MENTAL HEALTH IN NORTHERN IRELAND
Laws Ancient and Modern by William McCartan, Ireland Mental Northern Act of 1948 was enlightened and progressive when it became law, and it is a measure of the speed of change in recent times that it was outmoded in thirteen years, being repealed and replaced by the Mental Health Act (Northern Ireland) 1961. "But if the purposes of the new Act (the English Act of 1959) are to be achieved, it will be necessary to weaknesses as consider as well
THEHealth
strengths" according to the P.E.P. Report on Community Mental Health Services (Vol. XXVI, No. 447. 12/12/60). This is
equally germane in Northern Ireland. Progress in the hospital and ancillary fields has been remarkable in the province since 1948 when overall responsibility for the development of psychiatric hospitals was placed on the Northern Ireland Hospitals Authority as the body already detailed to develop a unified and comprehensive hospital
the hospital field developments in
In the Act of 1948 as in that the Authority was also charged with the duty to "provide or secure the provision of services designed to improve and maintain the mental health of the people of Northern Ireland" and "to make suitable arrangements for the integration and co-ordination of the services provided under this Act with the general health services
delinquency.
It is clear that creative leadershit by an integrating central body is essefl
tial for the development of those par' of the service whose boundaries af not co-terminous with the limits of tl" administrative control of one or othe' of the statutory bodies concerned, i-e' where there is overlap of the functio' and facilities of bodies such as tb' Hospitals Authority, Local Health Education and Welfare committees. The P.E.P. Report also states "It is unusual, too, for new legislate' to be preceded or accompanied
systematic investigation,
Maximum vision
mum
Mj
contrast#
well-plac^
regards systematic investigation this matter and any uncertainty th?; exists in England and Wales is n"1 for want of enquiry, as is shown b) studies of all aspects of the problem including the work of Dr. G. C. Tootf as
.
advantage
in of a health service
the foregoing is the comprehensive mental so integrated that maxiadvantage would be obtained existing services and any further
Implicit
as
the more discursive type 0 enquiry characteristic of Royal Con1! missions, which might provide a factum basis for policy-making or planning Yet in the mental health services thefc is much uncertainty as to the be* balance between institutional and oth?! forms of care and as to the difficultylikely to be encountered in tbf of development communityibasec services". Northern Ireland is less with
1961
.
is not matched N those parts of
service outside the statutory control o the Hospitals Authority. This is m?s obvious in the provision of chi'c guidance or child psychiatry service f?! and psychiatric provision
service. of
M.P
and Miss Eileen M. Brooke on th? basis of statistical returns by hospital* to the General Register Officer on tb?
from extension of these. Northern Ireland is and compact administratively wieldy and should lend itself to such co-ordination, but when the overall situation is considered as advised by P.E.P. it is seen that rapid progress in
one hand and the opposing views Dr. Kathleen Jones and Professor F Sidebotham on the other. Psychopathy is not included as 5 category in the Northern Ireland Ad although the need for accommodate
12
for the type
of person usefully if described as a psychopath is wily recognised (Section 80). The absence of psychopathy as a category d?es not preclude the admission to a
^aguely
Psychiatric hospital of anyone whose aggressive and seriously irresponsible conduct" (to quote the English Act) ls> in medical opinion, the outcome of
disability Rental usted under
of any of the types
Mental, Psychoneurotic
and Personality Disorders in Part V of the International Classification of leases; coming, as these appear to tlo> within the meaning of mental disorder as categorised in the Northern
Ireland Act. The Royal Commission was unable define psychopathic disorder; the y. Act does, but in the debates which preceded it the Baroness
j^?otton 59)
is stated (Lancet 13th June, have sajd in the House of Lords that "the definition of psychopathy in the Bill would cover practicthe whole of the recidivist populal0n". No agreement has been reached the type of accommodation that should be provided for such patients the only advice the Psychological Group Committee of the -M.A. can offer (British Medical i J??rnaI, 21st July, 1962) is that "The inistry of Health should not require Very regional hospital board to set P a , security unit but should allow
^.'ly
J^dicine
?ards
to
experiment.. .(italics mine)." as a category in Northern
jls exclusion and should
limit the
tendency
terpret delinquency overwidely
to
in mental disorder without any person, regardless of lethcr he is delinquent or not, of the ychiatric treatment he may need. rnis
of
wholly
rural
society
of
one
thousand
years ago or more?included, amongst their general provisions, safeguards for the care of the mentally ill and recognised five categories, i.e., idiots, fools, dotards, persons without sense, and madmen. The irresponsibility of the average small boy in the eyes of the law was recognised by including them in the category of "persons without sense". Account was also taken of the and diminished limited discretion responsibility of the insane or mentally disabled by provision to protect them from exploitation. In those days the alternatives to the care of such persons in the community by members of the community can only have been neglect or worse. The Brehon Laws?as they are more comknown?made such care monly "everybody's business" in a most literal way and the particular responsibilities of kinship were brought home by a system of fines for neglecting obligations to a mentally sick or disabled relative?the less able the patient to fend for himself the heavier the fine, hence the need for defined categories of mental disorder. The fines were imposed in numbers of cattle.
Attempt
at
community
This attempt to
care
ensure
proper
com-
munity care was, no doubt, primitive and elementary but its principles anticipated much of our modern? though fundamentally no more enlightened?legislation. During the
0
turmoil of the centuries that followed the invasion in the reign of Henry II, these laws were restricted to those parts of the country outside the Norman pale and in the welter of war and revolt probably sank more and more into abeyance until repealed in the Stuart period.
teg?ries of mental disorder and one 1 Ss Precise, the Ancient Laws of IreI comprehensive and astoundj 8ly enlightened laws of a tribal and
The first mental hospital in Ireland opened in 1757. It was made possible by Jonathan Swift's legacy of ?10,000 and is named St. Patrick's after the cathedral in Dublin of which he was Dean. Thirteen years before his death Swift wrote:
JjPriving Anc'ent
Irish laws
sid^0dern ered in
leSislati?n
should be
con-
historical perspective and rnight digress here to note that, eas the Law in Northern Ireland js satisfieti wlth two distinct cat n?W-
was
"He gave the little wealth he had, To build a house for fools and mad: And showed by one satiric touch, No nation needed it so much: Thai nation he hath left his debtor, I hope it soon will find a better".
(Verses 1731 by
on
the
Death
of
Dr.
Swift, written in
himself).
lecture to the Royal Dublin in 1941 the late Dean Wilson ?a successor in the deanery of St. Patrick's?said: "No jibe of Swift's is better known than this which he made against himself; and not one in a thousand understand the indignation that prompted it". Against the sorry story of social conditions of the time, Swift's munificence It is the is particularly impressive. first recorded instance of spontaneous and practical compassion on the part of an individual towards the mentally afflicted in Ireland: he was the forerunner of reformers and voluntary workers in this field on this side of the Irish Sea. Sir Robert Peel (then Mr. Peel) was Secretary of State for Ireland from 1812 to 1817 and during that time he was a member of the Select Committee in London in 1815 enquiring into the care of the mentally disabled. It is probable therefore that he was interested in the promotion of the Lunacy (Ireland) Act 1821 which led to the establishment of District Lunatic Asylums in Ireland; the first being that at Armagh and now known as St. Luke's Hospital. In 1842 Inspectors of Prisons undertook duties in relation to the mentally ill and in 1898, as a result of the Local Government (Ireland) Act, the powers of Governors and Directors of asylums were transferred to the appropriate County Councils on whom now devolved the duty of providing and maintaining such accommodation. After the division of the country by the Government of Ireland Act 1920, the Ministry of Home Affairs of the formed Government of newly Northern Ireland became responsible for the inspection and overall supervision of mental hospitals in its six county area and this arrangement 1944 the continued until when In
a
Society
Ministry
of Health and Local Govefi"
ment was formed.
The
Mental
Treatment
(Northern Ireland) 1932, under whic'
district lunatic asylums became "publ'1 mental hospitals" was, in tufl>( repealed by the Mental Health A1 (Northern Ireland) 1948 under whid1] as
already mentioned,
an
entirely nev
system of management was set up afl'i for co-ordination provided overall control of hospital planning and development with results tlw speak for themselves. The judicial order for the admissio'; of the mentally ill to hospital, apaf from court orders, had ended >' Northern Ireland with the introdUc tion of the 1948 Act although sue' provision was retained for admissi^ to the Special Care Services of son1' persons "suffering from arrested incomplete development of min^ (known as Special Care patients? improvement on the stark tertf mental deficiency, on which the mod' fication used in the English Act 1959 is only slightly better. Specif Care patients could also be admitte'
by their
own
consent
if twenty-ofl! by conse" was un#
years of age or over, or of relatives if the patient that age.
Mentally-ill patients were admits hospital as voluntary or temporal patients and the latter differed frof that in the English Mental Treatm^
to
Act 1930 in not being restricted those incapable of expressing a wis' f All mentally ill persons in need treatment in a mental hospital-"? 1 unfit to accept it voluntarily or, if as a voluntaf continue to hospital, be admitted on tP
^
patient?could application of someone closely relate
of a welfare officer. Such application had to be support by the "recommendation" of ^ medical practitioner. Treatment un^ this provision was for not more tba the first instance afl{ one year in c with the consent of the Ministry Health and Local Government, mig' be extended for two further periods not more than six months each. ' very special circumstances it could
or
j
J
14
n
extended further.
If the
patient stlU unable to leave at the hospital fend of that and was unable or period c
unwilling nen
',l
was
to remain voluntarily, it was to obtain a judicial
necessary
?fl
order. The Northern Ireland Act of 1961 pretty closely the lead of the vp?'lowed English Act of 1959 but differs signifi^tly in some details of procedure. for informality of 11 ,rrangernents are the same as in England fission nd compulsory admission to any is possible in theory although fp0sPital 'n w
,
Practice this is likely
to be confined described as mental in the older legislation.
j(,? institutions ^
n?spitais
special care" category I',. The omission of "psychopathic yaisorder" as a category has already 1 v,een mentioned, and also that in if. ?rthern Ireland mental subnormality not divided into degrees of severity )\
PurPoses statutory pro'c?h Anyone with "arrested in development of mind" of 's^^plcte *?.? to need under '
or
a
i!
ls
degree
as
care
Act
belongs to one category of "requiring special care". This 1^rs?ns :r ^Preb'msive description has been
Frlfd
in the OVer from the 1948 Act and' fourteen years since then, has expression "m Pk*ely
!lc '
nient^i deficiency", not only in prossior^l and official circles but also Public and press comment, England, compulsory admissin hased on the application of a re|n.'s i 'ative or welfare officer, except in 'diff,ers Cases> hut thereafter procedure greatly in detail. In Northern I land such application is supported aL?nly one medical recommendation, applies to applications under bo?. emergency and general provj Authority lapses in the case ^ former in seven days and, in th CaSe of the latter' *n twenty-one dav
;
< n
,
a?te-r
reo
Emission unless
a
"medical
made to the management com"1'' is of the hospital by ber nf'ttee consu'tant staff ?
stat
a
or
mem-
specialist things, that
his ln^-' .arnongst other opinion further detention
is
in
neces-
sary and giving the grounds on which he bases his opinion. On such evidence the patient may be detained for a further six months. If before the end of that period the "responsible medical officer" again reports that the patient is in need of more treatment he can be detained for a further twelve months. extension beyond that period the responsible medical to officer to be advisable, the Act requires that this will depend on two medical reports, at least one of which "shall be by a practitioner who has made neither the recommendation for admission or guardianship nor the medical report in connection with the detention of the patient". If
seems
.
.
.
in the history and stay in hospital, a sort of watershed in prognosis and the eve of institutionalisation. Further extensions are for two years as in England and based on the report of the responsible medical officer. There is no special provision for admission for observation but admission being limited to twenty-one days in the first instance (seven days in emergency applications) appears to cover that. Emergency applications may be made by any relative or the welfare officer instead of by the nearest relative or the welfare officer with the knowledge and consent of the nearest relative. As in England the County Court may, on application, direct that the functions of the nearest relative be exercisable by the applicant. This is of the
crucial period patient's illness
a
essential difference from the Act regarding compulsory admission is that the emphasis has shifted from precaution before admission to safeguarding against undue prolongation of his stay in the early stages after admission. Arrangements in relation to a patient in hospital are hardly applicable to Guardianship and in this case the application for guardianship must be supported by two medical recommendations, one of which shall be by a medical practitioner appointed by the Hospitals Authority for this purpose. The
English
Mental Health arrangements are
Review
Tribunal
substantially the same as in England, the appointments being made by the Lord Chief Justice.
The powers of the Lord Chief Justice under the Queen's Sign-Manual in relation to persons incapable of managing their affairs or the estates of such persons, and his power to order the admission or discharge of any person are not affected by the 1961 Act.
Arrangements for the admission of concerned in criminal profollow closely the English as pattern regards hospital and orders and orders guardianship restricting discharge except that in England and Wales the Court must ascertain before making the order that arrangements exist for the admission of the patient to the hospital named in the order. In Northern Ireland
patients ceedings
"it shall be the duty of the Authority
(the
Hospitals
Authority)
to
give
effect to the order by designating
hospital
.
a
.
to which the person directed by the court may convey the patient within a
period
of
twenty-eight days
as
in
but a guardianship order made by a court unless it satisfied that the person named willing to receive the patient it>
England, not be
guardianship.
Local authorities have certain dutif ^ e.g. in relation to guardianship "special care" patients, but there nothing in the Northern Ireland to correspond to the provisions residential and training accommod tion in Section 6 of the English A' On the other hand the Hospi^ Authority have, in addition to ex#f sive duties in the
hospital sphere,
responsibility
"to make suitable arrangements the integration and co-ordination the services provided under this ^ with the general health services P1 vided under the Health Services A1
(Northern Ireland)
1948 to 1958.
.
?
In philosophy, principle and gene' overall procedure the Mental Hed Act (Northern Ireland), 1961 folio1 the lead of the Mental Health A 1959 of England and Wales ^ alterations in a few matters of detf It cannot therefore be regarded pioneering legislation as was the Act which it replaces.
Laws Ancient and Modern by William McCartan, Ireland Mental Northern Act of 1948 was enlightened and progressive when it became law, and it is a measure of the speed of change in recent times that it was outmoded in thirteen years, being repealed and replaced by the Mental Health Act (Northern Ireland) 1961. "But if the purposes of the new Act (the English Act of 1959) are to be achieved, it will be necessary to weaknesses as consider as well
THEHealth
strengths" according to the P.E.P. Report on Community Mental Health Services (Vol. XXVI, No. 447. 12/12/60). This is
equally germane in Northern Ireland. Progress in the hospital and ancillary fields has been remarkable in the province since 1948 when overall responsibility for the development of psychiatric hospitals was placed on the Northern Ireland Hospitals Authority as the body already detailed to develop a unified and comprehensive hospital
the hospital field developments in
In the Act of 1948 as in that the Authority was also charged with the duty to "provide or secure the provision of services designed to improve and maintain the mental health of the people of Northern Ireland" and "to make suitable arrangements for the integration and co-ordination of the services provided under this Act with the general health services
delinquency.
It is clear that creative leadershit by an integrating central body is essefl
tial for the development of those par' of the service whose boundaries af not co-terminous with the limits of tl" administrative control of one or othe' of the statutory bodies concerned, i-e' where there is overlap of the functio' and facilities of bodies such as tb' Hospitals Authority, Local Health Education and Welfare committees. The P.E.P. Report also states "It is unusual, too, for new legislate' to be preceded or accompanied
systematic investigation,
Maximum vision
mum
Mj
contrast#
well-plac^
regards systematic investigation this matter and any uncertainty th?; exists in England and Wales is n"1 for want of enquiry, as is shown b) studies of all aspects of the problem including the work of Dr. G. C. Tootf as
.
advantage
in of a health service
the foregoing is the comprehensive mental so integrated that maxiadvantage would be obtained existing services and any further
Implicit
as
the more discursive type 0 enquiry characteristic of Royal Con1! missions, which might provide a factum basis for policy-making or planning Yet in the mental health services thefc is much uncertainty as to the be* balance between institutional and oth?! forms of care and as to the difficultylikely to be encountered in tbf of development communityibasec services". Northern Ireland is less with
1961
.
is not matched N those parts of
service outside the statutory control o the Hospitals Authority. This is m?s obvious in the provision of chi'c guidance or child psychiatry service f?! and psychiatric provision
service. of
M.P
and Miss Eileen M. Brooke on th? basis of statistical returns by hospital* to the General Register Officer on tb?
from extension of these. Northern Ireland is and compact administratively wieldy and should lend itself to such co-ordination, but when the overall situation is considered as advised by P.E.P. it is seen that rapid progress in
one hand and the opposing views Dr. Kathleen Jones and Professor F Sidebotham on the other. Psychopathy is not included as 5 category in the Northern Ireland Ad although the need for accommodate
12
for the type
of person usefully if described as a psychopath is wily recognised (Section 80). The absence of psychopathy as a category d?es not preclude the admission to a
^aguely
Psychiatric hospital of anyone whose aggressive and seriously irresponsible conduct" (to quote the English Act) ls> in medical opinion, the outcome of
disability Rental usted under
of any of the types
Mental, Psychoneurotic
and Personality Disorders in Part V of the International Classification of leases; coming, as these appear to tlo> within the meaning of mental disorder as categorised in the Northern
Ireland Act. The Royal Commission was unable define psychopathic disorder; the y. Act does, but in the debates which preceded it the Baroness
j^?otton 59)
is stated (Lancet 13th June, have sajd in the House of Lords that "the definition of psychopathy in the Bill would cover practicthe whole of the recidivist populal0n". No agreement has been reached the type of accommodation that should be provided for such patients the only advice the Psychological Group Committee of the -M.A. can offer (British Medical i J??rnaI, 21st July, 1962) is that "The inistry of Health should not require Very regional hospital board to set P a , security unit but should allow
^.'ly
J^dicine
?ards
to
experiment.. .(italics mine)." as a category in Northern
jls exclusion and should
limit the
tendency
terpret delinquency overwidely
to
in mental disorder without any person, regardless of lethcr he is delinquent or not, of the ychiatric treatment he may need. rnis
of
wholly
rural
society
of
one
thousand
years ago or more?included, amongst their general provisions, safeguards for the care of the mentally ill and recognised five categories, i.e., idiots, fools, dotards, persons without sense, and madmen. The irresponsibility of the average small boy in the eyes of the law was recognised by including them in the category of "persons without sense". Account was also taken of the and diminished limited discretion responsibility of the insane or mentally disabled by provision to protect them from exploitation. In those days the alternatives to the care of such persons in the community by members of the community can only have been neglect or worse. The Brehon Laws?as they are more comknown?made such care monly "everybody's business" in a most literal way and the particular responsibilities of kinship were brought home by a system of fines for neglecting obligations to a mentally sick or disabled relative?the less able the patient to fend for himself the heavier the fine, hence the need for defined categories of mental disorder. The fines were imposed in numbers of cattle.
Attempt
at
community
This attempt to
care
ensure
proper
com-
munity care was, no doubt, primitive and elementary but its principles anticipated much of our modern? though fundamentally no more enlightened?legislation. During the
0
turmoil of the centuries that followed the invasion in the reign of Henry II, these laws were restricted to those parts of the country outside the Norman pale and in the welter of war and revolt probably sank more and more into abeyance until repealed in the Stuart period.
teg?ries of mental disorder and one 1 Ss Precise, the Ancient Laws of IreI comprehensive and astoundj 8ly enlightened laws of a tribal and
The first mental hospital in Ireland opened in 1757. It was made possible by Jonathan Swift's legacy of ?10,000 and is named St. Patrick's after the cathedral in Dublin of which he was Dean. Thirteen years before his death Swift wrote:
JjPriving Anc'ent
Irish laws
sid^0dern ered in
leSislati?n
should be
con-
historical perspective and rnight digress here to note that, eas the Law in Northern Ireland js satisfieti wlth two distinct cat n?W-
was
"He gave the little wealth he had, To build a house for fools and mad: And showed by one satiric touch, No nation needed it so much: Thai nation he hath left his debtor, I hope it soon will find a better".
(Verses 1731 by
on
the
Death
of
Dr.
Swift, written in
himself).
lecture to the Royal Dublin in 1941 the late Dean Wilson ?a successor in the deanery of St. Patrick's?said: "No jibe of Swift's is better known than this which he made against himself; and not one in a thousand understand the indignation that prompted it". Against the sorry story of social conditions of the time, Swift's munificence It is the is particularly impressive. first recorded instance of spontaneous and practical compassion on the part of an individual towards the mentally afflicted in Ireland: he was the forerunner of reformers and voluntary workers in this field on this side of the Irish Sea. Sir Robert Peel (then Mr. Peel) was Secretary of State for Ireland from 1812 to 1817 and during that time he was a member of the Select Committee in London in 1815 enquiring into the care of the mentally disabled. It is probable therefore that he was interested in the promotion of the Lunacy (Ireland) Act 1821 which led to the establishment of District Lunatic Asylums in Ireland; the first being that at Armagh and now known as St. Luke's Hospital. In 1842 Inspectors of Prisons undertook duties in relation to the mentally ill and in 1898, as a result of the Local Government (Ireland) Act, the powers of Governors and Directors of asylums were transferred to the appropriate County Councils on whom now devolved the duty of providing and maintaining such accommodation. After the division of the country by the Government of Ireland Act 1920, the Ministry of Home Affairs of the formed Government of newly Northern Ireland became responsible for the inspection and overall supervision of mental hospitals in its six county area and this arrangement 1944 the continued until when In
a
Society
Ministry
of Health and Local Govefi"
ment was formed.
The
Mental
Treatment
(Northern Ireland) 1932, under whic'
district lunatic asylums became "publ'1 mental hospitals" was, in tufl>( repealed by the Mental Health A1 (Northern Ireland) 1948 under whid1] as
already mentioned,
an
entirely nev
system of management was set up afl'i for co-ordination provided overall control of hospital planning and development with results tlw speak for themselves. The judicial order for the admissio'; of the mentally ill to hospital, apaf from court orders, had ended >' Northern Ireland with the introdUc tion of the 1948 Act although sue' provision was retained for admissi^ to the Special Care Services of son1' persons "suffering from arrested incomplete development of min^ (known as Special Care patients? improvement on the stark tertf mental deficiency, on which the mod' fication used in the English Act 1959 is only slightly better. Specif Care patients could also be admitte'
by their
own
consent
if twenty-ofl! by conse" was un#
years of age or over, or of relatives if the patient that age.
Mentally-ill patients were admits hospital as voluntary or temporal patients and the latter differed frof that in the English Mental Treatm^
to
Act 1930 in not being restricted those incapable of expressing a wis' f All mentally ill persons in need treatment in a mental hospital-"? 1 unfit to accept it voluntarily or, if as a voluntaf continue to hospital, be admitted on tP
^
patient?could application of someone closely relate
of a welfare officer. Such application had to be support by the "recommendation" of ^ medical practitioner. Treatment un^ this provision was for not more tba the first instance afl{ one year in c with the consent of the Ministry Health and Local Government, mig' be extended for two further periods not more than six months each. ' very special circumstances it could
or
j
J
14
n
extended further.
If the
patient stlU unable to leave at the hospital fend of that and was unable or period c
unwilling nen
',l
was
to remain voluntarily, it was to obtain a judicial
necessary
?fl
order. The Northern Ireland Act of 1961 pretty closely the lead of the vp?'lowed English Act of 1959 but differs signifi^tly in some details of procedure. for informality of 11 ,rrangernents are the same as in England fission nd compulsory admission to any is possible in theory although fp0sPital 'n w
,
Practice this is likely
to be confined described as mental in the older legislation.
j(,? institutions ^
n?spitais
special care" category I',. The omission of "psychopathic yaisorder" as a category has already 1 v,een mentioned, and also that in if. ?rthern Ireland mental subnormality not divided into degrees of severity )\
PurPoses statutory pro'c?h Anyone with "arrested in development of mind" of 's^^plcte *?.? to need under '
or
a
i!
ls
degree
as
care
Act
belongs to one category of "requiring special care". This 1^rs?ns :r ^Preb'msive description has been
Frlfd
in the OVer from the 1948 Act and' fourteen years since then, has expression "m Pk*ely
!lc '
nient^i deficiency", not only in prossior^l and official circles but also Public and press comment, England, compulsory admissin hased on the application of a re|n.'s i 'ative or welfare officer, except in 'diff,ers Cases> hut thereafter procedure greatly in detail. In Northern I land such application is supported aL?nly one medical recommendation, applies to applications under bo?. emergency and general provj Authority lapses in the case ^ former in seven days and, in th CaSe of the latter' *n twenty-one dav
;
< n
,
a?te-r
reo
Emission unless
a
"medical
made to the management com"1'' is of the hospital by ber nf'ttee consu'tant staff ?
stat
a
or
mem-
specialist things, that
his ln^-' .arnongst other opinion further detention
is
in
neces-
sary and giving the grounds on which he bases his opinion. On such evidence the patient may be detained for a further six months. If before the end of that period the "responsible medical officer" again reports that the patient is in need of more treatment he can be detained for a further twelve months. extension beyond that period the responsible medical to officer to be advisable, the Act requires that this will depend on two medical reports, at least one of which "shall be by a practitioner who has made neither the recommendation for admission or guardianship nor the medical report in connection with the detention of the patient". If
seems
.
.
.
in the history and stay in hospital, a sort of watershed in prognosis and the eve of institutionalisation. Further extensions are for two years as in England and based on the report of the responsible medical officer. There is no special provision for admission for observation but admission being limited to twenty-one days in the first instance (seven days in emergency applications) appears to cover that. Emergency applications may be made by any relative or the welfare officer instead of by the nearest relative or the welfare officer with the knowledge and consent of the nearest relative. As in England the County Court may, on application, direct that the functions of the nearest relative be exercisable by the applicant. This is of the
crucial period patient's illness
a
essential difference from the Act regarding compulsory admission is that the emphasis has shifted from precaution before admission to safeguarding against undue prolongation of his stay in the early stages after admission. Arrangements in relation to a patient in hospital are hardly applicable to Guardianship and in this case the application for guardianship must be supported by two medical recommendations, one of which shall be by a medical practitioner appointed by the Hospitals Authority for this purpose. The
English
Mental Health arrangements are
Review
Tribunal
substantially the same as in England, the appointments being made by the Lord Chief Justice.
The powers of the Lord Chief Justice under the Queen's Sign-Manual in relation to persons incapable of managing their affairs or the estates of such persons, and his power to order the admission or discharge of any person are not affected by the 1961 Act.
Arrangements for the admission of concerned in criminal profollow closely the English as pattern regards hospital and orders and orders guardianship restricting discharge except that in England and Wales the Court must ascertain before making the order that arrangements exist for the admission of the patient to the hospital named in the order. In Northern Ireland
patients ceedings
"it shall be the duty of the Authority
(the
Hospitals
Authority)
to
give
effect to the order by designating
hospital
.
a
.
to which the person directed by the court may convey the patient within a
period
of
twenty-eight days
as
in
but a guardianship order made by a court unless it satisfied that the person named willing to receive the patient it>
England, not be
guardianship.
Local authorities have certain dutif ^ e.g. in relation to guardianship "special care" patients, but there nothing in the Northern Ireland to correspond to the provisions residential and training accommod tion in Section 6 of the English A' On the other hand the Hospi^ Authority have, in addition to ex#f sive duties in the
hospital sphere,
responsibility
"to make suitable arrangements the integration and co-ordination the services provided under this ^ with the general health services P1 vided under the Health Services A1
(Northern Ireland)
1948 to 1958.
.
?
In philosophy, principle and gene' overall procedure the Mental Hed Act (Northern Ireland), 1961 folio1 the lead of the Mental Health A 1959 of England and Wales ^ alterations in a few matters of detf It cannot therefore be regarded pioneering legislation as was the Act which it replaces.
