ASYLUM - -REFORM.
[To the Edito-r of the SrEcTATcm.] Sta,—Will you allow me to correct the wrong impression which is likely to be conveyed by Dr. Risien Russell's letter on the subject of Asylum- Reform ?
It is quite true that "a large number of patients suffering from mental disorders are best treated in nursing homes away from the atmosphere of an asylurri " ; but so long as they are not Certifiable there is •nothing to prevent us doing so ; and even when they are certified, I have not found in the course of twenty-five years' practice that the Lunacy Commissioners ever objected to having suitable eases in single care, so long as proper notice was given to admit of their inspection of the- patient and the provisions made for his comfort and safety. Under Section 46 of the Lunacy Act they can even grant leave for more than one certified patient being kept in one home. Dr. Russell's recommendation, therefore, that "the Lunacy Laws. should be so revised as to allow of people being treated in homes away from asylums, if, in -the opinion of the medical man in charge 'of the case, this is the best way of dealing with the patient's condition," can only be interpreted that still greater facilities should be given than are granted at present. If he means that doctors should be able to place certifiable patients in any nursing home they may choose, this would be incurring great risks, for the ordinary nursing home is not adapted for the lengthy treatment which most mental patients require. We cannot keep an otherwise healthy person for months in bed or shut up in one room. Besides, there is always the possibility, even -in mild forms of derangement, of the patient beeoming dangerous to himself or to others, or merely noisy-and trouble- some. It is on account of this possibility, and not from fear of being prosecuted by the Board of Control, as Dr. Russell states, that the owners of nursing homes refuse merital cases.
As you, Sir,' pointed out in your leading article, the fate of the genuinely insane in our asylums presents a problem more urgent. The public has always had a dread of these institutions, based on the fact that they are primarily plum's of detention, and not hospitals for the treatment of mental disorders, which they profess to be. Now, it is one thing to call for the appointment of a Royal Commission, and another to make practical suggestions which will ensure that the Commission serves a useful end. The principal reform that is needed, in my opinion, is that our asylums should be transformed into real mental hospitals, on the lines of other hospitals, by the appointment of Visiting physicians, each to treat a small number of patients. This would lead to a healthy rivalry, investigations would be made by the hundreds and thousands, and we should increase thereby our knowledge of brain and mind and their disorders. In public asylums the medical service would be honorary ; and in private asylums, where the patient or his friends choose the medical attendant, he would be paid by those who engage him. Even the staff of attendants should not be entirely residential, but should consist in part of voluntary or paid assistants—specially trained, companion-attendants —who would exercise a wholesome influence on the patients.
If this were done, we should do away with many of the present grievances, especially _with the frequent complaints of -wrong detention and ill-treatment, or. lack Of treatment ; the patient would come in contact with healthy minds who would bring in the fresh atmosphere of the outer world, so that he would feel no longer a prisoner ; and the dread of asylums would cease, for they would become mental hospitals in actuality!, and not in name only.—! am, Sir, &c.,
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