19 MAY 1923, Page 10


[To the Editor of the SPECTATOR.] Sia,—The letter written by " Lux," if unanswered, though it teems• with • misstatements of fact and signs of confusion of thought, may do much harm by delaying the adoption of those improved methods of treatment which are already so long overdue.

One may ask : " What is it that prevents the adoption of these methods ? " It is the Lunacy. Law of England, which makes it illegal at present to treat in nursing homeg; or hostels persona suffering from certifiable forms of mental

diseases, even if they desire to be so treated and no detention be used, unless they be first certified lunatics. A person, for example, suffering from melancholia, who is conscious of an impulse to commit suicide and desires to seek protection from this danger, if he be poor, must submit to be certified as a lunatic before he can receive the supervision he needs and wishes ; a woman suffering from puerperal insanity must be stigmatized in the same way, although the funda- mental disorder here is blood-poisoning and exhaustion, and the majority of such patients make a good mental recovery in from two to twelve weeks' time.

" Lux " would prevent the removal of these hardships, would delay this overdue reform, and says, in effect : " If a patient suffering from mental disorder be certifiable, let him be certified as in the past and placed in an asylum in order that he may enjoy there the full protection, which the law provides for persons of unsound mind, from the possi- bility of illegal detention." " Lux " would deny to an Englishman suffering from a mild, transient and curable mental disorder, if certifiable, the opportunity of escaping certification as a lunatic and of obtaining treatment till recovery in a suitable home, hostel or hospital, although he desired it, although no detention was involved, and although reasonable precautions were taken against abuse by placing such homes, &c., under the supervision of a department of the Ministry of Health. These privileges have, however, been enjoyed by Scotsmen for sixty-six years, having been conferred by the original Lunacy Act of 1857, and their success has been tested by a practical experiment lasting two- thirds of a century. What stronger guarantee can the most cautious and most conservative legislator in the world desire than this ?

" Lux " states that " the new Bill is meaningless unless detention is intended," and that " if no detention is intended, there can be no possible reason for the bringing in of such a Bill, for there exists no legal barrier of any kind to receiving uncertifiable cases into hospitals or nursing homes, provided no detention is practised." The passage I have put in italics is perfectly true, but this Bill does not refer to such patients or to any hospitals or homes receiving such patients. They can carry on as in the past. The Bill is applicable to certain certifiable patients and to homes, hostels, hospitals, &c., approved of for the treatment of such patients. It is illegal at present to treat such cases without certification, and Clause 4 of the Bill gives the necessary permission to " approved institutions." Sane and uncertifiable persons may also be admitted, provided they are suffering from some form of mental disorder and comply with the other require- ments. " Lux " is thus quite at sea as to the objects of the Bill and refuses to accept the plain language of the framers of the Bill, that its purpose is to provide treatment for those who are " willing to submit " and who may leave on giving " forty-eight hours' notice." In the case of those " incap- able of volition," for example those suffering from the delirious or confusional mental conditions of puerperal insanity, special precautions against abuse are laid down, but such patients are not excluded from its beneficent provisions.

" Lux " also writes : " If ' voluntary boarders ' are really able to leave on forty-eight hours' notice, why is there a sus- picious mention of a stay of six months ? " Voluntary boarders are dealt with in Section 2, and there is no mention of " a stay of six months " or, indeed, of any time limit. Under Section 4, relating to persons willing to submit to treatment in approved institutions, the Bill mentions not " a stay of six months," but that the patient " may be treated therein for a period not exceeding six months "—a very different story.

The position of the law in the two countries on this subject is quite Gilbertian. Any person in England suffering from a recent and curable but certifiable form of mental disorder, wishing to avoid certification, must slip across the Border. Many have thus come to bless what has been called " the

Scottish Section " ; indeed, Section 16 of the Act of 1886 is the only provision of the Lunacy Laws for which I have ever seen patients quite genuinely grateful. Other privileges they may take as a right, but this loophole of escape from the horror of certification, which encompasses them at present, is thoroughly appreCiated by patients and friends alike. A stage is reached in many mental cases when some action has

to be taken, and the late Sir George Savage would then advise " Certification or Scotland." But all cannot seek protection in Scotland.

I have probably had greater opportunities for experience of this form of care and treatment than any other person, and I would urge from my detached position North of the Tweed all interested in the happiness and welfare of those afflicted in mind in England to support heartily Lord Onslow's Mental Treatment am, Sir, &c., GEORGE M. ROBERTSON, President of the Medico-Psychological Association of Great Britain and Ireland.

The University, Edinburgh.