The Gazette 1971

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

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;

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