Mental Health—III CUSTODIAL BIAS OF EXISTING LAW

Press, Volume C, Issue 29518, 20 May 1961, Page 10

Mental Health—III CUSTODIAL BIAS OF EXISTING LAW

IContributefl by members of lie Canterbury Association for Menial Health I

If a tradesman were found to have changed the label on a bottle so as to pass off its contents as something more effective, more up to date, than in fact they were, he would be regarded as a cheat, and little the less so if he pleaded that from time to time he had been adding a little bit of the new and better stuff to make the contents look or taste better. When the New Zealand Parliament in 1954 changed (the name of the "Mental Defectives Act 1911" (preiviouslv the Lunatics Act 1908) ’to the “Mental Health Ace 1911" it was humbug on | a national scale. I The name “Mental Health I Act 1911” it was humbug on that the subject is indeed one of health —that society should treat illnesses of the mind like other illnesses, preventing or avoiding it if possible, reducing it by every available means, treating it adequately and humanely where it arises, with institutional care where necessary, and the speediest possible return of the patient to normal life and a recognition that some cases will require permanent institutional care. Official Attitude

One may veil agree that, of course, the act is humanely’ administered by an enlightened modern department of state with an enlightened and skilled staff. One cannot escape the feeling, however, that the very statute under which the department operates has something to do with its approach to its task. Certainly it has. something to do with the public's attitude towards mental illlness. So let us have a look at this act.

Section 2 contains, significantly. a definition of a "mentally defective person” 'extraordinarily obsolete m some respects). In as much as the statute then proceeds to deal almost entirely with what it still calls "mentally defective persons," it is worth pointing out that

"defective" means "incomplete” or "wanting,” which many patients are not. This observation might be put down as mere pedantry but tor the fact that the act proceeds on the assumption that all patients are indeed defective.

The next 16 sections (Part D prescribe what, in the purview of the statute, is the stock procedure for dealing with patients—certification by two medical practitioners. the magistrates' “reception order,” the use of constables to arrest and

retain, and the subsequent detention in an institution. Parts II and 111 deal respectively with the procedure for detention of single patients by what are called “householders" and the special procedure for minors. Part IV with 'mentally defective persons under detention for offences.” This, as we have said, is the stock procedure. So long as trial and imprisonment, which it so closely resembles, is the stock procedure for dealing with the more serious types of crime, it encourages a wrong attitude towards mental illness and its treatment on the part of the public, the patients, the patients’ relatives and even (dare one say) the department itself. Part V deals, in two sections and by way of exception, with "Voluntary Boarders.” Detention Provisions Part VI deals with statutory officers and machinery provisions regarding public and licensed (i.e. not state-owned) institutions. Part VII is encouragingly headed “Care and Treatment of Mentally Defective Persons” but its sub-headings are "Registers and Notices," “Visitation." "Escapes." “Absence on Leave,” “Transfer of Patients” and “Discharge of Patients"—little to do with health, that is to say, but much to do witli detention.

Part VIII deals with the administration of the estates of mentally defective persons and may be summarised by saying that all are deemed unfit to have anything to do with their business affairs which, in all but the most exceptional cases, are to be taken over automatically by the Public Trustee.

Part IX, by way of further protection, prescribes certain acts in relation to mentally defective persons as offences. As a general proposition—though there are considerable exceptions—it can be fairly said that the act breathes compulsion, regimentation, lack of choice, either for the patient or his relatives —the very people who most require consideration, and delicate handling. Safeguards

Certain safeguards are provided, certain avenues by which patients or their relatives may seek their release or lodge complaints but, as the statute stands at present, the patient is. in practice, very much in the hands of the medical staff of the institution in which he is detained. For instance, district inspectors are to be appointed with certain powers of visitation, inspection, inquiry and recommendation. , District inspectors, however, are unpaid although, for example, in Christchurch the sole district inspector has to deal with far more than 1000 patients. District inspectors must therefore rely to a great extent upon the hospital staff. From the nature of things magisterial and judicial inquiries are also forced to rely upon the staff. It seems obvious, for several reasons, that the functions of healing or alleviating the patient's condition and adjudicating upon his discharge or continued detention should be separated as far as possible. Recertification

Another similar superficial safeguard is the provision that the reception order under which each patient is detained shall lapse on December 31 unless the superintendent has given a certificate. signed during that December, “that he has considered the case of the patient . . . and is of opinion that his further detention is for his own good or in the public interest." In the case of a superintendent who has many hundreds of patients in his institution, this seems to invite, even to make inevitable, purely perfunctory recertification. Where the personal liberty of so many is concerned, surely nothing should be perfunctory. The act gives no right to private and independent legal or medical advice. That is not to say it is denied; but the express right should be there because its absence, taken together with the denial of so many other rights of citizenship, seems to imply that there 1* no such right.

In short, there is so much wrong with this act—written at a time when the nature of mental illnesses was so little understood that what is needed is not extensive amendment, but a new act altogether with a change of emphasis in many very important respects. (To Be Concluded).