I should like to say at the outset that it is not intended as a comprehensive amendment of the existing Mental Treatment Acts. Its main purposes are to improve procedures under the existing Acts and to make certain changes in the superannuation provisions applicable to mental hospital staff. As Senators will be aware, I have decided to set up a Commission of Inquiry into the whole subject of mental illness. There has been in the past decade or so, an enormous change in the approach to this condition and it is very desirable that, in the light of that change, there should be a full review of all aspects of our services for the mentally ill. The commission will undertake that task. While it is thus engaged it would be inappropriate, I think, that I should attempt to introduce new legislation to amend the existing code. Experience has shown, however, that as an interim measure, it is desirable to effect some machinery changes in the existing provisions and these are proposed in the Bill.
Unfortunately, the type of Bill before the House involves "legislation by reference". For the convenience of the members of the Oireachtas, I circulated a full explanatory memorandum with the Bill. I also decided that it would be desirable to publish a booklet setting out the procedure in relation to the reception and detention of patients and quoting the relevant statutory provisions as they will be amended if this Bill is enacted. A preliminary draft of that booklet has been made available to Senators. I trust that it will obviate much of the labour involved in linking the proposed provisions with the parent sections and that it will give a better picture of what the code will look like if the Bill is enacted. The booklet does not cover the provisions in relation to superannuation. These, however, are explained in the explanatory memorandum and I shall refer to them in some detail later. A few provisions of the Bill as introduced were amended in the Dáil. They were, however, largely of a drafting nature and have not altered the purport of the sections materially nor have they necessitated changes in the explanatory memorandum which was issued with the Bill.
In relation to patients, the principal change which the Bill will make is the extension to all medical practitioners of the power to make a recommendation, or to sign a certificate, in respect of the admission of a chargeable patient to hospital. A chargeable patient is, broadly, a patient in a local authority hospital who is in the lower or middle income group and is, therefore, eligible for hospital services free or at less than cost. Under the existing legislation, when a recommendation, or certificate, is required for such a person it can be provided only by the authorised medical officer, who is, normally, the district medical officer of the dispensary district where the patient resides. This restriction precludes a patient, or the person who may be obliged to act for him, from availing himself of the services of the family doctor, should the latter not be the local district medical officer. The majority of doctors including, indeed, psychiatric specialists, are thus debarred from providing their patients with the necessary certificate of recommendation. I am satisfied that this disability should be removed and that the power to make a recommendation, or sign a certificate for reception, in the case of a chargeable patient, should be extended to all medical practitioners, subject, however, to certain disqualifications—grounded mainly on relationship to, or financial interest in, a patient.
Section 3 of the proposed measure gives the Minister power to make Regulations authorising the making of payments to patients in respect of work done. At present there is no specific authority for the making of such payments although, in practice, payments are made in some hospitals. In general, I visualise the making of token payments only, Such payments will encourage patients and offer them an incentive to occupy themselves usefully and for their own good.
Section 9 is intended to operate in cases where it is believed that a person is of unsound mind and, that as a matter of urgency for the public safety or for the safety of the person himself, he should be placed under care and control. It puts beyond doubt the power of a member of the Garda Síochána to enter upon premises and to take such a person into custody and to bring him, if necessary, to a Garda Síochána station.
Sections 16 and 17 make it necessary that an application for the reception into a mental institution of a temporary patient, whether chargeable or private, shall be made only by a person who is at least 21 years of age. I think it will be generally agreed that nobody should be compulsorily detained in a mental institution otherwise than on the application of an adult person. In addition, Section 17 will provide that a Reception Order must be made only by a registered medical practitioner. This is designed to remove an anomaly in the existing Act, under which the Reception Order could, in the case of a private hospital, be made by a lay person.
Section 18 transfers from the Minister, to the chief medical officer of the institution concerned, the power to extend the period of detention of a temporary patient. A temporary patient is, broadly, a person who is mentally ill, but is believed to require for his recovery not more than six months' suitable treatment. Addicts who by reason of addiction to drugs or intoxicants would benefit by compulsory detention for a limited period also fall within the category of temporary patients. The initial period of detention for both types of case is six months. Under the 1945 Act, power is vested in the Minister for Health to grant extensions of this period up to a total of 18 months. In the case of an addict, though the period of detention can thus be extended to two years, it has been the practice not to grant extensions beyond a period of one year in the belief that if the patient's addiction is not successfully treated within 12 months, there is little use in continuing to detain him further. It is proposed, under subsection (1) (a) (i) of Section 18, to establish this practice by statute. In the case, however, of persons other than addicts, extensions up to 18 months may be granted as heretofore.
In relation to the change to be made under Section 18, it will be appreciated that in deciding whether or not to grant an extension of the period of detention of a mental patient, the person who happens, for the time being, to be Minister has to rely on his professional advisers. In view of the number of extensions involved—nearly 3,000 per year at present—they in turn have to rely, to a very large extent, on the recommendation of the chief medical officer of the mental institution concerned. They will seldom know the patient. Even in the exceptional case where they may remember having seen the patient, it will usually have been once or twice only and for short periods. The Minister's professional advisers are very rarely, therefore, in a position, from their own knowledge of the patient, to decide whether he should or should not be detained and, in practice the word of the chief medical officer of the institution has to be accepted.
It is at least doubtful if this procedure provides a real safeguard. I believe, indeed, that the procedure proposed under the relevant section will constitute a more effective protection for the patient. Under it the patient and the person who applied for the original reception order must be advised that they can send to the Inspector of Mental Hospitals an objection to the proposed extension. On receipt of any such objection, the Inspector of Mental Hospitals will be obliged to require the medical officer of the institution to submit a full report on the patient. On consideration of this report, the Inspector is then obliged to take such steps as he considers necessary to ascertain whether or not the detention of the patient should be continued. In this connection I may say that in Sections 239 and 240 of the Principal Act, that is, the Act of 1945, there is provision that if the Inspector has any doubt regarding the propriety of detaining a patient he is bound to report to the Minister and the Minister has power to require him to visit the patient and to make a report on his condition. Having considered the report, the Minister, if he thinks fit, may then order the discharge of the patient involved.
I gave serious thought to the question of whether it would be desirable to impose a duty on the Inspector to visit every patient in respect of whom or from whom an objection is received. I decided this would not be desirable or practicable. It is common practice for the Inspector to see patients who feel they are being illegally detained or who feel that they have a grievance of any kind; and it might happen that an objection would be received from or in respect of a patient whom the Inspector had seen only a week or two previously and of whose condition he was fully informed. In some instances too, it is very clear from the correspondence received from patients that, mentally, they are far from well. In the light of these considerations, it would be a waste of public money to impose a duty on the Inspector to visit a patient about the propriety of whose detention he had no doubt whatsoever. I should also point out that paragraph (b) of Section 33 imposes a duty on the Inspector, on the occasion of his statutory visits to mental institutions, to pay particular attention to the condition of those patients in them whose periods of detention have been extended since his previous visit.
Sections 197 to 202 and subsection (4) of Section 208 of the 1945 Act provide for the submission to the Minister of a mass of documents. Under these sections, notices of all receptions, departures, escapes, removals and deaths have to be submitted to the Minister. Copies of the reception documents and, in addition, in the case of temporary patients and persons of unsound mind a report on the condition of the patient 21 days after his reception, have also to be submitted. In all, these provisions result in the submission to my Department of something like 38,000 documents per year. The requirement is one that has obtained in this country since the middle of the last century.
When these documents reach my Department, they are examined to ensure that the facts recorded on the forms create a prima facie justification for the acts to which the forms relate; but since it is not possible to have the patients to whom they relate examined individually by my professional advisers, this routine scrutiny of documents cannot ensure that the statements made on the forms are accurate, or that any diagnosis made is correct. As a safeguard to the patient, the value of the whole procedure is, in my opinion, so limited as to be negligible, and I am satisfied that its continuation is not warranted, since it imposes an enormous amount of paper work on the Inspector of Mental Hospitals and his staff. I may say that a similar conclusion was reached by an expert committee of the World Health Organisation and by the recent British Royal Commission on the Law Relating to Mental Illness and Mental Deficiency.
I would ask the House when considering the wisdom of making the change which I propose to remember the many truer safeguards there are in the Mental Treatment Acts. The chief of these are:—
(1) The right which every patient has to have a letter forwarded, unopened, to any of the following: The Minister, the President of the High Court, the Registrar of Wards of Court, the Mental Hospital Authority and the Inspector of Mental Hospitals. In Section 36 of the Bill, the Oireachtas is being asked to add to these the Visiting Committee of a district mental hospital. Arising out of any such letter, the Minister may arrange for the examination of a patient by the Inspector of Mental Hospitals and for his discharge where justified; while similarly the President of the High Court may require the Inspector to visit and examine any patient detained and report to him.
(2) The fact that any person may apply to the Minister for an order for examination, by two medical practitioners, of a detained person and that the Minister must consider their report and may, if he thinks fit, direct the discharge of the patient.
(3) The fact that the law specifically requires that a patient who has recovered must be discharged.
(4) The penalties which are imposed by the Act for detention otherwise than in accordance with the provisions of the Act.
(5) The provision that the Inspector of Mental Hospitals must visit all mental institutions and that where the propriety of detention is doubtful, or where he is requested to do so by the patient himself, or by any other person, he has a duty to give special attention to the state of mind of any patient detained.
(6) That any relative or friend may apply for the discharge of a patient and that, should the application be rejected by the medical officer of the institution concerned on the certified ground that the patient is unfit for discharge, an appeal lies to the Minister.
(7) That every mental hospital authority must appoint a visiting committee, whose duties include a requirement to hear the complaints of any patient, and, if requested to do so, to see him in private.
I think the House will agree that in transferring from the Minister to the appropriate chief medical officers the power to extend the period of detention of a private patient, I am not in any way increasing the risk that any such patient will be improperly detained.
Lest there should be any misunderstanding, I should like to repeat what I told the House last week—that the decision to recommend to the legislature the change proposed in Section 18 was taken before, and is unrelated to, the events which necessitated the introduction and the passage into law of the recent Bill to regularise the situation in regard to the detention of certain patients.
Sections 19 and 20 obviate the necessity for a medical recommendation for the admission to a mental institution of a voluntary patient who is over the age of 16 years. I consider that if a person who has passed this age-limit is prepared to enter a mental hospital voluntarily he should not be unduly discouraged by formal procedures and that accordingly the existing requirement that a medical recommendation must be produced may be dispensed with.
Section 22 and Sections 26-30 transfer to the Medical Superintendent of a district mental hospital the functions hitherto vested in the Manager in relation to the release of a patient on trial, to the giving of notices of recovery and to the discharge of patients. I think it will be agreed that the Medical Superintendent should be in a better position than the Manager to exercise these functions. He knows the patients and by virtue of the appointment which he holds he must be presumed at least to be competent to decide whether it is appropriate that the particular patient concerned should be allowed out on trial or discharged. A similar change is proposed in relation to the release on trial of patients in private mental hospitals and homes. At present this function is vested in the Inspector of Mental Hospitals, and the Inspector will seldom from his own knowledge be in a position to say whether a patient should or should not be released on trial and it is therefore proposed to transfer the function to the person in charge. It is also proposed that in a private institution where the person in charge may happen not to be a registered medical practitioner notice of recovery must be given by a duly qualified person.
The present arrangements for preventive and after-care services for patients are regarded as inadequate. Section 31 of the Bill proposes to give a mental hospital authority a specific power, subject to the sanction of the Minister, to provide these effectively.
Apart from those I have mentioned the provisions in the Bill which relate to patients are mainly of a consequential technical or administrative nature and I do not think any major principle is involved in any of them.
I shall now deal with the provisions relating to superannuation. The main purpose of these is to bring mental hospital staff within the general scope of the Local Government (Superannuation) Act, 1956, and as a consequence to transfer from the Minister for Health to the Minister for Local Government functions in relation to the superannuation of such staff.
The Mental Treatment Act, 1945 and the Asylum Officers Superannuation Act, 1909 govern the superannuation of all mental hospital staffs and functions under these Acts are exercised by the Minister for Health. Apart however, from staff employed by harbour authorities all other local authority staffs are subject to the Local Government (Superannuation) Acts— in particular the Local Government (Superannuation) Act, 1956. The Minister for Local Government is the appropriate Minister for the purposes of these Acts. Apart from mental hospital staff, all other local staff, as I have said, engaged on health duties come within the scope of the Local Government (Superannuation) Acts.
Now that the Health Authorities Act, 1960, is in operation I think it is desirable to end the present anomalous position under which two separate superannuation codes are being applied to the two different groups of officers and servants engaged on the health services The Bill accordingly proposes that mental hospital staff shall be brought within the general framework of the code relating to local authorities generally, with the Minister for Local Government as the appropriate Minister.
The principal superannuation provisions are contained in subsections 1, 2 and 5 of Section 41 and the First Schedule. Subsection 1 of Section 41 provides for the application of the 1956 Act to mental hospital staffs subject to the amendments specified in the First Schedule. In effect, subsection 3 of Section 41 makes the Minister for Local Government the appropriate Minister in respect of the superannuation of mental hospital staff—with the exception of one small feature to which I shall refer later. Subsection 5 of Section 41 continues for existing permanent staff the provisions of Sections 77 and 78 of the Mental Treatment Act, 1945. These sections permit of the grant of a superannuation award to the widow and/or orphan of a person dying in the service from any physical or mental illness contracted while in the service. Under the Local Government code such awards can be made only if death results from injury sustained in the course of duty. The rights which existing officers and servants enjoy under the 1945 Act are thus being preserved. Officers and servants—and there are still some in the service—who are still governed by the 1909 Act opted out of the 1945 Act and accordingly have not the right to these special provisions. However, paragraphs 6 (5) (e) and 11 (5) (e) of the First Schedule to the Bill afford them a second opportunity of acquiring these rights.
Apart from making the necessary technical amendments to permit of the application of the Local Government code to existing and future mental hospital staff, the First Schedule makes special provision in regard to superannuation for those who have the care or charge of patients in the normal course of their duties. It applies to them the same provisions as already apply to fire brigade officers and servants. In effect this continues the existing arrangement under which in the calculation of superannuation each year of service in excess of 20 counts as two years, and retirement is possible at the age of 55 instead of at the age of 60.
At present mental hospital staffs pay a superannuation contribution of 3% while other local authority staffs first appointed on or after the 1st April, 1948 pay a contribution of 5% in the case of officers and 4?% in the case of servants. The First Schedule contains provision that any existing permanent officer or servant in the mental hospital service will not be required to pay a higher contribution than 3% during such time as he continues to be employed in the local authority service.
In general, it may be taken that the new superannuation provisions will be more advantageous than those operating at present for existing permanent staff. In case, however, there may be some particular circumstances which would make the existing provisions more attractive in an individual case, the option is given to every existing permanent officer and servant of accepting the new provisions or of staying under the provisions which at present apply to him.
It may help if I set out the main gains and losses in the new provisions. The main gains may be summarised as follows:—
1. Allowances and lump sums will be calculated normally on the basis of remuneration at the date of retirement, and not as at present on the basis of average remuneration over a period of three years.
2. If an officer or servant sustains an injury in the course of duty, and he dies within seven years as a direct result of the injury, a gratuity or allowance may be paid to widow or widower as the case may be, to a dependent father or mother and to or in respect of dependent children. Under the Mental Treatment Code the position is broadly that not only must death occur in service but gratuities or allowances are paid only to widows and children, and not to widowers or to dependent parents.
3. A short service gratuity will be payable after one year of service. A minimum qualifying period of ten years is necessary under the 1909 Act and of five years under the 1945 Act.
4. An allowance and lump sum will be payable on reaching an age limit after ten years of service. The qualifying period under the Mental Treatment Code is 20 years.
5. In the case of officers, added years for superannuation purposes may be granted in accordance with the provisions of Section 13 of the Local Government (Superannuation) Act, 1956. The chief advantages of these provisions are that years may be added in respect of professional qualifications, in respect of temporary service immediately preceding permanent service, and in cases where the officer retires due to an age limit imposed after his appointment.
6. Superannuation benefits will be payable to servants who are not continuously employed but who work more than 200 days in a year.
The losses are two in number and will apply only to future entrants—(1) future entrants will have to pay the normal Local Government Superannuation contribution, which is 5 per cent. in the case of officers and 4? per cent. in the case of servants. The present contribution for all mental hospital staff is three per cent. (2) Future entrants will be eligible for allowances for widows and orphans only if death is due to injury sustained in the course of duty, and not as at present in respect of death in service whether it is due to injury or not.
Future servants will be superannuated on the basis of 60ths with no lump sum as against the present 80ths plus a lump sum. I have not listed this as a gain or a loss as it could be either depending on the circumstances of the individual concerned. The remaining superannuation provisions are of limited application.
Section 40 covers the position of a person who was a civil servant, who became a mental hospital officer and later became a civil servant for a second time. The Section is designed to remove a doubt as to whether his first period of service in the Civil Service can now be reckoned for superannuation purposes. Section 41 (2) is a technical amendment covering the reduction of an allowance in the case of a person who is reappointed to the public service. Section 41 (4) deals with the keeping of a Register of persons who have the care or charge of patients in the normal course of their duties. This is the one superannuation aspect in respect of which the Minister for Health remains the appropriate Minister. Officers or servants who devote the whole of their time to the care or charge of patients are automatically entitled to be entered in the Register. In the case of officers or servants who devote only a part of their time to the care or charge of patients they may automatically be entered if they fulfil certain conditions which will be laid down in Regulations to be made by the Minister. Persons who are not entered in the Register in either of these ways and who think they should be so entered may appeal to the Minister. Any person whose name is removed from the Register and who feels it should not be so removed can also appeal to the Minister.
Section 41 (6) is of limited application. It provides that where before the passing of the Act a person who had to retire owing to an age limit which was not in operation at the time of his appointment and who did not obtain full pension may have years added for the purposes of calculating the amount of the allowance and lump sum granted to him. There was provision for a similar addition in the case of the 1909 Act and there is a similar provision in the 1956 Act.
Arising out of the new proposals for superannuation it is my intention in due course to prepare a detailed memorandum for the information of all existing officers and servants who are affected by them. This should enable those concerned to decide whether to accept the new provisions or to remain subject to the provisions which at present apply to them.
It will be noted from Section 43 that the provisions in regard to superannuation shall come into operation on a 1st day of April. This is necessary to keep these provisions in line with those in the Local Government (Superannuation) Act, 1956. I trust that the Seanad will see its way to permit the Bill to be enacted in time to make the coming 1st April the operative date.
