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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
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
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