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contained in section 28 of the National Health Service Act, 1946, from which the power
to act would derive. Moreover, the Royal Commission clearly envisage that compulsion
might be necessary in some of these cases, not necessarily only because of the
mental state of the patient, but because of the home circumstances and here again
classification would be necessary.
The Royal Commission point out that there are wide differences of opinion on the
question whether the term 'mentally defective' should be confined to people who are
sub-normal in intelligence or whether it should include those whose intelligence is
normal or even above normal but who show serious lack of maturity in other aspects
of their personality. The Royal Commission take the view that as applied to the feebleminded
and to moral defectives the wider interpretation is the correct one.
Whether or not this interpretation was intended by Parliament when the Act was
passed, there is no doubt that it is not understood or accepted by the general public
and that the certification of persons of normal or above normal intelligence as mentally
defective has given rise to the widespread public misgiving about the administration of
the Mental Deficiency Acts. This misgiving has even extended to the feeble-minded
who intellectually are below the accepted level of normality with I.Q.s of around 70-75.
Of course it is not the intention of the Royal Commission that all types in the same
group should be accommodated in the same institution. Although they consider that
any hospital, home, hostel or. training centre should be at liberty to receive any type of
patient for whom it has the requisite facilities for treatment or training, they envisage
that, as at present, some hospitals will specialise in treating certain types and that the
local authorities will provide small residential establishments to accommodate 20 to 30
residents (with a maximum not much over 50) of different types. Nevertheless the
diagnosis as a psychopath of a mentally backward person with no other personality
defect is likely to give rise to the same sort of misgiving in the mind of the public as
the classification of moral defectives and high-grade feeble-minded persons as mental
defectives has done hitherto. Although it is the intention of the Royal Commission
that the terms should be used only for administrative and legal purposes and the patients
themselves would not normally know the category in which they were placed, it is
inevitable that inquiry would be made by some parents or interested persons which
would make disclosure unavoidable.
From a practical point of view, the effect of the Royal Commission's proposal is
minimised by their recommendation that psychopaths should be dealt with compulsorily
after the age of 21 only if they commit a criminal offence. Nevertheless it is
considered that the terminology would be more acceptable and less likely to give rise
to contention if those persons hitherto classified as high-grade feeble-minded, whose
sub-normal intelligence can be demonstrated by standardised tests, were not included
in the same group as persons of normal or above normal intelligence who possess
pathological moral or emotional deficiencies. It is suggested that they might be described
as ' sub-normal persons' as against the term ' severely sub-normal persons' proposed
by the Royal Commission for low-grade defectives, leaving the psychopaths as a
separate group.
Admission procedures
(a) Mentally ill patients—As shown in the detailed analysis by Dr. Herd at page 106, of
the 7,439 cases of persons alleged to be mentally ill and in urgent need of care and
control referred to the Council's mental welfare officers for investigation during 1957,
of whom 5,486 were referred from medical and 1,953 from non-medical sources, no
action by the mental welfare officers was possible or necessary in 1,691 cases, 3,924 cases
were removed to observation wards, 1,296 were brought before a Justice and in the
remaining 528 cases other action or disposal was arranged or recommended by the
mental welfare officers. About one-sixth of the cases are referred between the hours
of 9 p.m. and 9 a.m. There is no specific provision under the present law for voluntary
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