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provided that they are not compulsorily detained for longer than 28 days. Psychopathic
patients of any age who break the criminal code should be liable to compulsory
admission to hospital or guardianship on medical advice if ordinary penal measures
alone are considered to be insufficient or inappropriate.
The above recommendations should apply irrespective of the age of onset of the
patient's mental disorder or the level of his intelligence.
Compulsory powers should be used only after every effort has been made to
persuade patients and their relatives to agree to care without compulsion, but, if such
efforts fail, doctors and others should not be too hesitant to use compulsory powers
when this seems the only way of giving the patient the necessary treatment or training
or when necessary for the protection of others.
A distinction is drawn in the compulsory procedures proposed according to whether
compulsion is necessary to override the unwillingness of the patient himself only or to
override the unwillingness of the patient's nearest relative.
The Royal Commission are opposed to the existing practice of bringing the patient
before a magistrate when compulsion is used as they do not regard this as so effective a
safeguard to the patient as requiring more than one medical certificate to be provided,
extending the powers of discharge and providing new opportunities for review by a
strong independent body.
No one who is not medically qualified should be required to take action without
medical advice and, except in emergency, compulsory admission to hospital or guardianship
should be effected on the application of a relative (or by a mental welfare officer
acting in place of a relative) supported by two medical recommendations, one of which
should be given by a doctor experienced in the diagnosis or treatment of mental disorders,
and one, if possible, by a doctor who already knows the patient. Except for
paying patients, it should be permissible and usual for one certificate to be given by a
doctor on the staff of the receiving hospital or of the local health authority which is to
act as guardian.
It is proposed that, in an emergency, admission could be arranged with only one
medical recommendation, the second to be obtained within 72 hours (or 28 days in
cases of guardianship which could be provided for any type of patient) if the patient
is to be detained longer than that. The medical recommendation should include either
a firm recommendation for hospital or community care or a recommendation for up to
28 days' observation in hospital.
The foregoing compulsory procedures apply in those cases in which the patient
objects to admission but the nearest relative does not. It is proposed that the patient
should have a right of appeal at prescribed times to one of the Mental Health Review
Tribunals, which the Commission recommend should be set up on a regional basis.
These tribunals should be independent bodies and have medical and non-medical
members appointed by the Lord Chancellor in consultation with the Minister of
Health.
In cases in which the nearest relative unreasonably opposes the provision of hospital
or community care, it is proposed that a mental welfare officer of the local health
authority (or another relative) should apply to a magistrates' court for the relative's
power to apply for admission and to order discharge to be transferred to the local health
authority or to another person or for the local authority or other person to be authorised
to act as guardian. If the application were granted, the patient would be admitted
informally or, if he also objected, under one of the compulsory procedures mentioned
above. The relative would have a right of appeal to quarter sessions against the magistrates'
decision, would be able to apply at any time to the appropriate authorities for
the patient's discharge and would have the right once a year to ask for review by a
Mental Health Tribunal.
The proposed compulsory procedures cover both admission to hospital or community
care for treatment or training and admission to hospital for observation and are
the same for all three groups of patients.
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