Northern Ireland’s Mental Health Act
The Mental Health Act (Northern Ireland)?which has just received the Royal Assent?reflects a state of public opinion well in advance of that which has so far received legislative embodiment in this country, and is of special interest in that it surely outlines the shape of things to come.
The Act deals both with mental illness and mental deficiency and is strikingly uncomplicated in its provisions. It is, to quote from the Explanatory Memorandum:
“… a health measure, and the predominant considerations are the promotion of mental health and the proper treatment and cave of the persons who need the aid the Bill is designed to provide.’’’’
Part II, concerned with ” Mental Illness re-enacts the principal provisions of the Mental Treatment Act (Northern Ireland), 1932, modelled on the British Act of 1930, but there is one almost revolutionary innovation to which attention should be drawn. Previously there were recognized three classes of mental patients?voluntary, temporary and certified. These categories remain, but the meaning attached to them is very different. In future all patients in need of mental treatment (other than ” voluntary ” patients) will be admitted to Mental Hospitals without certification, as ” temporary ” patients. Only one medical certificate will be necessary and treatment in such temporary capacity may continue for a period up to two years, or slightly longer in certain circumstances. At the same time, power of detention is given. At any time during the period of treatment, if the medical superintendent considers that recovery is improbable, it is his duty to inform the relatives to that effect. Unless they plan to provide some other means of care, they must then present a petition for the patient’s certification; if they do not do so, such a petition will be presented by a duly authorized officer of the Authority.
In Part III, dealing with Mental Deficiency (under the heading ‘’ Arrested or Incomplete Development of Mind “), the new concepts find equal recognition. It is noted in the preamble that Northern Ireland is 35 years behind Great Britain in having hitherto made no special provision of any kind for mental defectives, but?in theory at least?the Act now gives her a front line place.
In accordance with the recommendations of the Mental Health Services Advisory Committee which issued its report in September, 1946, considerable divergence is made in the Act from the provisions of our own Mental Deficiency Acts, particularly in the following directions :?
(1) The terms ” feeble-minded ” imbecile ” and ” idiot “?as well as the generic term ” mentally defective”?are replaced by the expression ” person requiring special care ” defined as ” A person who has in accordance with the provisions of this Act been ascertained to be suffering from arrested or incomplete development of mind (whether arising from inherent causes or induced by disease or injury) which renders him socially inefficient to such an extent that he requires supervision, training or control in his own interests or in the public interest.’’’’
The term ” socially inefficient ” is further elucidated (using some of the terms of our own Acts) as including a mental condition rendering the persons concerned to be {a) unable to guard themselves against common physical dangers, or (b) incapable of managing themselves or their affairs, or, being children, of being taught to do so, (c) children reported as being incapable of receiving education at school or (d) in need of care, supervision and control for the protection of others.
(2) Provision is made for the voluntary admission of defectives to institutional care, and it is intended as with mental patients, that certification involving judicial orders, shall be used only when there is opposition on the part of the parents or of the defective himself (if over 21), and in cases of defectives found neglected, abandoned or cruelly treated or charged with an offence. At the same time, power of detention is given in all cases.
(3) In the case of defectives in institutions by voluntary consent, the initial period of care will expire at the end of one year but may be ended at any time on giving 14 days’ notice to the Authority. If it is considered that such withdrawal would not be desirable, the Authority may then, if necessary, apply for a judicial order. (Only one medical certificate is required for this.)
(4) In accordance with the emphasis laid throughout the Act on voluntary care, there is a provision whereby any person over the age of 16 who “is of opinion that he stands in need of special care ” may present himself for examination. If under the age of 21, the receipt of such application must be notified by the Authority to the parent or guardian. (5) The duty of notifying defectives to the Authority is laid not only upon local education authorities and health authorities, but also upon medical practitioners.
Further, local education authorities are required to notify to the Authority, all school-leavers who have received special educational treatment, making special reference to those likely to need institution or guardianship.
The types of care included in the Act?Institution, Guardianship and Supervision?are of the familiar pattern, but the provision of suitable training or occupation in the case of the last two categories, is permissive only?a divergence from our own Act of 1927, to be regretted but due no doubt to the lack of the necessary personnel, premises and other facilities inevitable in a country introducing such legislation for the first time.
Finally, it should be noted that the Authority under both parts of the Bill is the Northern Ireland Hospitals Authority upon whom is laid the responsibility of “providing or securing the provision of, services designed to maintain and improve the mental health of the people of Northern Ireland.’’
The functions of Local Health Authorities in the scheme are limited to the notification of persons in need of special care and they will not be required to appoint Mental Health Officers of their own. Provision is, however, made for the use of any Services or Officers provided by them on an agency basis if this is found to be expedient. Correspondence on this subject is invited.?editor.
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