation of this measure.

You have farms. There is no calculation of the income of the farm. There is no question whether the proprietors of the farm have the right to live out of the income on the farm before making their payment to the local authorities when we make demands on them. I feel that while it is really a magnificent scheme and while it is a very simple matter for people to compliment the Parliamentary Secretary— mind you, I am not critical of him in this—it is vitally important that we should ask who is going to pay for it, and if we are to make sweeping and revolutionary changes, let us be cautious. Let us examine the possibilities or the advantages which this scheme will confer upon us. There is no use in pretending that agriculture is in such a healthy and prosperous condition that it can bear heavy burdens. You can load even an ass too heavily, and I feel that local authorities will be rather slow to undertake the obligations which this measure will impose upon them financially.

I frankly confess that I do not think it is a justifiable demand. In the first place, it is hardly fair to give authority to the Minister to require the local people to provide an institution, the erection and maintenance of which they will be compelled to pay for regardless of their incomes. I feel very strongly that the whole basis of our local taxation to-day is unsound, and that in the case of such a measure as this it is going to create very considerable difficulties and add to the inequities of the present situation.

I would beg the House to give a little consideration to that. Senator Healy made certain references to the institutions here in the city, but in the Senator's native County of Kerry, the rates are 24/- or 25/- in the £, and I have no knowledge of the conditions of the hospitals in that county to-day, but, quite obviously, there must be considerable additional expenditure in every county, in the Parliamentary Secretary's county as well as my own, if this scheme is to be implemented. I am afraid you can burden the farmers too heavily.

Are not costs going up in every direction everywhere?

Yes, and that is one of the reasons why you must be careful in keeping a balance because you are going to throw things very considerably out of balance. I do not like to introduce any jarring note on this Bill, but it is far better that we should be realists. The Parliamentary Secretary may be able to enlighten me and the House. We have problems in Cavan and Monaghan with regard to hospitals which are not yet solved, and I do not know what contacts he has at present directly with the ratepayers of his county, but I have a fairly shrewd idea of the attitude of the ratepayers to further increased expenditure on hospitals in that area.

While I would be very glad to make my contribution to the conditions as they are, I have to put down a note of interrogation whether, if this Bill is going to be put through by the Oireachtas, it is justifiable to ask the ratepayers to bear fresh burdens in relief of the Central Fund while giving the Minister power to impose the burdens against their wishes.

I would like to support this Bill perhaps from a rather more narrow angle than previous speakers. I have not very much experience in examining mentally infirm people, but, for many years, I have examined the examiners of the mentally infirm, inasmuch as I have examined candidates for the diploma in psychological medicine. As I am no longer an examiner I may say that one of the types of questions I used to put to candidates was: "What alterations would you like to see in the present state of the law as affecting mentally diseased people?" Almost invariably the only changes which the candidates felt desirable—they were actually working in these mental homes and knew what they were talking about— were drug addiction, the question of laboratory development in the diagnosis of mental disorders, and the application of modern methods to mental disorders and in connection with voluntary patients and temporary patients. I was particularly gratified to see these three points have all been raised in this Bill. I think the question of drug addiction has been dealt with extremely effectively, and, of course, the introduction of a section about laboratory development is music in my ears. Perhaps I could give some support to other Senators by saying that I would like it to be realised that a proper working laboratory is a very expensive institution to run and maintain, and I hope that it will be realised that the development of this side of the treatment is going to cost money. You will have to send people away to get trained and instal very good machinery and keep it going well.

Touching on this question, the issue is not so much how much money are we going to get from the people in the country, but what sort of value are we going to give them for the money, and certainly, anything that could contribute to the amelioration of this appalling condition is one of the best propositions that could be put up to sensible people.

The third point is this question of voluntary treatment, and it is the only point in this truly monumental work which I have made the subject of a small amendment. I hope the Parliamentary Secretary will deal kindly with it. The amendment provides that the person who has been a long time in charge of a particular patient should be able to issue a certificate which the appropriate medical authority could approve, so that the person who is being treated by his own doctor could easily be brought into these homes without the necessity of bringing him before strangers for certification. I know that some of the people on the borderline of these disorders are very sensitive indeed.

Very often their own private doctor could enable them to avail of this very splendid treatment which we hope will be provided. A good deal of time could be saved in that way. It would be much easier for the relatives if their own family physician, where there is such a person, were called in. But when the Senator spoke of the origin of these mental disorders, I do not really think that that can be awfully relevant, but it may be made relevant by taking that old Irish phrase, "The three shafts of death", and saying that the three most abominable shafts of death are tuberculosis, cancer and mental disease. As to tuberculosis, we know the cause, and we have, I believe, the key to the control and ultimate elimination of the disease. In the case of cancer, a good deal has been done, and it looks as if for the first time we are getting really near the secret. Mental disease is not death in the ordinary sense; it is a living death, and as the Parliamentary Secretary knows better than I do, it has been shown that it is amenable to treatment within the last ten years. The treatment by electro-shock therapy will be made available, I hope, under this Bill, and treatment by modern methods of nutrition. Consequently I feel that, in welcoming this Bill, we are making the Parliamentary Secretary an acknowledgment, for years and years of work must have gone into it, and it will be years before we get the harvest. I feel that if the harvest comes up to prospects, it will be giving excellent value for the money. From the general point of view, and from the narrow angle from which I speak, I welcome the Bill.

I do not want to take up time by repeating what has been said by other Senators, except to say that I am in general agreement. This is one of the measures which even a small State cannot afford to judge from the point of view of expenditure. There are not many things about which I would say that, but I think this is one. It is rather a tragedy that there is so much dissatisfaction with regard to local taxation, that we are not in the position that we could even discuss a measure like this without the danger that unless there is pressure from the centre, local economic circumstances may make it not the success it ought to be.

I would like to say that I hope somebody in another Department will be prepared to put the same amount of care and research into the codification and amendment of the whole question of taxation. Until that is done, and there is an effort to make it more equitable we will be faced with a danger, that when a really forward measure as this undoubtedly is, is introduced, not so much with objection as with a feeling that people who are not able to pay may be forced to pay more than their adequate share. I do not think we would be wise in spite of the large amount of truth in what Senator Baxter had to say in paying too much attention to this particular matter when discussing this Bill.

My principal reason for rising was that without taking away the credit properly due to the Parliamentary Secretary, I think one ought on the Second Stage to pay tribute to two classes of people without whose work a measure of this kind would be impossible. The first class I would refer to would be the civil servants who have undertaken the work. I do not know how long it took, but it must have taken some years. I should not be surprised if it were four, or five or six years. We should pay a tribute to the civil servants who started to do the work that was necessary. It is no detraction from the political leader or Parliamentary Secretary who has had the honour to bring in a measure of this kind, because he will agree with me that it is an honour to say a word as to the amount of real personal work and national service of the highest kind that must have been given by these people. In addition, I would also like to pay tribute to the large number of persons who, during the last 150 years, have slowly, often against great prejudice and opposition, brought about a change of mind and heart towards the treatment of persons who were suffering from unsound mind. A measure of this kind has not come straight from the sky as a bolt from the blue. It is not a terribly long time since prejudice was such that unfortunates afflicted with mental disease were almost regarded as criminals, even though there was no suggestion of a criminal act connected with them. They were ill-treated a century ago or less, and only slowly and steadily have we come to what is almost a correct attitude. But even in this country we have still a distance to go yet.

One of the things which this Bill may achieve if it gets talked about and considered is that it may complete the creation of a correct state of mind. I have been interested in a charitable mental institution which started in Dublin in 1811. I was particularly interested when my attention was drawn to the first report of the institution to see that it was not called a lunatic asylum but a retreat for persons afflicted with disorders of the mind. So that you had in 1811 in Dublin some people who could see ahead and were pioneers. I mention that because there is a danger when we are giving praise and expressing our satisfaction that we may feel a tendency to pat ourselves on the back as if we were doing something wonderful in passing this kind of Bill. This is an occasion on which it is always well to remember the work that has been done by pioneers, and who did what we are doing now with a great deal more difficulty.

I feel a great deal of sympathy and understanding with Senator Baxter's remarks, but I think they go outside the range of this Bill. I am perfectly satisfied that our social service policy is pursued regardless of fundamental examination of what the country as a whole can afford. Excepting perhaps the Minister for Finance who has to resist many demands made upon him, I do not suppose any spending Minister says to himself: "This may be desirable, but can the country afford it?" There is nobody really to look at the matter from that aspect, and try to examine what are our resources and what charges can they reasonably be expected to bear. I am inclined to agree with Senator Douglas that in this case it would not be right to stint the money required for mental treatment. In fact I go further. I think there should be practically no limit to spending to give us the best treatment in all questions of health. But that is that. Now we come to Senator O Buachalla. He will say that it would be disastrous to economise over the expenditure for the furthering of the Irish language and so on. Everybody will have their pet subject or activity on which no expense must be spared.

Senator Baxter might be found to be weak on that matter. He would not grudge expense for agricultural development or reseach or agricultural science, and there you are. I feel it is for somebody to look at this thing and say: "Here is some measure of national income; here is all we can afford to spend." It is unsatisfactory, but I do not think anybody looks at it in that way. I am not at all happy about the management of some of these institutions. It is not always as it should be. I do not think that the people responsible really make a study of what I might call scientific management. In business there is an enormous difference between good and bad management. There is an enormous difference between those who have good management as against the traditional old-fashioned methods. I feel generally in public activities there is not the same incentive to good management as there is in private enterprise, where there is a profit incentive. There cannot be a profit incentive in this case, but there can be a sort of prestige incentive.

Coming back to the old question, has the Parliamentary Secretary addressed himself to the question of units of cost? Mental hospitals are eminently suitable for application of the principle of units of cost. When this matter came up we had the advantage of some figures of the unit of cost in various hospitals, including mental hospitals. We see that it is an extremely low cost in the auxiliary hospitals because I take it they did not have such elaborate attendance. I hope the Minister is going to carry on the work in that connection and that he will address himself seriously to the question of efficient management. I speak with considerable experience of this. I have adopted it in certain businesses, and it is invaluable. Where you get a proper system of costing and you find an enormous difference in institutions working on the same basis, you can say: "So-and-so got this in some section at so much, why are you so much higher?" It is not done as a punitive approach. It is quite a critical examination. You call for an explanation and you get a convincing explanation or you may find that there is some weakness and then you will have an inquiry.

The question of cost is important and I am not at all satisfied that all through the Civil Service there is that realisation of that business method of using accounts to control and produce the most efficient management. I feel that whatever the farming community may have a right to, they have a right to the most economical management in the institutions they pay for. They are not in a position to do these things themselves. They have to look to the Government and the Civil Service to apply the necessary remedy. That is the only contribution I can usefully make to this debate.

This is a very serious matter and I am sure the House will continue to discuss it with all the seriousness that belongs to it, for no greater tragedy can befall an individual than that he should be afflicted with mental disease. The tragedy which incidentally befalls his family and his relatives is possibly even greater than the tragedy which affects the victim.

There has been considerable talk about the burden it may be necessary to bear to treat mental disease. Surely there is only one way to escape that burden, and that way is not open to a Christian community, namely that the person who is hopelessly insane be immediately removed from this life and be put in some form of lethal chamber, or otherwise he will be a burden on somebody. He will be a burden on the family if he is not removed to a mental home, and if he is removed to a mental home he must be a burden to the community. The question is, which is the most equitable way in which that burden should be borne—by the ratepayers or the taxpayers, and in what proportion should it be divided? The burden must be borne in some way or other by the community, and the burden to be borne by not treating mental diseases in the most modern and appropriate way, is going to be greater on society than the burden of incurring the additional expense caused by the successful treatment of this disease, which in many cases would be really curable if it was taken in time.

The matter is a very serious one, but if I may speak in a somewhat lighter vein, I may mention that I heard it rumoured that most of the legislation that was to be modified in this Bill was enacted on the advice of a very brilliant expert some generations ago who was himself an inmate of a lunatic asylum. If that were true it is quite time that much of that legislation was modified, repealed and codified. I welcome the efforts in this very comprehensive Bill to bring our laws affecting mental disease up to date and to provide a comprehensive code for dealing with the matter. Incidentally I am filled with admiration for the tremendous work which the Parliamentary Secretary's experts must have put into the preparation of the measure and I would like to add my quota of praise to their very valuable work. Referring for the moment to a remark of Senator Duffy who suggested that agricultural work is a suitable occupation for a person afflicated with mental disease, does the Senator suggest that it is the only suitable occupation? If so, it involves a very serious reflection on about 50 per cent. of the people occupied gainfully in this country, but perhaps in view of the injustice and inequitable treatment agriculturists have suffered for many years there may be some truth in that theory. Shakespeare, I think, said:

"Canst thou not minister to a mind diseas'd,

Pluck from the memory a rooted sorrow,

Raze out the written troubles of the brain."

He had to wait a long time for the answer. Apparently the Parliamentary Secretary and his Bill are the answer. Like Senator Hayes, I feel there are certain aspects of this matter on which I would have welcomed a statement from the Parliamentary Secretary if he had seen fit to make it. I suggest that there are aspects of the matter which require further investigation. I would like some hints as to what are the principal social and economic causes of insanity before I feel certain that ultimately the best remedy for a situation in which mental disease has to be dealt with is more of the social and economic order. I would like to know whether there is any statistical association between certain of the social phenomena which are characteristic of this community and the causes of insanity.

For example, we know that the marriage rate in this country is the lowest of any civilised country in the world. Is insanity more incidental to the state of unmarried bliss or to the state of married bliss? Now that is a question which should be capable of being answered by a proper statistical investigation of the data in possession of the Minister's Department. Or is there any special association between cases of insanity and certain forms of occupation? Are some occupations more prone to develop insanity in the persons following these occupations than others? If you examine this matter, you will find that some of the most brainy occupations are also some of those in which people are most likely to go off their heads The poet tells us:

"Great wits are sure to madness near allied,

And thin partitions do their bounds divide."

If that point of view is generally accepted, I think, so far from regarding the incidence of insanity in a family as a disgrace, it should be looked upon as something to be proud of, as something which indicates that the intellectual level of that family is higher than the average. But there again I speak without any real knowledge of the data which should be properly available.

I should like to emphasise that while the treatment of mental disease is chiefly a matter for medical men there is another element in its treatment and cure. In particular we should do everything we can to remove the false sense of shame that has been associated with the families of persons suffering from that disease. I think the stigma associated with the disease is one of the elements which prevent its treatment at a sufficiently early stage and complicates the problem of treating the disease even when treatment in an institution has become necessary.

I should like to say that I welcome in particular in this Bill the provisions which it makes for the voluntary treatment of patients suffering from the initial stages of mental disease. I think it is generally admitted by experts that the best hope of successful treatment exists if the disease can be attacked in its initial stages. It is very important that people threatened with incipient insanity should be encouraged to have expert treatment at the earliest possible moment and if the existing legislation had not gone out of its way to make it almost impossible for people to get that kind of treatment, perhaps our record of curative treatment would be more satisfactory than it is.

There are various institutions referred to in this Bill for the treatment of mental disease on a large scale. There are private institutions, and there are private charitable institutions, as well as various types of mental homes supported by the rates. I do not know the details, but I have the feeling that the element of private profit should not enter into the treatment of mental disease, good, bad or indifferent. There may be cases in connection with private institutions, as distinct from other kinds of institutions, in which the element of private profit is very prevalent, and in which considerations of private profit may sometimes take precedence over considerations of the welfare of the patient or the financial position of his family. I do not want to make any charges, because I am sure most, if not all, of these institutions are very careful in this matter, but at least one instance came to my personal knowledge of a certain institution which continued to treat a private patient, when there was obviously no hope of a cure, until it had exhausted all the resources of the patient's family and then threw him out to be taken elsewhere. There is that tendency in human nature to give the element of private profit too much prominence, and I suggest to the Minister that private institutions should be subject to the strictest supervision by his Department in order to see that they do not yield to the temptations which the element of private profit may put in their way. Consequently, I think the grounds for refusal of registration referred to in Section 119 of the Bill are not sufficiently comprehensive in the case of private institutions, and that they should include a provision that if there is reason to think that the institution is exploiting family pride and the financial resources of the patient's relatives, in cases where the prospect of cure does not justify expenditure being incurred, that that private institution should be deregistered.

Now, mental disease is a matter which has many aspects and the medical profession are, of course, directly and professionally associated with the attempt to diagnose and cure mental diseases, but it happens to be one of the kinds of disease in the treatment of which the medical profession cannot claim a monopoly. I think that, in this country at any rate, what I might call the religious element is one to which great importance is rightly attached. Consequently, there should be greater recognition of the contribution that spiritual medicine can make to the treatment of mental infirmity. I know that there are chaplains associated with our various mental homes. I know that they are paid certain incomes by the State, but I wonder whether these chaplains have had any special training in the scientific aspect of their functions which would give them special competence to contribute the element of spiritual medicine to the cure of mental disease? I hope, personally, that if they have not started with that training, they have at all events attempted to acquire it in the course of their practical experience.

I would suggest that the State should ask the co-operation of the various Churches in the training of theological students so that those of them who have an interest in this aspect of their work would get a training which would fit them afterwards to perform the functions of chaplains in mental homes. It could be arranged by the various Churches that such chaplains should have work provided for them in places conveniently near to a mental home so that they could combine their function of chaplains of mental homes with whatever other clerical or parochial functions they needed in order to have a full professional life. It is a matter in which I think the State and the Churches could co-operate, and I think that this co-operation might have fruitful results. The psychological approach to the treatment of mental disease is one which I think is recognised more and more in modern times, and I am sure that Senator Fearon will agree that, side by side with the laboratory and other more strictly scientific methods, the psychological method is one which should gain increasing prominence. If that be so, the functions of chaplains associated with mental hospitals are of considerable importance and their importance should be recognised more and more in the legislation governing mental hospitals.

I think they should be recognised as an essential part of the staff provided for the treatment of mental cases. I understand that some years ago a change was made depriving chaplains of pension rights, although under former legislation, after 25 years' service, chaplains to mental homes were entitled to pensions. Under this Bill, as it now stands, chaplains as such— chaplains of every creed—are, as I read the Bill, excluded from any superannuation rights. That, I think, is a retrograde step, and I hope the Parliamentary Secretary will see fit to amend this Bill in such a way as to recognise the great actual and potential importance of the contribution that ministers of religion of the various creeds can make, as chaplains, to the treatment of mental disease, and that he will put their superannuation rights on all fours with the superannuation rights of the medical and other officers associated with mental hospitals.

That is all I wish to say, except once more to express my appreciation of the work done in framing this Bill, and my congratulations to the Parliamentary Secretary and his staff on the tremendous work they have done in that connection.

It gives me great pleasure to support this Bill. It has been described by Senator Fearon as a monumental work and I think it deserves that name. Mental disease knows no boundary. It exists in all countries, unfortunately. Different countries, different States, have their own different ways of dealing with mental disease, but, broadly speaking, the treatment is more or less uniform and runs on similar lines in those different countries. Consequently, each country has always something to learn from the other country on the question of the prevention and cure of mental disease. Now, this has been a long-awaited measure so far as this country is concerned. This measure is, in effect, overdue. That is not the fault of our Government. It is not the fault of the Minister in charge of the prevention and cure of mental disorders. It simply had to take its turn in the queue, and now it arrives at its journey's end.

This monumental work, of course, took a number of years to bring to fruition, and the Parliamentary Secretary and his expert advisers and helpers in the preparation of this Bill deserve our congratulations. I said a moment ago that this Bill is overdue. Steps have already been taken in England and in the North of Ireland, by legislation, to deal with matters which are provided for in this Bill, and I must assume that in the compilation of this Bill we have taken some ideas from the legislation of other countries. We may have done so, but having read this Bill, and having read the Acts which apply to the prevention and cure of mental disorders in other countries, I think that we have now a model Bill from which, when it becomes an Act, other countries can learn something. So that, while we may have borrowed some of the ideas from other countries for the purpose of bringing this Bill to fruition, we have, in the course of this legislation, produced an enactment, which, so to speak, outsteps the excellence of the Acts of the other countries. So, as far as I can see, we have now a most up-to-date model so far as the legislative treatment of mental disorders is concerned.

In reading the Bill and the Acts which it repeals, one's mind is brought back to the barbaric days of 100 years ago, when a person suffering from mental disorder was treated as a criminal and thrown into prison, and it was only by a long and tiresome sequence of events that we have now a humane method of dealing with our unfortunate fellow-creatures who suffer from this disease. This Bill is overdue also because for a number of years we have been sailing under false colours as far as the admission of patients to mental hospitals is concerned. I have read the annual report of the inspector of mental hospitals, each year, from 1932 to 1942, and in that report are given certain statistics. I find that almost 60 per cent., between males and females, of the admissions to mental hospitals, on the average, during those years, were made under Section 10 of the Lunacy (Ireland) Act, 1867. That Act provided that if a person were discovered and apprehended under circumstances denoting a derangement of mind and a purpose of committing an indictable offence, such person could be committed to a lunatic asylum on the determination of two justices of the peace. That Act was passed in 1867 to bring to an end the system of sending unfortunate persons, suffering from mental disorders, to jail, and the alternative then was to send them to a lunatic asylum. In the year 1935, 69 per cent. of the males admitted to mental hospitals were admitted under this section.

In fact, nearly all poor lunatics were admitted under this section. In other words, they were admitted with the brand upon them, if not of a criminal, at least of a would-be criminal, and my own view is that a great number of miscarriages of justice took place because the evidence upon which they were committed was in many cases, I should say, very flimsy. In fact, the legislation itself was self-contradictory because Section 10 of the Act of 1867 spoke about dangerous lunatics or dangerous idiots. Well, an idiot is supposed to be a person who has been devoid of reason since birth, and it is difficult to understand how a person who has no reason at all could form a purpose of committing an indictable offence. However, that has been removed from the Statute Book by this Bill, and that is why we welcome it.

I also feel that if this Bill had been in force as an Act for a number of years, a number of crimes that had been committed, especially the crime of murder, would not have been committed, because the persons who committed those crimes would have been incarcerated in a mental hospital at an early stage, and so would not have been at large to commit the appalling crimes which they committed at a later date. Therefore, I think that when this Act is put into operation the number of patients in the Dundrum Criminal Lunatic Asylum will diminish, because it will be easier then to deal with cases which in the early stages may be harmless but which afterwards may prove very dangerous indeed.

I was rather surprised to hear Senator Baxter speak about the cost of this Bill. This is a Bill to provide for the prevention and treatment of mental disorders and the care of persons suffering from such disorders. Everybody will agree that one of the most appalling visitations that could afflict any human being is the loss of his reason. Therefore, if something can be done to prevent such an appalling visitation upon any person, money should not count. As has been stated here, we have up-to-date methods of science for dealing with the prevention and cure of mental diseases. We have also up-to-date methods of raising money. At a later stage, when the war will be over and when this country, because of our hospitals sweeps, will once again become the cynosure of world gamblers, if I may lightly use that word, I see no reason why we should not apply the surplus proceeds of the sweeps towards the cure of mental diseases. I say that in this matter we should leave the question of money aside, because I am satisfied that, given the scientific means of prevention and cure, the money will be forthcoming.

I said that this Bill is a monumental work. No doubt, it took a number of years to prepare. Consequently, it is very difficult for a member of the Oireachtas fully to understand and digest the Bill in a few days. In the course of the Committee Stage we may have explanations of a number of sections with which I should like to deal now, but which I will refrain from dealing with because they relate more to questions of detail than to questions of general principle. I am glad that, as the Bill progressed in the Dáil, the Parliamentary Secretary improved it, and it has come to us a far better Bill than when it was introduced in the Dáil. It may not be necessary to add anything further to it, but I would suggest that the Parliamentary Secretary should not give up the good work of improving the Bill. Even though it is now before this House, and even though members of this House may not be able to suggest the amendments which would improve the Bill, the Parliamentary Secretary should still continue to improve it. He may be able to get his ideas from the speeches of Senators, and therefore I am hopeful that when the Bill leaves this House it will be the last word in legislation for the treatment of mental diseases.

An té a bhfuil spéis aige i gcúrsaí sóisialta agus i sláinte phoiblí na tíre seo agus atá ag faire ar na figiúracha a foillsítear i dtaobh galraí, ní fhéadfadh gan iongantas a bheith air faoi chomh mór agus atá galraí áiride ag cur ar ár ndaoine le tamall. Is cúis mhór imní dhúinn chomh mór agus a fuair trí galraí áiride greim sa tír agus siad na galraí iad sin, an eitinn, an galra intinne agus an cancar.

Tamall gear ó shoin cuireadh in iúl dúinn go rabhthas le cogadh a chur ar na galraí seo. Bhí áthas orainn ar fad nuair a tugadh Bille isteach le cath a chur ar an eitinn agus tá súil againn agus tá an dóchas go láidir againn nach ró-fhada go mbéidh greim sgornaí againn ar an ngalra dona sin. Is cúis mhór áthais anois dúinn go bhfuil an Bille seo os ár gcómhair. Bille gurb é a chuspóir cosg a chur le leathnú an mheabhair-ghalra.

Tá an Bille seo le moladh agus ba mhaith anois aontú leis an moladh a tugadh inniú don Rúnaí Párlaiminte agus don fhoirinn eolaithe atá ag obair leis. Ba mhaith freisin a rá chomh mór agus is maith liom gur chuimhnigh an Seanadóir Bean Uí Choinceannain ar an Dr. Ada English agus ar an obair mhór a rinne sí ar feadh a saoil i gcúis na ndaoine mbocht a raibh sé de mhí-ádh ortha a bheith i ngéibheann ag meabharghalraí. Ba dochtúir iongantach í, na moltaí a rinne sí ó am go h-am i dtaobh an ghalra. Is anois atá áird á tabhairt orthu. Is maith liom go gcuimhuítear ar an Dr. Inglis inniú.

Rinne mé staidéar ar an mBille seo agus ní féidir liom aon cheó a rá ina thaobh ach an méid seo, go bhfeictear dom gur Bille thar cionn ar fad é. Nuair a bhí an Bille léite agam thugas é do dhochtúir óg a bhí sa mbaile as Sasana, áit a bhfuil baint aige le institiúid tábhachtach meabhar-ghalra. Ba maith liom inseacht don Seanad agus ba chóir go mbéadh fhios ag an Rúnaí Párlaiminte ina thaobh, agus sé an breithiúnas a thug seisean air, gurb é an rud is fearr a dtáinig sé fós air i dtaobh an ghalra atá i gceist. Tá colas ag an bhfear sin ar a bhfuil déanta ina lán tíortha agus níl Sasana féin chun deiridh san obair, agus ar an abhar sin tháithnigh a thuairim i dtaobh an Bhille go mór liom.

Ach ina dhiaidh sin agus uile, tá an bharúil agam gur beag is féidir leis an mBille a dhéanamh agus is beag is féidir leis an Roinn a dhéanamh gan cabhair mhór ón bpobal. Tá súil agam go mbainfear feidhm mhór as alt 24 den Bille. Tá súil agam go mbéidh daoine sásta agus ullamh i gcomhnaí a ngaolta a bhfuil comhartha orthu a thabhairt go dtí na clinicí agus go ndéanfaidh siad le fonn agus le dúthracht gach comhairle dá gcuirfear orthu. Gan comhoibriú an phobail ní bhéidh toradh ar an mBille mar ba chóir.

Tá alt a 24 ar na hailt is spéisiúla agus is tábhachtaí sa mBille. Ach chítear dhom nach mbeidh muid i ndon feidhm a bhaint as an alt sin gan rud éigin a dhéanamh le traenáil faoi leith a thabhairt do dhochtúirí na tíre ar an ngalra. Ní mheasaim féin go bhfuil an cúrsa a dhéanann na dochtúirí óga ar meabhar-ghalra sáthach iomlán. Is cúrsa an-ghairid é agus b'fhiú féachaint a bhféadfaí an cúrsa sin a leathnú.

Tá barúil agam go bhféadfaí rud éigin a dhéanamh le comhairle agus cabhair spéisialaithe a chur ar fáil ag muintir na tíre i gcoitinn. Níl fhios agam an bhféadfaí na ceanntair íoclainne a eagrú ar bhealach eile. Ba mhaith liom, abair, ceithre ceanntair a ghrúpáil. Bhéadh gach dochtúir 'na dhoctúir ghenearálta ach ina dhiaidh sin ba chóir go bhféadfadh gach dochtúir acu traenáil faoi leith a bheith aige ar brainse faoi leith den leigheas —semi-speisialaí a bhéadh ins gach duine acu. Ba mhaith liom duine acu a bheith traenáilte san eitinn, duine traenáilte sa meabhar-ghalra, duine traenáilte sa gcancar agus galra eile cosúil leis agus an duine eile sáreolasach ar na galraí sin a bhaineas leis na mná agus le páistí go háiride. Ar an mbealach seo bheadh deis ag na dochtúirí áitiúla comhairle údarásach a bheith acu ina gceanntar féin agus gan mórán moille. Ar an mbealach d'fhéadfaí comhairle fhóinteach a bheith ar fáil ag na dochtúirí agus ag na hothair shul a mbéadh an deis ag an ngalra greim ro-láidir d'fháil ar na hothair. Caithfimid na galraí a chosg más féidir agus caithfimid gan ligint dóibh an ghreim ró-dhaingean d'fháil ar na daoine. B'fhéidir nach fiú mórán an moladh seo; ar an taobh eile, b'fhéidir go mb'fhiú é a scrúdú.

Chuir mé spéis sa méid a bhí á rá ag an Seanadóir O Dubhthaigh. Bhí imní mór orm, chomh maith leis-sean go mb'fhéidir go bhféadfaí daoine a chur isteach sna hospidéil intinne gan lán-údar agus gan lán-chúis. Sílim féin go bhfuil cearta iomlána an othair agus sílim go bhfuil cosaint iomlán don othar curtha in áirithe go maith agus go cinnte fé ailt a 237 agus 265 den Bhille. Níl fhios agam a bhfuil na hailt sin iniúchta ag an Seanadóir; má tá b'fhéidir gurb é an chaoi nár iniúchta thuigeas i gceart na pointí a bhí á luadh aige.

Rud amháin eile, aontaím leis an Seanadóir O Catháin san athchainí a rinne sé maidir le stiúradh maith na nInistitiúidí seo. Ach sílim go bhfuil cuid mhór á dhéanamh cheana féin le bhartáil ins gach sórt ospuidéal sa tír a chosg. Is dóigh liom go bhfuilimid ag iarraidh doras atá ar leathadh d'fhosgailt agus bheith ag iarraidh ar an Roinn Rialtais Aitiúil áird a thabhairt ar an gcomhairle seo.

Sin an méid is mian liom a rá anois mura n-abraim arís chomh sásta agus atá mé leis an mBille agus mura dtraoslaím ath-uair leis don Rúnaí Párlaiminte agus a chuid comhairleóirí ar a fheabhas agus a rinne siad a gcuid oibre sa mBille seo.

I could hardly let this occasion pass without contributing my views on this Bill which is, in many ways, unique. It is the first time in my experience that the Parliamentary Secretary has been praised for his work. In his case, it is generally the other way. I hope that the effect will be permanently to his benefit.

The Senator should attend here more regularly and he would hear it more often.

I do hope that he is not going to be impressed by the arguments adduced by Senator Sir John Keane, who asked if the country could afford the expenditure involved by this Bill. That matter has been well dealt with by Senator Ryan, and I shall not deal with it further. As a matter of information, I want to be informed by the Parliamentary Secretary as to the position regarding the large sums of money lying to the credit of a number of inmates in these mental homes. The distribution of this money is extremely difficult, and where there are no immediate relatives to take out administration for these people, the money accumulates. I have known of a case in which distant relatives who never put themselves to any expense or trouble to help the inmate, came in, on death, to sums up to £200 or £250.

I wonder if the Parliamentary Secretary intends to do anything to make it possible to ensure that this money will be spent on some extra gifts for these people. It is very important that a provision should be made by the Parliamentary Secretary in the Bill, and that he should tell us whether he contemplates any change in that direction. So far as I know, the problem has not been dealt with up to now, and it is really important that the insured persons going in for treatment should be entitled to the benefits placed to their credit.

The institution cannot take advantage of it and use it, and therefore these gifts, which would mean so much to these unfortunate people, should be made available for them. Such moneys should not be left to some relative who is absolutely indifferent as to how these people got on during their lives, and who has shown no human kindness whatever to them while they were in the various institutions. I could go on for a good while stressing that point, but it is not my intention to do it.

I have very considerable experience in asylum administration, having been on the board of governors for a considerable time, and one of my sad experiences as a governor was the definite readiness of some doctors to certify persons as insane when they were not insane at all. I know at least one case where a patient was in the crisis of pneumonia and was rushed to an asylum and died in a few hours. They did not want the trouble of the patient in the hospital and sent him away. I hope that the Bill makes provision which will prevent that kind of thing happening. I expect that the Minister will give us some information, particularly on the aspect of national health insurance benefits.

Senator Ryan touched incidentally on a subject which has given me a little anxiety. I do not refer to his difficulty in recognising dangerous idiots. I find no difficulty whatever in that—I could recognise only too many of them now. I refer to his excellent scheme for making lunatics pay for themselves by starting a new sweep and transferring money from one set of lunatics to another. But in his reference to the 1867 Act and the extremely necessary provisions for dealing with emergency cases— cases of sudden frenzy or sudden mania —he did not refer to the fact that a safeguard, an inadequate, and, perhaps, a rather bad safeguard, is abolished by this Bill.

The 1867 Act, if my recollection is correct, was the last of a series of Acts whereby people who were considered to be in a state in which they were likely to commit a criminal offence could be brought before magistrates and put, first of all, under the earlier Acts, into gaol, and subsequently, under the 1867 Act, into lunatic asylums, but there was the safeguard of examination by an outside doctor, and there was the safeguard of the consideration of the case by the magistrates. I do not say that either of those safeguards was very sound, and I have in mind a case in which Senator Ryan and myself were on opposite sides, in which I was fortunate in persuading a series of courts that a person was rightly brought in, but I had a certain amount of doubt as to whether an abuse had not been perpetrated.

I agree entirely with the Parliamentary Secretary that it is absolutely necessary to have some method whereby a person who is afflicted with a sudden onset of mania which will make him dangerous to himself or to others can be put at once under restraint with the minimum of red tape, and in so far as this Bill abolishes what I think was the more apparent than real safeguard of the examination by the magistrates and doctor, I have not any fault to find, and I am prepared to support the power given to the Gárda Síochána of putting a person under restraint in a home of some kind at very short notice and on comparatively slight evidence.

But here is where I would like an assurance from the Parliamentary Secretary. I want to be quite certain that when a person is put in, in circumstances which apparently warrant it, every conceivable care is taken to make certain that that person is released at the earliest possible opportunity, and is not kept in, in any case which does not make it imperative for his own safety or other people's that he should be kept in. Those are cases in which I think the Bill should contain special provisions for regular and particular examination.

I take it that in addition to the competent and qualified doctor who will be in charge of the home into which such a person is consigned by the Gárda Síochána, there should be provisions for examination by at least two outside doctors. When I say outside doctors, I mean one doctor not connected with the State medical service and one who is connected as a visiting inspector with part of the State medical service. While supporting, and supporting fully, as a result of experience gained in the courts, and otherwise, the provisions for putting in persons rapidly, and I might almost say on grave suspicion, I would like the Parliamentary Secretary to give me an assurance that even more stringent precautions than usual are taken to prevent mishaps, such as those referred to by Senator Foran, and which are not untypical of what may happen.

That is my only criticism, if it be a criticism of this administrative measure which is extraordinarily far-reaching, and seems to me to be extraordinarily well designed. I would like to join my voice in the congratulations which have been tendered to the Parliamentary Secretary and invite him to allay the apprehensions, possibly ill-founded ones, that I have had in cases such as that—that it may be easier to get a man into a mental home than to get him out. I use the term "mental home," I may say, with great reluctance, because the term "asylum" was a magnificent term. It means a place where safety and peace are secured for you, and I regard it as a very retrograde step that we should have used the thin and meaningless term "mental home" for "asylum."

It is clear that Senator Kingsmill Moore did not understand what Senator O Buachalla said.

I am afraid I did not.

Senator O Buachalla referred to Section 237 of this Bill which provides that the inspector of mental hospitals is to visit each institution from time to time and has an opportunity to make investigations as to whether people should be detained there, particularly if he is requested so to do by the person so detained. If he thinks that the person should not be detained that person is to be liberated. That is a safeguard in the Bill to which Senator O Buachalla referred. It may be well to consider also the advisability of having a second doctor in all cases, instead of one doctor only, in committing a person to a mental home. Senator Foran referred to a case where a person was committed. I know a case where there were two doctors and they insisted on putting a man into a private mental home. Fortunately, his wife said she would not let him go and sent for a third doctor who said: "In the first place, he has got pneumonia and his temperature is 104," and so on. They treated the man and he got better without having the stigma of being committed to a mental hospital. It would be very hard to take too many precautions. I am delighted that the Parliamentary Secretary has devoted his mind to the treatment of these cases. I believe myself that there is a big percentage of these people in mental homes who could be cured if there were sufficient doctors to treat them, that is, doctors with sufficient knowledge of the disease. I know one superintendent of a mental hospital who told me that for the first four days he does nothing but examine the physical condition of the patient. I was reminded of it when I heard Senator O Buachalla say that it might be a very good thing to have experts in different diseases come into the hospital and examine the patients. If that could be arranged it would be a very good thing.

I also agree with Senator O Buachalla in that statement. I know myself where a man of very fine physique was sent to hospital. He was supposed to be out of his mind, but a very able surgeon looked at him and said: "I do not think that man is insane, but did he ever have an injury?" First they said "no", and after a while they remembered that he got a blow with a hurley many years ago. They had him x-rayed and found a bone protruding into his brain. An operation was performed and the man was perfectly sane immediately after the operation. This doctor to whom I refer, who was a superintendent of a mental hospital, said that he expected to be able to cure some enormous percentage—I think it was 60 per cent. If that could be done in the various mental hospitals it would be a great saving to the rates of the counties that will have to incur a great deal of expense, as Senator Baxter pointed out. I suppose, as I am a servant of a local authority, I have a great deal of sympathy with local authorities. I would like to see the rates reduced as much as possible and to have a good deal of the expenses taken off them. The tendency is to throw everything on to the local authorities. The old Poor Relief Acts provided that half of the expenses would be paid by the State. Recently I understood a figure was taken, standardising the amount. Senator Ruane mentioned that the capitation grant is only 4/-. That is a ridiculously low figure compared with the cost of maintaining these people in a mental hospital. I would like to see something done to have the expenses compared in that way.

Senator Duffy does not like the idea because he says the system of taxation is wrong. It may be wrong. After all, the Central Fund has got a great advantage out of the earnings of that person, and this disease is one in which it is in the interests of the State to save people from it. I think for that reason it would be a very good thing to save the local authorities. I hope that the cost will be reduced. I think it will. I believe that in many cases the disease is caused by something wrong with the blood. I heard of a case in which a man was brought to a doctor and the doctor said: "I will not examine that man; there is something wrong with his blood; if he had come in time I could have cured him." He went to a mental home and died in a short time. These clinics should be a wonderful help, and like Senator O Buachalla, I join in the congratulations that the Parliamentary Secretary has been given for the work he is doing.

Business suspended at 5.50 p.m. and resumed at 7 p.m.

I should like first to thank Senators for the manner in which they received the Bill, and for their very helpful attitude. My task in such circumstances is a very easy and pleasant one. I quite realise that sometimes it is difficult to bring yourself to express appreciation of something that emanates from a source which you do not like too well. That is human nature, and it is quite understandable. Consequently I appreciate the more, if there are people who do not like the source from which this Bill has emanated, the generous manner in which they have received it. Most of the points that have been raised on Second Reading will, as Senators have already mentioned, be more appropriately and properly dealt with in Committee. Consequently, I do not propose to deal with all the smaller Committee points that have been raised, because we shall have a further opportunity of dealing with them. I hope to deal with most of the important points, in so far as I have noted them, that have been raised.

Senator Hayes, who opened the debate, following my explanatory statement, talked about the need for an educational campaign. Senator Ruane followed on somewhat similar terms. I am sure we are all in agreement with them. An educational campaign is, unfortunately—I suppose it is part of our historic heritage—necessary in relation to many matters, particularly regarding public health. One of the greatest difficulties we have in relation to social reform and public health progress is the prejudices that have been created in the minds of the people through their failure to understand things in the more enlightened way that we should wish them to understand them, and which would be necessary in order that we might make more satisfactory progress. While saying that, I think we can agree that there is now a more enlightened outlook in relation to these matters than there has been in the past. To such an extent as we have succeeded in getting that better outlook, we have reason to congratulate ourselves. There is a tremendous amount of work to be done in that field, and if the discussion on the Bill had no other value than the educational value, it would be well worth while introducing the Bill for that purpose alone.

Mention was also made in relation to the education of the public mind, particularly as to the curability of mental disease. I do not want to lecture the House on a technical subject such as this except just to furnish Senators with some simple, understandable, fundamental facts. One fundamental fact that we may take away with us now in full agreement is that the scientific treatment of mental disease has advanced very substantially, particularly in the past ten years or so. There is now a very high percentage of cures and the earlier we can get cases, as many Senators have very properly remarked in the course of the discussion, the higher will be the percentage of cures. It is a fact that at least about 30 per cent. of the people, who under the old law had to be committed as dangerous lunatics, were discharged cured within six months in recent years. I think that is very satisfactory and very encouraging, and we hope for much better things when this Bill becomes fully operative. As some Senators have pointed out in the course of the debate, it is largely a machinery measure, but in so far as human ingenuity could construct a good machine I think we can all claim that it is a good machine and that if we can make it operative and fully effective, then we may expect to reap the fruits of our enlightened legislation.

The matter of the incidence of the disease was also mentioned by Senator Hayes, with particular relation to geographical distribution. I have not any statistics that are in any way convincing on that particular matter. It would appear that even within such a small area as one county the incidence would be higher in one part of that county than in another. Similarly, in groups of counties, in geographical areas there would appear to be a higher incidence in some parts than in others, but the incidence, in so far as we have been able to follow it, does not just remain stationary; it varies from time to time. As to the contributing factors to the incidence of mental disease or disorder, again, we cannot be very dogmatic, but it is generally agreed that such a factor as close inter-marriage, probably, has a considerable influence on the incidence of mental disease. Such factors, of course, as addiction to drugs, particularly to alcohol—over-indulgence for a very prolonged period—undoubtedly contribute to the incidence of mental disease, and the factor of venereal disease, where it enters into the picture, certainly is also a serious contributing factor, in certain areas particularly. Outside these matters, the causes of the rise and fall in the incidence of the disease must be largely a matter of conjecture for the present, until our scientific knowledge advances much further than it has gone up to the present.

Senator Hayes also talked about the general idea of trying to do something more to prevent the disease rather than, or perhaps in addition to, the provision we are making for treatment. Well, when Senators get more time to consider this Bill, which is a very comprehensive measure, in detail, they will find that the whole structure is intended to try to create a better machinery for the prevention of mental disease. The provision for dealing with addicts, the provision for dealing with inebriates, the provision for the admission of voluntary patients and, perhaps more emphatically than any other provision, the provision for the establishment of clinics where people, who are in the very early or incipient stages of mental disturbance, can seek and secure expert treatment and advice— all these are designed to create better machinery for prevention of the disease. I think that in the last provision I mentioned, the establishment of clinics, is the greatest hope of all, if we could make it general and operative throughout the State. At any rate, we have the machinery here to do it, and perhaps we would be able to get the necessary ammunition to make that machinery effective. I may have something to say, later on, on that, if I meet it in the course of the notes I have taken.

Senator Hayes also mentioned the matter of the increased duties that this Bill may put upon our medical staffs, without having made any corresponding provision for increased remuneration. Well, when the Bill becomes fully operative—and I think that, at an optimistic estimate, that will be in from three to five years' time, and if we have it fully operative by that time, it will be very good—we, very probably, will require increased staffs in our institutions. If whole-time resident medical staffs have to go out and spend a good deal of their time in clinics, perhaps in neighbouring towns, then clearly there would have to be increased staffs; but at any rate, so far as the remuneration of increased staffs is concerned, that would more probably arise and be dealt with under the Local Government Act of 1941. The question of the salaries of medical staffs does not arise here. The only thing that arises here is the matter of the superannuation of officers and staffs.

Senator Duffy, I am glad to see, has apparently been impressed by a speech that I made here on the Sanatorium Bill, when I discussed at some length the relative merits of local taxation and central taxation. Well, as it appears we are in agreement on that, perhaps I should get away from it as quickly as possible. Senator Baxter would prefer central taxation, if any, as would also certain other Senators, but I find myself in agreement with Senator Duffy. I do not know whether it was my contribution to the debate here on the Sanatorium Bill that set him thinking along those social lines, but, whether or which, it is a good thing that he finds himself in agreement with me, and I presume, therefore, that I can count on the support of the Labour Party when this becomes an issue.

Do not be too sure of that.

There is no harm in trying.

There are no Parties here, I understand.

Yes, I know, but I think that, like the rest of us, Senator Duffy is associated, at least remotely, with a Party, and I hope that he will pass on these views as to how we can finance all these measures of social reform. Senator Duffy also referred here to the stigma of criminality. I think that has been very well dealt with in the course of the debate, particularly by Senator Ryan. At any rate, we have now a measure before the House to get completely and entirely away from the criminal setting. It is just one of those prejudices, one of those handicaps, to which I referred at the outset that will take probably many years of education to get away from completely. Perhaps it is because of the criminal setting connected with the treatment of those unfortunate people that such a stigma has come to be attached to mental diseases, but when one applies intelligent reasoning to the actual position it is hard to understand why we should attach any stigma to a disease of the mind that cannot equally be attached to a disease of the body. Anyhow, it will be a long time before we can get public acceptance of that, and perhaps the whole background of the manner in which our mental patients were handled in the past has had a good deal to do with creating that position as we find it now.

Senator Duffy also raised the matter of the registration of certain groups of officers. I think that if the Senator studies the Bill more carefully, and if he should find time to relate it to the existing law, he will find that there is no radical departure from the law in that regard as it stands at the present time. Officers or servants who have, in the usual course of their duty, the care and charge of patients, will automatically become registered. As Senators are aware, registered officers —namely, those who have the care and charge of patients in the usual course of their duties—will be entitled to special terms of superannuation under the Bill. That is the real difference between the registered and the unregistered officers. Some Senators who are in touch with the actual conditions of service in those institutions will be concerned about the type of officer or servant who periodically has patients under his care. The position under the Bill will be that those who are normally employed in looking after the patients will automatically become registered; that those who occasionally have charge of patients, say, painters or tradesmen, who, perhaps, in the course of occupational therapy would have a group of patients working under their supervision, will apply for registration, and with the consent of the Minister any such persons' names can be added to the registered list. That is the procedure. Similarly, anybody who applies to the mental hospital authority for registration, and is refused, has the right of appeal to the Minister for a determination of the issue. At any rate, I can assure the House that there is no new policy being evolved in this regard. The policy that has been in operation, and has operated satisfactorily in so far as officers and servants are concerned, will continue to operate.

Senator Duffy seems always to take up a good deal of my time in replying to him on these Bills. Perhaps it is because he talks so early, and that I am more energetic in the early stages and take more elaborate notes than I do as time goes on and speakers begin to duplicate. He expressed some concern in regard to sub-section (2) of Section 63. Sub-section (2) provides that a mental hospital authority shall from time to time or as directed by the Minister determine, with the consent of the Minister, the annual value in money of the emoluments of their officers and servants and shall keep affixed in a conspicuous position in each institution maintained by them a detailed list of the values determined as aforesaid of the emoluments of the officers and servants employed in such institution. I do not think the Senator need have any anxiety as to the operation of that particular sub-section. It is in fact in the interests of the officers and servants that provision should be made for a revision.

I am afraid the Parliamentary Secretary probably did not quite get what I said. The point I wanted to get at was this: that the last valuation seems to have been made ten or 12 years ago, and there has been no revision in the meantime. I was anxious to know whether there is likely to be a revaluation under the Bill?

The Bill provides for the possibility of a revaluation from time to time either on the initiative of the mental hospital authority with the consent of the Minister, or by the mental hospital authority at the direction of the Minister. Apart altogether from that, I should tell the House at this stage—because I think it ought to influence the debate on the Committee Stage in regard to superannuation provisions—that for quite a long period now I have been in negotiation with representatives of the mental hospital workers through the Irish Transport and General Workers' Union, and directly with the staffs of some few institutions that are affiliated through other organisations, with a view to trying to establish uniform conditions of service. My particular anxiety in relation to the whole question of the remuneration of staffs in the service of the mental hospital authorities at the moment is that for the same type of service there is not uniform remuneration. In certain institutions, particularly in Letterkenny and Monaghan and Ennis—those are three of the worst in the State—the salary is lower, and very substantially lower, than in other institutions. Yet, they have to give the same type of service, and the same hours of duty, and very often even longer hours of duty. The standard of valuation of the emoluments is correspondingly low. I want to get away from that. I want to get uniformity in salaries and uniformity in the value of emoluments. There seems to be a very good prospect now that we have almost reached agreement in that regard, provided that the local authorities are in an agreeable mood. As far as Cavan and Monaghan are concerned, I am sure Senator Baxter will help me out there.

I will not be as soft as Senator Duffy. You are trying to pull him over with you. He is going to get something.

I think the officers and servants in Monaghan and Cavan will get something, too.

And I am to give it? Is that it?

If Senators feel in a generous mood in the matter of superannuation when we come to discuss the details, I want them to bear in mind that the new uniform scales of salaries, when they become operative, will be reflected in the superannuation of the future. We need not relate the superannuation provisions in the Bill to salaries as they are at the present time because it is a moral certainty that we must either face justifiable unpleasantness with the staffs of these institutions or see that they are as well treated in one part of the State as they are in another. While on that point, I might refer to the estimate of the probable increase in cost. We are not setting new standards. We are trying only to bring the lower-paid officers up to the reasonable standards that obtain in other areas. That is going to cost the ratepayers the sum of £80,000 when it becomes operative.

In three areas?

In the entire State. In the areas where the scales are very low, the amount will be proportionately heavier. It is well that we should bear that in mind in the event of Senator Duffy asking us to be more generous in the matter of superannuation. Senator Baxter was, I think, the only member who expressed uneasiness—others may have felt it—as to the financial repercussions of the operation of this Bill. I am in full agreement with him that there is no use in closing our eyes to the fact that, if we are to make these social revolutions effective, we shall have to pay. Unless we are prepared to pay the money necessary to make this Bill effective, we are merely wasting our time in passing it. The question to which we have to address ourselves is:

Is the additional expenditure justifiable? I suppose that every Minister of State will claim that expenditure in relation to his particular Department is entirely justifiable and he will doubt whether expenditure in any other Department of State is equally justifiable. I, at any rate, have no doubt that expenditure on public health, expenditure in preserving the lives of our people, expenditure in building up a healthy race, expenditure, above all, in saving people from mental derangement is fully justifiable.

So far as I am concerned, I shall fight as hard as anybody could for the maximum expenditure to this end, because I believe that, in the long run, it will give a good return to the State. I need not develop that point further, save to say this, which is elementary: that if we can so organise our health services as to prevent disease, whether mental or physical, if we can raise a healthy people physically and mentally, the cost of maintenance of our health institutions must go down. We shall pay, and pay heavily, in the early stages. We shall pay until the fruits of such measures as this become available, but I think it is good business and sound economy to pay and I only hope that I shall be able to persuade the Minister for Finance to accept the same viewpoint. I cannot, of course, make any attempt to forecast the possible financial commitments in the case of this Bill. Those will depend, as Senators will appreciate, on factors that are inestimable. The cost of future treatment of our mental patients will, of course, be affected by the success of our efforts to prevent mental disease. If our preventive efforts bear full fruit, the cost of maintenance will begin to fall but, when we are carrying the two burdens at the same time, the cost will be heavy.

What is that service costing annually at present?

I could not say off-hand. Senator Douglas paid tribute to the civil servants and other persons who contributed to the construction of this immense measure. In the Dáil, I took the unusual course of paying tribute to the senior civil servants for their work and I am glad that Senator Johnston, who assisted on this Bill, and Senator Douglas presented me with the opportunity of speaking quite frankly to the House on that matter. I feel that it is due to the Civil Service, when it gives an exceptional service, that somebody ought to know about it. Not many people do know about it. I have heard, as Senators have heard, civil servants referred to as bureaucrats and referred to in very offensive terms. The fact is that civil servants—particularly, the senior ranks—by the sacrifices they make for the people and by the manner in which they labour for the people, are responsible for making democracy function effectively in a country such as this. It is they who are really responsible for making democracy effective. It is the merest truth to say that. I know it. I have worked hard on this Bill. That is as it should be. I am happier when working hard than I would otherwise be. Senator Baxter thinks that, since I commenced to work hard, it is easier to talk to me.

It is easier to talk to you, whatever has happened.

Those Senators who said that this Bill represented years of work told the simple truth. It does represent years of work. But bear in mind that it does not represent years of continuous work, because neither senior civil servants nor ministerial heads can devote themselves exclusively to a particular piece of legislation for long. They are drawn off by matters that seem to be more urgent. Similarly, I have been drawn off, from time to time, from this piece of legislation. The fact is that the greater portion of this work was done outside office hours. It is true to say—I can say it of my own knowledge—that the men who assisted me with this measure—and I have grown up with every line of it—have worked until 1 o'clock and 2 o'clock in the morning. That is a rare service. It was given by people who are sometimes referred to as bureaucrats and I am glad of this opportunity of paying that public tribute to them.

Senator O Buachalla raised a question which is scarcely appropriate to this Bill. It is a nice idea, which is worth examination, but I rather think that it is not feasible. Senator O Buachalla spoke of the possibility of grouping three or four dispensary districts and having, in this grouped district, one medical man who would specialise in mental disease, another in tuberculosis, another who would be a general practitioner, and a fourth who would specialise in some other branch of medical science.

The idea of having a more or less specialised service available to all the people within the small unit looks all right in theory, but I do not think it is feasible; that is, on a superficial examination of it because, of course, it was raised only this afternoon. Our services must be made easily available to the people. If we quadruple the size of our units and if we merge four dispensary districts in, say, rural parts—it might be possible in the cities—the particular problem would be maternity. You would want a man in charge of maternity work, but if he has four dispensary districts to cover, it might be a long time before you would reach him.

He might be at the farthest point of the district.

Yes, and you might be in the position of having to do without him until he got back, as perhaps the tuberculosis officer could not do the job. I offer that criticism of it, although it is an interesting idea. I think the corresponding services which Senator O Buachalla has in mind can be better got in another way. We will have to have a skeleton general service within easy reach of the people and also the specialised service that any type of patient may require. We very nearly have that at the present time. We are sometimes inclined to disparage the services we have, but there is no patient suffering from any physical or mental disease in this country, whether rich or poor, and particularly if poor, who cannot have the services of a specialist. That is the fact and we sometimes do not realise it.

The Senator continued to develop his point that dispensary medical officers should be specially trained in these mental diseases. The only thing I want to say is this, that there are two branches of medical practice in which I want to see the dispensary medical officer specially trained. One is maternity and the other child health. I do not mind telling the House at this stage that in the early future I have in mind insisting in these appointments on a more specialised or post-graduate knowledge of maternity and child health. I am planning on the thesis, and I think it is sound, that if we can build up a fairly complete service for children, if we can make the children healthy, if we can prevent the children from contracting serious disease, if we can get hold of disease in the incipient stages, and if we have a healthy child population, we are working towards a healthy adult population. It may take some time, but we are on a sound footing if we at least look after the children.

As to the actual trend of mental disease, everybody would be naturally interested to know whether we are going up or coming down. Fortunately, we are coming down. From 1922 to 1940 there was a steady upward trend from year to year.

In inmates?

Yes, persons received in institutions. From 1940 there has been a steady fall. The fall since 1940 amounts to 10 per cent, a tremendous fall. That, too, is encouraging, and in seeking an explanation of the brighter side of things, one must conclude that the improved housing conditions and generally the better conditions of the people must be contributory factors. Another contributing factor worthy of note, and perhaps more encouraging, is the more advanced treatment we are able to afford to these people now than in former years. It is bearing good fruit.

Has the Parliamentary Secretary any figures on the result of treatment up to 1945?

Only in the general decline of incidence and the number of patients detained in our institutions. There has been a 10 per cent. fall since 1940. Senator Kingsmill Moore raised the matter of the possible danger of the reception of persons whose minds are not disordered. Well, there will be always, in any human machine that can be devised, an element of danger. We cannot have perfection, but, at any rate, I think the scheme of admissions provided for in the Bill is calculated to get as near to perfection as any machinery we can devise.

Under the old system, as Senators have been told to-day, the patient was first detained by the Civic Guards, or in olden times, by the R.I.C. Two peace commissioners were secured, and the dispensary doctor was sent for to examine the patient. The dispensary doctor had either to discharge the patient, or commit him as a dangerous lunatic. It was a rather serious responsibility, because it might be more serious to discharge him, if he had any doubt, than to commit him, but, notwithstanding that, the number of committals of persons who should not have been committed was very small.

When you come to relate that machinery to the machinery proposed in the Bill I think you should feel very happy as to the almost certain result. In the first place, the dispensary doctor does not commit the patient at all, he examines the patient and he recommends that the patient be received in a mental institution. The patient is not committed. Before the patient is received in an institution the resident medical superintendent, who is expert in mental diseases, examines the patient and he decides whether, in his expert opinion, such a person should be detained; so that you have not only two doctors, but you have two doctors one of whom is a specialist, whose opinions are brought to bear on the case before the patient is admitted to the institution. There is the possibility of error even with that machinery, but I think that it is as near to perfection as we can possibly get.

When the Parliamentary Secretary uses the word "admitted" does he mean admission immediately, or is the examination held after 24 or 48 hours?

The resident medical superintendent must determine at first whether the patient is to be received. I think I appreciate what is passing in the Senator's mind. He is thinking of a period of observation to make it foolproof if possible. I found there were tremendous difficulties in detaining persons for observation purposes. I think we have to accept the position that, if the resident medical superintendent who is an expert has that element of doubt that he considers it safer to detain the patient, we must give him the right to detain him.

Bear in mind, under the new system, the vast bulk of patients will be received as temporary patients. They will be received for a period so that the whole setting will be different. They will not be looked upon as suffering from any permanent derangement of mind. They will be sent to the institution as people who have had, in the vast bulk of cases, what is merely a temporary upset due to some domestic or other cause. I do not think there is very much more to say. I have touched on most of the important points that have been raised.

Will the Parliamentary Secretary reply to the point I made about chaplains in the service of mental hospitals?

I will deal with it but not finally. As far as I recollect Senator James Johnston as distinct from Senator Séamus Johnston——

Joseph, Seosamh.

I am very serious about this matter.

Do not let him assume because I smile at the Senator that I am not serious. If I am wrong the Senator I am sure will correct me, but I understand his principal concern is that chaplains should now be pensionable officers.

That is one aspect of the matter, but I also referred to the training of future chaplains.

On the question of pensionability of chaplains, I rather think that we can scarcely agree to make all chaplains pensionable officers inasmuch as we have chaplains who have only nominal duties to discharge. How we can classify those who have more than nominal duties to discharge seems to constitute some difficulty. The question as to whether we can call upon the church or churches to give special training to their clergy seems to me to raise some rather delicate points.

Very delicate, but I am shocked to hear the Parliamentary Secretary refer to religious services as nominal duties.

It seems to me that we might very well be told by the ecclesiastical authorities that the particular training given to clergy was for a particular purpose, and that all of them are trained for a spiritual purpose, and that the particular training was a matter for the ecclesiastical authority. This is a new idea that has been raised for the first time, and my immediate reaction would be that it would be a matter for the Church authorities to determine what the training would be. The clergy of the Catholic Church—and I am sure of other Churches, but of the Catholic Church in particular—give up all worldly attachments in order to give that spiritual service to the people. I rather think they are fairly well equipped for their work without special instructions from us or special training. However, it is a new idea that may deserve further examination.

I am content if the Parliamentary Secretary will consider the matter.

I assure the Senator I will think of it, because the whole idea has been a kind of shock, and I am not likely to forget about it. Perhaps I would react somewhat differently to such a proposition, because of my background and one thing and another, to the way the Senator would. My philosophy does not appear to run quite parallel to the Senator's philosophy on this particular issue. Once again I want to thank Senators for their help, and I hope we will have as pleasant a time on the Committee Stage as on the Second Stage.

Will the Parliamentary Secretary say whether it is possible to make for better distribution of national health benefits?

What does the Senator mean by better distribution of national health benefits?

I explained it earlier. The benefits to which these unfortunate inmates are entitled are accumulated, and if there was no kind or generous person to get them little comforts with the benefits, they mount up to a considerable sum, and then some callous relative comes and takes all. Can we in this Bill make for better distribution of these benefits on behalf of the inmates?

I understood the Senator's point to refer rather to property or estate belonging to persons in the institutions than national health insurance benefits. That narrows it down to a rather small issue. I would say that so far as property of persons detained in these institutions is concerned, that would be outside the scope of the Bill, because it is a matter for the courts and would come within the jurisdiction of a court of justice. The other matter of national health insurance benefits I will look into. If it is a matter of administration it would be easy to deal with it, but I rather think it would involve amending the National Health Insurance Act. If it is a matter of administration we can deal with it outside this Bill.

It is purely a matter of administration. Will the Minister promise to look into the matter and satisfy himself concerning the amount due to these inmates that cannot be used on their behalf?

I will look after it.

There is a very considerable sum due in some cases.

I will certainly get after it, and if I get my hands on the money I will certainly be glad to have it.

Question put and agreed to.
Committee Stage fixed for Wednesday next, April 25th.