On the State of Lunacy and the Legal Provision for the Insane / With Observations on the Construction and Organization of Asylums

by J. T. Arlidge

The decision of the Lunacy Commissioners, we are of opinion, should be held equivalent to that of a public court, and should not be set aside except upon appeal to a higher court, and on evidence being shown that there are good reasons for supposing the original decision to be in some measure faulty. Is not, it may be asked, the verdict of a competent, unprejudiced body of gentlemen, skilled in investigating Lunacy cases, of more value than that of a number of perhaps indifferently-instructed men, of no experience in such matters, under the influence of powerful appeals to their feelings by ingenious counsel, and confounded by the multiplicity and diversity of evidence of numerous witnesses, scared or ensnared by cross-examination in its enunciation?

Again, the more frequent visitation of the insane by the Commissioners would be productive of the further benefit of obviating the imputation that patients are improperly detained after recovery; and it would also, in some cases, be salutary to the minds of patients, fretting under the impression of their unnecessary seclusion; for the inmates of asylums naturally look to the Commissioners for release, anticipate their visits with hope, and regret the long interval of two, three, or more months, before they can obtain a chance of making their wants known, particularly since they are conscious how many affairs are to be transacted during the visit, and that only one or two of their number can expect to obtain special consideration.

There is, moreover, a new set of duties the Commissioners propose to charge themselves with, involved in the clause of the Bill introduced in the last session of Parliament (clause 26), requiring information to be given them of the payment made for patients in asylums, in order to their being able to satisfy themselves that the accommodation provided is equivalent to the charges paid. This task will necessarily entail increased labour on the Commission, and lead, not only to inquiries touching the provision made for the care and comfort of the patients within the asylum, but also to others concerning the means in the possession of their friends, and the fair proportion which ought to be alloted for their use. In short, we cannot help thinking that the duties proposed will frequently lead the Commissioners to take the initiative in a course of inquiries respecting the property of lunatics available for their maintenance.

According to present arrangements, although every asylum in the country is under the jurisdiction of the Commissioners in Lunacy, yet, beyond the metropolitan district, their jurisdiction is divided, and the county magistrates share in it. Indeed, provincial asylums are placed especially under the jurisdiction of the magistrates, by whom the plans of licensed houses are approved, licences granted or revoked, and four visitations made in the course of each year; whilst the Commissioners, although they can, by appeal to the Chancellor, revoke licences in the provinces, are not concerned in granting them, and make only two visits yearly to each licensed house beyond the metropolitan district. This variety in the extent of the jurisdiction of the Lunacy Board in town and country, is, to our mind, anomalous, and without any practical advantage. If the magisterial authority is valuable in the regulation of asylums at one portion of the country, it must be equally so at another; the ‘non-professional element’ (Evid. Com., Query 126), if of importance in the country, must be equally so in the neighbourhood of the metropolis. We do not argue against the introduction of magisterial visitation of asylums, but against the anomaly of requiring it in the country and not in town, and against treating provincial asylums as not equally in need of the supervision of the Central Board with the metropolitan. We perceive a distinction made, but cannot recognize a difference. There is a single jurisdiction in the instance of one set of asylums, and a divided one in that of another; and yet the circumstances are alike in the two.

The real explanation of this anomaly in the public supervision and control of asylums, is, we believe, to be found in the fact of the inadequacy of the Lunacy Commission to undertake the entire work. The superiority of the Commissioners, as more efficient, experienced, and independent visitors, will be generally admitted; but they are too few in number to carry out the same inspection of all the private asylums in the country, as they do of those in the metropolitan district. The Commissioners are free from local prejudices, unmixed in county politics, and constitute a permanent, unfluctuating board of inspection and reference; whereas county and borough magistrates owe their appointment usually to political considerations and influence: politics are a subject of bitter warfare among them in most counties; local and personal prejudices and dislikes are more prone to affect them as local men; and, withal, the Committees of Visiting Justices are liable to perpetual change, and, out of the entire number elected on a committee, the actual work is undertaken only by a few, who therefore wield all the legal powers entrusted to the whole body.

A passage from the ‘Further Report’ of the Lunacy Commissioners (1847) recently referred to (p. 189) may be serviceably quoted in this place. Speaking of the extracts selected by them for publication in the Report, “to show that occasions are continually arising, where the intervention of authority is beneficial,” the Commissioners proceed to remark that “the defects adverted to in the extracts may sometimes appear to be not very important; but they are considerable in point of number, and, taken altogether, the aggregate amount of benefit derived by the patients from their amendment, and from the amendment of many other defects only verbally noticed by the Commissioners, has been very great. It is most desirable that no defect, however small, which can interfere with the comfort of the patient, should at any time escape remark. A careful and frequent scrutiny has been found to contribute more than anything else to ensure cleanliness and comfort in lunatic establishments, and good treatment to the insane. These facts will tend to show how advantageous, and indeed how necessary, is the frequent visitation of all asylums. It is indispensable that powers of supervision should exist in every case; that they should be vested in persons totally unconnected with the establishment; and that the visitations should not be limited in point of number, and should be uncertain in point of time: for it is most important to the patients that every proprietor and superintendent should always be kept in expectation of a visit, and should thus be compelled to maintain his establishment and its inmates in such a state of cleanliness and comfort as to exempt him from the probability of censure. We are satisfied, from our experience, that, if the power of visitation were withdrawn, all or most of the abuses that the Parliamentary Investigations of 1815, 1816, and 1827 brought to light, would speedily revive, and that the condition of the lunatic would be again rendered as miserable as heretofore.”

We have in past pages referred to magisterial authority in relation with the pauper insane, as frequently exercised prejudicially, and with reference to asylum construction and organization, as sometimes placed in antagonism to acknowledged principles and universal practice, much to the injury of the afflicted inmates. Its operation is not more satisfactory when extended to the duties of inspection. We have heard complaints made that magistrates sometimes act very arbitrarily in their capacity of visitors to asylums, and that it is not uncommon for them, instead of acting in concert with the Commissioners in Lunacy, to place themselves in opposition to their views. In fact, the Annual Reports of the Commissioners testify to the not unfrequent want of harmony between the visiting magistrates and the Commissioners in Lunacy; and the very facts, that the latter have to make special yearly reports to the Lord Chancellor on the neglect or unfitness of certain private houses, and that they have sometimes to apply to him to revoke licences, demonstrate that the magisterial authorities are at times backward and negligent in their duties. Indeed, the impression to be gathered from the annual reports of the Commission is, that almost the only efficient supervision and control of provincial asylums are exercised by the Lunacy Commissioners.

The publication of the evidence before the Select Committee (1859) adds fresh proofs that magistrates make but indifferent visitors of asylums, and but imperfectly protect the interests of the insane; and that an extension of the jurisdiction and of the inspection by the Lunacy Commissioners is much needed. We would refer for particulars to queries and answers numbered from 2582 to 2605, and from 2788 to 2789.

We have commented in previous pages on the manner in which the Visiting Justices of public asylums perform their duties, and need not repeat the statements already made; yet we may here remark that the visitation of the wards of county asylums is often so very carelessly made, that it has little or no value, and that it is frequently difficult to get the quorum of two Justices to make it, the majority objecting on personal and other grounds.

From the foregoing considerations we would advocate the extension of the Commissioners’ jurisdiction, and its assimilation to that in force within the metropolitan district. To extend it merely to thirty miles around the metropolis, as some have proposed, would be only to increase the anomaly complained of. The lunatics, and those in whose charge they live, in every district in England, should be under one uniform jurisdiction, with the authority and protection of one set of public officers and one code of rules. If magisterial supervision have a real value, let it be superadded to a complete scheme of inspection and control exercised by the Lunacy Commissioners; and if it exist anywhere, let no district be exempt from it; for the existence of any such exemption furnishes a standing argument against the value attributed to its presence. For instance, it may be fairly asked,—Are the metropolitan licensed houses any the worse for the absence of magisterial authority, or, otherwise, are the provincial any better for its presence?