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persons who are suffering from subnormality or severe subnormality and any necessary
reports on the patient's home and social conditions are furnished by the mental welfare
officer. During 1961 the Council's staff were called upon to give evidence in the case of
56 adults and 11 children and young persons and were concerned in the compulsory removal
to hospital of 167 persons as the result of Court orders.
Guardianship—Guardianship of mentally subnormal persons under the Mental Health
Act, 1959 replaced (with some differences) the provisions for guardianship under the former
Mental Deficiency Acts. A local health authority can now itself act as guardian and guardianship
may now also be used as a form of control over mentally ill and psychopathic
patients who do not need to be in hospital. Up to the end of 1961 this form of control
for mentally ill or psychopathic persons had, however, not been used. In most cases it is
possible for mentally disordered persons to receive community care without being subject
to the legal control of guardianship over their place of residence and everyday life, but a
small number of patients in the community still require control for their own welfare or
for the protection of others.
The procedure for placement under guardianship follows the same lines as that for
securing compulsory admission of a patient to hospital. Applications to the Council for
securing care under guardianship are made by the nearest relative or by mental welfare
officers and must be accompanied by two medical recommendations (as in applications
for admission to hospital), but in these applications reasons must be given why the patient
cannot appropriately be cared for without powers of guardianship. The powers conferred
are those which would be possessed by the guardian if the authority or the person concerned
were the patient's father and the patient was under the age of 14. Guardianship in relation
to subnormality or psychopathic disorder is limited to persons under the age of 21 years,
but there is no such age limit in the case of severe subnormality or mental illness or in
relation to patients who are the subject of court orders.
The guardian is required in general, so far as is practicable, to make arrangements for
the occupation, training or employment of the patient and for his recreation and general
welfare and to ensure that everything practicable is done for the promotion of his physical
and mental health.
Under the new Act a 'responsible medical officer' was required to review all persons
remaining under guardianship on 1 November, 1960, in order to classify under the Act
the form of mental disorder from which they were suffering and to decide whether it was
necessary for them to remain under guardianship. There were 92 London cases under
guardianship on 1 November, 1960, of whom 51 were discharged from guardianship and
continued in community care on an informal basis, three were admitted to hospital and
38 were continued under compulsory guardianship.
It was decided that, save in exceptional circumstances, the Council should itself seek to
undertake the function of guardian in all cases where this form of control was appropriate
for mentally disordered persons under its care and that the Council's whole-time medical
staff who have been approved for the purposes of section 28 of the Act should be authorised
as 'responsible medical officers' in relation to these functions. Such officers act for the
Council under the provisions of regulation 24 (1) of the Mental Health (Hospital and
Guardianship) Regulations, 1960. Six members of the Health committee were appointed
to exercise the power to order the discharge of a patient from guardianship, a power which
is also given to the nearest relative.
Approval of medical practitioners for the purpose of compulsory removals and guardianship—One
of the two medical recommendations required for the compulsory admission
of a mentally disordered person to hospital or reception into guardianship must be given
by a practitioner approved by a local health authority as having special experience in the
diagnosis or treatment of mental disorder; the other certificate is normally given by the
patient's general practitioner. Before approving a medical practitioner a local health
authority must consult a professional advisory panel for its area (appointed by regional
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