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admission to an observation ward, and patients have been admitted under' three day
orders' of the mental welfare officer. The Ministry of Health have, however, recently
authorised the voluntary admission of patients to some observation units. About
21 per cent, of the patients admitted to observation wards were subsequently certified.
In view of the facts that, under the arrangements proposed by the Royal Commission,
it would not be possible, as it is now, for the mental welfare officers on their own
authority to remove patients to hospital and that patients are to be presumed to be
willing unless they positively object, it may be expected that some patients hitherto
dealt with by the mental welfare officers would be admitted to hospital, as many
voluntary patients are at present, by arrangements between the patient's doctor and the
hospital without reference to the mental welfare officers. On the other hand, it is not
unlikely that many doctors would continue to refer their patients, whether they object
or not, to the mental welfare officers for disposal and cases would continue to be referred
to them from non-medical sources. Most patients do not positively object to admission
and in these cases it would be possible for the mental welfare officers to arrange
admission without any formal medical certificates although the majority would be
referred by general practitioners, hospitals or other medical sources and it would be
necessary for the receiving hospital to agree to the patient's admission. No doubt some
patients, who do not positively object to admission at the time they arc seen by the
mental welfare officer, would do so on or after admission. In these circumstances,
compulsory action would then have to be taken if it was essential for the patient to be
retained at the hospital.
As a very tentative estimate it is possible that compulsion would be necessary in
10-15 per cent. of the cases which have hitherto been admitted to observation wards
or brought directly before a Justice (5,220 in 1957) in respect of whom two (one in
emergencies) medical certificates would be required. The Royal Commission envisage
that normally one of these would be given by the doctor attending the patient and the
other by a doctor specially experienced in the diagnosis and treatment of mental disorders
and approved by the local authority, who would usually be a doctor on the staff
of the receiving hospital. It is possible that some general practitioners, although prepared
to initiate the proceedings by referral, might be reluctant to give certificates in the
prescribed terms which would be required and some patients have no doctor. It would
accordingly be necessary for the mental welfare officers to be able to secure the services
of a doctor at short notice. As regards the second certificate it would be necessary for
the receiving hospitals to send a psychiatrist out to see the patient or for the certificate
to be obtained from another approved doctor. It should not be too difficult in Lordon
for a panel of doctors, who would be available to be called out when necessary either
when there is no usual medical attendant or to give a second certificate, to be drawn up
from the list of approved doctors. Clearly, however, the closest liaison will be necessary
between the mental welfare officers and the doctors at the receiving hospitals.
The Council is disturbed by the suggestion that mental welfare officers should be
completely deprived of their power to remove patients on their own authority. It may
be argued that purely in the interests of the patient it is desirable that he should always
be seen by a doctor before being compulsorily removed against his will. It has yet to
be seen to what extent general practitioners will be willing to be associated with the
process of compulsion. In the past, some of them have been very ready to pass the
responsibility on to the mental welfare officer. In any case the interests of the community
cannot be entirely disregarded. Some patients display extreme violence and in such
cases the need to obtain even one medical certificate could give rise to dangerous delay
and even result in tragedy. The Royal Commission propose that the police should be
able in certain circumstances to remove without a medical certificate a mentally ill
person found in a public place. The Council is of opinion that mental welfare officers
should have a similar power for use in cases of acute emergency. The difficulty of
defining the circumstances in which the power should be used without some risk of its
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