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The Royal
Commission
MENTAL HEALTH
In May, 1957, the Royal Commission on the Law relating to Mental Illness and Mental
Deficiency appointed in February, 1954, issued a unanimous report.* The report had
been eagerly awaited and its publication was without doubt the most important event
of the year in the field of mental health and, indeed, probably in the whole realm of
public health.
Pressure for reform has probably been directed principally towards the Mental
Deficiency Acts because of allegations of the illegal detention of high-grade defectives
and also, to a lesser degree, the cumbersome and legalistic procedure for securing the
admission to hospital of low-grade defectives whose need for care is obvious even when
parents or guardians desire it. Judgments in the High Courts in recent years in cases
arising out of the detention of mental defectives have made the administration of the
Acts by local health authorities extremely difficult. The outstanding case was that of
Regina v. The Board of Control ex parte Rutty (February, 1956), the effect of which
was given in my annual report for 1956.
In another case in which application for a writ of habeas corpus had been made the
learned judge found that an order sending a defective to an institution was bad because
he did not consider that an ulterior motive on the part of the parent in refusing consent
had been proved, and that accordingly the parent's consent must be regarded as being
withheld with the bona fide intention of benefiting the defective. An implication of this
decision is that, however misguided or mistaken a parent or guardian may be in withholding
consent and however unsuitable the circumstances in which the defective is
living may be, consent cannot be regarded as being unreasonably withheld unless positive
proof of bad faith is produced. It is obvious that such proof is extremely difficult to
obtain which means that it is now virtually impossible to remove a person to a mental
deficiency institution in the face of the refusal of consent by his parent.
It may be that there have been instances of the law being stretched by zealous local
authority officers and that a corrective was necessary, although I cannot feel that these
instances have been at all frequent or that the intention of the officers concerned has
been other than well-meant. The effect of the Court decisions, however, has been to
swing the pendulum so far the other way that some sections of the Act have been
completely nullified and for this reason alone fresh legislation is urgently needed.
In broad outline, and with few exceptions in detail, the Council is in substantial
agreement with the proposals of the Royal Commission which are welcomed as
providing an imaginative charter for a complete mental health service.
The proposed changes in nomenclature and procedure, which are in accord with
modern opinion, would in the main need legislation, but so far as the Council is concerned
could be put into effect without great difficulty. On the other hand the proposed
development and extension of the services, which in the opinion of the Royal Commission
could largely be carried out under existing powers, would involve practical
difficulties in the fields of finance, staffing, and the provision of accommodation which
could not be completely overcome for a long time.
As regards the procedures for the admission and discharge of patients, which have
been the source of much criticism during the past few years, the Royal Commission's
proposals are more liberal even than the recommendations of any of the witnesses who
appeared before it. In my report for the year 1954,1 set out a summary of the Council's
recommendations to the Royal Commission. It is extremely gratifying to the Council
that the pattern of the services proposed by the Royal Commission for the mentally
backward is very much on the hnes of the recommendations of the Council in respect
of mental defectives.
* The Report of the Royal Commission on the Law relating to Mental Illness and Mental Deficiency, Her Majesty's
Stationery Office, 10s. 6d.
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