Wednesday, 18 April 1945
Seanad Éireann Debate
Parliamentary Secretary to the Minister for Local Government and Public Health (Dr. Ward): The purpose of this Bill is to make provision for the prevention and treatment of mental disorders and for the care of persons suffering therefrom. The need for this measure has been stressed at various times by medical experts engaged in the care and treatment of mental patients. The Commission on the Relief of the Sick and Destitute Poor including the Insane Poor also referred to the matter in their report which was published in the year 1927. They particularly emphasised that the law governing lunacy was in many respects obsolete, that the numerous statutes relating to the matter did not form one consistent whole, and that they were defective and even contradictory.
This position can be understood when it is remembered that some of the statutes at present in operation were enacted over 120 years ago. Although several Acts passed during the course of the 18th century enabled the authorities of houses of industry to provide cells or wards for the accommodation of insane persons, and Acts passed in the years 1817 and 1820 provided for the establishment of asylums for lunatics, the Act which formed the basis of the existing code of laws was the Lunacy (Ireland) Act, 1821, which provided for the formation of asylum districts and the establishment of district asylums.
From the Act of 1821 the existing scheme of institutions for the insane poor developed. A further Act passed  in the year 1845 made two important provisions—it provided for the removal of all lunatics from the houses of industry to the district lunatic asylums and it gave power for the establishment of an asylum for chronic or harmless patients for each of the provinces. No steps were taken to implement this latter provision. It was repealed by the Local Government (Ireland) Act, 1898, which substituted a power enabling asylum authorities to establish auxiliary asylums for the reception of patients who, being chronic lunatics, were not dangerous to themselves or others and were medically certified not to require special care and treatment in a fully equipped lunatic asylum. Section 79 of the Local Government Act, 1925, provided for the substitution of the term “district mental hospital” for the term “district lunatic asylum.”
As regards the provision of institutions, the position under the existing law is that the local authorities concerned are empowered to provide two classes of institutions only, district mental hospitals and auxiliary mental hospitals. As the House is aware, district mental hospitals and auxiliary mental hospitals are not the only class of institution available for mental patients. Mental institutions were established by private enterprise at different times throughout the 18th and 19th centuries, and these institutions are maintained under private control. The first and most notable private mental institution to be provided was St. Patrick's, Kilmainham, which was established in the middle of the 18th century in pursuance of the will of Dean Jonathan Swift.
A certain amount of legal control over private institutions was provided for by the Private Lunatic Asylums (Ireland) Act, 1842. This Act provided for the inspection of private institutions, the regulation of their management and the admission of patients thereto. Institutions other than charitable institutions supported wholly or in part by voluntary contributions and not kept for profit by any private individual were required to be licensed annually by the Quarter Sessions Courts. This function was subsequently assigned to the Circuit Courts.
 The inspection of mental institutions was provided for in two enactments, one passed in the year 1826 and the other in the year 1845. The Act of 1826 related to prisons and provided for the appointment of two inspectors-general of prisons. One of the duties of these inspectors was to inspect every place where lunatics or idiots were confined and to report thereon to the Lord Lieutenant. They could also inquire into matters of expenditure, discipline and the observance of rules and regulations required to be observed in such places. The Act of 1845 provided for the appointment of one or two inspectors of lunatics and transferred to those inspectors the functions of the inspectors-general of prisons so far as they related to the institutions for lunatics. lunatics.
The existing laws relating to the admission of patients to district mental hospitals were also enacted early in the last century. The only provision for the admission of patients contained in the Act of 1821 was one which related to the admission of prisoners who were found insane. An Act for the prevention of offences by insane persons, passed in the year 1838, empowered any two justices of the peace to commit a dangerous lunatic or a dangerous idiot to gaol. The Lord Lieutenant was empowered at his discretion to order the removal of any such lunatic or idiot from the gaol to the district lunatic asylum. These provisions were superseded by the Lunacy (Ireland) Act, 1867. This Act prohibited the committal of dangerous lunatics to gaols and empowered any two justices of the peace to commit to the district lunatic asylum any person apprehended or discovered under circumstances denoting derangement of mind and a purpose of committing an indictable crime.
This is a very brief outline of the main provisions of the law at present in force in relation to lunacy. The law contains many defects which are obvious even on a casual examination and the principal of which are: (a) the powers given in regard to institutions are very rigid and permit of the provision of two classes of institutions only, namely: a mental hospital and an auxiliary mental hospital; (b) the provisions in regard to the admission  of patients to institutions which appear to be based on the criminal code are out of date and do not accord with modern views on the treatment of mentally afflicted persons; (c) no procedure is laid down for the admission of early or incipient cases of mental disorder for treatment in mental institutions; (d) there is nothing in the law to enable a poor person to submit himself voluntarily for mental treatment; (e) no power is given to permit of the admission of a patient for treatment for a mental disorder of a temporary nature; (f) mental hospital authorities are not empowered to provide consulting rooms or clinics for the investigation of cases of suspected or incipient mental disorders and the advice and treatment of such cases; (g) there is no provision for the medical care and treatment of inebriates and drug addicts.
In relation to all these matters very considerable progress has been made in medical science since the laws at present in force were enacted, and there is no doubt as to the necessity for reforming these laws to bring them into harmony with modern medical views on the treatment of mental illness. The Bill before the House is intended to effect this purpose by substituting for the existing law a new enactment under which the full benefit of modern medical science will be made available for persons in danger of developing or suffering from mental disorder.
There is nothing in the first three Parts of the Bill that calls for special comment. Part I contains definitions of terms and expressions used in the Bill, while Parts II and III contain provisions relating to central and local administration. It might be mentioned; in connection with Part III, that it is proposed to continue the existing local administrative districts, but to give power to the Minister for Local Government and Public Health to rearrange or alter those districts, provided that in any such rearrangement the area included in a county or a county borough shall not be divided and placed in two or more mental hospital districts. For each local administrative district there will be a local administrative authority, to be known  as the mental hospital authority. Where the district consists of one administrative county the county council will be the mental hospital authority. If the district consists of a county borough the corporation of the county borough will be the mental hospital authority. In all other cases the mental hospital authority will be a joint board appointed by the council or councils of each administrative county and the corporation of the county borough, if any, included in the mental hospital district.
Part IV of the Bill imposes a general duty on each mental hospital authority to provide such treatment, maintenance, advice or service as may, by reason of mental illness, be required by a person ordinarily resident within their mental hospital district who, with the persons, if any, liable to maintain him, is unable to provide the whole of the cost thereof.
The provision and maintenance of institutions by mental hospital authorities will be governed by Part V of the Bill. This Part of the Bill alters entirely the rigidity of the existing enactments regarding the institutions to be provided. Each mental hospital authority is required to provide and maintain proper and sufficient accommodation for carrying out their functions. They are also required to provide a district mental hospital for their district. They may on their own initiative, and shall, if required by the Minister, provide a mental hospital auxiliary to their district mental hospital for the accommodation of patients who are not dangerous to themselves or others, and accommodation for temporary patients and voluntary patients, and also consulting rooms and clinics. A mental hospital authority is also required to provide and maintain such other institutions and accommodation in connection with the discharge of their functions as the Minister from time to time directs. Under this provision an institution of any class or variety considered necessary by the Minister could be provided.
As regards consulting rooms and clinics I mentioned earlier that the absence of any power to provide them was one of the serious defects in the existing law. There is no provision  to enable a poor person to consult with medical experts in order to obtain advice as to incipient mental illness. To obtain advice and treatment he must be certified as insane and received into a mental hospital. The establishment of consulting rooms and clinics is recommended by medical scientists as an essential feature of the institutional scheme for the treatment of mental disorder. It affords an opportunity to patients to seek early advice. This aspect of the matter was strongly emphasised by the Commission on the Relief of the Poor in their report of 1927, and also in the Second General Report of the Hospitals Commission.
Section 24 of the Bill clearly indicates the functions of the consulting rooms and clinics, namely, to afford advice and preventive and curative treatment in cases of mental disorder, including suspected or incipient mental disorder and to investigate such cases. Although the clinic is intended primarily for the investigation and treatment of early cases it could also be availed of for the purposes of aftercare in the case of discharged patients. Another important provision in Part V is that contained in Sections 32, 33 and 34 empowering a mental hospital authority to contribute to the capital cost of a public water supply or public sewerage scheme or to the capital cost of a clinic, dispensary or health centre where the service to be provided will be available for the mental hospital authority. It is possible to visualise a situation where a contribution to the capital cost would be an inducement to the authority concerned to proceed with the project. Part V also contains provisions to enable mental hospital authorities to provide an institution or a laboratory for research in connection with mental and nervous diseases.
There is nothing calling for special comment in Part VI, which contains provisions relating to the finances of mental hospital authorities; or Part VII, which gives to mental hospital authorities powers to acquire land similar to those given by the Public Assistance Act, 1939, to public assistance authorities. It is proposed in  Part VIII of the Bill to make entirely new provisions for the superannuation of officers and servants of mental hospital authorities. The superannuation law in relation to those officers and servants is at present contained in two enactments, the Pauper Lunatic Asylums, Ireland, Superannuation Act, 1890, and the Asylum Officers Superannuation Act, 1909. The Act of 1890 empowered the governors of an asylum in their discretion to grant to an officer or servant of an asylum who became, by confirmed sickness, age or infirmity, incapable of executing his duties in person, or who had been an officer or servant for not less than 15 years, and was not less than 50 years of age, such annuity as they thought fit, proportionate to the merits and length of service of the officer or servant. The annuity was subject to the approval of the inspectors of lunatics or one of them, and the maximum limit to the amount of the annuity was two-thirds of the value of the lodgings, rations and other allowances payable to the officer or servant. This Act applies to a number of existing officers and servants, inasmuch as they signified their intention not to avail themselves of the provisions of the Act of 1909. An outstanding feature of the Act of 1909 was that it provided for the division of officers and servants into two classes, the first being established officers and servants who had the care or charge of patients in the usual course of their employment, and the second class being all other established officers or servants.
An officer or servant of the first class was entitled to superannuation if he had not less than 20 years' service and was not less than 55 years of age. The allowance was calculated at the rate of one-fiftieth of the salary or wages and emoluments for each completed year of service. An officer or servant of the second class was entitled to superannuation if he had not less than 20 years' service and was not less than 60 years of age. The allowance in his case was calculated at the rate of one-sixtieth of the salary or wages and emoluments for each completed year of service.
 Both classes were entitled to superannuation after ten years' service if permanently incapacitated for duty. A mental hospital authority in computing the amount of the allowance could take into account any peculiar professional qualifications or services or special circumstances and add a number of years not exceeding ten to the actual service for the purpose of calculating the allowance. In actual practice permanent incapacity which was directly due to the nature of the duties was regarded as special circumstances for the purposes of the addition of years to the actual period of service. The maximum limit to an allowance was two-thirds of the salary or wages and emoluments—an allowance was calculated on the average of the salary or wages and emoluments for the last ten years of service. In more recent legislation governing pensions to public officers provision has been made for the payment of a lump sum on retirement, together with an annual allowance calculated at a lesser rate than would be allowed if no lump sum were paid. Provision on these lines has been made in the law relating to the superannuation of civil servants and prisons officers. A lump sum on retirement serves a useful purpose, particularly for an officer who has to provide a new dwelling when he leaves the service.
Under the Bill officers and servants are dealt with in two classes as in the Act of 1909—officers and servants who have the care or charge of patients are referred to as registered officers and servants because their names are entered in a register kept by the mental hospital authority. Other officers and servants are referred to as “not registered.” An effort has, therefore, been made in the Bill to bring the superannuation law relating to unregistered officers and servants of mental hospital authorities into line with that applying to other services. Officers and servants who have not the care or charge of patients in the usual course of their employment were provided for in the Act of 1909 on the same lines as civil servants were dealt with before the superannuation law respecting them was changed 36 years  ago. They are allowed superannuation calculated at the rate of one-sixtieth of the salary or wages and emoluments for each completed year of service subject to a maximum of two-thirds.
Civil servants are now given two allowances on retirement, one a lump sum calculated at a rate of one-thirtieth of the salary and pensionable emoluments for each completed year of service subject to a maximum of one and a half times the yearly salary and emoluments, and the other a pension calculated at the rate of one-eightieth of the yearly salary and pensionable emoluments for each completed year of service subject to a maximum of forty-eightieths. It is proposed in the Bill to provide on the same lines for the superannuation of officers and servants of mental hospital authorities who have not the care or charge of patients in the usual course of their employment.
As regards officers and servants who have the care or charge of patients in the usual course of their employment the Bill provides that in respect of the first 20 years of service the annual allowance shall be calculated at the rate of one-eightieth of the yearly salary or wages for each completed year of service, and a lump sum at the rate of one-thirtieth. For each completed year of service over 20 years two-eightieths shall be added to the annual allowance and two-thirtieths to the lump sum. In this matter the Bill follows the provisions of the Superannuation (Prisons Officers) Act, 1919. To qualify for superannuation under the Bill an officer or servant who had the care or charge of patients must have reached the age of 55 years and have had 20 years' service. Any other officer or servant must have reached the age of 60 years and have had 20 years' service.
Those are the main provisions of the Bill in relation to superannuation, but the Bill also contains numerous other provisions for allowances and increases of allowances in special circumstances. An officer or servant of either class may be superannuated after a service of 10 years if he ceases to hold office or employment on account of  having sustained or contracted, otherwise than through his own misconduct, any physical or mental illness which is certified to have caused permanent incapacity.
Where an officer or servant is permanently incapacitated by reason of an injury received otherwise than through his own misconduct while discharging his duties and the injury is directly attributable to the nature of his duties, he may, even though his service is less than ten years, be given such allowance and lump sum as the mental hospital authority, with the consent of the Minister, consider proper. A registered officer or servant who has a service of five years and less than ten years and who contracts, otherwise than through his own misconduct or negligence, any physical or mental illness in the service of a mental hospital authority may, with the consent of the Minister, be granted such allowance or lump sum as the mental hospital authority may consider proper, but the amounts of such allowance and lump sum shall not exceed the amounts appropriate for a service of twice the number of the completed years of service served by the officer or servant.
Special provision is also included to enable a mental hospital authority, with the consent of the Minister, to grant such annual allowance as they consider proper to an officer or servant who has a service of not less than ten years and (a) who is removed from office for a cause other than misconduct or incapacity, or (b) whose office or employment is abolished, or (c) whose position has been materially altered to his detriment owing to changes in his conditions of service made without reasonable cause and who resigns his office or employment with the consent of the Minister. If any such officer or servant has less than ten years' service, the aggregate amount of his contributions are to be returned to him.
Power is also given to mental hospital authorities to increase, in special cases, the fixed allowances provided for in the Bill. In the case of an officer or servant with a service  of ten years or longer who has been permanently incapacitated as a consequence of an injury received, otherwise than through his own misconduct, while discharging his duties and the injury was directly attributable to the nature of his duties, the mental hospital authority may, with the consent of the Minister, increase to such extent as they consider proper the allowance and lump sum to which he would ordinarily be entitled.
Where a registered officer or servant with a service of ten years or longer is permanently incapacitated by reason of any physical or mental illness contracted in the service of a mental hospital authority otherwise than through his own misconduct or negligence, the mental hospital authority may, with the consent of the Minister, increase to such extent as they consider proper the allowance and the lump sum to which he would ordinarily be entitled, but the amount of the increase shall not exceed the increase that could have been made in the allowance and lump sum by the addition of ten years to the actual completed years of service.
Where a female officer or servant retires from the service of a mental hospital authority in order to be married, the authority are required, if she had less than five years' service, to refund to her the aggregate amount of her contributions. If the officer or servant has a service of not less than five years, the mental hospital authority are required to pay her a gratuity calculated at the rate of one-twelfth of her yearly salary or wages for each completed year of service, subject to a maximum of one year's salary or wages. Under the Act of 1909, there is provision only for the return of contributions, which may be returned, if the mental hospital authority think fit, to a female officer or servant who has not less than three years' service. If an officer or servant dies as a result of an injury sustained otherwise than through his own misconduct or negligence while discharging his duties and he is survived by a widow, the mental hospital authority may, with the consent of the Minister, grant such allowance to the widow as they consider proper. If the officer or servant  was a widower or a widow and is survived by a child or children, the mental hospital authority may, with the consent of the Minister, grant an allowance in support of the child or each of the children. Where a registered officer or servant dies as a result of any physical illness which was contracted otherwise than through his own misconduct or negligence in the service of a mental hospital authority, the mental hospital authority may, with the consent of the Minister, grant an allowance to his widow. If the officer or servant was a widower or a widow and is survived by a child or children, the authority may, with the consent of the Minister, grant an allowance in respect of the child or each of the children.
Where an officer or servant who has had, at least, five years' service dies whilst in the service of a mental hospital authority, they may make a payment to his legal personal representative, calculated in the manner prescribed in Section 70. If the officer or servant has less than five years' service when he dies, the mental hospital authority may pay to his legal personal representative a sum equal to the aggregate amount of his contributions for the purposes of pension. An officer or servant who is removed from office or dismissed on account of grave misconduct is not entitled to receive any allowance and lump sum calculated by reference to his service. The mental hospital authority may, in their discretion, pay to such officer or servant or to or in respect of any person whom he is liable to maintain a sum equal to the whole or part of the aggregate of his contributions in respect of pension. The maximum limit to the amount of a lump sum is one and a half times the yearly salary or wages and emoluments. The maximum limit to the amount of an annual allowance is one-third of the salary or wages and emoluments in the case of a widow and one half of the salary or wages in any other case. Where allowances are granted to two or more children of a deceased officer or servant, the aggregate of the allowances shall not exceed one half of the yearly salary or wages and emoluments.
Broken periods of service with two  or more mental hospital authorities or with other local authorities may be aggregated in reckoning the period of service of an officer or servant for pension purposes, provided that a period of service of less than one year with any one authority shall not be so reckoned. Under the Act of 1909, a period of service of less than two years could not be so reckoned; and service with a local authority other than a mental hospital authority could not be reckoned. There is also provision for the calculation of allowances on joint service in the case of an officer or servant who becomes a civil servant or in the case of a civil servant who becomes an officer or servant.
Every officer and servant is required to pay a contribution of 3 per cent. of his salary or wages for the purposes of the scheme of pensions. This is the percentage required to be paid under the Act of 1909. Allowances and lump sums under the Bill are to be calculated on the average of the salary or wages and emoluments for the last three years of service. There is provision for appeal to the Minister where the officer or servant or the representative of a deceased officer or servant is aggrieved by the neglect or refusal of a mental hospital authority to make a grant. An officer or servant to whom the Act of 1909 applies will have the right to signify within six months after the pension provisions of the Bill come into operation, his wish not to avail himself of the provisions of the Bill. In any such case, the provisions of the Bill will not apply but the pension under the Act of 1909 shall be calculated on the average salary or wages for three years instead of the average for ten years, as provided for in that Act.
Miscellaneous provisions in relation to mental hospital authorities are contained in Part IX of the Bill. This Part empowers mental hospital authorities to appoint committees and visiting committees and provides machinery by which two or more mental hospital authorities may combine to administer a joint service. Part IX also empowers a mental hospital authority to arrange for the maintenance of patients in an institution not maintained by them. Two mental  hospital authorities may arrange for the reception into an institution maintained by one authority of patients of the other authority. This Part of the Bill also gives power to provide by regulations for the admission of private patients to any of the institutions of a mental hospital authority.
A radical proposal contained in this Part of the Bill is that providing that, where a chargeable patient admitted to an institution maintained by a mental hospital authority is not ordinarily resident in the mental hospital district of that authority, arrangements may be made for his transfer to the district mental hospital for the district in which he ordinarily resides.
This provision is intended to meet the situation which arises where a person suffering from mental disorder wanders away from home and, for reasons of urgency, is admitted to the district mental hospital for the district in which he is apprehended and which is not the district in which he ordinarily resides, or the case of a person who becomes of unsound mind while in search of employment in a district other than the one in which he ordinarily resides, or in the case of a patient who in order to conceal the fact that he has found it necessary to seek mental treatment is brought to another district for the purpose of being received into a mental hospital removed from his native place. It would be obviously unjust that the ratepayers of a district in which any such person did not ordinarily reside should be called on to meet the cost of his maintenance and treatment in a mental hospital.
Part X of the Bill provides for the registration of private institutions by the Minister. A private institution means an institution or premises in which one or more than one person of unsound mind is or are taken care of for profit. Hitherto these institutions have been licensed annually by the Circuit Courts in pursuance of the Act of 1842 to which I have already referred. The Commission on the Relief of the Sick and Destitute Poor in their report of 1927 recommended that the power  to license these institutions should be transferred to the Minister. There are good reasons for the transfer inasmuch as the Minister is in close touch with the institutions and kept fully informed of their conditions and circumstances by the inspector of mental hospitals.
Part XI of the Bill provides for the registration of private charitable institutions by the Minister. A private charitable institution means an institution for the care of persons of unsound mind which is supported wholly or in part by voluntary contributions and which is not kept for profit by any private individual. Hitherto these institutions have not been registered or licensed. The proposal to register them follows a recommendation by the commission which reported in 1927.
Part XII of the Bill empowers the Minister, in the case of an institution authorised by special Act or charter for the care, maintenance and treatment of persons of unsound mind, to satisfy himself as to the competency of the person in charge, the arrangements for the medical attendance of patients, the suitability and adequacy of the food given to the patients, the accommodation in and state of repair of the institution. If not satisfied on any of these matters the Minister may order the person carrying on the institution to take such steps as he considers proper, and in the event of a conviction for a contravention of any such order the Minister may direct that the care of mental patients in the institution be discontinued.
Under Part XIII of the Bill the Minister is given power to approve of institutions for the reception of temporary patients and voluntary patients and to make regulations in relation to the administration of such institutions. The admission of persons of unsound mind to mental institutions is dealt with in Part XIV of the Bill, but before explaining the provisions of that part of the Bill I would like to draw attention to the procedure under the law hitherto in force for the admission of mental patients to institutions. In the case of private institutions licensed in pursuance of the Act of 1842 a patient could be admitted on  the order of a relative or other person accompanied by two certificates, each signed by a medical practitioner. A patient could be admitted to any other private mental institution on a certificate by two medical practitioners accompanied by an order of admission signed by a peace commissioner. There were various ways for admitting patients to institutions maintained by mental hospital authorities. Admission could be obtained on a prescribed form in pursuance of regulations adopted by the mental hospital authority. In the prescribed form was included a form of certificate to be signed by one medical practitioner and an order of admission to be made by one peace commissioner. The costs connected with the certification were borne by the next-of-kin or by the person seeking the patient's admission.
Paying patients could be admitted in pursuance of regulations adopted by the mental hospital authority. These regulations prescribed a certificate to be signed by two medical practitioners and an order of admission to be signed by a peace commissioner. The costs and expenses of certification were borne by the next-of-kin. There were other modes of admission, such as admission on the order of the President of the High Court, in the case of a ward of court, or an order of the Minister for Justice in the case of a prisoner and admission of members of Defence Forces certified to be of unsound mind. By far the greater number of poor persons admitted to mental institutions were committed in accordance with the Act of 1867 to which I have referred in the opening part of this statement. Section 10 of that Act was based on principles embodied in earlier legislation under which a person who was mentally deranged was committed to an institution as if he were guilty of a crime. The Act of 1838 provided that if any person were discovered and apprehended under circumstances denoting derangement of mind and a purpose of committing some crime which, if committed, would render him liable to be indicted, any two justices before whom he was brought could call to their assistance any legally qualified  physician, surgeon or apothecary, and if upon examination of the person or from any further proof, the justices were satisfied that the person was a dangerous lunatic or a dangerous idiot, they could commit him to gaol, to be kept therein until discharged. Where it was certified by two physicians or two surgeons or a physician and a surgeon that any such person was insane, the Lord Lieutenant could, if he thought fit, by warrant direct the removal of the person from the gaol to the lunatic asylum established for the county, city or town in which the person was in custody. The Act of 1867 prohibited the committal of lunatics to gaols. Section 10 of that Act, however, retained objectionable features of the earlier Act.
Under the Act of 1867 the procedure was that the Gárda Síochána apprehended the person and brought him before two peace commissioners. Evidence was given to the peace commissioners that the person was dangerous and likely to commit an indictable crime. If it was proved to the satisfaction of the peace commissioners that the person was discovered and apprehended under circumstances denoting derangement of mind and a purpose of committing an indictable offence they called in the dispensary medical officer and if he certified that the person was a dangerous lunatic or a dangerous idiot the peace commissioners by warrant directed the person to be taken to the district mental hospital for the district in which he was apprehended. This procedure was similar to that in a criminal case. The patient was dealt with as if he were being tried for some crime. The Bill proposes to discontinue this procedure and to provide machinery whereby provision for the treatment of persons suffering from mental disorder will be arranged by medical practitioners.
Two methods for the reception of persons of unsound mind in mental institutions are provided for in the Bill, one relating to chargeable patients and the other to private patients. The methods are so clearly set out in the Bill that it is hardly  necessary to explain them here, and I therefore propose to make but a brief reference to them. Where it is desired to have a person received in a district mental hospital as a person of unsound mind and a chargeable patient an application may be made to the authorised medical officer for a recommendation for the reception and detention of the person in that mental hospital. The expression “the authorised medical officer” is explained in Section 5 of the Bill. The authorised medical officer is required to visit and examine the patient within 24 hours of the receipt of the application and, if satisfied that it is proper to do so, to make the recommendation.
The person on whose behalf application was made may then be conveyed to the district mental hospital by the applicant for the recommendation or any person authorised by the applicant. On the arrival of the person at the hospital he must be examined by the resident medical superintendent of the hospital or another medical officer of the hospital acting on his behalf. If the medical officer who makes the examination is satisfied that the person is of unsound mind and is a proper person to be taken charge of and detained under care and treatment he is required to make an order forthwith for the reception and detention of the person as a person of unsound mind in the hospital. This briefly is the procedure and it will be observed that before an order is made for the detention of a person in a mental institution he is examined separately by two medical practitioners. The second of these examinations is conducted by a medical officer of a mental institution who would be an expert in the diagnosis of mental diseases.
 Other provisions are made in this Part of the Bill ancillary to the removal of persons of unsound mind to a district mental hospital. The appropriate assistance officer is required to pay the reasonable expenses of the conveyance to the mental hospital— except where a person is conveyed by a member of the Gárda Síochána. The resident medical superintendent of a district mental hospital is empowered, in his discretion, to provide an escort where one is necessary to ensure the safe conveyance of a person to the hospital. The Gárda Síochána are required to provide an escort in case of necessity. There are also provisions in Part XIV enabling the Gárda Síochána to have a person of unsound mind admitted to a district mental hospital for the public safety or the safety of himself and to have a person of unsound mind admitted where he is not under proper care or control or is neglected or cruelly treated.
The procedure for reception of a private patient as a person of unsound mind differs from that relating to a chargeable patient. In the case of a private patient application may be made to a registered medical practitioner for a private patient reception order. If the practitioner accepts the application he must arrange with another medical practitioner for two separate examinations of the person concerned, one by each practitioner, and if they are each separately satisfied that it is proper to do so they shall make an order to have the person received and detained as a person of unsound mind.
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