I wish to raise a question relating to mental defectives, and I should like to deal with the matter in the most judicial way I can. It came to my attention three or four months ago, when I found that a number of youngsters had been before the police court and had been sentenced to short terms of imprisonment. On completing their sentences, they were, apparently, medically examined and were found to be mentally defective. They were ordered to one of these mental institutions or colonies. As the House knows, under the Mental Deficiency Act, 1913, they can be ordered by the Secretary of State for the Home Department to be detained there for one year. On the certificate of two doctors, one the medical superintendent of the institution and the other another medical man, it is on the cards that an individual may be certified for a further five years. At the end of that five years, the individual can be re-certified for another five years.
As a result of raising this matter with the Ministry of Health I received a mass of correspondence from all parts of the country, and it seemed from the correspondence that there was a widespread anguish, not only on the part of parents who had discovered that they had lost legal guardianship and control of their children, but on the part of adolescents growing into adults, who feared they had been deprived permanently of any prospects of being allowed to return home. I am not particularly well up in this matter, but I have done some work on it during the last four or five weeks, and I understand that there are two classes of mental defective. A child under the age of 16 can be certified as a mental defective if it cannot—I am not quoting the actual words of the Act—benefit from a normal course of education. After the age of 16 a person is a mentally defective adult, and there is no question of an education test. People over the age of 16, in the great majority of cases of this kind, do not go to public elementary schools. I think that institutions for mental defectives should be educational institutions. In the time at my disposal, I will confine my remarks to young mental defectives.
I wrote on various occasions to the Board of Control at St. Anne's, mentioning various cases that had been given to me, and I got a reply in more or less the same terms. It was to the effect: "This patient is a feeble-minded person who does not know what is celebrated on the 25th December, does not know how many pennies there are in a half-crown and cannot recite the months in the right order." The letter generally went on to say that the patient's home was very untidy and dirty and that the parents had lost all control over the child. At that time, and now I confess, I was wrong, I thought there was very little connection between the conditions of a child's home and the fact that it was mentally defective and should remain incarcerated as feebleminded. On making further inquiries, I discovered that there was a considerable amount of concatenation—if that is the right word—between high-grade feebleminded people and bad home conditions, and, often feeble-minded parents as well. Therefore, I have no objection to raise that those two matters were put in the same category, although at first sight they did seem to me to have no relation to one another. I think that I was wrong.
These institutions should be very much more concerned with the education of these children, so as to allow the children to be rehabilitated into ordinary social and communal life. That is what they are for. I discovered that a large number of the children had learnt trades, such as house decoration. The question was, Why did they seldom return to the outer world? I was recently reading a book by a man called J. Duncan, headmaster of the Hampshire County Council Special M.D. School. On page 49, in the early edition, he says this:
As far as possible the needs of the institution and its inmates are supplied by the efforts of the inmates, and some of the products of their labour—e.g., hand-made mats and brushes—are sold. These efforts assist in appreciably reducing the maintenance cost of public funds. One very efficiently-run institution has an average maintenance cost per head of under a pound per week. When one realises that a proportion of the inmates are chronic bed cases, that others are of imbecile grade able to do only the simplest work, and that all need constant social care, and many need considerable medical care, it will be appreciated that the efforts of the higher-grade cases are of considerable economic value.
It seems to me, to put it in my own words, that you have these institutions, and there seems to be no discrimination or no separation of the high-grade mental defectives, the slightly low grade mental defectives and the idiots and the imbeciles. The right hon. Gentleman shakes his head but I have taken some trouble to go into this and in the cases I have inquired into they do in fact mix together.
I should like the House to understand that a person can be certified as being mentally defective and therefore, in the eyes of certain authorities, presumably a fool because he has only the mind of a child of nine years of age. But a child of nine is not a fool. What happens in the ordinary way is this, and it is a very sad story. You do, in fact, find that children of the same chronological age vary considerably in their mental age, and it is quite possible that in a school class where the average age of the children is 10 years there are some children of a mental age of only seven while the mental age of others is higher than 10. The teacher has a very difficult job in trying to deal with these cases, and the unfortunate thing is that the child below the normal mental age begins slowly and definitely to sink to the bottom of the class, to be regarded as the dunce, to be the butt of the other pupils and sometimes, possibly, the butt of the teacher. He becomes unhappy at school and in due course he has a tendency to play truant.
We have all here played truant. We all—I am sure even my right hon. Friend on the opposite side—have done the same kind of thing, we have played truant, but for different reasons. We have not played truant because we were necessarily unhappy at school, but from the point of view of a spirit of adventure. I am glad to see the Under-Secretary for the Home Department here; I asked him to come. As a result of this kind of unhappiness and playing truant children get into the hands of the police. They come before the magistrates. I know of cases in which the magistrates have acted on the suggestion of the superintendent of a colony that "If you will certify him as feeble minded I will look after him in my own colony." I am not blaming anybody. I wish, as I said at the outset, to do this in the most judicial way I possibly can. I think the system is wrong. Under it there is a tendency for medical men who have not the necessary qualifications in anything to do with psychology being placed in the position of having to look after these children, and also to get cases certified. They and ordinary medical men have the right to certify.
Medical superintendents of a certain number of colonies are in any event very busy men. They have large colonies to look after, and their time is very largely occupied with matters of administration. I think the time has come, in view of some of the legislation which has been introduced by the Ministry of Labour in the matter of ordinary physical rehabilitation, when these mental institutions should now regard themselves as being occupied with and liable to perform the duties of mental rehabilitation. Unlike the position in the days that are dead, when if a person was physically defective he was regarded as almost unfit to be associated with, and as of no use to the community, now, owing to the work of the Ministry of Labour, such people are fitted-in in a most magnificent way. I feel we need a similar policy in the matter of mental defectives, which does not mean idiots or imbeciles, but a large number who are not regarded as normal who are in these institutions. I feel that we should try, if we can, according to some of our slogans on this side of the House, to provide for "each according to his psychological need. I say finally, as I understand both Ministers are to reply, that this is a matter which should be looked into. I will go further. I will see if I can get the support of other Members for another inquiry. I also feel that this is a matter which cannot be really and truly left out of any post-war planning that has to take place.
I am very glad my hon. Friend has raised this matter, though I was in a little difficulty because I was not quite sure on what particular points on this very important subject he desired to speak and desired information from me. This Debate arises from a Question he asked and I got the impression that he was not so much concerned with the way in which mental defectives were admitted to institutions as with the safeguards there were against their unduly long detention and that he was also concerned with the matter of their education and development.
Perhaps I might say first that of course there is a great amount of modern Statute law on this subject. There is the Mental Deficiency Act, 1913, as amended by the Mental Deficiency Act, 1927, and their scope is such that it is impossible to describe in detail, on the Adjournment, the regulations with regard to admission, In view of the fact that the hon. Member asked that the Home Department should be represented, I should, perhaps, make it clear that most of the functions of the Secretary of State under the 1913 Act were transferred to the Minister of Health by the Ministry of Health (Lunacy and Mental Deficiency, Transfer of Powers) Order of 17th May, 1920. So far as admission is concerned, the safeguards are very substantial, with regard to the medical certificate, the rights of parents, and in proceedings before the judicial authority, which consists of selected magisstrates. The Home Secretary is concerned only with persons already detained in prison, or some other place of detention, by sentence or order of the court, and the Orders he makes deal, in the main, with those in approved schools.
There are a great many checks on the certificate of any doctor—and to a smaller extent the young people in remand homes or Borstal institutions. A court of law can make an order after conviction, if it is satisfied on medical evidence that there is mental deficiency. I should also say, in introduction, that mental defectives were newly defined in the 1927 Act. They include, as my hon. Friend has pointed out, people described as idiots, imbeciles, feeble-minded persons, and moral defectives. 1, personally, have not had a single specific case brought to my attention by my hon. Friend, but I should gladly have any particular case investigated.
May I deal shortly, first, with the question of unduly long detention, and, secondly, with that of education and the development of the abilities of those, in respect of whom an order has been made? The matter does not rest simply on the order. Within seven days after admission to the institution, the medical officer of the institution has to make to the Board of Control his own medical statement on the case. He may concur with what has been done by the judicial authority, according to their procedure, or he may disagree. If there is any disagreement, there is consultation, and at any time, with regard to any case, the Board of Control can discharge the patient. As my hon. Friend has pointed out, the conditions of the home are very relevant. There are some homes in which a mentally defective child may be better looked after than in others. The first order operates only for a year. So far as institutions are concerned, the Board of Control have directed that the detention shall be extended to the quarter day immediately after the anniversary of the original order and, unless another order is made, the original order ceases to operate on that date. The case is visited, and there are always two, and more often five or six, visitors, including one medical man at least. That medical practitioner must be a medical practitioner appointed under the Lunacy Acts.
No. In addition to the report of the visitors, there has to be special report and a certificate from the medical officer of the institution. There are arrangements also by which a privately employed medical practitioner, employed at the request of a parent, relative or friend, can make an investigation. Investigations are made at the end of the first year, at the end of the second year, and, after that, at the end of every five years. Also, with regard to young people, when they have reached the age of 21, there must be a special investigation within three months. Then discharge may be ordered; and 'if the visitors do not order discharge, the Board of Control can step in, if it thinks fit, and order discharge. In addition to all these successive investigations, there are, once or twice a year, special visits by Commissioners and inspectors of the Board of Control. All that procedure has been embodied by Parliament in quite recent legislation.
May I pass to what has been done under particular headings—which is all I can manage in the time available—for these unfortunate young persons, and older persons, in institutions? It is very far from being the case that there is any inducement to detain too long. At present, many institutions are overburdened with serious cases and there are applications which cannot be accepted, because of the shortage of accommodation. There is a constant attempt to release, in one way or another, those who could be cared for, in some other way outside the institution.
The accommodation is undoubtedly insufficient. I think I can best put the matter under three heads. First, for children, there is the institution school; and for others, as they get older there are opportunities for learning various occupations. I think I had better describe that with some accuracy. The curriculum in the school has to be suitable for those who are there because they are handicapped in an ordinary school. Then there is training in particular occupations, in such departments as the farm and the garden, the kitchen and the sewing room, training in tailoring, shoemaking and repairing, in joinery, upholstery, brush-making and mat and rug-making, and employment with the engineer, the blacksmith, the painter, and so forth. Rewards are given in appropriate cases, so that, in the sort of instance to which my hon. Friend referred, the person detained may learn the use and the value of money and how to handle it—a very important matter for these people.
Secondly, there is another stage, which the Board of Control have consistently encouraged. That is the system of hostels outside the institution, where those who have been found to be what is described as stabilised, when the way in which they will behave is known, may live more freely, and with less close supervision than in the institution itself, and so may progress. That system has been growing steadily. It is used for those who, as I have said, are described as stabilised and for those who have a good prospect of becoming fit for employment. In February this year, in spite of the difficulties of setting up new institutions in war-time, a circular was issued by the Board of Control, encouraging local authorities to set up hostels of this kind, in existing houses which can be readily adapted. The suggestion is that for such hostels 20 to 25 patients is the appropriate number.
Certainly some have. I cannot give particulars at the moment, but I shall most gladly provide any information of this sort. Now I come to my final point. Although something like 50,000 mental defectives are receiving care and training in institutions, there is a very substantial system of absence on licence. Indeed, out of those 50,000, at any particular time something like 5,000 are on licence. If the local authority does not allow patients to be absent on licence, when, in the opinion of the Board of Control, such absence should be allowed, the Board has again an overriding power. The system has been encouraged by the Board of Control consistently and must, I think, be right.
With regard to discharge itself, I think it must be comforting to those who take an interest—and all should—in this important subject to know that about Boo mental defectives are discharged annually. This is a matter which excites the sympathy of every one of us not only with regard to a young person or older person detained but with regard to relatives and friends and all concerned. Great progress has been made and progress is still made. In any care in which hon. Members are interested, I should be most happy to make inquiries and investigate any facts which they give me.
The discharge of 800 out of 50,000 does not seem to me to show that the institutions are doing their work very well, in rehabilitating these persons and restoring them to society.
What one should appreciate is the fundamental difference between mental disorder and mental defect. A mental defect is something that can be mitigated but cannot be removed. Disorder or derangement may become order and arrangement, but there is no way in which a particular defect may be restored.
I cannot think that it is logical to disparage any particular figure unless there is some attack on the system of certification. If the system of certification is correct and unless definite faults are pointed out, I doubt if it can be helpful to object to what is being done by basing an argument merely on theory.
I am afraid I cannot give the number of inspectors at the present time. There are commissioners and inspectors of the Board who visit every institution once or twice a year, but to understand what inspections are necessary depends on what is being inspected. If any case of an institution thought to be unsatisfactory were brought to my notice, I should have it inquired into, but one cannot argue a priori what the number of inspectors should be.