H.—7

4

It will be seen that there is an all-round shortage of accommodation, amounting to 156—0f 101 for men and 52 for women, and voluntary boarders are not included in tho table. I shall submit to you a, building programme to make good this shortage, but 1 must repeat what I have often said before —that in fairness to the patients and staff it is necessary to have accommodation more than just enough; otherwise, from time to time, now this and now that ward will bo crowded, patients being distributed in them according to their varying mental condition, a matter which cannot be estimated with mathematical accuracy. Then, again, there are necessary additions which do not add, but replace ; and there are additions for the accommodation of the staff and the comfort and amenities of the patients, a proportion of which must be included in each year's programme. You will be aware of the general scheme of our policy, which is not to add indefinitely to the larger institutions, just making changes in them to further the improvement of the classification and amenities of the inmates and simplify the administration as far as possible ; to build on the villa system, at the smaller institutions, sufficient accommodation to provide by transfer for any excess in the larger institutions, at the same time reducing the area from which larger institutions receive their patients and increasing the area from which the smaller institutions draw theirs. Included among the smaller institutions is Tokanui, where we possess approximately 5,000 acres of land, and where, building on the villa system, grouped in such a way that each group will be, so to speak, a small institution, we can provide for a large number of patients without such, being in evidence. Tokanui will thus ultimately draw patients from a considerable area, leaving Auckland to supply the needs of Auckland City and. north of Auckland, and Porirua to supply the needs of Wellington and adjacent districts. lam sure, sir, that you will appreciate, as did your predecessor, our difficulties and the justice of the claim of those unable to state their own case, and that I may look for your support in maintaining a continuous forward movement. Tables XVIII and XVIIIa show in detail the expenditure and credits for the year ended the 31st March, 1922 ; while in Table XIX the various items are grouped and stated in terms of per patient per annum. The gross cost per patient was £71 18s. B|d. ; the average received for maintenance was £19 os. 3fd. ; and allowing for other repayments, such as sales of farm-produce, &c, the net average cost of maintaining patients was £49 os. sd. per patient per annum. Of course, there are patients whose maintenance really costs less than this ; on the other hand, there are some, especially the newer admissions, who cost considerably more. The, following is the return of receipts and expenditure for our farms : — Expenditure. £ s. d. Receipts. £ s. d. Salaries and wages .. .. .. 12,310 2 4 Live-stock and produce— Peed .. ..• .. .. 4,590 6 2 Sold .. .. .. .. 11,463 10 0 Seeds, fertilizers, &c. .. .. .. 2,715 12 5 Consumed., .. .. .. 23,377 8 4 Implements, harness, &o. •• •• 1,503 10 0 Stock . . .. .. .. 990 6 6 Rents, rate;-, <S:c. . . .. 1 ,854 4 5 Fencing, draining, roading . . . . 508 3 1 Harvesting, &o. .. .. ■■ 449 4 8 Railages .. .. .. .. 381 4 1 Buildings .. .. ■ • • • 14 12 8 Sundries • .. .. .. .. 841 9 8 Balance .. .. .. .. 8,676 2 4 £34,840 18 4 £34,840 18 4 Recently, one of the periodical conferences of Medical Superintendents was held, when views were exchanged and many subjects of common interest discussed. The question of " stigma," which looms so largely in the public mind, was brought up incidentally, and the practically unanimous opinion voiced may be expressed much as follows : How often, at a small gathering of friends, one of the company will remark, " He was never quite the same man after that severe illness." Some bodily illness of ten or fifteen years ago is referred to, and thereupon examples to support the assertion are, supplied, first by one, and then by another. Ho had lost something in accuracy, and, when one came to think of it, his judgment was not quite so confident or weighty, anil so forth. In fact, he was carrying the stigma of that illness, whatever it was. In respect to mental disease, thoiigh by no means inevitable, there are a proportion of recovered persons who have similarly lost a something which is felt undefinably by others until discussed at such a gathering and definite instances of slight reduction in the highest faculties are quoted. Talk will turn to the probability of a second attack —to one attack predisposing another. Cases of others suffering from recurrent insanity will be recalled and confused with the one under discussion ; and, then, finally, the question is put, " Can we employ him in the same responsible position ?" Can they ? Possibly not; the responsibility may be too great, and he may have to re-order his life in terms of mental prophylaxis. Therein lies the real stigma, sometimes partly just, however cruel, but mainly unjust— a confused ignorant conception, probably an unrecognized residuum of the, superstitious past and demoniacal possession. The part such old beliefs, no longer believed in, play in creating unreasoning prejudices is undoubted. The insane have no stigma branding them in Mohammedan countries, because of a passage in the Koran- ■" Give not unto those who are of weak understanding the substance which God hath appointed you to preserve for them ; but maintain them thereout and clothe them and speak kindly to them." In this .matter we may get enlightenment from the Turk. The consensus of opinion pointed to the stigma being mainly attached to the, malady, and not to its treatment in any particular place; that our voluntary patients do not feel, because! of their residence in a mental hospital, that a stigma attaches to them; that those, admitted under a reception order had already made their condition known before admission, and hence often the, necessity