Abstract
The principal reference of the Royal Commission was certification and detention, and treatment without certification of persons suffering from mental disorder.
The general principles laid down as the result of the inquiry are set forth and shown to accord with the views of the medical profession.
The Commission supports the medical view that greater facilities should be granted for treating mental disorders in their early stages without certification and repudiates the contention that grave abuses exist.
It makes proposals for avoiding the stigma of certification by admitting patients to treatment under a provisional order without full certification. The real objection of the public to certification appears to lie in the judicial intervention and the legal formalities. Since these are accentuated in the proposed method, it is very little different from the present procedure. The reason for this anomaly appears to be adherence to what is said to be “an inviolable principle of law.”
This principle is violated in the present law, in the proposals of the Royal Commission and was disregarded prior to 1890.
A scheme is put forward to avoid these objections by extending the present facilities on the lines of the Report and simplifying the procedure, thus eliminating the magistrate from the proceedings prior to admission unless the patient desires his intervention, and placing the authorization for treatment on the relatives and friends in all cases where the patient does not apply voluntarily for treatment. The Board of Control is the safeguard in these matters. These two procedures would be applicable to all cases in the first instance; but should the friends prefer full certification, that should be possible at any stage.
The proposals for voluntary boarders are approved with the proviso that it should not be necessary to apply these proposals where restraint is neither necessary nor, in fact, applied.
The protection that doctors signing certificates need is considered and it is proposed that a medical assessor should advise the judge to whom application to stay an action is made.
It is held that if the law is at present wrongly interpreted and unjust, this should be cleared up by public action rather than that a doctor should have to go through the anxiety and expense of appeal to the House of Lords.
In the main the Report commands professional approval, but in points of the greatest importance to doctors practising psychiatry and to their patients it is unsatisfactory.