The Gazette 1971

there are five auxiliary mental hospitals and twelve private hospitals also. Prior to 1945, most patients were admitted to mental hospitals by order of a judicial authority. Reception is now effected on medical certi- fication only. The Act provides for three main classes of patients, (i) voluntary patients, who are broadly speaking persons who enter mental hospitals of their own free will, (ii) temporary patients who are persons regarded as not requiring more than six months treatment, and (iii) persons "of unsound mind" who are regarded as unlikely to recover within a six month period. Procedure for admission varies for each of the different categories of patients, and, under the law great care is taken to protect the patients rights prior to and during his hospitalisation. An inspector of mental hospitals was appointed who is required to inspect and visit every district mental hospital at least once a year, and every private institution at least every six months. He must ascertain whether or not the accommodation, care and treatment provided are adequate and must determine "whether or not any system of coercion, restraint or seclusion is in operation". The system of voluntary informal admission is com- paratively successful. However, in the subsequent years little was generally accomplished in reducing the num- ber of persons in mental hospitals. Unfortunately the very institutions for which such treatment is recom- mended are still suffering from over crowding, sub- standard conditions and shortage of professional per- sonnel, and at the same time the stigma historically attached to mental illness is still so prevalent. In 1961 the then Minister for Health, Mr. MacEntee, estab- lished a commission to inquire into the problems of mental illness. The report published in 1966 stated that at any given time one in every seventy of our people above the age of twenty-four years is in a mental hospital. When it is remembered that every mentally ill person brings stress into the lives of people around him, it is clear that in Ireland mental illness poses a health and indeed a social problem of the first magnitude. Seven in a thousand in mental hospital beds is the national average. There are indications that mental illness may be more prevalent in Ireland than in other countries. These figures include the mentally handi- capped, whose needs lie more in training and education rather than in psychiatric care. The report also laid particular emphasis on the integration of psychiatry within the ambit of general medicine and above all by showing the necessity for public education through community service and the necessity for concentration on the preventive aspects in treatment services. It would seem that a pattern of organisation is now required in which new tasks will be performed in a new and wider setting. In order to achieve this a community mental health service appears to be essential. Mental health education within the community is a very neces- sary one if the stigma attached to mental illness in Ireland is to be finally eradicated and in order that re- integration into a community aware of their problems will be fully achieved and that the system of voluntary informal admission can be fully successful, as a result of proper public attitudes. The good intentions of the legislators on paper should be transmitted into effective workable schemes. It is satisfactory to note that in- patient clinics are in the process of being provided in general hospitals in Galway, Limerick, Cork Regional and St. Vincent's, that such units already exist in Waterford and at St. Joseph's Hospital, Clonmel—but obviously this is not enough. Psychiatrists and politi- cians as lawmakers must come together, as indeed they did in the commission, not alone to deliberate but to 9

MENTAL ILLNESS AND THE LAW The eighty-seventh inaugural meeting of the Solicitors' Apprentices Debating Society of Ireland was held in the Library of Solicitors Buildings, Four Courts, on Thursday, 25th February 1971. The President, Mr. McGrath, presided. The auditorial address was deliv- ered by Miss Elizabeth Ann Ryan, who was the first lady auditor elected since 1921, on "Ireland, its Laws and its Mentally 111". In the course of her address, Miss Ryan said : The whole question of the mentally ill in Ireland deserves consideration. It would seem best to treat it under the guise of the legislative executive and judicial arms of the state because ultimately it is by these means that real change and overall treatment of social problems must come about. It is first intended to make a brief historical resume of the law relating to so-called "insane persons". As regards the three possible categories, first of all there are patients governed by the Mental Treatment Act, 1945; secondly those who come under the juris- diction of the High Court as wards of court, and finally those who are designated as "criminal lunatics". The problems of the mentally handicapped and of juvenile delinquency have had to be omitted. The first legal reference to the mentally ill is thought to be found in the Brehon Laws, the ancient laws of Ireland which were compiled by the fili or the learned class of Celts, codified about the time of St. Patrick, 432 AD and which were in effect until the fall of the Gaelic order in 1603. These laws placed great emphasis on protecting the mentally incompetent. Different types and degrees of mental illness and mental defect were recognised. Generally their maintenance was the duty of their families and one could be fined from five to ten cows for neglecting this duty. Humane provision was made for the care of children of insane parents. Both "fools and madmen" were exempted from punishment inflicted for certain crimes and were protected from possible exploitation by others who might take advantage of their mental incompetence. Before and during the Middle Ages no satisfactory provision was made for the institutional care of the mentally ill. The first hospital which was devoted exclu- sively to their care in Ireland was St. Patrick's Hospital, founded in Dublin in 1745 on a bequest made by Jonathan Swift. Then, in 1787, the Irish Parliament passed an Act to provide for wards for "idiots and insane persons", and it appointed an inspector for all such institutions. However, none of the above-mentioned laws had been carried into effect. The main legal pro- visions governing the erection of asylums were contained in the Irish Lunacy Act in 1821, which dealt mainly with adequate housing and humane treatment. Little had been done in providing trained or competent personnel. In 1900 the totai number of registered insane in institutions was over 17,000. The workhouses still contained 3,800 persons classified as insane, but the jails were at long last empty of such individuals—the population of Ireland in 1900 was in the neighbourhood of three million. The Mental Treatment Act, 1945, introduced some important comprehensive and enlightened change in the status of the mentally ill. Under the provisions of this Act the country is henceforth divided into nineteen mental hospital districts, in each of which there is a district mental hospital administered by county councils;