Mental Hospitals.

Orders of the Day — Civil Services Supplementary Estimates, 1924–25. – in the House of Commons on 10th March 1925.

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Photo of Mr Robert Taylor Mr Robert Taylor , Lincoln

I beg to move, That, in the opinion of this House, a reform of the conditions existing in Mental Hospitals is of urgent importance. As a Royal Commission is taking evidence on the mental hospitals, and reviewing the whole question of changes in the law, and with regard to the detention and segregation of patients, I do not propose to waste the time of the House by traversing ground which is being much more effectively dealt with elsewhere. I do, however, find in the Departmental Report, published last July, the following paragraph on page 45: We wish to make a strong appeal to visiting committees and to officers of authority in public mental hospitals to give effect to our recommendations at a very early date. A little lower down on the same page is the following observation: In order to carry out the recommendations. they must be adopted generally. I want to offer some very short remarks about the conditions under which the mental hospital staff are working. That Commission reconsidered the matter with particular reference to the question of the nursing staff, and discovered that there were, roughly, four groups. First of 'all, there were the mental hospitals that had already adopted the 48-hour week, and were working with three eight-hour shifts per day. In these the conditions were, on the whole, better for the patients and better for the staff than in any other group. In the second group were a number of mental hospitals in which the average number of hours per week worked was 56. In the next group the average number of hours worked per week by the nursing staff was 60. In the fourth group 66 hours per week was the number of hours worked.

I want to make this plea. There is no need to wait for the Report of the Royal Commission before giving effect to the recommendations of this committee When we consider the physical and mental strain under which this magnificent body of men and women do the dirty work of society, a work which would be repulsive were it not for their gift of human charity, kindness and love—when you consider that these people are working under conditions in which they may he subjected to physical violence; in view of the mental suffering of the patients and the degree of suffering, which is such in some cases that it leads to conditions of indescribable filth among which these people have to pass their daily lives, I do think that people who spend most of their lives looking after the insane are entitled to expect from the rest of society much better treatment than they are getting to-day.

The average wage of a fully-qualified and trained male nurse in charge of a ward is less than the minimum wage of a police probationer. I suggest to the Government that, while J believe that a forty-eight hour week in asylums could b, secured, if necessary, by legislation, an is quite long enough for people in that kind of occupation: whilst I believe that a. forty-eight hour week enables the staff to look after the patients better, to give the patient a long day, and avoid putting them to bed at seven or eight o'clock when the Summer Time Act comes into operation; whilst it allows them to keep the patients up to a reasonable time so that when they retire they are physically tired, and therefore enables all to have an easier time; while, I say, I believe that a forty-eight hours week is the right thing, still when you have the Committee which examined this specific problem 12 months ago and reported in favour of 56 hours, giving a day and a half a week compulsory holiday to the mental staffs. and when you realise there are numbers of institutions that are actually working 60 and 66 hours per week, then I think the Board of Control might very well try through administrative action, limited thought I know the powers to be, to achieve something in the right direction. The Board of Control could, by judicious pressure, bring up the worst asylums to the level, at any rate, of the recommendations made by the Committee.

Whilst I am on my feet, perhaps the House will forgive me for drawing attention to another pressing question in regard to asylum administration. About a fortnight ago I went through an asylum and discovered about 30 boys and girls who ought not to have been there at all. According to the medical evidence of the superintendent of that institution, they were capable of being trained and educated in some degree, and they ought to have had an entirely different environment. As a matter of fact, those children were in the wards with adult patients, with idiots, and with lunatics of every degree of suffering. The medical superintendent of that institution is not keeping those children in that environment because he is not a humane man, for he is a most humane and efficient administrator, but the difficulty is that there is no alternative accommodation. He has made representations to the local authorities with regard to those children, but the local authorities, when it comes to tackling the problem from the practical point of view, are up against the difficulty that it is necessary to embark on large capital expenditure in order to provide accommodation for mentally defective children who are now either huddled with idots in Poor Law institutions or in mental hospitals.

In areas which have suffered from abnormal unemployment, which are bearing extra burdens, where the rates are high, and where there are thousands of pounds that cannot be collected from the citizens, you have the utmost difficulty in getting local authorities to face their responsibilities with regard to these children. If the Government can do anything in the way of assisting local authorities to meet the new capital expenditure involved in giving effect to the new ideas with regard to colonies for treatment, I hope they will give it their sympathetic consideration, because even the 60 per cent. grant which, under the Mental Deficiency Act, they can make towards capital expenditure, is not sufficient, in view of the financial position of many of the authorities. I hope the Government will not wait for the Report of the Royal Commission upon other matters, difficult matters and debatable matters—there are a great many things wrong in our mental hospitals—before doing justice, or giving an instalment of justice to the staffs who are doing the dirty work of society. and I trust the Minister will do his best to bring the worst authorities up to something like the level of the recommendations contained in the Report.

Photo of Mr Robert Richardson Mr Robert Richardson , Houghton-le-Spring

I beg to second the Motion.

I do so because of the long experience I have had of these institutions. While serving for 23 years on a visiting committee, I have tried my level best to gather all the information I could as to the whole of the circumstances attached to this deplorable side of life. I am firmly convinced that thousands of people find their way into our mental hospitals who ought never to be there, seeing the class of institutions they are. There is nothing inside our hospitals that lends itself to these poor people ever becoming well again. People go there because they are mentally depressed. Through business worries or some family trouble, people become depressed, and they find themselves sent to these hospitals, where they mix with those who are hopeless maniacs. What hope can there he for this class of patient ever coming out again? I hope the Minister of Health will take this matter into his serious consideration, and introduce legislation that will give us a real hospital where people who become depressed from these causes may be sent just as freely as a patient goes to any other hospital. If that were done very much of the expenditure now incurred by local authorities would be obviated, and for these reasons I hope that in the near future we shall have some legislation on this subject. My hon. Friend who has just sat down referred to cases where a number of children in one asylum had to mix with the adults. I have known cases in my own district where this has frequently occurred.

There are one or two other points which I should like the Minister of Health to take up. I think arrangements ought to be made to have these cases placed in charge of the health committees of the local authorities. I would also like to call attention to the insufficiency of the medical staff. Take the case of a hospital which I know very well. In that hospital there are only four doctors to attend to the needs of some 1,400 patients, and what can they do under such conditions. I think a very much larger medical service ought to be provided in those hospitals, and if that were done, in my opinion, instead of having a percentage of 19 or 20 patients recovering it could easily be increased to 40 or 50 per cent. in the near future.

With regard to nurses nearly every hospital I am acquainted with is entirely understaffed, and you find one nurse has to look after 40 or 50 patients during very long hours indeed, and no wonder they become irritable and not fit to carry out their duties. In the Durham Asylum we tried the 48 hours' week, but now the female staff are called upon to work 56 hours per week exclusive of meal times, and they have now 10 times as much sickness to deal with as they had under the 48 hours system. I trust the Home Secretary will see that more humane conditions are granted to these people who do such a very necessary work. I also want better provision made for looking after the people discharged from our asylums. In many cases what happens is very deplorable to many of us who know what actually takes place. Very often the result is that these people are taken back to the place in which they have been incarcerated so long. I appeal to the Home Secretary to take into his serious consideration this very important matter, and endeavour to make our mental hospitals real hospitals, and not so much like prisons, as they are at the present time.

Photo of Sir Kingsley Wood Sir Kingsley Wood , Woolwich West

I am sure the whole House will have every sympathy with both the spirit and the letter of the Resolution, and I wish it were possible to-night to deal more effectually and adequately with the matter. I would, however, like to remind Members of the House that, so far as the general question to which the Seconder of the Resolution has just referred, at the present moment, as the hon. Gentleman proposing the Motion knows, there is a Royal Commission sitting which has very wide terms of reference, and which is empowered to examine many of the points raised by the hon. Member for Houghton-le-Spring (Mr. R. Richardson). It is a Commission which is sitting under the able chairmanship of Mr. Macmillan, and its terms of reference are to inquire as regards England and Wales into the existing law and administrative machinery in connection with the certification, detention, and care of people who are or are alleged to be of unsound mind and to consider as regards England and Wales the extent to which provision is or should be made for the treatment without certification of persons suffering from mental disorder. Therefore I think the hon. Gentleman who seconded the Resolution will not feel that I lack sympathy when I say I think it would be better to await the judgment of the Report of that Commission before I indicate any views which I myself have on the matter. I inquired this evening when that Report is likely to be available. As the hon. Member knows, it is a very important subject. I anticipate that the Report of the Commission will be forthcoming next year. I think it will be time well spent if we get a, considered judgment on this matter. At present many witnesses are being heard and the Commission have to hear many others who have to come before them. I am advised that no time is lost in considering the cases, and as soon as the Report is received it will receive the immediate attention of the Department.

I wish to say upon the immediate matter raised by the hon. Gentleman who moved this Resolution which referred particularly to a report which has not been very long issued and which is called the Report of the Departmental Committee appointed to inquire into the nursing service in county and borough mental hospitals. I agree, I think, with almost everything he said in his speech. If I may say so, the work of the mental nurses in this country certainly does not receive the public commendation that it ought to do. We hear—and it is often emphasised, particularly in connection with mental cases—many charges of ill-treatment, but I certainly think—and I am glad the hon. Gentleman to-night has referred to it—that the people engaged in the very difficult and exacting task of nursing these poor people should receive every sympathy from this House and the local authorities up and down the country. It cannot be too fully recognised that the fate and cure of a very large number of people in these asylums up and down the country rest very largely in the hands of the nursing staff itself. They are the people who, day after day, have to look after these people, and my Department desire in every possible way to see that they receive sympathy and carry out their duties under the most favourable conditions. I have only to say that this Report contains many important recommendations regarding the staff of these authorities. Various methods of reform are suggested in the Report which should be adopted and the Board of Control is most anxious that, at any rate, many of the recommendations shall be adopted by the local authorities. I want to assure both hon. Gentlemen who, to-night, have made such powerful speeches, that, so far as the Board are concerned, they have done and as far as possible will do what they can to improve the conditions of people who have such difficult tasks to carry out in their every-day life. I should tell the House, however, that the difficulty is, as the hon. Gentleman who introduced the Resolution knows, that the Board of Control have no powers to enforce on the local authorities better terms and conditions with regard to mental nursing. What the Board has done, and will do, will be to keep these recommendations constantly before them, and, so far as they can, to bring them before the notice of the local authorities. The few remarks which the Seconder of the Motion made to-night will, I am sure, do good. My Department will endeavour, so far as we possibly can, to improve the conditions of a body of people whose conditions we think need improvement, but that, as the hon. Gentleman who moved the Resolution knows, is as far, at the present moment, as we can go.

Photo of Mr Robert Richardson Mr Robert Richardson , Houghton-le-Spring

May I suggest that something might be done by increasing the miserable amount of 4s, 8d, which is allowed to the authorities? It was fixed many years ago, and I feel sure the authorities would spend the money wisely and well.

Photo of Sir Kingsley Wood Sir Kingsley Wood , Woolwich West

I will certainly make that suggestion to my right hon. Friend, and see whether anything can be done. As the hon. Gentleman knows, there is another Department that is concerned in that connection. I want, finally, to say to both hon. Gentlemen that, so far as we are concerned, we will endeavour to improve the conditions of the people in these hospitals, and will continue to bring the matter before the notice of the local authorities. By that means I hope that something may be done for a very important body of, I venture to think, deserving people. I hope that with that assurance both hon. Gentlemen will consider, having regard to the short time we have been able to discuss this matter to-night, that it will not be necessary for them to press the Motion further.

Photo of Mr Robert Taylor Mr Robert Taylor , Lincoln

In view of the fact that a certain amount of money has been placed at the disposal of the Board of Control for the purpose of encouraging local authorities to develop the provision of accommodation under the Act, will the hon. Gentleman confer with the local authorities in the worst areas, where the need is most pressing, and, if possible, increase the total amount of grant to the Board over and above the 50 per cent., in order that the most pressing needs may be met in the worst areas?

Photo of Sir Kingsley Wood Sir Kingsley Wood , Woolwich West

I will undertake to consider the suggestion which the hon. Gentleman has made, and to confer with him first as to what further can be done. As he knows, I am not in a position myself to give any undertaking, but I can assure him of my personal sympathy and the anxiety of the Department to help in the matter.

Photo of Mr John Whitley Mr John Whitley , Halifax

Does the hon. Member wish to press the Motion?

Photo of Mr Robert Taylor Mr Robert Taylor , Lincoln

I beg to ask leave to withdraw.

Motion, by leave, withdrawn.