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extension to cases in which it would not really be necessary is recognised but this is the
lesser of the two dangers, at least until medical resources are such that a doctor is as
readily available as a lay officer in a round-the-clock service. Under the existing law
it is only under section 20 of the Lunacy Act, 1890 (i.e., removal to an observation
ward on a three-day order) that the mental welfare officer has this power.
It is difficult to forecast the effect the Royal Commission's proposals would have
on the volume of work of the mental welfare officers. While, as previously stated, there
might be a reduction in the number of cases they would deal with, many individual
cases would undoubetedly take up more time.
For the past year or so, there has been an arrangement with Bexley hospital by which,
whenever possible, when cases in that hospital's catchment area have been referred to
the mental welfare officers, the hospital has been notified and a doctor from the hospital
has visited the patient. This has facilitated the proper disposal of the patient. It must be
remembered, however, that this arrangement has been possible because the catchment
area is reasonably accessible to the hospital. A similar arrangement has recently been
instituted with Cane Hill hospital and it is hoped to extend it to other hospitals but
difficulties arise when, as is the case with a number of the mental hospitals serving
London, the catchment area is remote from the hospital.
It has always been the Council's view that it is desirable that patients needing removal
by the mental welfare officers should, whenever possible, be admitted in the first instance
to an observation ward. The reasons for this view are that (i) in many cases this procedure
avoids admission to a mental hospital, e.g., when the condition clears up in a short
time, and (ii) even when admission to a mental hospital is found to be necessary,
compulsion is often avoided and the patient is admitted on a voluntary basis.
It is felt that under the proposed arrangements accommodation in general hospitals
should be available for psychiatric patients on the lines of the existing observation
wards for the reception of selected mentally ill patients whether they are willing to be
admitted or whether compulsion is necessary. It is also considered that as regards patients
needing compulsion the procedure authorising compulsory detention for not more
than 28 days should normally be used in the first instance. This would comply with the
Royal Commission's expressed opinion that the use of compulsion should be kept to a
minimum.
No suggestion has been made that observation ward (or similar) facilities will not
be available in future. In fact, since the Royal Commission envisage that any suitable
hospital may receive any patient for treatment or observation, there is scope for enlargement
of these facilities within the framework of the proposals. In view of the Royal
Commission's intention that one of the two medical certificates required for compulsory
detention shall normally be given by the receiving hospital, it is considered that the
facilities for the treatment of mentally ill patients would be much improved if a small
unit were established in a general hospital in the catchment area of each mental hospital
(or of two or more mental hospitals) with appropriately qualified medical staff, including
a consultant from the mental hospital who would visit regularly. Individual mental
welfare officers could be allocated to deal with cases arising in the catchment area and
the doctors could decide which patients should be admitted direct to the mental hospital
and which to the local unit or otherwise dealt with and give any necessary medical
certificates.
An arrangement on these lines would seem to be very necessary if the admission
arrangements proposed by the Royal Commission are to work smoothly. It would
also provide a better integrated service although it might necessitate the employment of
more doctors by the hospitals and would involve inter-regional agreement since the
catchment areas of some hospitals are not in the same region as the hospital.
The Royal Commission's opinion that their proposed new procedures for compulsory
admission should authorise the authorities to receive the patients but should
not be construed as orders that they must do so, should not be allowed to give hospitals
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