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Mental welfare officers should be free to decline to act on a medical recommendation
in favour of admission but they should never act without the support of at least one such
recommendation.
Powers of discharge should be held by each of the following :
(a) The patient's nearest relative, subject to a barring certificate which might be
given only if the patient is dangerous to himself or others ;
(b) the medical superintendent or other responsible doctor ;
(c) any three members of the hospital management committee, or board of
governors (or of the appropriate committee of the local health authority in cases of
guardianship) ;
(d) Mental Health Review Tribunals on specific occasions ; and
(e) the Minister of Health.
The law should allow patients to be placed under the guardianship of local health
authorities, as well as of private individuals, analogous to local authorities' present duty
to act as a 'fit person' under the Children and Young Persons Acts, but admission to
hospital or placing under guardianship, even when compulsory powers are used,
should be contingent upon medical acceptance of the patient by the hospital or local
health authority concerned. The proposed new procedures should authorise the
authorities to receive the patients, but should not be construed as orders that they must
do so.
Community care—The Royal Commission lay down a clear division of functions as
between the hospitals and the local authorities. The hospitals should provide in-patient
and out-patient services for patients who need specialist medical treatment or continual
nursing attention, including the care of helpless patients in the severely sub-normal
group.
Local authorities should be responsible for preventive services and for all types of
community care for patients who do not require in-patient hospital services or who have
had a period of treatment or training in hospital and are ready to return to the community.
This will involve the provision of day or residential training centres for severely
sub-normal children ; training or occupation centres and social centres for adult severely
sub-normal patients, psychopathic patients or patients with residual disability after
mental illness; residential accommodation in private homes or in homes or hostels
provided by voluntary societies or the local authorities themselves for many types of
patient, including old people with mild mental infirmity; and general social help and
advice to patients of all types and ages and to their relatives.
Social work for patients who are not receiving hospital treatment, including patients
who have left hospital, should be the responsibility of local authorities, who, in the
opinion of the Royal Commission, could also do a great deal in co-operation with the
hospital staff for hospital out-patients and even for in-patients. Arrangements should
be made in each area to ensure the closest co-operation between the hospitals and the
local authorities.
Attendance at occupation or training centres by children who require training in
place of education at school should be compulsory and the procedure to be followed
in individual cases should be similar to that used when a child is recommended for
education at a special school. The Royal Commission are of opinion that the centres
should continue to be run by the Health Authority and not by the Education Authority.
Children not attending school should receive health and welfare services similar or
equivalent to those provided for school children.
Sub-normal children should not be excluded from the general child care services
if they can suitably mix with other children, although it is recognised that most such
children need specialised care which can more suitably be provided through the mental
health services.
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