Mental Health—I LEGAL FRAMEWORK OF HOSPITAL SYSTEM

Press, Volume C, Issue 29515, 17 May 1961, Page 14

Mental Health —I LEGAL FRAMEWORK OF HOSPITAL SYSTEM

(Contributed by members ot tne Canterbury Association for Mental •ieaitnj

The World Health Organisation declared the year 1960 to be World Mental Health Year—a year for communities to take stock of the mental health of their members, to reconsider how best to treat and rehabilitate those whose variation from the mental norm is such as to mark them as mentally ill. In Christchurch, there is to be a mental health con. ference in August this year as part of New Zealand's own contribution to the world effort. This is it, therefore, an opportune time to reconsider other aspects of the social system affecting mental patients in New Zealand. Three years ago “The Press" published a number of articles by such authorities as Dr. Sanford Meyers. Dr. Harold Bourne, and Miss Isobel Story calling attention then to what seemed to them to be a serious state of stagnation in the treatment of mental illness In this country, and in the legal framework within which 'the treatment is given. There , were also some forthright editorial articles on the same lines. | One immediate local reaction to this publicity was ,the founding of the Canterbury Association for Mental Health, which since then has 'sought to increase public awareness of the problems and needs of the mentally ill, and to help in every practicable way in the rehabilitation of those who have recovered. In addition the association has founded a study group on the law relating to mental health: and it is this group which now offers this short series of articles on the legal aspects of this social problem. Personal Liberty To a community that values personal liberty to the extent that New Zealand does, the law affecting mental health presents difficult problems, and the reconciling of the need of personal liberty with the patient’s need for skilled treatment may be a matter of delicate balance. Clearly, mental illness differs from any other illness in that compulsory powers must exist, since a patient may, from the very nature of his illness, be unable to appreciate his need for care and treatment In relation to gross physical disorders a person need not take medical treatment if he does not want to: but there

the patient is in a position to make a free choice. With mental illness, the disease may itself obscure to the patient the facts upon which the choice of taking or refusing treatment depends. Again, some mental illness may manifest itself in violent conduct by the patient, which renders his removal to a place of safety necessary not only because of the patient's needs but also because of those of his family. It is estimated that one in every 10 persons in New Zealand will at some time in his life require treatment for mental illness or stress: it -s therefore a matter of importance to every member of the community to know what provision is made for this occasion and ’ upon what terms. Admission to Hospital Under the present legislation. the two principal methods of obtaining a hospital bed for a mentally ill patient—which at present is virtually the only public provision—are by voluntary entry and by reception order. Voluntary boarders nowadays represent rather more than half the total number of patients admitted to mental hospitals: a voluntary boarder is admitted by the hospital superintendent on a request in writing made by the patient himself. A voluntary boarder is entitled to discharge himself from hospital on giving seven day's notice; although if the hospital superintendent is of the opinion that the patient’s condition requires treatment of a kind for which he is not suitab'e as a voluntary boarder, he may make arrangements for a recention order to be made and the patient will then lose his right to discharge himself. The other method of securing hospital treatment, and the only method if the patient is too ill to be able to sign the application fully knowing what it entails, is that of obtaining a magistrate’s order to receive and detain the patient. Nearly half of all patients admitted (but Including virtually all mentally subnormal patients) are admitted under this procedure. Legal Consequences The importance of the distinction between these methods of admission lies in the legal consequences; the property of a patient admitted under a reception order at once comes under the control of the Public Trustee, his driving licence lapses, his car insurance may become void, his membership of certain public bodies automatically terminates, and so on. He has. as it were, assumed the status of a “lunatic” or "person bf unsound mind " And even if he is shortly discharged as recovered and the majority of admis--ions nowarfays are for short stays—the consequences of (hat status may cling to him. None of these badges of status affect the person admitted as a voluntary boarder. And, indeed, one may legitimately ask what advantages are achieved by them. A person goes into a mental hospital to be cured of his disorder, just as a person enters an ordinary public hospital to be cured of appendicitis or pneumonia; and there is no more justification for many of these legal consequences in the one case than in the others. There is. of course, ample justification for the provision of machinery to look after a patient’s property—assuming that he cannot do so himself —but there is no need to invoke this machinery without discrimination By the Mental Health Act. 1959, in England, which followed closely the recommendations of the Percy Commission, many of these “status" rules, which until then applied in the United Kingdom, also have been discarded and the formal machinery of the magistrate's order, with its suggestion of a semi-criminal process, has been abandoned. A patient is admitted to hospital on a doctor’s recommendation and if subsequently he should wish to leave contrary to the advice of the medical superintendent, he may apply to an independant mental health tribunal for his case to be reconsidered. This represents an enormous advance in the social and legal attitude to mental illness. (To be Continued.)