A CONVERSATION WITH MEMBERS OF THE BOARD OF CONTROL.

AT the request of Sir Frederick Willis (Chairman of the Board of Control), on Thursday, February 15th, we sent the member of the staff who had written our original leading article, " Behind the Shut. Door," to have an informal conversation with him at the offices of the Board of Control.—ED. Spectator.

SIR FREDERICK Wirzas was good enough to give me nearly an hour of his time when I went to see him, and by good fortune I was also able to have a talk with Dr. Bond.

I had previously sent Sir Frederick Willis copies of the article which had appeared in this paper and of the subsequent correspondence to which we had opened our columns. Here is a condensed version of our talk, written down immediately on my return from it, and (as for their part of it) passed as correct by my two interlocutors.

THE SPECTATOR I was sorry to bother you with so many documents, but thought it might save your time in our talk if I sent them to you beforehand and you knew exactly what the points were which the Spectator had made.

Sin FREDERICK WILLIS : I have read them all and was interested by them.

THE SPECTATOR Let us agree that the Board of Control and its critics are equally anxious for the welfare of lunatics, but that you differ as to the present degree of their welfare and as to the methods by which their well-being could be increased. Speaking as a representative of the public, which is what I am—(not an expert on lunacy administration or the psychology of insanity)—there are one or two points in the

official attitude which have not, I think, been made dear. First of all, do you entirely deny that there are cases of ill- treatment in mental hospitals ?

SIR FREDERICK : Not absolutely ; but I believe them to be very infrequent.

Tim SPECTATOR : Are you satisfied with the existing per- sonnel of your asylums, and with the new recruits you are getting in your medical, nursing and domestic departments ?

SIR FREDERICK No, we are not satisfied. Neither are we inactive. We have recently appointed a Committee to inquire into all this—to see how we can attract a better type of personnel to the work of asylum nursing, especially on the female side—how we can increase our medical officers' interest in laboratory work. To this latter end the first step is to provide them—as we are pressing local authorities to do— with apparatus and time for carrying out routine laboratory work as well as research work.

THE SPECTATOR : Why is the Board of Control against the appointment of a Royal Commission ?

SIR FREDERICK : Whether there should be a Royal Com- mission or not is a question for Ministers, but this is how it strikes me. The demand has arisen in consequence of allega- tions of widespread cruelty. These charges we knew- were unfounded, but Sir Cyril Cobb's Committee was appointed to investigate them. They now state, after careful investigation, " We are satisfied that the present provision for the cure and treatment of the insane is humane and efficient." As to the reforms which are needed in our mental hospitals—improve- ments in the nursing, the medical staffing, scientific work, the treatment of early mental illness and so on—there is unanimity as to what is required. Legislation and money are essential. We are hoping to get both in the near future. The appointment of a Royal Commission would delay matters for years. Everything would be hung up and the expense of a Commission would be serious. Moreover, all the various complaints which have been shown to be unfounded would again be brought forward, and some of our newspapers would be full of sensational statements. The public would be misled. You know we poor officials are treated with a good deal of unfairness in the Press. Take the case of an inquiry on oath

which I held into the allegations of a certain ex-patient. A well-known daily contemporary of yours printed in full the evidence of the patient with a grievance, but entirely sup- pressed the counter-evidence (that of ex-patients, not of attendants). Don't you think it possible that this might be repeated in the case of the evidence heard before a Royal Commission ?

THE SPECTATOR : Would that matter ? The Commission would hear both sides and would, I hope, be uninfluenced by newspaper reports.

SIR FREDERICK : Might not such alleged revelations have a bad effect on what is at the moment the chief plank in our reform platform—the attracting of a better educated and more highly qualified personnel ? However, you know it is not for me, as an official, to decide this question. You asked me to state the case against a Royal Commission, because you said you could not see what possible objections there could be to such an inquiry. I have merely stated them for you.

Tan. Siscrxroa ; Your attitude is perfectly correct, but

I cant say I am convinced by the case for the defence. Do Royal Commissions really take so long ?

At this point Dr. Bond joined us, and agreed that these were the chief objections which had been raised in some quarters to the appointment of a Royal Commission. Dr. Bond is the Chairman of the Committee appointed to inquire into the obtaining of better nursing personnel.

Da. BOND : It's all very well for outsiders to say we should have better nurses, attendants and doctors. But how to

attract them to mental hospitals ? That's what my Com- mittee is trying to find out, and we are having a good deal of difficulty..

THE SPECTATOR : I suppose the suggestions which at once occur to a layman have already been considered at

length by you--better pay, shorter hours, improved status and—perhaps above all—a more scientific and interesting training ?

I proceeded to make a few slightly more detailed suggestions on these lines, and Dr. Bond and Sir Frederick Willis seemed to think that the Committee of Inquiry would be interested to hear an outsider's suggestions, and we therefore arranged that I should make them before Dr. Bond's Committee.

I wish I had remembered to ask them at this point with what organizations, such as the Red Cross, the general hospitals, the Women's Service Office and the Women's Employment Bureau they were already in touch.

THE SPECTATOR : One of Dr. Lomax's allegations against asylum administration is that too much administrative work falls upon the chief medical officer. Is this the case in your opinion ?

DR. Box]) : Yes, often. But it does not really " fall upon " him ; it is seized by him. There has to be one head in an institution, and there are some people who will not delegate, and so, as in other businesses and organizations, it sometimes happens that the head undertakes a needless amount of work which could be properly delegated. Have not you, too, had experience of this ?

I said I had, and we passed on to a discussion of other aspects of asylum administration which are alleged to be faulty. The question of employing patients seems to have had a great deal of attention from the Board, and considerable effort has been directed to obtaining suitable instructors and to inducing patients to take up work. Dr. Bond pointed out that there was often a difficulty in combining congenial employment with an outdoor life, and that often it was difficult to interest patients in work. He described, however, a hospital of which he had been deputy-superintendent, and another of which he had been superintendent, where, besides all the ordinary occupations followed at every mental hospital, a very great variety of trades, &c., were arranged for the occupation of the patients. I suggested that some of the old crafts which had lately been revived could perhaps be taught, especially if inter-asylum exhibitions were arranged.

Da. BOND : Oh, yes. We have considered this and even carried it out on a small scale—though not on an inter-asylum basis.

SIR FREDERICK : You know we are not entirely free from the Trade Unions' objection to trade " competition " from inmates of public institutions.

TEE SPECTATOR : Surely it has been ruled in the case of prisons that all objection was waived as long as the inmates are. paid Union rates, with, naturally, the cost of their keep and treatment deducted.

SIR FREDERICK : Yes. Generally, the cost of the patient Would exceed the value of the work done.

Sir Frederick then raised the point that it was very depressing to administrators of asylums to hear so much criticism from people who had never raised a finger to help the insane. I said. I thought that the public were not aware that they were allowed to offer practical help.

Tim SPECTATOR : The Board of Control might find it worth while to invite such co-operation, and I feel sure that some organizations, such as the Red Cross, would be willing to supply voluntary workers. They could take, perhaps, off-duty time for some of the less-skilled attendants, they might teach crafts such as weaving, embroidery, light metal work, &c., or organize concerts or outdoor sports or enter- tainments for the patients.

This suggestion was favourably received. (We should be happy to forward offers of voluntary help; from organizations not individuals, to the proper quarter.) We touched upon the fact that all large institutions must necessarily be a little slow in absorbing the newest discoveries (or conjectures, hinted Dr. BOnd) of science. But surely, I suggested, in the case of asylums the time-lag was much greater than in the case of our voluntary hospitals.

Dn. BOND : Not at all. 'They can well stand comparison with voluntary hospitals.

. Here are a few general conclusions which I came to as a result of our talk : .

1. The sincere desire of the members of the Board whom saw for the proper running Of their department and the well-being of the patients under their care.

2. As the two Conu-nissioners stated them, the points brought forward against a Royal Commission seemed to me weak.

3. The feeling in favour of departmental reform rather than the appointment of a Royal Commission struck. me as a matter of individual preference largely concerned with our common human desire to avoid an " upset." We shall soon see this feeling working in every household in the matter of spring-cleaning.

4. Sir Frederick and Dr. Bond's acknowledgment of the way in which asylums lagged behind• present-day medical knowledge was satisfactory.

5. The willingness to accept my suggestions was very flattering. (perhaps intentionally so ?). I thought there seemed some lack of knowledge of where to go for various pieces of information. I thought it showed the Board (no doubt through overwork) to be somewhat out of touch with a good many movements and organizations which it might well have pressed into the service of the insane.

6. I thought also that they considerably under-estimated the efficacy of " eyewash " in a big institution. I have had myself experience of applying eyewash to military inspectors, and fancy that the Board do not appreciate all the convolutions of that interesting art and are a little innocent.

7. The total impression left with me was that these members of the Board were more broad-minded and capable of receiving fresh impressions, but also less mercilessly efficient and imaginative, than I had expected. Their task is a difficult one. They ought not to be content in bringing to it the qualities which would enable them to deal successfully with simple material things, such as are involved, say, in running a business concern. Theirs is a task which can only be successfully carried through by the exercise of the higher faculties of the mind. They need scientific exactitude, legal cynicism, and a careful sympathy.

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THE SPECTATOR.