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Mental Treatment Billlords

Volume 237: debated on Friday 11 April 1930

The text on this page has been created from Hansard archive content, it may contain typographical errors.

As amended (in the Standing Committee) considered.

CLAUSE 1.— (Power to receive Voluntary Patients.)

I beg to move, in page 1, line 8, to leave out the words "for mental illness".

On a point of Order. Is it not in order to move my Amendment to leave out the Clause?

May I ask you, Sir, to note the reason for moving it. This is the only opportunity we shall have of raising the question whether this treatment of voluntary boarders is the appropriate treatment for their cases. I desire to raise the main issue whether we ought to send to these institutions, which do not a present exist, people who are only nominally voluntary patients.

Shall we have an opportunity on further Amendments of debating the matter whether they are really voluntary boarders or whether they are boarders who are compelled by the fear of being certified to apply for voluntary treatment?

The right hon. and gallant Gentleman will have plenty of opportunity of debating all the points that he wants to raise.

In that case. will it not be possible to intimate to us what Amendments will be taken, instead of leaving us in the absolutely indefensible position of not knowing whether we shall be able to use these arguments at all on the Report stage?

It would be quite impossible for me to do that at this stage. I cannot foresee what course the House will take.

May I point out that this is the first occasion on which an Amendment to leave out the first Clause of a Bill has been kangarooed. There has been no evidence that there will be any undue debate on the Bill. To cut out any debate on the first Clause is certainly taking a very serious step.

If the Amendment in my name, the fourth on the Paper, is passed over there will be no opportunity given to discuss what, in my opinion, is one of the most vital principles contained in the Bill, and it will be no longer possible for the House to decide whether voluntary patients shall be under the control of the Ministry of Health or under other control.

Would it not really be in the interests of debate if we could discuss the Clause? That might save trouble on the Amendments that come lower down. One debate on the general principle of the Cause might serve the purpose of the House far better than repeated debates on Amendments to the Clause, which will naturally be very circumscribed in area.

May I ask your guidance, Sir? This Clause creates an entirely new category of persons. Would it not be for the general convenience of debate that the issue whether or not that category should be created, which is raised in the first Amendment, might be raise by means of a general discussion? The other Amendments are consequential upon the creation of the category.

Is it not a fact that the question of principle, one of the most important principles in the Bill, was, in fact, decided on the Second Reading?

I have always found it best, in selecting Amendments, to carry out the powers given me under the Standing Orders without giving reasons for not selecting Amendments. It only leads to endless argument, which is quite unnecessary. We must always consider that the House has decided something on the Second Reading.

I raised on the Second Reading the question whether it would be possible or not to deal with the whole question of the powers of the Board of Control here. I was assured that that would be a matter. for Committee or Report, and that we should certainly have an opportunity of dealing with it.

The hon. Member is assuming that I am shutting out all the Amendments. There are plenty of Amendments or, which this question will be raised, notably on the one I am now selecting and on the fourth on the Paper.

The point at issue in this Amendment may at first sight appear to be a small one, but it is very important. This is not a lunacy Bill. The idea of the Measure is to get patients in the very earliest stage of mental illness to submit themselves for treatment. There is in the mind of the general public a very great horror and shame about the name lunacy which is not confined to those who may be afflicted, but applies even more to the relatives, the wife or the husband, and particularly to the children. We have this shame and horror of any relationship in any shape or form to the person who may be mentally afflicted. The whole object of the Bill is so to get the co-operation, the approval and the goodwill of the people of the country that they will recognise that we are, for the first time, attempting to deal with mental illness in the same way that we deal with physical illness. In the same way as we deal with diseases of the heart, the lungs or some other part of the body, we now propose to deal with any trouble in the brain. We say that, the further we can keep away from any contact or association with lunacy, the more successful the Bill is going to be. In Committee, the Minister objected to the Amendment. He said:

"As I have said, we must have some name by which we can describe it; we cannot go on regarding it as an unnamed disease throughout the Bill, which is specifically designed to deal with mental disorders."—[OFFICIAL REPORT (Standing Committee A), 25th February, 1930, Col. 7.]
The Bill does not give a name to the disease at all. Mental disorder, or mental illness, may consist of an infinite variety of different diseases, and so it is quite unnecessary to say he must have a name for it. A stronger argument still is that the Lunacy Act, which deals with patients who are certified, never mentions the words mental illness or lunacy. On an application for admission, the doctor, first of all, gives a provisional diagnosis and says: "On such and such a day, I examined so and so, and came to the conclusion that he is a lunatic, or idiot, or person of unsound mind, or a proper person to be taken charge of and detained under care and treatment." The House will notice that he does not say "detained and put under care and treated for lunacy." The doctor, first of all, gives the diagnosis that the patient is a person of unsound mind. Under this Clause, any person who is desirous of voluntarily submitting himself to treatment has to make written application to that effect. Nowhere, as far as I am aware, is there any form laid down as to how that application is to be worded, and a patient, submitting himself or herself voluntarily for treatment, might say "I, A or B, feeling that I am worried or nervous or anxious and cannot sleep, wish to apply for treatment." That covers the whole ground sufficiently and takes away from the patient the idea of mental trouble.

What is going to happen? These persons who are anxious for treatment are always nervous that they may become insane. That is the fear at the back of their minds. They say: "Now, I wonder this trouble or anxiety is going to worry me so much that I am going to become mad and have to go to the asylum." That is the constant horror at the back of their minds, often preventing them from applying for treatment until, unfortunately, it is too late. The result is, that we get these cases going on without treatment, and we get our suicides. The rate of suicides has been going up for many years. Last year there were over 5,000 suicides, 14 suicides every day of the year. This Bill, if properly administered, is probably going to prevent a great many suicides in future. If a man, in signing an application form, has to say "I desire to submit myself to voluntary treatment for mental illness," he may think, "Well, I will not run the risk," and his family may try and prevent him, and say, "Do not go there; they will say you are mentally ill, and that will be a reflection on the family." I suggest that the elimination of the words "for mental illness" will not have a detrimental effect on the Bill, and will simply bring it into line with the Lunacy Act. I think it will have a very material effect in encouraging these people to come at the earliest possible moment, and submit themselves to treatment.

I beg to second the Amendment.

We had, during the Committee stage of the Bill, a very interesting discussion on this subject, and it is only right that the House should be reminded that on that occasion the word "disorder" was originally in the Bill and the word "treatment" was substituted for it. am not sure whether I am not personally responsible to some extent for the change. I objected to the word "disorder" partly for reasons already advanced, but also for reasons which go a good deal further and with which there was a good deal of sympathy in all parts of the Committee at the time. It was thought that the word "disorder" cast a definite slur on the individuals who might come within the provisions of this Clause of the Bill, and it was also thought that it might have a tendency to obstruct the main object of the Bill, which is to endeavour, as far as possible, to get these people to come for treatment early so that they may be treated and cured before they really become very bad. It is a little difficult for me, not having the medical knowledge of some hon. Members of this House, to explain fully the position. I am assured that there is an important point in the history of these diseases when you can do a very great deal. When the word "illness" was substituted for the word "disorder" the Minister did something to make this a better Bill. I hope that he will not think that because I second this Amendment I am not grateful for the step which he took on that occasion. I am grateful for what he did then, and I realise that he was acting in keeping with the general feeling of the community on this subject, and was breaking away a little from the cast-iron instructions of his Departments.

It appears to be quite easy now to take out these three words altogether. It is recognised that the whole principle of the Bill applies to a particular type of patient, and I do not think that it is really necessary to retain these words. They give a harsh appearance to the Bill and they are unnecessary from the point of view of explaining what is meant in the Clause. If any of the Law Officers were here and assured us that it would not be possible to administer the Bill without these words, it would make some difference to our attitude in the matter. We have had little legal advice so far, and as far as I understand the position the words do not appear to be absolutely necessary to the Bill, and they create a position which the Minister doss not wish to be created.

There still appears to be misunderstanding about Clause 1. with regard to this particular point. The Clause does not invent a new category of patients; it does not do anything of the kind. Voluntary patients have been known to the Lunacy Acts for half-a century. Under the Act of 1890 they are received into private institutions. The only object of the Clause to enable them to be treated in public mental hospitals and other approved places instead of being confined, as they are at present. It is clearly necessary to define what kind of treatment is contemplated.

"Any person who is desirons of voluntarily submitting himself to treatment and who makes a written application for the purpose"
and so on—that is a perfectly general statement. It is treatment in respect of what we now call "mental illness." There is nothing derogatory in describing in a Bill the plain fact about a person's disease. You must define diseases, as I explained in Committee. You cannot have numerous diseases without names, and clearly there cannot be Anything which is less objectionable and more neutral than the term "mental illness." As a matter of fact, there is a difference of medical opinion on this matter, because one hon. Member who is a member of the medical profession, supported the inclusion of these words in Committee, and another hon. Member who is a member of the medical profession wanted them to be left out. In cir- cumstances of that kind, I think they are best left in. I see no reason why there should be any doubt in people's minds as to the effect that they are likely to have upon voluntary patients. Already they go in considerable numbers to these institutions. There is no form prescribed in the case of voluntary patients as is prescribed for other categories of mental patients; therefore the words "mental illness" need not appear on any document which is necessary before a person enters some institution for treatment. I cannot see any point in taking out these words. We ought to define what kind of treatment people are to receive, and unless we keep in the words "for mental illness," the treatment is of a general character and the Clause would not convey what is its object, namely, to deal with people who are suffering from mental illness.

I do not think that this Amendment makes much difference to the Bill, but I do think that the Minister of Health is wrong in saying that there is not a new category created in this Bill.

Perhaps in that case the right hon. Gentleman will be able to explain the Bill to my inferior intelligence and to the House. There are people who are defective and insane and under the lunacy laws. People who come under this Bill come under the lunacy laws, and therefore are to be classed as lunatics.

indicated dissent.

Then are we to understand that people who voluntarily apply for treatment in these hospitals are not in the same category as lunatics. Perhaps it would be worth while explaining to the House that these people are the same as lunatics who come under the Lunacy Laws, and at the same time are in a different category, and are intended to be in a different category. The argument for this Amendment is that if the words "for mental illness" are left out of the Clause, there will then be nothing in the Clause which would connect these voluntary patients with lunatics in any way.

The hon. Member for Royton (Dr. Davies) is right in arguing that these words should be deleted. Nothing that the Minister of Health has said has shaken me in my support of that view. There seems to be no technical definition of the words "mental illness," and it is not right for this House to insert words, if there is no technical definition of them in the Bill. It is dealing with an entirely new category of persons so far as the law is concerned.

I am sorry to have excited the hon. Lady at so early a stage of our proceedings. It seems to me that these words are redundant. If we leave them out, anyone who desires voluntarily to submit themselves to treatment, and makes application, may be received as a voluntary patient in an institution within the meaning of the Act. If their disease is not mental illness they will not be likely to go to such an institution if, for instance, they had a pain in the foot they would not go to a mental institution. There is a definition of the kind of institution further on in the Clause. Having read the Debates which took place in the Committee, it seems to me that there is a considerable volume of expert opinion against these words being put into the Bill. In column 8 of the OFFICIAL REPORT of the Committee, the hon. and gallant Member for St. Albans (Lieut-Col. Fremantle) pointed out that the Royal Medical Psychological Association considered that these words were a definite limitation of treatment for mental disorder, and that if they were inserted in the Bill they would keep out certain patients who otherwise might receive treatment which it was desirable to give to them. He quoted the following words from the report of that Association:

"The presence of these words may give rise to difficulties in admitting cases showing only the early neurological and other physical signs of mental disorders, and may operate against fruitful measures of prophylaxsis best carried out in mental institutions. Furthermore, it is recognised that some physical conditions yield to mental treatment when physical treatment alone fails, especially functional nervous disorders."—[OFFICIAL, REPORT (Standing Committee A), 25th February, 1930, Cols. 8 and 9.]
I am not an expert, and I am trying to take a common-sense view os a Member of this House. Medical men may argue one way or another and experts on lunacy may argue one way or another, but, for what it is worth, there is something in bringing to the notice of the House the opinion expressed by people who definitely are experts in this particular field of knowledge. That being so, we are entitled to a little further explanation from the Government. It is obvious that you cannot set up a list of anonymous diseases, or call them by letters or figures. It is well that we should know what the diseases are. I object to the words "for mental illness" because there is no definition of them. If they were defined in the Bill, it would be another matter. This Sub-section is purely a question of grammatical English, and the words seem to be entirely redundant.

I hope that we shall not waste much time in discussing this Amendment. It is obvious that those who take exception to the phrase "for mental illness" ought to take exception to the remainder of the Clause. If it is implicit in all that follows, I do not see why any exception should be taken to these words. It is a relatively unimportant matter.

It is a very old established rule in Parliamentary drafting that you never put in words if they are unnecessary. If the hon. Member admits that these words are implicit in the rest of the Clause, we are acting according to precedent in leaving them out.

I have often listened to the hon. and gallant Member with considerable delight, and I know that he has often said that Acts of Parliament ought to be more explicit. Therefore, one cannot blame the Minister of Health if he is trying to meet the hon. and gallant Member's wishes in that respect. There are a number of places in which we can strengthen this Bill, but the point that has been raised in connection with this Clause is relatively unimportant.

I think the word "illness" is an improvement on the word "disorder" in the original Bill. We have had reference; to the Royal Medical Psychological Association. That rather turns my mind in favour of the Bill as it stands than the Amendment, because if we are going to be judged merely on psychological grounds, we shall all be in danger. I hope, with all kindness, that the psychological state of the Minister will improve as we proceed with this Bill and that he will be more equable than he has been at the beginning of our proceedings.

Amendment negatived.

I beg to move, in page 1, in line 14, to leave out the words "Board of Control" and to insert instead thereof the words "Minister of Health."

This Amendment is of fundamental importance and upon the decision will depend whether the Bill will or will not be of real value to the public. This is an attempt to bring into existence what has been described as an entirely new public health service, designed for the purpose of the prevention of lunacy. It is suggested that a large percentage of those who are received into lunatic asylums could be prevented from entering if there was in existence some form of treatment of which they could avail themselves. This Bill has, as one of its objects, the making of such provision. Let us examine the problem as it now stands. The number of people who are admitted into our asylums at the present time is on an average 22,000 a year, that is over the last ten years, and each and every one of them will be certified. It is now suggested that if. additional provisions were made prior to the stage of certification that a large proportion of these people might be saved the stigma of certification, to the general advantage; and I agree.

Let me say at the commencement that so far as it is suggested that this new public health service should be established for the prevention of lunacy I am wholeheartedly in agreement with it, and I should like to see such a service established at the earliest possible moment. That is the reason why I propose this Amendment; and I hope the House will support us in seeing that the Board of Control have nothing whatever to do with this new service from beginning to end. As this is the first mention of the Board of Control in the Bill I hope we may have a fairly full discussion and decide once and for all whether the new service is to be successful or not, because I contend that directly the Board of Control is allowed to come into contact with the new service from that moment it will be doomed to failure. Whoever drafted this Bill is entirely ignorant of the attitude of mind of the ordinary general public towards institutions as they at present exist and those who control them. If we are voicing a strong objection to the Board of Control it is because for a long long time, in common with those amongst whom we live and move, we have learned from experience to dread the very name of the asylum and all those connected with it. This experience over a long period of years has driven us to the conclusion that in the public interest the Board of Control should not be allowed to interfere in this new service. The Board of Control has only itself to blame for this attitude on the part of the general public.

There are a number of things that must be discussed in connection with this matter. One of the first problems to be considered is the question whether there is any possibility of success in appealing to an individual, who believes that a certain form of treatment will be to his advantage and may prevent his becoming insane, right at the very commencement or in the early stages of his trouble and say to him "your place is in the asylum." All those who have moved amongst the ordinary people of this country will know at once that one has only to make such a statement to any such individual to be met with a point-blank refusal; and quite a justifiable refusal. They have learned to hate the very name of the asylum; and it is to these individuals that we are now making our appeal in this Bill. We are not proposing to make any provision for people who are wealthy and who find at any period of existence that they are in need of special treatment because of any mental trouble or disorder. They are provided for already. The only people we are seeking to provide for are those who are not able, owing to their economic circumstances, to make the same provision for themselves as is provided for those who are better off. It, is to those people that we must direct our attention, and we must meet their objections as far as possible if the new service is to be developed successfully.

While 22,000 persons on the average each year have been admitted to our asylums during the past ten years, we must bear in mind that this does not represent the sum total. The hon. Member for Royton (Dr. V. Davies) has pointed out that several thousands of persons commit suicide every year, and almost invariably coroners' juries return a verdict of suicide whilst of unsound mind. These should be added to the number and would bring it somewhere in the neighbourhood of 30,000 a year. We are to imagine a constant stream of individuals gradually developing day by day from the normal to that point at which they can be certified, and it is suggested that if the new service can be established these individuals, at some point or other of that progress, may receive treatment which will prevent them ever reaching the stage at which certification may take place. That is the good thing in the Bill. It is that which one hopes to save and to make effective by cutting out from the Bill anything which would make such a development impossible.

Perhaps we may be permitted to stray a little from the Clause in order to make passing reference to certain other provisions in the Bill, for the purpose of explaining fully why it is so important that the Board of Control should be left out and the Ministry of Health inserted. The proposed new service involves one of two things—either the new patients are to be treated in existing institutions or they are to be treated in entirely new institutions which will have to be provided by the local authorities. If the patients are to be treated in existing institutions the net change arising from the passage of this Bill is nil; you will have the same number of people going into the same institutions to be treated by the same staffs in the same buildings and under the same conditions. From that point of view I suggest that unless this change can be made the Bill will not be worth the paper on which it is printed. If we hope to achieve anything at all we must bring into existence some new service which will prevent as many as possible of these people from getting within the reach of the lunatic asylum or anything connected with it.

It is all very well to say that these places are no longer to be called lunatic asylums, that they are to be called mental hospitals. While that may be of some significance to some hon. Members who may go amongst people outside and suggest to them that a certain institution within their reach is to have its name changed from "asylum" to "hospital," the people would reply, quite rightly, "It is Bedlam just the same." A change of the name will nowhere have the result of persuading people that the character of the institution or the patients or the control has been changed. We should agree that the new service is required, that it could render valuable aid to the people, that there is a crying need for an expansion of the public health service on these lines, and that in order that it may be successful we should decide that the new service shall be a public health service under the public health authorities in the localities, controlled by the Minister of Health at headquarters.

I suggest that the Board of Control has been condemned in the public mind for very many years, and that that condemnation has latterly been justified because it has been decided by a Royal Commission that the Board as previously constituted was not worthy of continued existence and that it should be fundamentally altered. Fundamental alterations are proposed in the Bill. I am not going to say that the individuals who comprise the Board of Control have been responsible for the failure, but I do suggest that the record of their works, so far as we can ascertain it from statistics, proves that if there is one thing that is important in our public health service to-day it is that the Board should not be permitted to enlarge its scope until it can first of all prove to the nation by results that the power which has been vested in it has been well vested. From all that I have been able to discover there is no justification for any statement that the Board has been successful.

I am amazed to find that longbefore now there has not been a minute and severe investigation into the whole of the operations of the Board. In answer to questions addressed to the Minister of Health during the last few weeks, I have ascertained that on the average 22,000 people are admitted to asylums every year, and that over 30 per cent. of these are recorded as deaths inside 12 months. I want to know why it is that in these institutions over the last ten years there have been 30 per cent. of deaths, and why it is that no minute investigation has been made into the operations of these places. It is true that approximately one-half of the admissions are discharged each year. Just imagine! You get an average over ten years of 22,000 admitted, 10,000 discharged and 8,000 to 9,000 who die. Over the same period the number of suicides has increased from 47 in the first of the ten years to 61 in the last year. Why is there that increasing number of suicides without any severe investigation taking place to ascertain why Such things are possible? I hope that we are not going to take it as a normal thing for a lunatic to commit suicide. If it were a normal thing one would want to know why the 22,000 did not commit suicide.

Another reason suffices to condemn the Board of Control. According to a reply given to me only a week ago by the Minister of Health, in the publicly-owned institutions the patient has the advantage of the service of a resident medical officer to the extent of one doctor for 280 patients. Under no circumstances can that arrangement ever give the results that we are entitled to demand. If after such a period of service the Board of Control have presented us finally with this state of affairs, I suggest that the Board should under no circumstances be permitted to have the slightest direct or indirect contact with the new service that we are now hoping to establish.

I beg to second the Amendment.

I wish to deal briefly with an entirely different aspect of this question from that which has been referred to by the Mover. The Board of Control has out-lived its usefulness. at least in the eyes of the public authorities who have been appointed under the Ministry of Health to discharge the functions necessary in dealing with mental cases. It is obvious that the Board was necessary in the days when private institutions were the only institutions dealing with eases of this kind and when it was necessary, in the public interest, that there should be close examination of all complaints concerning those places. But as time has gone on, county councils have found the Board of Control to be not a help but rather a hindrance. I can cite cases where purely technical matters of an architectural character, such as the size of a balcony, have caused lengthy correspondence and much delay. The Middlesex County Council has repeatedly found, when there are reports that the accommodation for mental cases in Middlesex is inadequate, that at almost every step the Board of Control has some criticism to make which does not affect the professional treatment of the cases.

In the opinion of many mental hospital committees their functions would be assisted if the work could be done in the same way as the work of other health services, directly under the Ministry of Health. In the second schedule we find that two neighbouring county councils, such as those of Middlesex and London, representing a very large population, must before they can combine have the consent of the Board of Control. Quite apart from the question of the psychological effect involved in the retention of the name "Board of Control" many of those who have been engaged in work of this kind for years, believe that it would be just as efficiently carried on without the Board of Control.

I am sure that everyone has full sympathy with what I understand to be the object of the Mover and Seconder of this Amendment, namely, to restore to health as speedily as possible, people who are mentally afflicted, but I cannot share their views either in their condemnation of the Board of Control as at present constituted, or in the suggestion which they are making. I do not wish to debate the charges which have been made against the Board of Control. We recently had a Royal Commission at which there was full opportunity for anyone who wished to do so to make accusations against the Board. That was the proper place to make such charges and to have the whole matter discussed in the proper spirit.

There is not a word in the report of that Commission—which included Members of this House—to substantiate the rather reckless statements which have been made this morning. It is a good thing that, in this House, Members should not be liable to proceedings, individually, for statements made here. Probably debate would be impossible if we had not that protection, but Members of the House, having that immunity, should be careful not to abuse it. It is unfair to a number of men who, as far as I know, endeavour to do their work with sympathy and efficiency to make such statements and I hope the hon. Member opposite will not think that I am putting the matter too hardly against him when I say, that I do not think he ought to take advantage of his position here to make charges which were not made before the Royal Commission.

To whom is the right hon. Gentleman referring? Two of us spoke on this matter.

I am referring to the hon. Member who made the charges, and if both hon. Members made charges then I refer to both. As to the Amendment itself, it suggests that, as re 12 n. gards all these cases of voluntary boarders we should substitute "Minister of Health" for "Board of Control". There is a considerable administrative difficulty in that proposal. It would mean, I take it, a duplication of machinery and the setting up of two administrative staffs which would seem to be a very unfortunate thing to do, unless there is an overwhelming necessity for it. Speaking subject to correction, I think it is also the fact that a large proportion of voluntary boarders are already under the jurisdiction of the Board of Control. I believe that a number of people who suffer from what we call mental disease, and who are well-off, and who have the advantage of this kind of treatment, are under the jurisdiction of the Board now. That being so, one must ask if anything has happened which has in any way retarded the reoovery of those people. I am not aware of any case of that kind and I ask any hon. Member who puts forward suggestions such as we have heard this morning, whether there have been any complaints arising out of any of the hundreds of cases of people who may be called voluntary boarders, belonging to the class who may be described as the richer members of the community—if there are any such to-day—who are now under the Board of Control.

I think indeed that the Board gives a measure of protection to people who take advantage of this treatment and I think it is desirable that there should be such a measure of protection. I do not regard the members of the Board as people who are seeking to make things worse and more difficult for mental sufferers. As I say, I regard them as providing a measure of protection for people who suffer in this way, and, that, I understand, was the view of the Royal Commission. On those grounds also, I submit that we cannot accept this Amendment.

Finally, I do not think that the support of the House can be asked for this Amendment, having regard to a further Amendment on the Paper, which deals with the question of the appointment of lay commissioners. I hope it will be possible for the Minister to retain on the Board of Control what we call the lay element. I think it strengthens the Board in the eyes of the public if there are on it some people who can be said to represent the public point of view. I know that there may be departmental objections to that proposition, but I believe it would add to the strength of the Board and inspire greater public confidence in its operations. There are statements that the Board of Control do not make much investigation, although I know of no evidence to that effect, but perhaps it would give a further protection to the public to have on that Board some lay representation.

The right hon. Member for West Woolwich (Sir K. Wood) began by charging some of my hon. Friends on this side with attacking the Board of Control. I would only say that we must in this House reserve the liberty to attack public departments. I cannot see that there is any crime committed. In fact, if we did not criticise, this House would be largely useless. The operations of the Board of Control are certainly open to criticism in this House from all sides, and ought to be. I do not know enough about their work either to join in those criticisms or to reject them. but I would point out that the Amendment is not merely the taking out of the words "Board of Control" from this Bill, and substituting "Ministry of Health", but it is indeed deciding whether these voluntary boarders or the people dealt with in Clause 5 later on shall go to a lunatic asylum or shall go to other institutions, free from the taint of connection with lunacy.

It is true that we have not at present enough of these institutions. Voluntary boarders at present would not find places to receive them in most cases, and if the Ministry of Health is in charge of this Department, sooner or later institutions will be built by the local authorities in order to deal with this particular class of case. If, on the other hand, the words "Board of Control" remain in, you get for all time the people referred to in Clauses 1 and 5 dealt with in connection with the lunacy laws, and in these establishments that exist at the present time, but that exist, unfortunately to house other than voluntary patients.

The right hon. Gentleman in charge of the Bill was evidently very much upset by the fact that there was opposition to this Bill, or perhaps I should say opposition from me to this Bill, but it is absolutely essential that we in this House should not allow ourselves to be carried away by the evidence and the decisions of experts in this matter. I suppose there is nothing on earth that haunts people in this country more than the idea of being sent to a lunatic asylum, and we are deciding on this Amendment whether they are to go to a lunatic asylum or to something in the nature of a Poor Law institution.

That is the actual fact. At present there are the institutions, but if the Board of Control is left in charge there will not be the institutions, and if the Ministry of Health takes charge there will be the institutions. I do not think many people will volunteer under Clause 1 till there are institutions free from the lunacy taint for them to go to, but do let us remember that we in this House represent not the views of the bureaucracy as to what is most efficient and most convenient; we have to represent here the point of view of the man in the street. There is not a Member of this House who would not ten times rather go to a home than to a lunatic asylum. It is the most arwful fate that all the people in this country who are on the border-line fear. There are a great many of them, and as civilisation becomes more and more complicated, you get more and more of that class of person, and the fear that is over them is that they may be sent to perpetual incarceration, under conditions which may be sanitary, where they are well looked after, but where they always have to obey orders, where their word, whether complaint or otherwise, does not count, where there is no hope of getting out except by the decision of some expert. With that fate hanging over people, you will find that the people of England are very very cautious about extending the powers of the Board of Control, the old Lunacy Commissioners, over the lives of the people of this country.

I dare say some hon. Members may have read G. K. Chesterton's "The Ball and the Cross." Does the House remember how, in that novel, gradually more and more people are found insane by the doctors, till gradually the whole world is found insane, except the doctor in charge of the institution, and he turns out to be the Devil? Every extension of the category of lunacy takes us in that direction. Here we are in the position that every lunatic is, or ought to be, roughly speaking, in a lunatic asylum now. Anybody, according to the definition of the British Medical Association, for whom detention is a necessity, may be assumed to be detained now. They divide all the classes of mentally deranged people into those for whom detention is a necessity and those for whom detention is not necessary, those who are harmless and inoffensive, but still mentally deranged. All the first class, presumably, are already in lunatic asylums, and what we are trying to do, or what I hope the Government are trying to do, in this Bill is to provide an opportunity, for those whom it is not essential to lock up at present, to go to institutions where they might be cured, so that they might not become one of that class that must be locked up.

Obviously, if you take this new class of people who, in the interests of society—much as I hate that phrase—are not locked up at present, but are still allowed to be free, although slightly queer, and allow that class that is brought in under this Bill to be sent to lunatic asylums, whether under this voluntary Clause—which is a Clause called voluntary, but where we are dealing with poor people there is a very thin line drawn between what is voluntary and what is coercive—or whether under Clause 5, people who are not in lunatic asylums to-day, people who need not be in them in the interests of the public, and say, "Now we have got you; you are a new category, or, rather, a new lot of people who are suddenly, although not dangerous, brought within the purview of this Bill and enabled in some way or other to get this new curative treatment," does not the House realise what it means to those people if this treatment is really curative, or if, on the other hand, it is only part of the old, terrifying machinery of the Lunacy Commission? If this House could save these people from the fate of lunacy by making this alteration, I am sure it would do so. It is because we have our brains turned and deadened by these doctors and experts who know so much better what is good for people than people know for themselves, that, cowed in this way, the House adopts the proposal which it knows is wrong, simply because it is most convenient for the great bureaucracy of this country.

I suppose that it is useless to appeal to the Minister in this matter. He can have his Bill this moment if he makes this change, if he saves from the Lunacy Commissioners people who will come under this Bill. From an electoral point of view, I cannot imagine anything worse than that it should be said that the Labour Government bring in a Bill to put poor people in lunatic asylums. The choice is between the Commissioners and the Minister of Health. Why cannot he do the job? Because his officials will not let him. There is another reason. If this is put under the Ministry of Health—and we had better get down to hard facts—if the Ministry of Health and the local authorities have to find these homes for the slightly mentally defective but not dangerous people, then there is more money to be spent. That is the difficulty.

If to prevent people suffering from puerperal fever, or whatever it is, from going right over the border line, the Min- istry of Health established hospitals under their own management under the local authority, it would be a really great step forward in the treatment of these cases. But just think what it is for persons suffering from delusions and high temperature, or something of that sort, getting into a mental hospital under Clause 1 or Clause 5, and coming to and finding themselves with all the other lunatics! I cannot imagine a worse atmosphere for the cure of delusions than to come to and find yourself in the horrible condition of being with irrational beings. That alone would prevent cure and drive people over the border line. As long as you leave the words "Board of Control" as you do in Clause 5, as long as you leave it not only possible but probable in nearly every case a poor people that they have to go to the existing mental hospitals, even though they are in a separate part, the very fact that they are there is likely to make them worse and not better, and the reason for their going there will be less and less the desire or the possibility of cure, but the fact that this is in the interests of the public and of the family. It is the worst way of dealing with these temporarily afflicted people.

I do beg the House to consider that the liberty of the subject is one of the most sacred charges upon every Member of this House. It is fatally easy to make law after law in the interest of society, in the interest, very often, of the greatest good of the greatest number, but that should not be the aim and object of the Members of this House. We are the custodians of individual liberty, because this scheme is cheap, because it is approved by doctors, for every individual who ought not to be locked up and who is locked up under this Bill, we and we alone, will be personally responsible. Of course, they are not "locked up"; they are only "detained." There is a chance of getting out. But there ought not to be the possibility of any British citizen, if not quite insane, being locked up without being able to state his case in a court of law, without having some appeal against the decision of two doctors. As long as the rights of the British citizen endure, he should have, at least, some appeal to a court to escape from the control of the expert, the control of the bureaucrat and the control of the Lunacy Commissioners.

I am very reluctant to delay the House on this long controversial Bill. I am sure that we have listened to the right hon. Gentleman with a great deal of interest, as we always do. He is the champion in this House of liberty. Perhaps I may be allowed to say in the discussion on this Amendment what I intended to say at a later stage. The right hon. Gentleman, I say, is a great champion of liberty. Unfortunately, we know that there is a large number of people suffering from mental disorders. The right hon. Gentleman se:ms to object to their being treated by the expert. Who does he suggest should treat them? The right hon. Gentleman, I assume, to save his life would submit to a grave operation at the hands of a surgeon, but he will not trust a medical commissioner in lunacy.

Liberty, after all, is a limited matter. We are only allowed liberty as long as we conform to the social order of society, and I am very sorry, personally, to hear the very strong remarks that have been made about the Board of Control. I appreciate the fact that the hon. Member who moved this Amendment spoke quite sincerely. I listened to him in Committee, and I have the greatest respect for the sincerity of his views, but I do suggest that he was entirely misinformed, entirely misguided, and made references to a body, which is doing very difficult work, in a way which, I think, was not altogether worthy of the work he did on that Committee. The Board of Control seem to have hardly a friend, or, if they have, their friends are very inaudible. They are a body dealing, after all, with mentally disordered people—people who are extremely sensitive and difficult, as we know. Is there any Member of this House who, if he had the misfortune to have suffered from any mental affliction, would be prepared at any time to say so? It is an affliction to which our whole temperament is most sensitive.

Take even the case of a man who is indulging in alcoholic liquor. On more than one occasion I have hapoened, in the course of my professional work, to mention to a man that be drinks too much, and he has got most angry and strongly objected to it. The Board of Control are dealing with thousands of people, not one of whom is normally mental, and I think they have done their work extraordinarily well in the circumstances. The name is unfortunate. I do not think that the British people like the word "control," and it is very unfortunate that in the year 1913 they were given the name "Board of Control." I am sure the House will allow me to read the views of a great expert on that Board. It is only fair that the House should hear it. This expert is Sir Maurice Craig, who was at one time very much against the Board of Control. His views are more worth hearing because of that fact. He states:
"I am aware that there is a diversity of opinion as to who should be the central authority responsible for supervising patients in the early stages of mental disorder. For many years I felt, with others, that the Board of Control were too much steeped in the traditional treatment of mental disorder, and that it might be difficult for them to free themselves from this outlook, and in consequence I feared it might, in practice, be difficult to have the body visiting patients who are not insane. But it has been impossible to watch the work of the Board of Control during recent years without appreciating how much they have taken up the more modern views of psychological medicine, indeed, they have shown such power of adapting their functions to the medical outlook and I am now of opinion that this body is fitted to undertake the supervision of all mental patients, including those in the early stages of illness."
That is an unbiased opinion, and I may perhaps be allowed to read the summary of a final conclusion of the Royal Commission on the subject. I am glad that a Member of the House, the hon. Member for East Woolwich (Mr. Snell) was a member of that Commission, and I hope that later in the Debate we may have a contribution from him. His knowledge of this subject, technical as it is, must be very profound. This is the conclusion on the Board of Control of the Royal Commission in 1926:
"We are satisfied that the criticisms to which this Department has been subjected are to a large extent ill-informed, and that where criticism is justified the cause is to be found rather in defects in the existing system than in any want of zeal on the part of members of the Board. Having had opportunities of observing the care and thoroughness with which their work is done and the wide scope of their activities and their vigilance, we think that the Board have discharged their duties under the present code in a manner deserving of great commendation; but they are handicapped by three factors beyond their control."
That is a very fitting and impartial testimony to the Board of Control. The Royal Commission went on to make certain suggestions, which are embodied in this Bill. In this Clause, voluntary patients will gain tremendously, and I am sure that they will need the protection of the Board of Control. It would be a great pity to take them away from that protection. As the right hon. Gentleman the Member for West Woolwich (Sir K. Wood) said earlier, the Board of Control is the greatest protection which an insane person has at the present moment. I hope that British public will realise that, for it is the only protection that they have. It is amazing to me how constantly this body is assailed on all sides. I have tried to express what I believe to be the reason for it. The members on the Board are dealing with abnormal people by the thousand, and I am sure that they are quite prepared to do their work conscientiously, and go on doing it in spite of any criticism. I have great hope in this Clause. The medical man will make great use of it, and try and encourage patients to go in voluntarily, and so avoid serious mental disorder later on. Every successful doctor is an optimist. Gloomy deans may have a vogue, but gloomy doctors, as a rule, go their rounds on foot. I am sure that the medical profession generally will give the utmost encouragement to patients under this Clause, which I hope that the right hon. Gentleman will be able to have as it stands.

Clause I does not represent the views of the bureaucrats or the experts, but the conclusions of the Royal Commission, which, if I may say so in the presence of one of the members, was neither expert nor bureaucratic in its composition. It was a body set up by the Labour Government of 1924, and consisted of people of broad mental experience. Clause I really embodies recommendations which they made. The voluntary boarder is not a new category of person. He has existed under the law for a considerable time, and all that we are trying to do is to render this early form of non-certifiable treatment, which is at present available only to the well-to-do, available for the mass of the people. The proposal is to extend treatment for voluntary boarders to public mental hospitals and other institutions. Under the principal Act of 1890, the well-to-do, who cherish their liberty perhaps even more strongly than other people, have been under the supervision of the Board of Control, and no complaint has been made. The experience of the voluntary boarder system of the past shows that the Board of Control has really not been a force working against the success of that system of treatment. During 1929, there were admitted to registered hospitals 562 certified patients, and 668 voluntary patients. In the case of licensed houses, 974 certified patients were admitted, and 759 voluntary boarders.

How is it that the figure is now 759, and during the Committee stage it was 757?

I apologise; the number is 757. The point is that pretty nearly one-half the entrants to the registered houses and hospitals are people who go in voluntarily. That is borne out in Scotland in the case of the Royal Edinburgh Hospital. In referring to the large number of patients who entered that hospital for voluntary treatment, the report shows that practically two-thirds of all the admissions were of that character. To many persons it may appear surprising that any person should go to a mental hospital voluntarily, but times have changed, and it is clear from these statistics that they do go. Therefore, there is not in the minds of these people that fear with regard to places where there are certified people which many people imagine exists.

Those people do not go to lunatic asylums; they are all nursing homes.

This is a report about the Scottish hospital. There you have certified patients in the same institution as persons who are not certified.

When the right hon. Gentleman speaks of mental hospitals, I suppose he is referring to what are generally known as asylums?

No, I do not prefer the term; I am asking for the sake of making plain what is meant.

Would the right hon. Gentleman also make it clear that a large number of those so-called voluntary boarders are of unsound mind?

I should not like to go into the question of degrees of unsoundness of mind. Let us consider exactly what it is we are being asked to do by this Amendment. We are not being asked to abolish the Board of Control or to supersede it by the Ministry of Health; if we were, this Bill would not to be under discussion today. That would require a very far reaching Bill amending drastically the principal Act of 1890. Obviously that cannot be done in this Bill, particularly at this stage. In this Amendment hon. Members are asking that the Ministry of Health should be directly responsible for certain aspects of mental illness whilst retaining the Board of Control for the major portion of the responsibility for mental health. That would mean that in many cases—in most cases—there would be going into the same institutions the medical visitors of the Board of Control and the medical visitors of the Ministry of Health. There would necessarily be a duplication of inspection and a duplication of administration.

The problem is more complicated than that. Hon. Members must not suppose that the voluntary patient is in a category which is unalterable, that once he is a voluntary patient he will always be a voluntary patient, or that if he comes under Clause 5 he is always going to remain so, or that if he is certified he is certified for ever. These three categories of persons are ever changing. A man may to-day be a voluntary patient and next week incapable of volition. Mental disease takes many forms It is more acute in some cases than in others, and one form passes into another. It seems to me to be bad administration, impossible administration, to take one particular category of people suffering from mental illness and say they shall be supervised by the Ministry of Health, and that the other categories are to come under the supervision of the Board of Control. What are we going to do about people who oscillate between one category and another?

Hon. Members are asking for an administrative system which no Minister would pretend to begin to work, because it would be utterly impracticable. In that view we are fortified by the Royal Commission. They were a body of very distinguished people. One of them was a Member of this House. [HON. MEMBERS "Two!"] They included the present Attorney-General, who was not then a Member of this House. That Commission reported quite definitely that they did not regard it as being either desirable or practicable to make a differentiation of this kind. I need not read the passage.

Will the right hon. Gentleman explain what he means by "differentiation of this kind"?

The point about the impracticability of the differentiation? I think it is quite clear. You may get a case of a person incapable of volition, a person who would come under Clause 5 of the Bill, who may be cured altogether. On the other hand, his position may become so much worse that it does not appear that he is likely to respond to treatment, and then he would fall within the category of persons certified as being of unsound mind. It is the same with the voluntary boarder. He might have left his entry into an institution so late that in spite of all that was done he became incapable of volition in a few days and passed into the second category of people, dealt with under Clause 5.

I do not want to use all the lurid language of the right hon. and gallant Gentleman, but it seems to be assumed that these people are to be locked up, are to be herded in lunatic asylums. I believe there is a good deal of substantial evidence to show that it is certification that people dislike, that they dislike that more than the name of the institution to which they go, and that they dislike that far more than the Board of Control, of whom they have never heard in their lives. What we are trying to do is to get away from that. It is quite clear that in many areas those people who might voluntarily enter a place for treatment if they had the opportunity will either have to stay outside or go into another one of the existing institutions; but it does not in the least follow that all these voluntary patients are going into mental hospitals. Read what the Clause says:
"May without a reception order be received as a voluntary patient in an institution within the meaning of this Act, or in any hospital, nursing home or place approved for the purposes of this section by the Board of Control."

No, it is not. It is perfectly open to a local authority, now that it has under its control institutions which it did not have until April 1st of this year, to organise its resources in such a manner as to provide something for these people—not necessarily for rich people. The point I am trying to make is that it is quite inaccurate to assume that there is nothing for the voluntary patient except the mental hospital, though I am prepared to admit that in a number of cases at the present time it is either that or nothing, and on the whole I would rather have that than nothing. On the other hand, it is possible that other institutions which are not necessarily mental hospitals, but which must be approved to see if they are properly equipped, and so on, can be used for this purpose.

This point raises a matter of principle. A distinction has been drawn between the Board of Control and the Minister of Health, but I cannot follow the argument that, if the responsibility for certain institutions rests with the Board of Control, we shall not get any more new buildings. There is only one person responsible for the estimates of the Board of Control, and that is the Minister of Health. The Minister of Health is responsible for the finances of the Board of Control and of his own Department, and why he should desire to curb the work of the Board of Control I cannot understand. This mistake arises through a wrong impression in regard to the change which is proposed in the power, structure, and duties of the Board of Control, by which we are trying to make it conform to the general administrative principles of all Government departments. Lastly, I would say that whether this kind of work remains where it is, or whether it is decided that it should come under the control of the Minister of Health, the Minister is equally responsible. I submit that, on practical grounds, we ought not to accept this Amendment, because it would make greater confusion, and would not in the least assist the cause of those people whom we all desire to help.

I would like to ask the Minister of Health to indicate whether he will accept an Amendment giving the local authorities a right of appeal to the Minister of Health against any decision of the Board of Control. I think an Amendment to that effect would remove a good deal of opposition to the Clause. The only fear in the minds of local authorities is that if they have not the right of appeal to the Minister they will be subject to a sort of autocratic control. I know it was stated during the Committee stage that the local authorities or their representatives would be consulted in regard to certain matters, but I would like the right hon. Gentleman to implement that by accepting the Amendment to Clause 14 which stands in my name.

I can only reply that, on this matter, I stand precisely where I stood during the Committee stage.

I rise to support this Amendment. I am certainly not going to charge the Minister of Health with driving people into lunatic asylums, but I think, if you had within one room certified and non-certified people, you would find it very difficult to get people voluntarily to sign a form asking that they should receive mental treatment. The Minister of Health said that this service was to enable the mass of people to have the same service as the rich people, but I would like to point out that if this Bill was an Act of Parliament to-day it would be quite impossible to make anything like sufficient provision for the number of people who would be likely to apply, and who would voluntarily apply for such mental treatment.

Of course, if no such accommodation was available, those people would be sent to the only available institutions, namely, the lunatic asylums, or the so-called mental hospitals. The hon. Member for Denbigh (Dr. Morris-Jones) was anxious that we should be impressed by the view of the specialists, while the Minister of Health was very anxious that we should not be impressed by the specialists but by non-specialists. As I stated during the debate on the Second Reading, the definition of a specialist is one who knows more and more about less and less. It is quite true to say that what is ordinarily called a specialist's view is one that is not accepted by many people. The right hon. Gentleman, the Member for West Woolwich (Sir K. Wood), in dealing with the speech of the Mover of this Amendment, said that he had made certain very reckless charges without putting forward any basis for them. I should have like the right bon. Gentleman, when he was dealing with those charges, to have been more specific in rebutting them.

That was not my point. I said that it was not for a person who makes a charge to put the onus on somebody else to prove it. The person who makes the charge ought to support it.

That is exactly my point. The hon. Member who moved this Amendment gave certain figures which any seriously minded person who reflects upon them must agree shows a very grave state of affairs. The hon. Member said that the death-rate among people in these mental hospitals was 10,000 a year, which works out at over 30 per cent. I suggest that that is a very serious state of affairs indeed, and if, instead of blaming the hon. Member for making reckless charges, the right hon. Gentleman had sought to explain away that argument, he would have been doing better work. The right hon. Gentleman the Member for West Woolwich said that, by this Bill, we were duplicating the machinery, but I suggest that, in a matter like this, it would be a good thing not only to have a duplication of machinery, but also to have a duplication of inspectors. You are dealing with a number of people who are sometimes in a very serious set of circumstances, and, even if it meant that alone, I should be prepared, as I certainly am this morning, to support it.

Throughout the whole of this Bill the Board of Control is wt, large. I support this Amendment on two main grounds. In the first place, I said on the Second Reading, and I say it now, that if there is any complaint locally against the Board of Control—against whose officials I am not going to say anything whatever—we are never in a position to get a grip of the Board of Control. We never can get hold, of that somewhat mysterious body, that seems to sit, up aloft above the reach of all. That is a serious state of affairs. I think that most Members of this House, or certainly a large number of them, will agree with me that even here in this House we cannot get to close grips with the Board of Control.

In the second place, many hon. Members will have read the recently published book entitled "The New Despotism." My political views are not those of the author of that book, but I certainly think that it has a very substantial basis of truth, that more and more the Ministries are becoming swollen and overworked, and that less and less can this House get control of them. If this Bill is passed, we shall have, in a sense, less and less control of the Board of Control. It is because, as a Socialist, I want to get a closer control over each Department, that I make this plea to-day. There is no one in this House, no matter to what political party he belongs, but would agree that it is desirable that we should get a closer grip of the Departments, so that what is usually called officialdom may be controlled. I am not saying a single word against individuals. If we were there, we should be doing exactly the same as they are doing. They are most of them highly patriotic, capable and efficient men and women. I am speaking here of Parliamentary control, and I plead that on this ground alone Members should vote for this Amendment.

In the third place, I am anxious for this Amendment because I am anxious that the purpose of the Bill shall be achieved. I agree with the Minister that there is to-day a very large number of people in our industrial areas who would need a place such as is envisaged in the Bill. There are masses of people, particularly working-class mothers, whose health is undermined by embarrassments and financial worries of all descriptions, and who, undoubtedly, are in a position in which they would need a place of rest for a time, especially in certain circumstances. If this Bill becomes an Act, there is no place available for thousands of people to-day who might be anxious to take advantage of such pro- vision. The only places that are available are what are usually called mental hospitals, as a euphemism for another term altogether. I want the House to-day to try to change the whole current of this Bill, so that people, instead of being deflected into the usual places, shall be deflected into a totally different place; so that the service shall be run entirely by the local authorities; so that there shall in fact be differentiation—

I am only showing the basis of my argument in support of this Amendment. I suggest that what I have just said relevant for this reason that, if the local authorities have thrown upon them the complete onus of developing this new service, that will tend to enable them to develop their actual institutions. If this Bill were passed into law, and matters were left as they are to-day, there would not be next week any of these institutions into which people could go, but only the ordinary lunatic asylums. I hope that we shall get a considerable number of members of the House with us on this Amendment. In my opinion it is a serious Amendment, and one which ought to appeal to those who may think that the officials are getting beyond our control. It would enable us to control them, and to provide, much more rapidly than the Bill as its stands to-day would provide, a number of institutions for men and women in the large industrial areas who would be only too glad to take advantage of them.

I do not think that this Debate has been quite as serious as it might have been con- 1.0 p.m. sidering the importance of the subject that we are discussing. The right hon. Gentleman the Member for West Woolwich (Sir K. Wood) side-tracked the Debate, and it has never got back to the really serious level on which my hon. Friend the member for Bootle (Mr. Kinley) set it going. It seems to me to be the most utter mockery of a Parliamentary institution for it to happen that, when an hon. Member on a back bench gets up and quotes figures such as were quoted by my hon. Friend, showing that last year 22,000 people were admitted to these institutions, that 9,775 died, that 61 com- mitted suicide, that for 10 years there has been a steady increase in the percentage of deaths and the percentage of suicides among the inhabitants—

May I inform, the hon. Member, as he does not seem to know it, that quite a large number of the people who go into mental hospitals are people of advanced age, who are really suffering from senile decay?

I also know that that is not a new condition in 1929. It has always been the case. What we are asking for is an explanation of the fact that every year for the last 10 years the percentage of deaths and the percentage of suicides have increased. It is surely not going to be put forward as a serious argument that that is because the average age of admission to mental asylums has gone up—

If my hon. Friend will let me develop my argument, I will tell him what I am going to suggest. What I am saying for the moment is that here is a serious fact, and the right hon. Gentleman the Member for West Woolwich ought not to reproach my hon. Friend the Member for Bootle for bringing it forward. It is a responsibility of Ministers and ex-Ministers, and of all Members of this House, in whose keeping these people are, to devote themselves to finding out whether it is due to the Board of Control, or what is the cause of it. There is no doubt and I do not believe that my hon. Friend who interrupted me would contradict it that there is a very great degree of misery, unhappiness and suffering among the people in these institutions and I think my hon. Friend will agree that it is the duty, and should be the desire, of Members of this House, when we are discussing a new and far-reaching Measure dealing with the treatment of these people, to get from Ministers and ex-Ministers, not a reproach for having raised the matter, but an account of the cause.

I suggest that a very considerable proportion of the trouble is due to the methods of the Board of Control. During the six years for which I have been a Member of this House, I have been brought into touch with the Board of Control on a great number of occasions, and I cannot remember a single case in which I have had to deal with the Board of Control where, when the case has been finished and I have done all that was in my power as a private Member of the House, I have felt satisfied in my mind that the right thing had been done. I cannot remember a single case in which I have had to deal with the Board of Control where I had correspondence from them which I considered to be fair, honest or candid. I will give the House one experience that I had. I wish that the right hon. Gentleman the Member for West Woolwich were here, because I went to him about it, and he investigated the whole of the particulars that I put before him, so that he could have stated if they were not correct.

I had a case of a young woman, almost a child, in my last constituency, who had met with an unfortunate lapse and had come under the charge of the Board of Control. Her mother was a very well-known and respected member of the women's section of the Labour party in the constituency. This girl had been away for three years. Her parents wanted her home, and I wrote to the Board of Control and said I should like to know whether they considered het responsible enough to be allowed to return to her parents. I knew them as respectable people who could afford to look after her. I received a letter asking if I was aware that this was the second illegitimate child she had had. I took the matter up and found that was quite untrue, I wrote to the Board of Control, but I got no apology. They take about six months to answer a letter. I took the matter to the right hon. Gentleman the Member for West Woolwich. He expressed his sympathy, as he always does, and he exhibited a strong feeling at the charge that was quite unjustly brought against the girl. Some two months afterwards I received a letter from the Board of Control, not apologising, but saying they had discovered that it was a mistake, but they still wondered whether I was aware that the girl's accident had occurred because the mother was in the habit of taking money from men to go out and get drink and leaving the girl in the house alone. Many of my friends knew the mother well, and we knew that was an absolutely unfair statement. I again went to the right hon. Gentleman and said unless something was done about it I was going to raise a fund to take the Board of Control into court for libel. That succeeded in eliciting an apology.

Here are the facts of one case. I have never had a case in which I have had to deal with the Board of Control where I have not had every excuse put forward whereby once people get into their charge they seek to detain them. In this case I was able to trace all their lies, their malevolence, their libellous statements and their maliciousness. I was able to take it to the Ministry and finally, by threats of publicity, to get an apology. A ease like that leaves a very uncomfortable feeling in the mind that, in many other cases in which I have failed, had I been able to get as much information as I did in this case, and had the Board of Control made one little slip in their facts, as they made in this case, I might have been able to do much more. I disagree with the Minister with very great regret because, although I may have criticised some of the Government Departments, I have had very great respect for the things that he has brought forward, but on this occasion I think he is unaware of the distrust and fear that is felt amongst working people with regard to the Board of Control. He ought to answer or account for the figures that were brought forward by the hon. Member for Bootle. It is no good saying they are wild and reckless figures, because they were given by the Minister himself in reply to the question a short time ago.

Both the right hon. Gentlemen who have spoken have said well-to-do people submit to it and do not complain. I do not suppose that they do. It is no good quoting the experience of well connected people. We have to consider the way the Board treats people who are not in such a position. My experience of the Board of Control has convinced me that it is permeated by the very worst type of charity organisation mentality. I wish we could have got the Minister to meet us on this point. I should support the Amendment with very great reluctance indeed if a division were called, but I would much rather that the Minister could have made some proposal whereby he himself took the ultimate authority, and took out the name of the Board of Control from the Bill and put himself in. The hon. Lady may reply that questions may be addressed to the right hon. Gentleman or to herself, but I do not feel that that is the same as having them in actual authority under the Bill. If questions are. put down, the reply usually comes from officials of the Board, and it is very difficult for the Minister, however sympathetic he may be, to analyse the position for himself. I should like to ask whether there cannot be some form of compromise. No one says the Bill is not necessary. It will do a let of good, but it is giving increased power to a body over which the House has no effective control and in which a very great many Members have no confidence. I hope the Minister will try to find some way by which the Board of Control may be brought under more effective control by the Minister and, therefore, by the House.

We have listened to a rather unfortunate speech in which a Member of the House has thought it necessary to make a distinct and deliberate charge against the Board of Control, and has given an instance of a certain specific case within his own knowledge. He is, of course, perfectly within his rights in bringing that case before the House, but I hope he has informed the Minister that he was going to bring it forward so as to enable him to reply to it.

In the first place, I should be very pleased to let the hon. Member, or anyone else, see the correspondence in relation to it, and, secondly, the present Minister is not responsible for the case. It occurred during the early part of last year and I saw the right hon. Gentleman the Member for West Woolwich and, on representations from him to the Board of Control, these libellous statements were withdrawn.

The hon. Member has not taken my point. Whatever happened in the past, the hon. Member has now exercised his right to bring the case before the House and to make a definite charge against the Board of Control. The Board of Control cannot answer for themselves. They are responsible to the Minister, and the Minister has to defend the Board of Control. As the hon. Mem- ber has thought it necessary to bring this charge and to relate this case, he should have informed the Minister of Health, so that when the Minister or the Parliamentary Secretary replied it would have been possible to give the other side of the case. It is no argument to say that what happened occurred under the last Ministry. That is not the point. The hon. Member has made a definite charge against the Board of Control in regard to a specific case, and in justice to the Board of Control, whether they be innocent or whether they be guilty, the charge should be met on the Floor of the House. If the hon. Member has not informed the Minister of Health, then, as a Member of this House, I regret the position that he has taken up. I will even go so far as to suggest that he has abused the privileges which belong to a Member of this House. We know that the officials of a department cannot defend themselves, and, although I have no love for officials as a class, and believe that there is a great deal to be said against the introduction of a new despotism, they should not be the subject of a charge in this House unless the Minister is given an opportunity to reply to that charge.

I am sorry that I cannot agree to this Amendment, because one of my principal objections to the Bill is that you are lowering the status of the Board of Control. You are taking a body, which up to the present had been appointed by His Majesty the King on the recommendation of the Lord Chancellor or the Minister of Health, and degrading it to the position of civil servants by making it a department of the Ministry of Health. Certain hon. Members seem to have a wrong idea of the functions of the Board of Control. The Board of Control can almost be described as a judicial body. They act as judges on all documents or medical certificates in order to see that they are absolutely in order. The Board of Control are the guardians of the liberty of the subject. When they go round to these mental hospitals and other places, they do not certify—they have not the power to certify—but simply examine cases. If they think that a case is being improperly detained, they draw the attention of the medical superintendent to the matter and say "You have a case here which you are not entitled to detain. This patient is not insane." Through the action of the Board of Control the liberty of such a person may be restored. It may happen in another case that the patient, who may be a voluntary boarder, may become insane and a reception order may have been obtained lasting for a limited time. The relatives of the patient may wish to remove him, but the medical superintendent has the power for a limited time to retain the patient under the reception order. The Commissioner of the Board of Control, if he goes down, can waive it and can put on one side the reception certificate of the medical superintendent and say: "No, the case must be discharged."

They are looking after the liberty of the subject the whole of the time. They do not certify; they do not order certificates. They simply point out the risks of a man of coming under the penal provisions of the Lunacy Acts if he does not certify. Certain hon. Members think that the Board of Control are an autocratic body hidden in some recess in London with their tentacles spread all over the country, keeping all these patients in asylums, determined Once they get them there that they shall never come out again, or that as few as possible shall he allowed to do so. The facts are entirely different. They see that patients get out as quickly as possible and that no one is detained unnecessarily. The power of a body like that should, if possible, be increased. To reduce them in status as they are being reduced under this Bill by placing them under the Minister of Health is to weaken their position. The Board of Control will simply become a department of the Civil Service.

I was surprised to hear that the hon. Member for South Tottenham (Mr. Messer) preferred to deal with the Ministry of Health than wish the local authorities or county councils, because he thought he might get a little more leniency or better treatment from the Ministry of Health than he would from the Board of Control. The hon. Member has an excess of optimism. There is no more difficult department of State with which to deal than the Ministry of Health. If you go there and come out with anything at all, you are an extremely fortunate individual. You are putting the Board of Control under one of the departments, and the result will be that we shall have permanent officials again, departmentalism, and a new despotism, and I even go further and say that we shall have a new tyranny. How are we to be able to get information concerning a Board of Control which is subject to the Ministry of Health? If as hon. Members we ask a question the Minister will only tell us what he wants us to know or what his department wants us to know.

We know that private Members get little satisfaction by asking questions at the present time. We can ask for statistics and get nine answers, but if we ask for information which the Department does not want us to have we do not get to know anything. The result will be, that if we have the Board of Control under the Ministry of Health and any hon. Member wants to bring forward a particular case, he will only receive such information in answer to his inquiries as the Department wish to give. At the present time, the Board of Control, appointed by His Majesty the King, are in a superior position. They are quite separate and distinct from the Civil Service, and it is in the interests of the people of this country that they should be kept in that proud position and should remain a body to whom everybody can look with confidence and with trust.

We have, later on, an Amendment on the Paper to include lay commissioners. We feel that this proposal is essential in order to obtain the full approval and confidence of the public. I ask hon. Members to try and get out of their minds the idea that the Board of Control are a body who only concern themselves with the detention of patients in an asylum or mental hospital and to

Division No. 256.]


[1.27 p.m.

Adamson, Rt. Hon. W. (Fife, West)Bennett, William (Battersea, South)Clynes, Rt. Hon. John R.
Adamson, W. M. (Staff.,Cannock) Benson, G.Cocks, Frederick Seymour
Addison, Rt. Hon. Dr. ChristopherBentham, Dr. EthelCompton, Joseph
Aitchison, Rt. Hon. Craigie M.Berry, Sir GeorgeCrookshank, Capt. H. C.
Alpass, J. H.Bowerman, Rt. Hon. Charles W.Daggar, George
Ammon, Charles GeorgeBroad, Francis AlfredDallas, George
Angell, NormanBrothers, M.Davies, Dr. Vernon
Arnott, JohnBrown, C. W. E. (Notts. Mansfield)Denman, Hon. R. D.
Aske, Sir RobertBrown, Ernest (Leith)Dickson, T.
Ayles, WalterBurgess, F. G.Dugdale, Capt. T. L.
Baker, John (Wolverhampton, Bliston)Buxton, C. R. (Yorks. W. R. Elland)Duncan, Charles
Baldwin, Rt. Hon. Stanley (Bewdley)Buxtun, Rt. Hon. Noel (Norfolk, N.)Ede, James Chuter
Balfour, Captain H. H. (I. of Thanet)Cameron, A. G.Edge, Sir William
Barnes, Alfred JohnCharleton, H. C.Edmunds, J. E.
Benn, Rt. Hon. WedgwoodChater, DanielEdwards, E. (Morpeth)
Bennett, Capt. E. N. (Cardiff, Central)Clarke, J. S.Elmley, Viscount

visualise the position from another angle entirely and regard them as a body of ladies and gentlemen independent of political control whose sole object is to see that no subject of the King shall be detained in any place in this country unless there is legal cause for such detention. They are the one great support of the people of this country to see that the liberty of the subject is not infringed.

Would the hon. Gentleman leave that to the doctors alone, without the magistrates?

In this Mental Treatment Bill the whole idea is that there shall be no magisterial or judicial intervention. That is where it differs from the Lunacy Act, and it is, of course, the great Argument in favour of the Bill. Judicial intervention and certification has been one of the great drawbacks to the early treatment of cases of mental disease. Therefore, I do not think that the right hon. Gentleman's interruption quite met my point. I would ask hon. Members to agree with me that, instead of handing this Department over to the Ministry of Health, the more we can dissociate it from the Ministry of Health as a Ministry the better. We must keep it under the control of the Minister, which is absolutely necessary in order to have control in Parliament, otherwise the less this Department has to do with the Minister of Health the better for the patient, the better for the health of the country and the better for the Board of Control.

Question put, "That the words 'Board of Control' stand part of the Bill."

The House divided: Ayes, 205; Noes, 18.

Falls, Sir Bertram G.MacDonald, Malcolm (Bassetlaw)Sawyer, G. F.
Ferguson, Sir JohnMcElwee, A.Sherwood, G. H.
Forestler-Walker, Sir L.McEntee, V. L.Shield, George William
Freeman, PeterMaltland, A. (Kent, Faversham)Shiels, Dr. Drummond
Fremantle, Lieut.-Colonel Francis E.Makins, Brigadier-General E.Shittaker, J. F.
Ganzoni, Sir JohnMansfield, W.Short, Alfred (Wednesbury)
Gardner, B. W. (West Ham, Upton)March, S.Simmons, C. J.
George, Major G. Lloyd (Pembroke)Margesson, Captain H. D.Sinclair, Col. T. (Queen's U., Belfst)
Gibson, H. M. (Lanes, Mossley)Markham, S. F.Sitch, Charles H.
Gillett, George M.Marley, J.Smith, Alfred (Sunderland)
Gossling, A. G.Mathers, GeorgeSmith, Ben (Bermondsey, Rotherhithe)
Gray, MilnerMatters, L. W.Smith, Frank (Nuneaton)
Greenwood, Rt. Hon. A. (Colne)Melville, Sir JamesSmith, Rennie (Penlstone)
Grenfell, D. R. (Glamorgan)Middleton, G.Smith, Tom (Pontefract)
Griffith, F. Kingsley (MIddiesbro' W.)Millar, J. D.Smith, W. R. (Norwich)
Griffiths, T. (Monmouth, Pontypool)Mills, J. E.Smith-Carington, Neville W.
Gunston, Captain D. W.Monsell, Eyres, Com. Rt. Hon. Sir B.Snell, Harry
Hall, G. H. (Merthyr Tydvil)Montague, FrederickSouthby, Commander A. R. J.
Hall, Capt. W. P. (Portsmouth, C.)Morley, RalphStewart, J. (St. Rollox)
Hamilton, Mary Agnes (Blackburn)Morris, Rhys HopkinsStrachey, E. J. St. Lot
Hamilton, Sir R. (Orkney & Zetland)Morris-Jones, Dr. J. H. (Denbigh)Strauss, G. R.
Hastings, Dr. SomervilleMorrison, Herbert (Hackney, South)Sueter, Rear-Admiral M. F.
Hayes, JohnHenry Morrison, Robert C. (Tottenham, N.)Sutton, J. E.
Henderson, W. W. (Middx., Enfield)Mort, D. L.Taylor, R. A. (Lincoln)
Hirst, W. (Bradford, South)Mosley, Lady C. (Stoke-on-Trent)Taylor, W. B. (Norfolk, S.W.)
Hoffman, P. C.Muff, G.Thomas, Rt. Hon. J. H. (Derby)
Hopkin, DanielMuggeridge, H. T.Thomson, Sir F.
Horrabin, J. F.Nathan, Major H. L.Thurtle, Ernest
Hudson, Capt. A. U. M. (Hackney, N.)Naylor, T. E.Tillett, Ben
Hudson, James H. (Huddersfield)Noel Baker, P. J.Tinker, John Joseph
Isaacs, GeorgeOldfield, J. R.Titchfield, Major the Marquess of
Iveagh, Countess ofOliver, George Harold (Ilkeston)Tout, W. J.
John, William (Rhondda, West)Palin, John Henry.Viant, S. P.
Jones, Morgan (Caerphilly)Paling, WilfridWalkden, A. G.
Kennedy, ThomasParkinson, John Allen (Wigan)Wallace, H. W.
Kenworthy, Lt.-Com. Hon. Joseph M.Penny, Sir GeorgeWatkins, F. C.
King, Commodore Rt. Hon. Henry D.Perry, S. F.Wellock, Wilfred
Lansbury, Rt. Hon. GeorgePethick-Lawrence, F. W.Welsh, James (Paisley)
Lathan, G.Phillips, Dr. MarlonWestwood, Joseph
Law, Sir Alfred (Derby, High Peak)Picton-Turbervill, EdithWhiteley, Wilfrid (Blrm., Ladywood)
Law, Albert (Bolton)Preston, Sir Walter RuebenWilkinson, Ellen C.
Lawrence, SusanRamsbotham, H.Williams, Charles (Devon, Torquay)
Lawrie, Hugh Hartley (Stalybridge)Reynolds, Col. Sir JamesWilliams, T. (York, Don Valley)
Lawson, John JamesRichardson, R. (Houghton-le-Spring)Wilson, C. H. (Sheffield, Atterclitte)
Lawther, W. (Barnard Castle)Riley, Ben (Dewsbury)Wilson, R. J. (Jarrow)
Leach, W.Romeril, H. G.Womersley, W. J.
Lee, Frank (Derby, N.E.)Rosbotham, D. S. T.Wood, Rt. Hon. Sir Kingsley
Lees, J.Ross, Major Ronald D.Wood, Major McKenzie (Banff)
Leighton, Major B. E. P.Rowson, GuyYoung, R. S. (Islington, North)
Lloyd, C. EllisSalter, Dr. Alfred
Longbottom, A. W.Samuel, H. W. (Swansea, West)TELLERS FOR THE AYES.—
Lovat-Fraser, J. A.Sandeman, Sir N. StewartMr. Charles Edwards and Mr.
Lowth, ThomasSanders, W. S.William Whiteley,
Macdonald, Gordon (Ince)Savery, S. S.


Baldwin, Oliver (Dudley)Kelly, W. T.Stephen, Campbell
Beckett, John (Camberwell, Peckham)Longden, F.Wallhead, Richard C.
Brockway, A. FennerMaxton, JamesWedgwood, Rt. Hon. Josiah
Buchanan, G.Messer, FredWinterton, G. E (Leicester,Loughb'gh)
Carter, W. (St. Pancras, S.W.)Rathbone, Eleanor
Groves, Thomas E.Sandham, E.TELLERS FOR THE NOES.—
Jowett, Rt. Hon. F. W.Scrymgeour, E.Mr. Kinley and Mr. McShane.

I beg to move, in page 1, line 18, at the end, to insert the words:

"But unless the said voluntary patient is of unsound mind within the meaning of the Lunacy Acts, 1890 to 1922, he shall not be received or lodged as a patient, either rate-aided or paying, in a public mental hospital (asylum)."
On the Second Reading of the Bill, there was very much congratulation to the Minister of Health on the general framework of the Bill, but quite a number of those who took part in the debate were anxious and concerned about the suggestion that voluntary boarders should be put within the purview and control of the ordinary lunatic asylum. The right hon. Member for West Woolwich (Sir K. Wood), who has this morning made a speech in support of the Government, went so far as to opine that the provisions regarding, voluntary boarders might be considered in Committee with a view to their removal from the jurisdiction of the Board of Control. The hon. Member for Reading (Dr. Hastings) desired that voluntary boarders should be treated in some other institution than the present asylums, and I look forward to his support in the Division Lobby should it be necessary. The hon. Member for the Scotland Division of Liverpool (Mr. Logan) declared that the Bill was of no use if it did not provide for the segregation and demarcation of cases for early treatment. He speaks with some knowledge of the working of the present Lunacy Laws. He said:
"I am convinced from my observations that unless you segregate you are going to make insane those you are now dealing with."—[OFFICIAL REPORT, 17th February, 1930; col. 1003, Vol. 235.]
That is an exceedingly strong statement I admit, and one which calls for serious reflection on the part of hon. Members. The Minister of Health has frankly confessed that there are a number of voluntary boarders going to the ordinary lunatic asylums, and when he was challenged by the hon. Member for Royton (Dr. V. Davies) I heard no denial of the statement that these voluntary boarders were persons who in any case were certified as of unsound mind. If that is the fact I want to query how much their voluntary action is worth. There is presumed to be, on the part of people who are to submit themselves for treatment on a voluntary basis, a real choice. It is suggested that there can be a voluntary act of a person of weak or impaired will who will make the choice of treatment in one of these institutions.

Is there any real difference—I think it is worth consideration—between the voluntary act of a normal person and the voluntary act of a person who is not normal? Obviously there is, yet this Bill assumes that the voluntary act of a perfectly normal person is in the same category as the voluntary act of an abnormal person. Surely the very basis of mental disorder is the loss of will power for the time being, the loss of control of the normal faculties. Yet there is this curious suggestion, that a person who has voluntarily desired to submit himself treatment is to be regarded as though he were in full possession of his faculties. I brush aside the figment that the person who goes for mental treatment into any kind of institution, whether rate-aided or not, is really discharging an ordinary voluntary act. He would be under the control and pressure and advice of some other person and it will be that other person's dominating will which will decide his supposed voluntary action in this matter. If that is so, you are providing in this Measure that a person may be received into any hospital. I have no objection to that because that is the place to which anyone who is ill should go—or into a nursing home—I have no objection whatever to that—or to any "institution within the meaning of this Act," which is, of course, an ordinary lunatic asylum.

Hon. Members should not allow themselves to be deceived by the suggestion that because you alter the name, the crude and vulgar name, of a lunatic asylum and call it a mental hospital you have thereby made any difference in its real character. There is the old saying that "a rose by any other name will smell as sweet." I might also say that a thistle by any other name will sting as much. This euphemism—it is nothing more—ought not to deceive the House, and the objection remains, and is bound to remain in the minds of a great number of people that the institution to which they may be consigned is practically a lunatic asylum. It has been suggested this morning that there is no stigma in sending people to a lunatic asylum and that the real stigma is in going before a magistrate, whom probably they know, who is probably a town councillor and perhaps lives in the same street. It is suggested that if they are taken there by their friends with a medical certificate that that is going to be the real objection in the mind of many of these poor unfortunate people. Obviously that is not so. I know that the Minister of Health holds a different opinion, but I would suggest that there is no stigma in that. The stigma is in the place where the person finds himself, in the association with a lunatic asylum.

People in a temporary state of mental aberration, under stress or excitement, business anxieties, worries, or even as the result of those normal periods of illness which come to men and women, may find themselves consigned to an ordinary lunatic asylum, and I plead with the Minister not to bow down to this false god of standardisation, this worship of the card-index, treating all men in all moods in the same way and judging them all by the same yard-stick. We are now in a region where these mechanical methods should not be applied and where we should make that discrimination to which the Minister alluded earlier in the Debate. Where will these voluntary boarders go, and in what association will they sometimes find themselves if this Amendment is not accepted? The hon. Member for East Islington (Dr. Ethel Bentham) herself a medical woman, told us some of the experiences which these people are likely to have. Speaking on the Second Reading, she pictured the incidents which sometimes take place in an ordinary lunatic asylum. She said:
"I have seen a reception ward which had about 18 patients. In one corner I saw a case of puerperal mania; in another bed a raging drunkard who had been brought in in the middle of the night; then two people who spent their time whining in a corner; and somebody who took the opportunity to throw things at the nurse every time she turned her back."—[OFFICIAL REPORT, 17th February, 1930; col. 988–9, Vol. 235.]
It is into those associations and into those institutions, where that kind of thing normally happens, that the poor distracted sufferer from temporary aberration will be imported, unless this Amendment is accepted. If the Minister has hardened his heart against every other suggestion put to him this morning, here is an opportunity for him to accept a reasonable Amendment. One hon. Member this morning quoted a high authority, Sir Maurice Craig. Sir Maurice Craig happens to be on the side of the angels this time, because I notice that in a speech which he delivered to the National Council for Mental Hygiene he said:
"Mental disorder must not be regarded as synonymous with insanity."
Obviously, if it be not synonymous with insanity, the treatment should be different. I find a very important statement on the subject in the report of the Royal Commission on Lunacy and Mental Disorder. The report states:
"Restriction of liberty is necessary only where the instability of the individual has reached the stage of being a danger to himself or to his neighbour, or is such that he is incapable of managing himself. In a slight or incipient case, compulsion is unnecessary or harmless."

The Parliamentary Secretary says "Hear, hear!" I should be very pleased to hear that these voluntary patients are not to be compulsorily detained in an institution. Detention is the very essence cf the Bill, as regard voluntary patients, directly they get into an institution. I know that they can come out afterwards, but an Institution is like this House, in that it is sometimes easier to get in than to get out, especially if the Whips are against you. This is what has caused the tear in the minds of many poor people. Their knowledge, their practical experience of the difficulty of escaping from these surroundings, makes them suspicious of this provision. If you really want to treat these poor people who have fallen into this first stage of mental trouble, you must do something to encourage their to accept the remedial treatment that you are prepared to offer, and you must not associate it with something which creates a barrier in their minds from the start.

Does the Parliamentary Secretary or anyone who is championing this Bill suggest that the ordinary lunatic asylum is the place in which to treat these people? Is it suggested than for those who require rest or new surroundings, who require to be taken out of themselves and to have new interests provided for them, a mental hospital or lunatic asylum is an ideal place to which to send them? Such an institution is what it purports to be, a place for the detention of lunatics who are dangerous to themselves and to society. The "Lancet" said a little while ago:
"If a person with mental disturbance voluntarily asks for treatment in a hospital or home, why should he, more than any other invalid, have to he noticed to the Board of Control?"
There seems to be no ground whatever for saying that a voluntary patient should be treated in exactly the same way as a hopeless lunatic. The retention of this Clause will defeat the real object of the measure. If the desire is real that these people should be treated in the early stages of their affliction, that they should be taken in hand in the hopeful stages before the dangerous stage has been reached, a drastic rule of the kind suggested here will not do. I admit that there are some other places to which they might go, but as the provision is so in- adequate and as admittedly there is no provision yet in the ordinary institutions for such cases, why press the issue at this point? Why send people into an institution to receive treatment which they cannot get, which is not provided for and for which provision will need to be made in future? If we seek to do the best that can be done for these people, we shall seek to make it easy rather than more difficult for them to accept whatever treatment is available.

There is a great deal of difference between the degrees of mental aberration. I remember that a famous judge was hearing a case on one occasion, and counsel, who desired to disturb the credibility of a certain witness, turned to the judge and said, "You know, my Lord, this witness's testimony ought not to be accepted, because he is what we call 'a little bit cracked'"; to which the judge retorted, "Oh, but that is no argument at all. We are all cracked. It depends on the width of the crack." Whether a patient has a wide crack or a narrow crack, he will go to the same institution under this Bill. Our plea is for a real discrimination, and that until you have made satisfactory provision for the treatment of these people in our present public institutions, you should not by this Bill take any step to put them into an ordinary lunatic asylum.

I appeal to the Minister to make some concession on this point. We are dealing with one of the most difficult subjects that any Member of the House can be asked to consider. We are sailing in uncharted seas. There is no man here, layman or doctor, who can lay down the laws which govern the realm in which we are venturing to tread. There is more than party loyalty at stake in this matter; there is human liberty, a far greater thing. Even though we may be defeated on this Amendment we know that in bringing it forward we are voicing the fears and the needs of a great mass of the poorest of the afflicted people of the country. We are on holy ground, and we ought to take off our shoes and not apply mechanical methods which suit other cases to the cases that we are considering at the moment.

I beg to second the Amendment.

I hope that the Parliamentary Secretary will be able to move towards us in this matter. The purpose of the Amendment is one which no one could oppose. It is, in effect, asking that no voluntary patient, unless that voluntary patient is of unsound mind, shall be admitted to a lunatic asylum and I venture to think that, either in this House or in the country, if a judgment were to be given on the merits of that question, those who are moving the Amendment would have no doubt of receiving a majority. I do not claim to be an expert on this subject but I became interested in it because for three years I was joint Secretary of the Prison System Inquiry Committee, and if I remember aright, the hon. Lady was a member of that Committee. During that investigation I discovered how very close was the relationship between mental instability and crime.

I admit, straight away, the point which has been made from the benches opposite, that a great many men and women would have been saved from the prisons of this country had it been possible to certify certain eases which were not certifiable in the past. But beyond those cases there is the great area of border-line cases, people who through anxiety, worry, poverty, unemployment, overcrowding, and the vicissitudes of the like of one kind and another, are rendered temporarily unstable. That is the type of case we are now discussing, and I wish to put forward the perfectly simple argument that that type of case is likely to be harmed rather than helped by being sent to a lunatic asylum. In the first place, such people will suffer from the mere association of the name. It may be said that the term "mental hospital" is to be used, but in the public mind that institution will be regarded as a lunatic asylum, and the mere association with the type of patient ordinarily to be found there will have a disturbing and what may easily be—temporarily at least—a decisive effect upon a patient whose mind is unstable and who is on the borderline. By proper treatment a patient of that kind could be brought back to sanity and stability but at the moment of crises, an association of the kind I have indicated may easily send such a person's mind in the other direction.

Secondly, there is the personal association with the actual lunatic population, which it is impossible to prevent within those institutions. I know that there are all kinds of laws in those institutions about segregation. There is 2.0 p.m. supposed to be no communication and no contact between various classes of patients. During the War I spent three years in another institution in which there was supposed to be similar segregation, and I know that those rules cannot be applied. Once you get human beings together in an institution, means of contact between them will be found. I can give an example from my own experience. For eight months I was kept in solitary confinement, yet during those eight months, without ever seeing the other prisoners, I was having communication with them every day. One knows very well that in an institution like a lunatic asylum you may attempt to segregate the lunatics from other classes of patients, but association will take place, and the effect is bound to be bad in border-line cases of the kind to which I refer.

Thirdly, I wish to argue that the effect of a lunatic asylum is bad in cases of mental instability because, inevitably, there is the fear that when one enters a place of that kind, one will never get out of it. That fear may not be real, but it is not necessarily the real fears which are decisive factors in the state of mind which we are discussing. That fear, entering a mind which is already abnormal, may send that mind across the border-line. The view is widely held that once such people enter those institutions it will be extraordinarily difficult if not impossible for them to get out again. What is the alternative? The alternative surely is to develop under local authorities, under the public health authorities, institutions intended for dealing with these cases, with the type of psychologist who can deal these cases in a curative way, and with the proper type of treatment generally for these cases. It is because we wish to see a positive and constructive medical health service developed under public authority and under the control of the Ministry of Health, and to prevent people of unstable mind from being sent to lunatic asylums, with the danger that they will become lunatics themselves, that we press this Amendment on the hon. Lady and on the House.

This discussion has, to a considerable extent repeated what we have already had in previous discussions, but that is almost inevitable when we are dealing with matters which are so closely related. There is still in the minds of hon. Members, I think, considerable confusion on this subject. The Mover of the Amendment spoke of people who were suffering from a "Temporary derangement; but the people of whom we are now speaking are not people who are suffering from temporary derangement. These are people who are worried, who are oppressed with trouble, who are no more deranged than the hon. Member himself but who desire a specialist's care and attention. They are people who are so tired, or worried, or unhappy, that they think they may go out of their minds. Then hon. Members are continually using the expression "sent to these institutions." The class of persons of whom we are speaking cannot be "sent" to institutions. The people who can be sent are people of unsound mind, who are incapable of managing their own affairs, who either have been certified under the Lunacy Acts or who will, we hope, come under Clause 5 of this Bill—the people who cannot say "Yes" or "No."—

I understand that these people make written applications. In such application can they state specifically that they do not want to go to an asylum?

They can make application to be received in an institution, but they can no more be taken against their will into a lunatic asylum than any Member of this House could be taken, and I wish to make that point quite clear. There is no question of "sending" these people to institutions. They have to ask before they can go to any institution registered for this purpose.

They ask to go to some institution where they can be looked after, but they have no voice in saying, after they have asked, "No, that is a lunatic asylum; I did no; mean to go there."

They have to apply to the person in charge of a particular institution to be received in that institution. These people do not make a demand in the air, as it were. They ask to be received in this, that, or the other place where the individual doctor or the reputation of the place is likely to attract them. They can no more be pushed into a place than can any Member of Parliament. They are free people, who are asking for treatment at the hands of a particular institution, and I want that to be quite clear, because that would remove a very great part of the fear of which we have heard. If people have this horror, this terror of the term "mental hospital" or "asylum" they will not go there.

These people are not new cases at all. Ever since the Lunacy Acts were passed, private institutions have been allowed to receive people under their care on voluntary application, and they are protected by a Section in the Lunacy Act. People can go into registered hospitals now, and they do so. In the registered hospitals are certified lunatics and voluntary patients. There is a large number of persons in the 14 registered hospitals in which in some wards there are lunatics and in some wards there are people who are not certified. Scotland has caused a good deal of trouble. Scotland has the Edinburgh Royal Asylum, which is a mental hospital. We have changed the name from "asylum" to "mental hospital." Under treatment in the Edinburgh Royal Asylum are 281 voluntary patients and 772 certified lunatics. It may appear strange that any person should go to a mental hospital voluntarily, but it appears from these statistics that they do, especially those suffering from depression, who form the majority, and who desire protection and treatment.

No, they are not mad. They cannot be certified: they are people suffering from depression, from worry, from what we call nerves, and they can no more be sent anywhere than you yourself, Mr. Deputy Speaker, can be. I put it as high as that, because these people are perfectly sane people.

They are not certified, and no one in the world can send them anywhere. They are not lunatics, but people who are a little worried about themselves, and they do go into these institutions that deal with all classes of cases between lunacy itself and the mildest forms of mental worry. The objection raised to these people being treated in mental hospitals is part of that old, stupid superstition which considered a lunatic to be an accursed person. There is no clear-cut medical distinction between a case of hopeless melancholia and the person who, like any one of us, may become depressed. If hon. Members agree to that, what is the sense of saying that the same institutions should not be allowed to treat the extreme forms of a disease and the mild forms of the same disease? The doctor best qualified to look after the very mild cases that are not over the borderline ought to be a man with experience in the advanced stages of the disease, and anyone who attempts to draw a line between melancholia and the depression which may lead to melancholia is still under the spell of the absurd old delusion that lunacy is an affliction from the devil himself.

These people may also go to any one of the different forms of institution mentioned in the Bill, and I think very likely that with the enormous amount of fresh institutions coming into the hands of the local authorities, where public opinion would allow it, they may set apart separate buildings if they find a reluctance on the part of the voluntary patients to go into the other places. The local authorities have undertaken the voluntary patients, and if there were many people in a town who looked at the mental hospital in the same way as do some of my hon. Friends, I think they would provide separate institutions for these voluntary patients. But people do go into these general institutions. People now flock to Edinburgh and to the private institutes and the private practitioners who may take people into their houses. There are hardly any places in England and Wales, except the two London County Council hospitals under a special Act, where local authorities can take in voluntary patients without their being certified. It is an insuperable barrier. Some people say that certification does not matter, but people do mind certification very much indeed, and no human creature would wish voluntarily to be certified.

As the hon. Lady has referred to the Edinburgh Institution, may I say that my information is that the numbers are considerable—I agree with her figures—owing to the fact that a large number of people go into the institution because they are unemployed and have been for a long spell. They find that they get there considerably better food than in almost any other place. Their choice is between this institution and a Poor Law house, where their food would be very much inferior.

If that is so, it is a very serious thing, but I am afraid that the people of which my hon. friend speaks would not be admitted unless they had been certified to be a little mentally ill. It is quite true that misery and unemployment might send men and women off their mental balance, and it may be that the people of whom my hon. Friend speaks have been thrown off their mental balance by poverty and misery. If so, I am glad that. they applied to the asylum, because they would be properly looked after there. Those who support this Amendment, whether they know it or not, are doing their very best to wreck the Bill, and to deprive these people of their chance of getting treatment. We are all experienced politicians here, and we all know that you are not doing a Bill any particular good when you prolong its passage, and, if we want to give these people the liberty of applying for treatment, we shall get this through as quickly as possible and not spend so much precious Parliamentary time in arguing over details. I hope we may have this Clause without very much more discussion.

The hon. Lady, I think, quite innocently, perhaps, has overstated the case of the voluntary patient when she insists so much that voluntary patients have been going into mental hospitals for many years. That is perfectly true, but, if I may say so with respect, it is not exactly the case that we shall have in the future. She knows as well as I do that voluntary patients can be admitted now into a mental hospital, and you will find at the present time voluntary patients in our hospitals with suicidal tendencies, cases of mild mania and also cases of general paralysis.

I do not mean to deny that some of such patients may be cases for certification. I was emphasising the fact that there is no perfectly clear line of demarcation.

At present there are a large number of these voluntary patients really of unsound mind, but who have been able to recognise that it is to their advantage to put themselves under treatment by going to these places and remaining there, because it is the best place for their health. We must also bear in mind that the number of voluntary patients has been increased lately, first of all by the fact that the relatives have been so afraid of certification that they have persuaded them to go as voluntary patients. Another large part of the number, I am afraid, is due to the fact that medical men have refused to certify on account of the financial and legal difficulties which may ensue later on. I have the greatest sympathy with this Amendment, because I maintain that the very worst thing that could happen to an early case would be to find himself in an asylum. What would happen to this poor worried and harassed patient to which the hon. Lady referred so feelingly? The medical man says to him, "The best thing for you to do is to put yourself in some place where you can have the benefit of this Mental Treatment Act," and the patient says, "Very well, doctor, I am perfectly willing to do. this." When he hears that the only place to which he can go is the asylum or mental hospital, the patient says, "I am not going to an asylum."

At the present time, however, we have not other accommodation for them, and so, although I am bitterly opposed to sending them to these mental hospitals which are already overcrowded, I recognise that there will be some mental cases who are anxious to have something done, and the point we have to stress is that by this Bill we must exert pressure upon the local authorities to see that they supply other places which are not mental hospitals, that is, voluntary general hospitals. Under the new Local Government Act, the borough or county authority can establish what may be called convalescent homes for those cases, with no suggestion of the asylum environment, the only thing being that, of course, these patients would have to be looked after by a medical man with some experience of the subject. We want to push on with that, and that is why I agree with the hon. Member that we may have 100 patients anxious to receive the benefits of this Measure and there is no place for them to go. Therefore at the present time we must include the mental hospitals. But, as the hon. Lady so truly said, people cannot be sent there, and they are in the position that if they want treatment they must either go to these mental hospitals or not get treatment. Though I have the greatest sympathy with the hon. Members, I shall not be able to support them in the Division on this Amendment.

It is just as well that we should come back to the actual Amendment, which is quite simple. It is a proviso saying that under this Clause no one who is not a certifiable lunatic shall be sent to a lunatic asylum. The hon. Lady, in arguing against this Amendment, treated it as though we were arguing against the whole Clause. Nothing of the sort. We accept the Clause, but with the proviso which says that no sane person shall be sent to a lunatic asylum. The hon. Member made the point clear that if you put this proviso in, many people who apply for this treatment will not be able to get it, because there is no place for them, and he rightly said that all sides of the House wish to see as many of these mental hospitals as possible devoted specially to this class of case. We want to get local authorities to do their duty. If these words go through, they will have to refuse treatment where they have not got accommodation.

I maintain that this will stimulate the increased supply of special places, and I say that the more strongly in view of what the hon. Lady herself said. She looked at this question, not from the point of view of the individual, but from the point of view of the institution. She said it was much better for the institution and the doctors to have the same institution dealing with the elementary cases and the further cases, and that it was the same doctor who dealt with both. That is a most dangerous thing, and will lead local authorities to use the asylum instead of the disused Poor Law buildings which will be available. Are we really to suppose that for all time the majority of these voluntary cases will be sent to the lunatic asylums, or are we to look forward to a time when the local authorities will either have to put up new buildings, or to take over the old Poor Law buildings, in order to provide special hospitals for voluntary applicants? The latter alternative is that to which we should look forward, and what we are likely to get if we carry the Amendment.

I should like to add one or two words to support the point of view which was put by the Parliamentary Secretary in her defence of the Clause as it stands, and in support of my hon. Friend the Member for Royton (Dr. Davies). Again and again the right hon. and gallant Gentleman, the Member for Newcastle-under-Lyme (Colonel Wedgwood) makes the misstatement that these people will be sent to an institution. It is a deliberate mis-statement—

Perhaps I should say that they are going to apply to an institution, and will find themselves in some place which they do not expect.

We all do that if we do not look where we are going. If the right hon. and gallant Gentleman would only read the Bill, he would understand the point, but I am certain that he has not read the Bill. What he has said again and again this morning shows that he has not read it.

If the hon. and gallant Gentleman has ever put down 20 Amendments to a Bill, he will know that it would be a remarkable thing to do without having read the Bill.

I think that the right hon. and gallant Gentleman is quite capable of carrying out that remarkable feat without reading the Bill. At any rate, if he has read it, he has not digested it, and I suggest that he should go away and get a little better mental digestion. These mental patients are to make a written application to the person in charge of the institution. They know what the institution is, because they have to make this application to the person in charge. The hon. Member for Loughborough (Mr. Winterton), who moved the Amendment, like the right hon. and gallant Gentleman the Member for Newcastle-under-Lyme, is a conservative and a reactionary of the deepest dye. They both talk as if there were a division between lunatics and people who are not lunatics and whom we are trying to help in this Bill. The Parliamentary Secretary has tried to disabuse them of that idea. The idea that you cannot draw a line has been at the root of all progressive ideas of treatment of mental illness for the past 20 years. Is it in the interests of the lunatics that they should be considered for ever as incurable? Medical science says that they are not insurable, and, though we never know in any individual case that it is curable, there is no border line between the two. You might just as well try and get two separate institutions for the incurable and the curable cases of heart disease. Nature is so recuperative that you cannot say that the one case which is supposed to be incurable will not show a sudden and unexpected improvement. You cannot have a hard and fast distinction between the two sets of cases.

What is the ideal towards which we are looking The hon. Member for Royton has thrown out a most reasonable suggestion. We look forward to the time when local authorities will have institutions which one might call convalescent homes, in which people seeking rest may go for treatment for a time. I hope that eventually that may be a possibility, anti that ultimately it will not be confined to mental cases, but that menal illness will be treated as part of general sickness. The Parliamentary Secretary said that these people have to be treated by those who understand the subject. Hon. Members seem to have forgotten the fact that the number of members of the staffs of hospitals, who are experts, is limited, and I should like to ask those who are supporting the Amendment whether they really want to have experts looking after these patients or not? Judging from the vituperation of the right hon. gallant Gentleman the Member for Newcastle-under-Lyme, he does not approve of the expert, and one would imagine that, if he wanted an operation performed on himself, he would want to be treated by a blacksmith. Most people want to be treated by those who understand the subjects, and mental cases must be treated by mental experts.

The framework of the Bill is to give the very best expert professional and nursing attention to these patients whether they are sliding down the hill, or have already slid down the hill. The object is to fix up a strong Board of Control which shall not be at the mercy of the experts, to decide when these patients shall go into the hands of the experts, and how long they shall remain there; under what conditions they shall go in, and under what conditions they shall come out; and in what way their freedom of movement in and out can be facilitated. The expert control must be kept, and you cannot suddenly devise new institutions, because there are not the new experts to run them. This Amendment is merciless towards the patient. There are innumerable people who are longing to see this Clause put into force, because it would enable them to recover their sanity and to face the world. There are cases, especially of people in small houses, with large commitments and families, and with circumstances much against them, who want the seclusion and quiet of rest.

It is all very well for people to come forward, like the hon. Member for Loughborough and others who support the Amendment, and say that the ideal thing is to have a new set of institutions all over the country. We know perfectly well that that will not be practicable within 20 or 30 years. Therefore, this Amendment would condemn these people by refusing to allow them to go into the county asylums, however well and kindly they may be managed. I am not responsible for the details of other counties, but I know a good deal of my own county. I know that the institution there has the confidence of the great mass of people in the county, and that there are many who would be only too delighted to avail themselves of that institution. There we come to the acid test. Is this House going to pass this Amendment and refuse to allow the people who are calling out for this kind of rest and quiet treatment to go into the Hill End Asylum outside St. Albans? That would be a cruel and brutal thing to do in defence of some dogma of one kind or another.

I intervene only to call the attention of my hon. Friend responsible for the Amendment to the fact that it lacks coherence. The Amendment "looks to" a person of unsound mind within the meaning of the Statute, that is to say, a person who is incapable of exercising volition; but it says that if such a person chooses to apply as a voluntary patient he shall not be sent to a particular institution. Therefore, the Amendment contemplates that a person who is incapable of exercising volition does so exercise it, and I suggest that it ought not to be accepted.

I wish to support this Amendment, and I am convinced that if the hon. Lady were applying her own mind to this Bill the Amendment would be accepted. It is in the latter part of the Clause that there are the possibilities of danger for the patients with whom we are concerned. A man might find himself in a different institution from that to which he had applied to go. I regard this point as vital if advance is to be made, and, with all due respect to the medical fraternity, I would say that this is not the only line of advance in which they have not led. There is no necessity to disparage blacksmiths. They are doing bone-setting better than the doctors.

Does the hon. Member wish to suggest that the medical profession have not led in the progress of mental science during the past 20 years?

I consider that what advance is being made is due very largely to the lay experience of people who have gone through those vicissitudes of life, which we all deplore, and I submit that this question has now become a vital public issue as the result of pressure out with the ranks of the experts. I am not at all surprised to find that the experts identify themselves with the official position which has been taken up in regard to the treatment of cases. If the same advance had been made in our knowledge of how to deal with mental depression that has been made in the treatment of bodily afflictions, we should not have had to discuss this subject today. The treatment would have been available already, separate treatment.

I know of a private institution where treatment was given by a lady with marvellous results, and if that experience—which I admit has not been on a very extensive scale—had been followed up by the members of the medical fraternity with the aggression which we should expect of them as leaders and not as followers, institutions of the class required would have been established long ago, and the power of the Board of Control would have been broken down. We have had case after case—appalling tragedies—of people going into those institutions commonly known as asylums and it being almost impossible to get them out—even in cases where they have gone wrong through intoxicating drink. They have been left there and they have died there. I am convinced that if such people had had the opportunity of getting the treatment which I have indicated substantial results would have been obtained.

I thoroughly agree with the hon. Member who said that here we are giving a definite legal imprimatur to the local authorities. If we throw the onus on the local authorities, that will be the responsibility of the Government. I have had an interview with the Minister of Health as to this particular point and I understand his point of view, that though we may desire a much greater advance it is the financial aspect of the matter which is the trouble; but I consider that no question of money ought to stand in the way of safeguarding the mental health of our people and assisting them to recuperate, so that they may have an opportunity of starting anew in life. I have known such cases. We should certainly expect of a Labour Government that they would make it plain in the Bill that no person in the incipient stages of insanity should be relegated to what is known as an asylum, but should have the opportunity of getting other treatment of a kind which experience has shown has given good results.

I have an Amendment on Clause 5 which really serves the same purpose as this Amendment, and I desire to say a word or two as to why I shall vote in favour of this Amendment and cannot support the view put forward by the hon. and gallant Member for St. Albans (Lieut.-Colonel Fremantle). I am as anxious as anyone that people who are in the position contemplated by this Clause should have every facility for early treatment, but I am convinced that the very worst thing would be to put them into the atmosphere of an asylum or a mental hospital. Suppose that a person were capable of applying for this early mental treatment and that then a brain disturbance supervened and when it had passed he woke up to find himself in a mental hospital. What would be his feelings if by chance he had read the conditions of this Bill and knew that under Clause 5, Sub-section (14) the Board of Control might at any time deal with a temporary patient as a person of unsound mind? He would realise that he was in an asylum and might never get out.

That being the position, the result would be that we should prevent the people who ought to apply for this temporary treatment from applying, because they would be afraid of doing so, and we should render the whole Clause nugatory. In many cases where the mental stability of a person is just on the balance by placing him in a public asylum where the majority of the other patients are of unsound mind, you would be doing the very worst thing you could possibly do in his interests. I do not go so far as the hon. Member for Dundee (Mr. Scrymgeour), and on account of the expense I do not agree that all these institutions should be created at once, but at the same time I think there ought to be places where these people could receive proper treatment from experts. We ought to treat these people outside lunatic asylums, and we should not mix up the sane with the insane population. If people want early mental treatment, we should make it impossible that they should find themselves inside a lunatic asylum without any chance of getting out. That is not the way to proceed in this matter, because the Bill is intended as a curative Measure.

Question, "That the Question be now put," put, and agreed to.

Question, "That those words be there inserted in the Bill," put accordingly, and negatived.

I beg to move, in page 1, line 19, to leave out Subsection (2).

This is the Sub-section which deals with a person under the age of 16 whose parent or guardian desires to submit him to treatment for mental illness. I think that is a very dangerous principle to establish. This is a proposal which does not very much affect the poor, but it is in cases where money is involved in the guardianship that you have most need of a judicial investigation before a patient is taken into an institution. Most of the cases of children under 16 are those of abnormally developed children, and we have to guard against the odd case where advantage might be taken of this Clause to get children put away into institutions where they are actually shut up, because their release from that institution depends upon the guardian or paren who has asked that they should put put into the institution.

I have been told so often that I do not know this Bill that I am very 10th to make any positive affirmation about it, but I should like to ask some of these experts who do know all about it what there is in the Bill to prevent that sort of bad guardian or bad parent from so taking advantage of it. The Board of Control only inspects after the case has gone in. I would like to know what is the process by which the Board of Control, dealing with the whole country, is able to prevent cases of that sort from occurring. I dare say we all get exaggerated ideas of the terrors of lunatic asylums, but I read "Hard Cash" when I was young, and, although I have no doubt that lunatic asylums are quite different now from what they were then, the prospect of unfortunate children under 16—[Interruption.] I think it is a very good thing to read books of that sort. They may not be strictly accurate in every detail, but, by over-painting the picture, Reade got a good deal—

Would the right hon. and gallant Gentleman judge America by "Uncle Tom's Cabin?" I think very probably not.

Very probably the books we read in our youth are the ones that shape our political convictions. Certainly I have been inspired with the terror of people who are not lunatics getting locked up in lunatic asylums. I have no doubt that the Board of Control could extract a case if they came across it, but I am not satisfied that that is good enough when one thinks how small the Board of Control is and how large is the number of people who are certified. When you get a borderline case like that of a sexually precocious child, how is the Board of Control to know better than the doctor or the parent whether that child should be locked up or not? It is very important that these cases should be dealt with with great care when the liberty of a citizen, even a child, is concerned, and I think we ought to know from those in charge of the Bill whether there is anything in the Bill or in the existing law, beyond the supervisory power of the Board of Control, that would prevent any such injustice happening to a child.

I do not think that my right hon. and gallant Friend has really given as much attention to this Bill as he has to many other Bills. The object of this Amendment is to make is quite impossible for any minor to get the advantage of treatment as a voluntary patient—

It may be done in certain nursing institutions, but if it is going to be done in these nursing institutions, what becomes of the protection of the liberty of the individual? It disappears entirely. The only way in which it can be done with a certain measure of protection to the individual is under this Bill, which recasts and extends the law with regard to the treatment of voluntary patients. I think most people would agree that in the kind of cases mentioned by my right hon. and gallant Friend there ought to be some form of appropriate treatment. My right hon. and gallant Friend asks me what protection there is apart from the Board of Control. It seems to me that there is the best conceivable kind of protection.

If my right hon. Friend had read a little further in Clause 1, he would have seen that it provides that in the case of a minor, a person under 16, treatment as a voluntary patient is possible
"if the parent or guardian makes to the person in charge a written application for the purpose accompanied by a medical recommendation."
The medical recommendation referred to is dealt with in Sub-section (3), and there is a further safeguard in Subsection (4). If it be admitted that in the case of, say, the sexually precocious or abnormal child it is necessary that there should be some form of 3.0 p.m. treatment, I can see no better way than this. After all, it is a medical question, and if the desire of the parents—which may be an honest one, or may be an impure one in a very small minority of eases, where there are estates at stake and so on—is checked by a medical practitioner with the safeguards laid down in Sub-sections (3) and (4), I think you have all that it is possible to get. Under Sub-section (3) the medical recommendation must be signed by a medical practitioner who is the usual medical attendant, or by some other medical practitioner approved by the Board of Control or by the local authority. In the next place, it must state his qualifications and so on, and not only so, but that
"the said person is likely to be benefited by being received as a voluntary patient for treatment for mental illness under this section."
The doctor is called upon to make a definite statement, in which his professional honour and reputation are at stake. Sub-section (4) goes further, and says:
"A medical recommendation shall cease to have effect for the purposes of this section on the expiration of fourteen days from the last date on which the person to whom the recommendation relates was examined by the medical practitioner for the purpose of making the recommendation."
If it is desired, and I think it is desirable, to make provision for the treatment of minors as voluntary patients, I think it must be done in this way, with the protection that is afforded in the Bill.

This Debate has probably given some Members on this side an opportunity of seeing an entertainment which we are not usually allowed to witness—that of a Socialist party meeting. The right hon. and gallant Gentleman the Member for Newcastle-under-Lyme (Colonel Wedgwood) accused the Bill of being rather the act of a tyrant, and the Minister said that his right hon. and gallant Friend had not read the Bill. As the Minister was kind enough on one occasion in Committee to explain to the Committee that he thought that the hon. Member for Torquay knew all about it, I will not make a long speech on this occasion, but will put the matter quite shortly, so that the right hon. and gallant Gentleman may understand what would be done by this Amendment. I realise his or anyone else's difficulty in following the extraordinarily long speeches we have had from the Front Bench, long and complicated, and very often of an extraordinary nature. All that happens under the Sub-section is this. If you omit it, you prevent children having the possibility of cure. There is a complete protection for the child if you look over the page, because the child can only get in if the parent or guardian desires it, and no child can possibly get in of its own wish. There is the further necessary protection that you should have a certificate from a medical person. Under these circumstances, you are giving the fullest amount of protection that you can as far as this section of the community is concerned. I could find fault if I wished with the Sub-section, but it is not to the advantage of the Bill to do so. I will only make a personal appeal to the right hon. Gentleman to withdraw his Amendment.

The Sub-section seems so strangely confused in its drafting that I should like to raise a point for the consideration of the Minister. It provides for the reception of those under 16 as voluntary patients. Does a voluntary patient mean a person who goes to the institution of his own free will or not? The Sub-section provides clearly, possibly rightly, for the parent or guardian in suitable cases to make application, with the safeguards that are set out, that it shall be possible for these people to be received in the institution, but that is entirely contrary to the wording, because it is implied that these young persons are put into the institution involuntarily, and there is no suggestion throughout of any consent being required from the young person. Yet in the teeth of those declarations these people are described as voluntary patients. It is not an insuperable difficulty, because it would be quite easy to have so drafted the sub-section that such a person should be deemed to be a voluntary patient, which would be a sensible way of drafting it. As it stands, it is a contradiction in terms. It provides for no person being received into an institution against his will and inclination, and yet it describes them as voluntary patients, which makes the Subsection absurd.

It is rather an extraordinary thing that you should insist on having a magistrate for certification, and in other cases later on you have two doctors, and here for these children your sole safeguard is one doctor's certificate, though it is true it is repeated every 14 days. I do not think the protection is adequate, but evidently the House does, so I do not propose to press it.

Amendment, by leave, withdrawn.

CLAUSE 2.— (Notice of reception, death and departure of voluntary patients and provisions as to discharge of patients.)

I beg to move, in page 3, line 14, after the word "incapable," to insert the words "in the opinion of a magistrate."

This Amendment was argued at great length upstairs. I do not know what the right hon. Gentleman's arguments were to reverse the ordinary procedure. I have often been asked to give a certificate and it is not very much of a safeguard to the unfortunate people, but at the same time it is the business of the judiciary to be responsible for incarceration and not the business of doctors. In fact, I should say the chief reason for having a magistrates' certificate on the order for certification is that it takes some of the responsibility off the doctors, who are only responsible for the state of the person's health, whereas the further question of whether in the interests of the public the individual should be incarcerated should rest, I maintain, with the lay members of the community. The argument which has been advanced for withdrawing this protection—far too weak as I think it—is that people who are certified hate having to go before a magistrate. People who are being certified do not, I am afraid, generally know very much what is going on. If there are cases of people who are sufficiently sane to resist the idea that the word of a doctor should be final, I feel that the actual fact that a magistrate can be seen and possibly support them against the doctor is something of a safeguard and should be preserved in the law. Subsection (3) of this Clause says:
"If any person received as aforesaid becomes at any time incapable of expressing himself as willing or unwilling to continue to receive treatment, he shall not thereafter be retained as a voluntary patient for a longer period than one month."
Who has to decide as to whether a person is incapable of expressing himself as willing or unwilling to continue? If you leave it to the doctor or to the superintendent in charge of the institution, you will be leaving in their hands the vital power to decide whether the temporary boarder is to become more or less a permanent inmate of the place. Therefore, you are subjecting the temporary boarder to the particular test and risk to which the ordinary person when he is certified and goes to a lunatic asylum has been subjected. That seems to be the time when the patient should be out of the hands of the doctor and of the superintendent of the institution, and able to get his voice heard by other people outside. All that I have asked is, that after the word "incapable," there should be inserted the words "in the opinion of a magistrate." This is not certification.

You may use all the arguments you like against the magistrate coming in and helping to certify a patient. At the moment when the boarder in an institution changes from being a voluntary boarder and becomes a detained boarder, it is vital that the man should have some outside help. In fact, the good sound principle of English Law is that no man should be incarcerated without an appeal to Law. It is being taken away in the case of the transfer of a man from the position of temporary boarder to that of a permanent boarder. I have been discussing this matter with the hon. Member for Cambridge University (Sir J. Withers), with whose views I do not always agree, and as a lawyer, he was anxious to stop and support this Amendment on the ground that it was desirable to preserve this safeguard. I ask the Minister of Health whether it would not be possible to meet the opposition to this Bill by accepting this simple Amendment. It does not interfere with the principle of the Bill in the least. It merely gives to the patient one safeguard to prevent his becoming a permanent inhabitant of the institution. If he is judged,
"incapable of expressing himself as willing or unwilling to continue to receive treatment, he shall not thereafter be retained as a voluntary patient for a longer period than one month, and shall, if he has not been previously discharged, be discharged on the expiration of one month from the date on which he became incapable of so expressing himself, unless in the meantime he has again become capable of so expressing himself—"
Then come the fatal words,
"or steps have been taken to deal with him either under the principal Act as a person of unsound mind or under section five of this Act as a person who is likely to benefit by temporary treatment."
If these words remain in, he can be transferred from Clause 1 to Clause 5 without having anybody except the superintendent deciding what shall be done with him. This provision might be improved if we gave him a chance of seeing a magistrate and the magistrate had a chance of saying whether he had sunk from the category of a voluntary boarder into that of a person who is incapable of "expressing himself as willing or unwilling." That is a test which a magistrate can decide much more easily than in many cases he can decide a case of certification. Such an Amendment would prevent a certain number of cases of injustice and would give to the temporary boarder an added degree of security, which would make him more willing to adopt the voluntary treatment that he would be in other circumstances.

We are here up against a clash of principle. I am all for the exclusion of magisterial interference to the largest possible extent. That was one of the conclusions at which the Royal Commission, after very full consideration of this question, arrived. My right hon. and gallant Friend wishes to include a little more magisterial supervision and control in the Bill. Obviously, therefore, this is an Amendment which we cannot accept. The point of the Amendment is this: a person goes into an institution as a voluntary patient, and subsequently his condition deteriorates and he passes into the category of the Clause 5 cases. In circumstances of that kind, the Amendment suggests that there should be the intervention of a judicial authority, on the ground that a justice of the peace is in a better position to determine the question as to whether the person is a Clause 1 or a Clause 5 case, than the medical people under whose care he has been.

I want to get mental disease out of the kind of hugger-mugger atmosphere in which it has dwelt for so long. Mental disease is in no wise different from physical disease except as regards this question of personal liberty. Even there the difference is more apparent than real, for in a case of highly infectious disease, where is the liberty of the subject? It is as non-existent as in a case of mental disease. If we can get rid of judicial interference and, therefore, get away from the stigma of certification, which was proved over and over again to the Royal Commission to be a stigma that meant something, we shall help these unfortunate people.

The real objection to the justice of the peace is that his intervention has always been associated with certification. In Clause 5 we have departed from the recommendation of the Royal Commission. They also wanted to get away from the use of any judicial authority, but they elaborated a procedure which got so close to it that, in fact, it would not have been possible to distinguish it from certification; therefore, we cut it out. If we cut it out in the case of people who are incapable of expressing a desire one way or the other, then clearly we must follow the same procedure in this case. If this Amendment is accepted the stigma which attaches to certification will be imported into the cases of people who are voluntary or temporary patients under Clause 5.

I hope the right hon. and gallant Member will not press this Amendment. The intervention of magistrates in these cases is harmful, and I speak not only as a medical man, but as a magistrate. The less you bring the atmosphere of the criminal law into this business the better. In the mands of most of the people with whom you are dealing, the poorer classes of the community, magistrates are always associated with the criminal law. I suggest that the procedure in Scotland is a splendid example to follow. For over 70 years there has been no magisterial intervention at all in regard to these cases, neither is there any magisterial intervention in Ireland. In England this question is mixed up with the criminal law. The Royal Commission in their Report say that after a careful examination of the matter in no case could they find any instance of wrongful detention in these institutions, and that in no case was there any doubt as to the propriety of the certification. Does the right hon. and gallant Member suggest that in a case where one or two medical men give a certificate there is any magistrate in the country who would countermand the order?

This is not a question of certification, but of a man in the institution. The question whether he is incapable depends on the superintendent of the institution.

I can find no instance in the Report of the Royal Commission in which any magistrate has actually countermanded or gone against the medical certificate. From that point of view what is the use of magisterial intervention? I suggest that we should follow the procedure in Scotland, where there is a different atmosphere in regard to this matter, and where the system has worked with perfect amity and complete concord for over 70 years. The same thing is true of Ireland. It is quite sufficient justification for us to adopt the policy in this country.

I wish to refer to the great change of status in which the individual is involved under this Clause. A man enters an institution as a voluntary patient, and at some stage the medical officer in charge, or other doctor, decides that the man is incapable of expressing for himself whether or not he should remain. As the Bill stands that doctor can change the status of the patient from that of a free individual who volunteers to go into the institution into than of a person who loses all his rights.

I will put a practical case to the House. Suppose that other persons, relatives, allege that the doctor's view is wrong. That allegation may be completely unfounded. All that the Amendment says is that before the change is effected the circumstances shall be reviewed by some judicial person. The case has to go before a justice of the peace or some other person who is charged with the responsibility of finding whether on the evidence the change should be effected. It does not involve going into a court of justice, as the last speaker suggested; it can be carried out as most of the duties of justices of the peace are performed. The evidence is simply taken before the justice and he has to review the whole of the facts. In the interests of the subject this safeguard should be inserted, and I support the Amendment.

Could not the Debate be adjourned on this point? This change of status is rather a serious matter.

I shall be prepared to move the Adjournment of the Debate, but this question has been threshed to death and I want a decision at the earliest possible date.

Then I must reply to the arguments used against this very reasonable Amendment. You are asking the superintendent of the institution where a patient is to decide whether that patient shall be a voluntary boarder or shall, under Clause 5, become a perpetual inmate of the institution. The superintendent has an interest, or he may have an interest if it is a private institution, in detaining the patient. You leave the decision to him and there is no appeal against it to any court or to any magistrate. Under Clause 5 the patient is dealt with by two medical officers, and again there is no possibility of appeal to any court of law. The right hon. Gentleman alleged that the Royal Commission

Division No. 257]


[3.33 p.m.

Albery, Irving JamesDavison, Sir W. H. (Kensington, S.)Longden, F.
Atkinson, C.Ganzoni, Sir JohnMakins, Brigadier-General E.
Baldwin, Oliver (Dudley)Groves, Thomas E.Maxton, James
Beckett, John (Camberwell, Peckham)Hore-Belisha, LesliePeto, Sir Basil E. (Devon, Barnstaple)
Brockway, A. FennerJowett, Rt. Hon. F. W.Ramsbotham, H.
Buchanan, G.Kelly, W. T.Rathbone, Eleanor
Crookshank, Capt. H. C.Knight, HolfordRoss, Major Ronald D.
Dalrymple-White, Lt.-Col. Sir GodfreyLeighton, Major B. E. P.Sandeman, Sir N. Stewart

was opposed to any appeal to the judiciary. I understood that the Royal Commission urged that the appeal to the judiciary should be strengthened, that there should be a better means of securing justice for the certified person, and that the magistrate was not good enough. Here you are taking away the magistrate in the one instance where he could be very useful, and far more useful than in certification. You are taking away the law when the question simply is whether or not a man is incapable of expressing himself as willing or unwilling to continue to receive treatment. This is a definite matter upon which any independent and impartial person could judge, just as well as the person in the institution. If there is any moment at which a magistrate ought to come in and review a case of this kind, I should have said that this was the moment and I am sorry that the right hon. Gentleman will not accept my Amendment and insists on carrying this matter through now. I shall certainly divide the House on this Amendment and I hope that all who value the liberty of the subject, as opposed to the rule of this new tyranny of the bureaucratic expert, will vote in favour of the Amendment.

rose in his place, and claimed to move, "That the Question be now put."

Question put, "That the Question be now put."

The House proceeded to a Division

Mr. WILLIAM WHITELEY and Mr. HAYES were appointed Tellers for the Ayes, but there being no Members willing to act as Tellers for the Noes, Mr. SPEAKER declared that the Ayes had it.

Question put accordingly, "That those words be there inserted in the Bill."

The House divided: Ayes 30; Noes, 192.

Sandham, E.Stephen, CampbellTELLERS FOR THE AYES.—
Scrymgeour, E.Williams, Charles (Devon, Torquay)colonel Wedgwood and Mr. Kiniey.
Southby, Commander A. R. J.Winterton, G. E.(Leicester,Loughb'gh)


Adamson, Rt. Hon. W. (Fife, West)Grenfell, D. R. (Glamorgan)Parkinson, John Allen (Wigan)
Adamson, W. M. (Staff., Cannock)Griffith, F. Kingsley (Middiesbro' W.)Penny, Sir George
Ainsworth, Lieut.-Col, CharlesGunston, Captain D. W.Perry, S. F.
Aitchison, Rt. Hon. Craigle M.Hacking, Rt. Hon. Douglas H.Pethick-Lawrence, F. W.
Alpass, J. H.Hall, G. H. (Merthyr Tydvil)Phillips, Dr. Marlon
Ammon, Charles GeorgeHall, Capt. W. P. (Portsmouth, C.)Picton-Turbervill, Edith
Angell, NormanHamilton, Mary Agnes (Blackburn)Pole, Major D. G.
Arnott, JohnHamilton, Sir R. (Orkney & Zetland)Ramsay, T. B. Wilson
Asks, Sir RobertHannon, Patrick Joseph HenryRichardson, R. (Houghton-le-Spring)
Ayles, WaiterHardle, George D.Rodd, Rt. Hon. Sir James Rennell
Baker, John (Wolverhampton, Bilston)Hastings, Dr. SomervilleRomerll, H. G.
Baldwin, Rt. Hon. Stanley (Bewdley)Haycock, A. W.Rosbotham, D. S. T.
Barnes, Alfred JohnHenderson, W. W. (Middx., Enfield)Rowson, Guy
Benn, Rt. Hon. WedgwoodHoffman, P. C.Salmon, Major I,
Benson, G.Hopkin, DanielSalter, Dr. Alfred
Bentham, Dr. EthelHudson, Capt. A. U. M. (Hackney, N.)Samuel, A. M. (Surrey, Farnham)
Berry, Sir GeorgeHudson, James H. (Huddersfield)Samuel, H. W. (Swansea, West)
Bowen, J. W.Hutchison, Maj.-Gen. Sir R.Sanders, W. S.
Bowerman, Rt. Hon. Charles W.Isaacs, GeorgeSavery, S. S.
Broad, Francis AlfredJenkins, W. (Glamorgan, Neath)Sawyer, G. F.
Brothers, M.John, William (Rhondda, West)Sherwood, G. H.
Brown, C. W. E. (Notts, Mansfield)Jones, T. I. Mardy (Pontypridd)Shield, George William
Brown, Ernest (Leith)Jowitt, Rt. Hon. Sir W. A.Shiliaker, J. F.
Buckingham, Sir H.Kennedy, ThomasShort, Alfred (Wednesbury)
Burgess, F. G.Kenworthy, Lt.-Com. Hon. Joseph M.Simmons, C. J.
Burgin, Dr. E. L.Lansbury, Rt. Hon. GeorgeSinclair, Col. T. (Oueen's U., Belfst)
Buxton, C. R. (Yorks. W. R. Elland)Law, Albert (Bolton)Smith, Alfred (Sunderland)
Buxton, Rt. Hon. Noel (Norfolk, N.)Lawrence, SusanSmith, Ben (Bermondsey, Rotherhithe)
Cameron, A. G.Lawrie, Hugh Hartley (Stalybridge)Smith, Frank (Nuneaton)
Carter, W. (St. Pancras, S.W.)Lawson, John JamesSmith, Rennie (Penistone)
Charleton, H. C.Lawther, W. (Barnard Castle)Smith, Tom (Pontefract)
Carter, DanielLeach, W.Smith, W. R. (Norwich)
Clarke, J. S.Lees, J.Smithers, Waldron
Cocks, Frederick SeymourLittle, Dr. E. GrahamSnell, Harry
Compton, JosephLlewellin, Major J. J.Somerville, A. A. (Windsor)
Cove, William G.Lovat-Fraser, J. A.Stewart, W. J. (Belfast, South)
Cranbourne, ViscountMacdonald, Gordon (Ince)Strachey, E. J. St. Los
Daggar, GeorgeMacDonald, Rt. Hon. J. R. (Seaham)Strauss, G. R.
Dalton, HughMacDonald, Malcolm (Bassetlaw)Stuart, Hon. J. (Moray and Nairn)
Davies, Dr. VernonMcElwee, A.Taylor, R. A. (Lincoln)
Denman, Hon. R. D.McEntee, V. L.Thomson, Sir F.
Dickson, T.Mansfield, W.Thurtle, Ernest
Duckworth, G. A. V.March, S.Tillett, Ben
Dugdale, Capt. T. L.Markham, S. F.Tinker, John Joseph
Dudgeon, Major C. R.Marley, J.Tout, W. J.
Duncan, CharlesMathers, GeorgeViant, S. P.
Ede, James ChuterMatters, L. W.Walkden, A. G.
Edge, Sir WilliamMelville, Sir JamesWallace, H. W.
Edmunds, J. E.Middleton, G.Wallhead, Richard C.
Edwards, C. (Monmouth, Bedwellty)Monsell, Eyres, Com. Rt. Hon. Sir B.Watkins, F. C.
Edwards, E. (Morpeth)Montague, FrederickWellock, Wilfred
Elliot, Major Walter E.Morgan, Dr. H. B.Welsh, James (Palsey)
Fermoy, LordMorley, RalphWestwood, Joseph
Forestier-Walker, Sir L.Morris, Rhys HopkinsWhiteley, Wilfrid (Birm., Ladywood)
Freeman, PeterMorris-Jones, Dr. J. H. (Denbigh)Wilkinson, Ellen C.
Fremantle, Lieut.-Colonel Francis E.Morrison, Herbert (Hackney, South)Williams, T. (York, Don Valley)
Gardner, B. W. (West Ham, Upton)Morrison, Robert C. (Tottenham, N.)Wilson, C. H. (Sheffield, Attercliffe)
Gardner, J. P. (Hammersmith, N.)Mosley, Lady C. (Stoke-on-Trent)Wilson, R. J. (Jarrow)
George, Major G. Lloyd (Pembroke)Muggeridge, H. T.Wood, Rt. Hon. Sir Kingsley
Gibson, H. M. (Lancs, Moseley)Nathan, Major H. L.Wood, Major McKenzie (Banff)
Gillett, George M.Naylor, T. E.Young, Rt. Hon. Sir Hilton
Gossling, A. G.Nicholson, O. (Westminster)Young, R. S. (Islington, North)
Gower, Sir RobertOldfield, J. R.
Gray, MilnerOliver, George Harold (Ilkeston)TELLERS FOR THE NOES.—
Greenwood, Rt. Hon. A. (Colne)Paling, WilfridMr. William Whiteley and Mr. Hayes.

Ordered, "That further Consideration of the Bill, as amended, be now adjourned."— [Mr. Greenwood.]

Bill, as amended (in the Standing Committee) to be further considered upon Monday next.