3

H.-7

At Auckland there are 551 patients, but only floor-space for 493; the Asylum therefore is overcrowded to the extent of 58 patients. At Porirua there appears to be sleeping-accommodation for 492 patients in the common dormitories, but the floor-space is only sufficient for 438. The number of patients in the dormitories at 31st March was 448. The following shows the extent of the overcrowding at our asylums : — Auckland ... ... ... ... ... 58 patients in excess. Christchurch ... ... ... ... ... 96 „ Seacliff ... ... ... ... ... 61 „ Nelson ... ... ... ... ... ... 4 „ Porirua ... ... ... ... ... ... 10 „ Wellington ... ... ... ... ... 47 276 Less room at Hokitika for ... ... ... ... 24 Total ... ... 252 All our New Zealand asylums, without exception, in so far as regards bed treatment, feeding, clothing, and attendance, are as well looked after as any of the best managed asylums of either England or Scotland, of which I have seen a great many during my visit last year. Our Medical Superintendents, as a body, are as capable and careful as any that I have seen elsewhere. The one thing in which I believe we are hopelessly astern of the whole British Empire is the overcrowding of our asylums, a fact which goes far to nullify, so far as rational treatment of patients is concerned, all our other advantages. I have some hopes, however, that the Government may soon take steps to provide intermediate accommodation for uncertifiable cases near Christchurch. The following extract from my report of 1898 expresses all that my further experience could put forward to-day in explanation of our present position : — " The Asylum Department in this colony has to face a choice of difficulties. On the one hand the public are very exacting in their demands for the proper treatment of the insane, but they are roused to indignant clamour only when some painful occurrence reveals the difficulties which their officers are daily confronted with, and almost despairingly struggle to overcome. In the intervals there is no sustained resolve that their representatives shall provide the means of proper classificacation and treatment. On the other hand, the Government are straining every nerve to open the country for settlement, with all the necessary expenditure this involves; and it must be admitted that to expect them to provide out of revenue for modern asylum requirements is very hard. By far the hardest and most unpleasant part of my duty is to induce the Government to give the means to meet the spasmodic demands of the people for rational treatment of those terrible nervous diseases that afflict so many of our fellow-creatures. As things are now in New Zealand, the lack of accommodation makes it impossible for me in nearly all of our asylums even to pretend to a rational classification, which is the indispensable condition to the scientific treatment of mental disease. " I have over and over again explained how it is that there seems to be such a large proportion of insane among our population. For 1897 the latest report of the Lunacy Commissioners for England and Wales gives the proportion of 3-20 for every 1,000 of the population, or lin 313. In New Zealand the proportion per 1,000 is (exclusive of Maoris) 333, or lin 300; and, if Maoris are included, 3-16, or lin 316. We must not forget, however, that in New Zealand a very large proportion of old and infirm persons, suffering merely from senile decay, are thrust into our asylums simply because we have not here, as in older countries, infirmaries and similar places where such cases could be taken care of. In England and Wales 11,118 out of the total number of the insane— namely, 99,365 —are maintained in such intermediate institutions. The result is that our asylums are hopelessly cumbered with an accumulation of persons for whom there is no hope of recovery, so that we are quite unable to secure proper classification and rational treatment for our curable patients. " One of the many ways in which our lavish distribution of charitable aid through local bodies has degraded and pauperised our people is demonstrated by the constantly increasing tendency to get rid of aged relatives, who are simply in their dotage and require care and attention, by getting medical certificates that they have delusions, are dirty in their habits, or are unfit to take care of themselves. The Magistrates, when an information is laid regarding such cases, are placed in a very painful position, and so are the doctors. They have to consider the possible consequences when such people are friendless or neglected, and they shrink from the outcry which follows if they decline to certify when such eases can be brought within the legal definition of insanity, and some scandal arises from their not being under proper care and control. Another cause which tends largely to fill our asylums with incurable cases, which swell our admissions and our death rate, is the fact that the whole cost of maintaining the insane comes out of the consolidated revenue ; while the sick and aged and doting poor are a burden on local rates. There arises, in consequence of this, a determined and an increasingly widespread struggle on the part of hospital officers, guardians of old people's homes and refuges, and Charitable Aid Boards to get persons who are troublesome from senile decay admitted to the public asylums. No officer of the Lunacy Department can interfere until after admission to the asylum, and they find that, once there, they cannot discharge them unless they can hand them over to some responsible body to take care of them.