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.