3

H.—7

The figures of the year under review are similar to those of the year before, and show the extent of the problem awaiting solution. According to Table 111, in 1922 we admitted 52 persons aged between seventy and eighty, 21 between eighty and ninety, and 2 between ninety and a hundred. They contributed 9 per cent, of the admissions of known age. I repeat that such admissions largely represent persons who could be provided for in comfort less expensively than in the infirmary divisions of mental hospitals ; and should be, if for no other reason than to protect our legitimate sick from the depressing environment of decay. It was necessary to get some approximate data to ascertain the size of any special institution or division of an institution needed to accommodate the senile cases referred to, and the Director-General of Health circularized the Hospital Boards, and kindly supplied me with the figures. Some Boards did not favour the proposal, preferring to look after their own cases, because they could be kept in their Old People's Homes for less than in a mental hospital. That is exactly our contention, and hence our suggestion that if such persons are to be sent to us, as heretofore, by Boards who cannot arrange to have, them looked after in their own Old People's Homes, the time seemed ripe for us to consider separate provision for such cases at one, or other of the mental hospitals, where they would be provided for simply and comfortably at a, figure considerably below our average cost. Many Boards favoured the proposal, with a proviso that they should not be charged the cost of maintenance, and that the whole charge should be borne by the State, whatever Department of State undertook the work. The effect of this would be practically an undertaking by the State to provide all the cost, instead of a part as at present, of maintaining the, aged poor. The difference between persons undergoing senile decay, with its accompanying dementia, and the other inmates of an Old People's Home, is merely a matter of time, depending on whether the other inmates will live long enough. When mental infirmity goes on pari passu with natural physical deterioration, we contend that, with few exceptions, such patients can be managed in a properly equipped Old People's Homo, a contention which some of the replies support. When in that Home the State is responsible for a moiety, and not the whole cost of maintenance. If sueh an inmate were, sent from one, Old People's Home to another, where similar cases are nursed and attended to properly, the State would continue to pay part cost only, but if the same inmate in the same condition were sent to a mental hospital because too troublesome in the particular Old People's Home, why should the State be expected, as a matter of course, to pay his entire cost ? Last year I quoted Dr. Macgregor writing as far back as 1895 : — " Our peculiar system of local government has the effect of crowding into our asylums . . . an unusually large number of aged people suffering from senile decay—people who elsewhere find refuge in workhouses and other similar institutions. In fact, the proportion depends on the issue in each ease of a struggle between the local bodies, who are anxious to relieve the local rates, and the General Government officers, who try to defend the consolidated revenue." In Great Britain a proportion only of the cost of the maintenance of the insane is paid by the General Government; the remainder is contributed locally, which accounts for the local administration, similar to our Hospital Boards, representing the ratepayers. Under that system, persons labouring under ordiuary physiological decay of old age with dementia were not sent to asylums until the Government raised its proportional contribution for the, insane poor, and then it became apparent that numbers were being certified insane and transferred from, refuges for this aged poor. The return, above alluded to, from the Boards is to the eifeet that about 40 male and 25 female senile dements were resident in Old People's Homes, a total considerably loss than those resident in mental hospitals. Also, that tho same figures represented the estimated annual increment, which more or less roughly corresponds with our own annual admission of patients answering the description. I suggested last year that if the, Boards cared to make terms with us for the maintenance of such cases, we would be willing to look after them separately from other patients. Under sueh circumstances, the Boards being responsible for spending the ratepayers' money, would appoint visitors to see that, they were getting their money's worth. But, as the general contention seems to be that the consolidated revenue should not provide, a part only, but the whole expenditure, I do not feel justified, at this juncture, in asking you,-, sir, to support a sum being placed on the estimates for the, purpose. Hereunder is a return of the patients in State, institutions on the register, as distributed on the Kith June, 1923, and classified under the Act, showing the number on leave and those resident at that date, together with the accommodation available, and the number of wards into which it is divided.

i led. Class VI, Epileptics. Total. Mental Hospital. Patients on llegister on 16th June, 192IJ, as classi] Patients m lfith June, .923. Accommodation on 16th June, 192;). Class I, Unsound Mind. KJfc Class III, Class IV, Mentally . ,. , TmWtloi leebleInflrm. lmots - lmtleclles - minded. Absent on Probation. Eesident in Institution. Number! Bed a^ ms Wards, j Dormitories Auckland .. Christchuroh Dunedin (Seaolifi and Waitati Hokitika .. Nelson and Stoke . . Porirua Tokanui M. K. 302 242 240 306 434 317 M. 1''. 158 52 30 3 i 47 30 M. F. II 0 8 0 13 5 ST. F. 99 66 39 44 51 36 M. F. 7 31 21 I) 10 37 M. I!'. 63 38 35 45 55 44 M. If. 040 435 379 444 Oil) 475 M. K. II I) 10 lo 10 I I M. F. 029 426 369 431 630 404 M. F. 9 8 7 7 II 8 M. F, 629 401 385 448 5:17 -:l5(i 126 41 33 31 539 387 71 49 33 14 79 45 14 14 41 27 2 1 3 5 2 4 44 17 22 32 27 16 2 ! 5 5 17 • 12 16 I 8 3 18 8 54 47 4 3 171 05 179 107 049 497 159 90 I .. 1 .. 13 27 170 05 178 107 636 470 ! 59 96 '3 3 3 4 8 7 3 2 156 88 198 III 590 403 172 100 Totals 1,745 1,373 408 219 35 25 284 21.5 108 96 237 188 2,817 2,116 40 57 2,771 2,059 44 39 2,607 2,007