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The comment on the Royal Commission's proposals later in this report is concerned
principally with a few matters on which the Council does not agree with the recommendations
of the Royal Commission and with difficulties which it is anticipated may
arise. This should not, however, obscure the Council's admiration of the general
excellence of the report and the thorough and painstaking manner in which the complex
and difficult problem of the care and treatment of the mentally disordered has been
dealt with.
Summary of Royal Commission's proposals
It is not practicable, of course, to set out here all the recommendations of the Royal
Commission. The principal recommendations affecting the services of local health
authorities are, however, summarised as follows :
Nomenclature and classification of patients—The Lunacy and Mental Treatment Acts and
the Mental Deficiency Acts should be repealed and the terms 'certified patient',
'certification', 'person of unsound mind ' mental deficiency 'mental defective
'idiot' and 'imbecile' should no longer be used. The term 'mental disorder' should
be used as a general term to cover all forms of mental ill-health or disability and for
legal and administrative purposes the following three main groups of patients should be
recognised:
(i) Mentally ill patients—The term mental illness would be used in the same sense
as at present, including the mental infirmity of old age.
(ii) Psychopathic patients or patients with psychopathic personality—This term would
be used in a wider sense than it is commonly used at present and is intended to include
any type of aggressive and inadequate personality which does not render the patient
severely sub-normal in the sense of the third group. It would include patients at
present classified as feeble-minded or moral defectives not coming in group (iii)
and the term ' Feeble-minded psychopaths' is proposed to describe these patients.
(iii) Severely sub-normal patients—This term would be used when the general
personality is so severely sub-normal that the patient is incapable of leading an
independent life. This group would include all patients at present classified as idiots
and imbeciles and some of those classified as feeble-minded.
Admission procedures, etc.—All forms of hospital and community care should be available
in future to mentally disordered patients who are content to receive them with no
more restriction of liberty or legal formality than is applied to people who need care
because of other types of illness, disability or social difficulty. The law should not
prevent mentally ill persons from entering hospital without being subject to detention
if they cannot make a valid positive application for admission, but these patients, like
physically ill patients, should be assumed to be content to enter hospital unless they
positively object.
Compulsory admission to hospital or legal control under guardianship while
receiving community care should be permitted for mentally ill or severely sub-normal
patients when compulsion is necessary for their own welfare or for the protection of
others, but it is considered that there is not now sufficient justification for special compulsory
powers for older feeble-minded or other psychopathic patients, whose
characteristic is their general behaviour, not loss of reason or serious lack of intelligence,
except when they have broken the criminal law. Psychopathic patients should be liable
to compulsory admission to hospital or guardianship if this is necessary for their own
welfare or the protection of others, if under the age of 21 at the time of admission,
the compulsory powers to lapse when the patient reaches the age of 25, if he has not
already been discharged, unless his admission follows court proceedings or transfer from
prison or approved school or unless he has become liable to compulsion in another
category. Psychopathic patients, as well as mentally ill and severely sub-normal patients,
should be liable to compulsory admission to hospital for medical observation at any age,
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