The Gazette 1971

simply by signing his name to a pink form he can take away an individual's freedom and liberty literally for the rest of his life. As we know, the whole judicial process of the courts, the right to defence counsel, trial by jury, the right of appeal to higher courts, the onus on the state to prove guilt and the assumption of inno- cence is a most elaborate and indeed welcome apparatus designed to protect the liberty of the individual from wrongful imprisonment. Even when imprisonment does follow this process, unlike in a mental hospital, the duration of stay is fixed and limited by the courts. It is true that there are theoretical safeguards such as the right to appeal to the Minister and the inspectorial staff of the Department of Health which is designed to safeguard the individual's rights in a mental hospital which are so grossly inadequate in extent and in number as to be totally ineffective for this purpose. In the first place the process whereby a justice on summary trial attempts to make the punishment fit the crime by setting a fixed period for imprisonment cannot be rationalised on any scientific grounds whatever. Is the purpose of imprisonment punitive, attributive or therapeutic and rehabilitatory ? The truth is that no one can be certain of the correct length of time needed to reach any of these objectives for each individual person. The recidivist, for instance, is said to have an uncon- scious need to be punished and imprisoned. To him then punishment and imprisonment bring relief for his neurotic need just as a cigarette, or a drug or a drink serve a similar purpose with others. But for another individual this could be completely destructive. There is a feeling that the psychiatrist may no longer appre- ciate the enormity of his responsibility and powers to deprive for an indefinite period the individual of his right of freedom. The advice of psychiatrists could lead to the imposi- tion of the indeterminate sentence and would throw considerable new stress and responsibility on these social workers in considering their advice to the courts parti- cularly on the question of his suitability to return to society. But they would have the support of the represen- tative of the community, the judiciary, in making this decision. Yet the bed occupancy figures of our mental hospitals would appear to suggest that the psychiatrist tends to err on the side of restricting unduly the patient. Another remedy suggested is that there should be a public sworn inquiry after the coroner's verdict to be held by the Department of Health. In fact so traumatic is this experience that many psychiatrists decide consciously or unconsciously that their first experience of the coroner's court shall be their last. The simplest and safest decision for the authorities is to hold on to the patient in custodial care long after they should be discharged and involves no risk whatever. This is a real and comprehensive fear. Some attempt should be made to help the psychiatrist in this regard. The psychiatrist needs some support in his decision to take a risk of charging a depressed patient who is always a potential suicide and to whom in addition the psychiatrist in the ordinary course of practice must give what can be at the same time a therapeutic and a lethal supply of thymoleptic drugs on his discharge. The problem is now greatly exacerbated by the fact that without any such legal protection many psychiatrists are trying to close the custodial mental hospitals and return the maximum number of patients to the com- munity. By doing this we are greatly increasing the risk to ourselves of appearing in a coroner's court—a fright- ening experience. There have been examples of enthusi- astic superintendents who have opened their doors and removed their walls but who because of consequent 13

but that, over such control there should be a general impartial check and surveillance. Such a system when so stated, coincides with considerable preciseness in practice with the administration of the wards of court jurisdiction by the High Court as it is presently known. It is futile and over idealistic to suppose that you could devise a method of looking after the financial and other affairs of a ward of court, which would in every case be perfect. Basically nobody can look after their own business as well as they can them- selves. Allowing for these qualifications, there is much to be said for the point of view that the existing system of administering the affairs of wards is not unsound. Much publicity has recently been given to what has been described as "The Lisadell Affair". To lawyers, however, who, for very many years practised before Mr. Justice Davitt and who knew the fierce integrity and abiding commonsense of him as a judge, it is unthink- able that the underlying suggestion of a perversion of justice in that case as distinct from some frailty in the method of administration has any grounds at all. The only conceivable alternative is some sort of vague and anonymous administrative body or person, who would take over as a kindly state official, the affairs of a ward of court. All modern experience of the kind laid on an anonymous state official who deals with the affairs of another, would deter one from such an alternative. In the jurisdiction of the courts over wards of court, there should be an emphatic obligation to pay particular attention to the cure and treatment of the ward, as distinct from the administration of his affairs. It seems to me again, that the court should have the opportunity and the duty constantly to review the medical treatment of a ward, to have before it the reports of doctors, psychiatrists and psychologists attending upon the ward, and any sugges- tions which may come from them with regard to change or betterment of the treatment. Dr. Noel Browne, T.D., said that while it is true to say that the 1945 Mental Treatment Act was enlightened legislation and advanced for its time, because of changes and impending changes in the general pattern of care for psychiatric patients from custodial to community care services with closer liaison with general medical services a new amended Mental Treatment Act is now needed. It is essential that mental illness be no longer isolated from other medical conditions as a separate rather frightening illness. To achieve this end the whole pro- cess of the pattern of approach for treatment must be re-examined. The present powers of signing a form seeking admission voluntarily should be dropped. It is not needed or used in general medical hospital practice and is now no longer indicated in mental illness. The belief generally held that the psychiatrist has a right to hold a person on a voluntary certificate for seventy-two hours should he indicate a wish to leave the hospital, is probably not valid in law. There will continue to be a need for some process whereby a person who is a likely danger to himself or to the community may be isolated in a therapeutic set- ting until quite well again. There are disturbing aspects about the present process of certification on a temporary form. There are nowadays persons whose freedom is unnecessarily denied to them in these benevolent jails called mental hospitals. The reasons are no doubt many and complex. I suspect that one of them stems from the strangely ambivalent position of the psychiatrist in our community. On the one hand he is a person with com- plete authority given to him by the community whereby