B."—4a,

600. The following is a summary of the expenditure which Sir Truby King considered would be necessary to carry out the above-mentioned provisions : — £ Purchase of land .. .. ... .. •• .. 52,000 Admission cottages .. .. ■ ■ • • • • • • 7,000 Hostels for nervous affections .. . . .. . . . ■ 19,500 Additional accommodation for women ' .. .. .. 76,000 Additional accommodation for men .. .. .. .. .. 76,000 Infirmary wards .. .. ■ • • • • ■ • ■ .. 21, 500 Nurses' homes .. .. .. •• 35,000 Stores, kitchens, bakehouses, and laundries .. .. .. .. 49,500 Various headings as per scheme .. .. .. .. .. 25,000 361,500 Add £82,000 for works already authorized .. .. .. 82,000 £443,500 601. The main lines of policy laid down as a result of Sir Truby King's investigation were —• (1) To vacate the Avondale Mental Hospital at Auckland and erect a new institution on the villa system some distance from the city. The Government of the day gave an undertaking that this would be completed within ten years —i.e., in 1936. (2) To improve the classification more especially in regard to recent and recoverable cases, and to provide adequately for their separation from the chronic patients of an objectionable type. (3) To make such alterations in the existing main buildings as would bring them into line with modern ideas, particularly in regard to ventilation, size of dormitories, and general hygiene. (4) To enlarge and rebuild where necessary the stores, kitchen, laundry, and administrative offices, which in most institutions had been designed to deal with a much smaller population than has now to be provided for. (5) To limit the accommodation of each institution to one thousand beds. (6) To avoid adding to existing main buildings and to secure additional accommodation by the erection of separate villas. 602. It was thus considered that the sum of £443,500 was necessary to carry out the most urgent provisions which should be made well within the following two years. Although a great deal has been done in the meantime to improve conditions in the mental hospitals, the fact remains that there is still a resident mental hospital population of some eight hundred for whom proper accommodation is not provided, and that population is increasing at the rate of approximately two hundred and forty per annum. The position is grave. 603. As regards new construction, the old barrack system of mental asylums has been discarded in favour of what is known as the " villa system," the essence of which is that, instead of numerous wards and dormitories concentrated in a single large building, institutions are composed of several entirely detached units each designed for a particular class of patient. This system has to a degree been followed in the Dominion in recent years, and has enabled the Department to use cheaper materials, such as timber, for construction. 604. It is estimated that the cost of erecting in timber a building to accommodate fifty patients is approximately £8,000, or £160 per patient, as against £12,000 for erection in brick—i.e., £240 per patient. It therefore appears that, for the erection of buildings alone, the sum of £160,000 is immediately required in order to relieve the congestion in the present institutions, while an annual capital expenditure of approximately £50,000 is required to cope with the annual increase in the mental-hospital population. The growing burden on the State is really serious, and it appears that early consideration should be given to any suggestions whereby this might be minimized. In particular, the various suggestions contained in parliamentary paper H. -7 a, 1927, demand serious consideration. General. 605. There are two further matters to which attention should be drawn. They are : — (1) The care of Senile Patients. 606. The Department has about five hundred patients who are over seventy years of age, and of that number there are three hundred and fifty who do not require the highly organized and expensive form of care provided in the mental hospitals. These patients could be accommodated in buildings of a much less costly nature, and could be attended to by a relatively small staff. They are of the same type as are now cared for in old people's homes, and it would appear that they could be more economically cared for in institutions of that type. This was apparently contemplated in 1929 when the Rest-homes Act was passed, but suitable accommodation has not yet been provided. It is worthy of note that these patients are under the care of the Mental Hospitals Department, mainly on account of the desire of local-governing bodies to avoid the cost of caring for the patients as a charge against local rates. Incidentally, the matter has been commented upon in the annual reports of the Department for many years, indeed as far back as 1895 the matter was mentioned in the report of the late Dr. MacGregor.

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