Persons of Unsound Mind in United Kingdom

Persons of Unsound Mind and the Poor Law Commissioners

In this issue about persons of unsound mind, the book “English Poor Law Policy” [1] reads as follows: A separation of lunatics from the other inmates of the workhouses had been suggested in the Report of 1834. But it was in the course of this period 1834-47 that persons of unsound mind became recognised as a distinct class. It was, however, long before any settled term was used. We read of “idiots” (1), dangerous (2), or not dangerous (3), curable (4), or not curable; “the insane” (5), “persons of weak intellect” (6), or suffering from “mental infirmity” (7), or from “mental imbecility” (8), or from “disease of mind” (9), or merely “persons of unsound mind” (10).

Persons suffering from “mental infirmity” (explained to mean “insane”) were repeatedly excepted from the prohibition of the grant of outdoor relief. In the Outdoor Labour Test Order a similar exception allows outdoor relief, without work, and even if the applicant is in employment, on account of the mental infirmity of a member of his family. Finally, a similar exception was definitely incorporated in the Outdoor Relief Prohibitory Order of 1844 (still in force) and the Outdoor Relief Regulation Order of 1852 (still in force).

We are not here concerned with the increasing statutory powers, and the practical application of them, for the compulsory removal to asylums or other licensed houses of persons certified to be dangerous; or with the question of their chargeability. When persons of unsound mind found their way to the workhouse they were to be detained. It should be noted that the Central Authority supported the Government proposal to enable unions to combine for the establishment of district asylums for the insane poor, a proposal which was not proceeded with.

Persons of Unsound Mind and the Poor Law Board

In this issue about persons of unsound mind, the book “English Poor Law Policy” [1] reads as follows: It is difficult to discover what was the policy of the Central Authority during this period with regard to lunatics, idiots, and the mentally defective. Lunacy had always been, and remained, a ground of exception from the prohibition to grant outdoor relief. The provision of a lodging for a lunatic was, moreover, an exception to the prohibition of the payment of rent for a pauper. As a result of these exceptions, there were on 1st January 1852, 4107 lunatics and idiots on outdoor relief, and this number had increased by 1859 to 4892 and by 1870 to 6199. The Central Authority took no steps to require or persuade boards of guardians not to grant outdoor relief to lunatics, nor yet to get any appropriate provision made for them in the great general workhouses on which it had insisted. Parliament in 1862 (in order to relieve the pressure on lunatic asylums) expressly authorised arrangements to be made for chronic lunatics to be permanently maintained in workhouses, under elaborate provisions for their proper care. These arrangements would have amounted, in fact, to the creation, within the workhouse, of wards which were to be in every respect as well equipped, as highly staffed, and as liberally supplied as a regular lunatic asylum. The Central Authority transmitted the Act to the boards of guardians, observing, with what almost seems like sarcasm, that it was not “aware of any workhouse in which any such arrangements could conveniently be made”; and the provisions of this Act were, we believe, never acted upon. Whilst consistently objecting to the retention in workhouses of lunatics who were dangerous, or who were deemed curable, we do not find that the Central Authority ever insisted on there being a proper lunatic ward for the persons of unsound mind who were necessarily received, for a longer or shorter period, in every workhouse. Moreover, the Central Authority took no steps to get such persons removed to lunatic asylums. In 1845 it had agreed with the Manchester Board of Guardians (who did not want to make any more use of the county asylum than they could help) that they were justified in retaining in the workhouse any lunatics whom their own medical officer did not consider “proper to be confined” in a lunatic asylum. In 1849 it expressly laid it down that a weak-minded pauper or, as we now say, a mentally defective, must either be a lunatic, and be certified and treated as such, or not a lunatic, in which case no special treatment could be provided for him or her in the one general workhouse to which the Central Authority still adhered. We can find no indication of policy as to whether it was recommended that such mentally defectives should be granted outdoor relief, or (as one can scarcely believe) required to inhabit a workhouse which made no provision for them.

The explanation of this paralysis of the Central Authority, as regards the policy to be pursued with persons of unsound mind, is to be found, we believe, in the existence and growth during this period of the rival authority of the Lunacy Commissioners, who had authority over all persons of unsound mind, whether paupers or not. The Lunacy Commissioners had not habitually in their minds the principle of “less eligibility”; and they were already, between 1848 and 1871, making requirements with regard to the accommodation and treatment of pauper lunatics that the Poor Law authorities regarded as preposterously extravagant. The records of the boards of guardians show visits of the inspectors of the Lunacy Commissioners, and their perpetual complaints of the presence of lunatics and idiots in the workhouses without proper accommodation; mixed up with the sane inmates to the great discomfort of both; living in rooms which the Lunacy Commissioners considered too low and unventilated, with yards too small and depressing, amid too much confusion and disorder, for the section of the paupers for whom they were responsible. Such reports, officially communicated to the Poor Law Board, seem to have been merely forwarded for the consideration of the board of guardians concerned. But other action was not altogether wanting. Under pressure from the Lunacy Commissioners, the Central Authority asked, in 1857, for more care in the conveyance of lunatics; urged, in 1863, a more liberal dietary for lunatics in workhouses; in 1867 it reminded the boards of guardians that lunatics required much food, especially milk and meat; it was thought “very desirable that the insane inmates … should have the opportunity of taking exercise”; it concurred “with the Visiting Commissioner in deeming it desirable that a competent paid nurse should be appointed for the lunatic ward,” in a certain workhouse; it suggested the provision of leaning chairs in another workhouse; and, in yet another, the desirability of not excluding the persons of unsound mind from religious services. In 1870 it issued a circular, transmitting the rules made by the Lunacy Commissioners as to the method of bathing lunatics, for the careful consideration of the boards of guardians. But we do not find that the Central Authority issued any Order amending the General Consolidated Order of 1847, which, it will be remembered, did not include among its categories for classification either lunatics, idiots, or the mentally defective; and the Central Authority did not require any special provision to be made for them.

The policy of the Lunacy Commissioners was to get provision made in every county for all the persons of unsound mind, whatever their means, in specially organised lunatic asylums in which the best possible arrangements should be made for their treatment and cure irrespective of cost, and altogether regardless of making the condition of the pauper lunatic less eligible than that of the poorest independent labourer. Unlike the provision for education, and that for infectious disease, the cost of this national (and as we may say communistic) provision for lunatics was a charge upon the poor rate. Under the older statutes, the expense of maintaining the inmates of the county lunatic asylums was charged to the Poor Law authorities of the parishes in which they were respectively settled; and the boards of guardians were entitled to recover it, or part of it, from any relatives liable to maintain such paupers, even in cases in which the removal to the asylum was compulsory and insisted on in the public interest. The great cost to the poor rate of lunatics sent to the county lunatic asylums, and the difficulty of recovering the amount from their relatives, prevented the whole-hearted adoption, either by the boards of guardians, or the Central Authority, of the policy of insisting on the removal of persons of unsound mind to the county asylums. For the imbeciles and idiots of the Metropolitan Unions, provision was made after 1867 in the asylums of the Metropolitan Asylums Board.But no analogous provision for those of other unions was made. The result was that, amid a great increase of pauper lunacy, the proportion of the paupers of unsound mind who were in lunatic asylums did not increase. On the other hand the indisposition of the Central Authority to so amend the General Consolidated Order of 1847 as to put lunatics in a separate category, and require suitable accommodation and treatment for them-an indisposition perhaps strengthened by the very high requirements on which the Lunacy Commissioners would have insisted-stood in the way of any candid recognition of the fact that for thousands of lunatics, idiots, and mentally defectives, the workhouse had, without suitable provision for them, and often to the unspeakable discomfort of the other inmates, become a permanent home.

Persons of Unsound Mind and the Local Government Board

In this issue about persons of unsound mind, the book “English Poor Law Policy” [1] reads as follows: It does not seem necessary to trace the slight changes in the law relating to pauper lunatics, or in the orders and circulars of the Central Authority. There appears to have been no alteration in the relation of the Central Authority to the Lunacy Commissioners, practically no steps being taken to initiate policy except upon the suggestion of the latter, whose standard of accommodation and treatment continues steadily to rise for pauper as for non-pauper lunatics.

The only point of interest is the continuance, virtually unchanged, of the three methods of treatment, viz. maintenance in the workhouse, treatment in a lunatic asylum, or grant of outdoor relief.

The number of persons of unsound mind in the workhouse continued practically undiminished, without any steps being taken to prevent their retention among the aged, the sick, and the children, who came more and more to make up the workhouse population. There were, in fact, three classes of cases in which a lunatic might be detained in a workhouse. Firstly, there is the old provision, under which “the visitors of any asylum may, with the consent of the Local Government Board and the Commissioners, and subject to such regulations as they respectively prescribe, make arrangements with the guardians of any union for the reception into the workhouse of any chronic lunatics, not being dangerous, who are in the asylum, and have been selected and certified by the manager of the asylum as proper to be removed to the workhouse.” Secondly, “where a pauper lunatic is discharged from an institution for lunatics, and the medical officer of the institution is of opinion that the lunatic has not recovered, and is a proper person to be kept in a workhouse as a lunatic, the medical officer shall certify such opinion, and the lunatic may thereupon be received and detained against his will in a workhouse without further order, if the medical officer of the workhouse certifies in writing that the accommodation in the workhouse is sufficient.” Thirdly, if it is necessary for the welfare of a lunatic, or for the public safety, that he should immediately be placed under care and control, pending regular proceedings for his removal, he may be taken to a workhouse (if there is proper accommodation therein) by a constable, relieving officer, or overseer, and may be detained there for three days, during which time the proceedings are to be taken; and in any case in which a summary reception order has been or might be made, he may be further detained on a justice’s order till he can be removed, provided that the period does not exceed fourteen days. Moreover, any other lunatic might be “allowed to remain in a workhouse as a lunatic” if “the medical officer of the workhouse certifies in writing: (a) that such a person is a lunatic, with the grounds for the opinion; and (b) that he is a proper person to be allowed to remain in a workhouse as a lunatic; and (c) that the accommodation in the workhouse is sufficient for his proper care and treatment, separate from the inmates of the workhouse not lunatics, unless the medical officer certifies that the lunatic’s condition is such that it is not necessary for the convenience of the lunatic or of the other inmates that he should be kept separate.” Such a certificate signed by the medical officer is sufficient authority for detaining the lunatic in a workhouse for fourteen days, but no longer, unless within that time a justice signs an order for his detention. Failing such a certificate, or, after fourteen days, such an order, or if at any time the lunatic ceases to be “a proper person to be allowed to remain in a workhouse,” he becomes “a proper person to be sent to an asylum,” and proceedings are to be taken accordingly.

Meanwhile the Central Authority continued to permit the grant of outdoor relief in cases of lunacy; and about 5000 were always so maintained.

Regulations for the boarding-out of pauper lunatics first appear in the Act of 1889. “Where application is made to the committee of visitors of an asylum by any relative or friend of a pauper lunatic confined therein that he may be delivered over to the custody of such relative or friend, the committee may, upon being satisfied that the application has been approved by the guardians of the union to which the lunatic is chargeable, and, in case the proposed residence is outside the limits of the said union, then also by a justice having jurisdiction in the place where the relative or friend resides, and that the lunatic will be properly taken care of, order the lunatic to be delivered over accordingly.” The authority liable for such a lunatic’s maintenance is to pay an allowance for his support to the person who undertakes his care; the medical officer of the district is to visit him and report to the visiting committee every quarter, and two visitors may at any time order the lunatic to be removed to the asylum. Any two Commissioners have also the right to visit any pauper lunatic or alleged lunatic not in an institution for lunatics or in a workhouse, and call in a medical practitioner; if the latter signs a certificate, and they think fit, the Lord Chancellor may direct that the lunatic be received into an institution.

For the paupers of unsound mind in the Metropolis there was even a fourth alternative, namely, the “district asylums” of the Metropolitan Asylum Board. On the opening of the Darenth Asylum, the Central Authority quoted, without disapproval, the following remarks of the Lunacy Commissioners: “The withdrawal, for proper care, of helpless children of this kind from the households of many of the industrious and deserving poor is a frequent means of warding off pauperism in the parents.” We do not find, however, any more explicit statement on this point. What the Central Authority continued to press on the Boards of Guardians was, not so much the importance of relieving the struggling poor from the burden of their insane or idiotic dependants, nor yet the freeing of the workhouses from the presence of persons of unsound mind; but rather of appropriate discrimination. “It is of great importance not merely to exclude from the asylums those who, by reason of violence or irritability, are proper subjects for the county asylum, but also those who, from old age or disease, are unfit for the journey to the asylum, or who, from the slight degree to which their mind is affected, might more properly remain in the workhouse.” “The removal of helpless, bedridden persons, whose mental weakness is, in many cases, the result of old age, to asylums situated a considerable distance from the Metropolis, is calculated, on the one hand, to be injurious to the persons thus removed, and, on the other, to occupy the district asylums with a different class of persons from that for which they were constructed.” Imbecile children are to be kept in the workhouse till they are five years old, and may then be sent to the asylum at Darenth. Outside the Metropolis there is no specialised Poor Law provision for idiots, who, if not received into the county asylum, must either be placed in non-Poor-Law institutions at considerable expense, or detained in the workhouse. In 1885 the Central Authority even suggested that harmless and aged lunatics had, on grounds of economy, better be retained in the workhouse, rather than removed to an asylum. We hear incidentally of a Special Order in 1900 under which certain chronic lunatics were actually transferred from the Suffolk County Asylum to the workhouse of the Mildenhall Union. As late as 1905 we find the Central Authority expressing regret that so many cases of senile imbecility were removed from the workhouses to asylums.

Under this policy the number of paupers of unsound mind receiving outdoor relief diminished very slightly, being 4736 on 1st January 1906; those in the asylums of the Metropolitan Asylums Board and in county and borough lunatic asylums rose to no fewer than 92,409; whilst those in workhouses nevertheless did not fall off from the total of thirty-five years previously, being, in fact, on 1st January 1906, 11,484, or an average of nineteen in each workhouse.

Towards the latter part of the time we begin to find the inspectors, somewhat in disaccord with the suggestions of the Central Authority itself, protesting against the presence in the workhouses even of the chronic lunatic, the harmless idiot, or the senile imbecile, on the new ground that their presence caused annoyance to the sane inmates-annoyance which had, for seventy years, been apparently either unnoticed or not considered. “I am sorry to say,” reported Mr. Preston-Thomas in 1901, “that in all but six of the workhouses in my district imbeciles mix freely with the other workhouse inmates. Many of them are mischievous, noisy, or physically offensive.

In some instances, even if their bodily ailment is very slight, they sleep in the sick wards in order that they may come under the supervision of the nurses, and they frequently disturb other patients at night. By day they are a source of much irritation and annoyance, and in a small workhouse I have known the lives of a number of old men made seriously uncomfortable by a mischievous idiot for whom no place could be found in an asylum…. I am much afraid,” prophetically continued Mr. Preston-Thomas, “that … the question will be postponed indefinitely, and six or eight years hence the idiots will still be worrying the sane inmates of workhouses…. It is in the country workhouses, sometimes with only a dozen imbeciles or less, divided among the sexes, that the chief difficulty arises…. A good many are often found useful in the laundry and other domestic work of the institution, but I do not think this consideration ought to outweigh what may almost be characterised as the cruelty of requiring sane persons to associate, by day and by night, with gibbering idiots.” When the Select Committee on the Bill to establish Cottage Homes for the Aged Poor in 1900 strongly recommended the removal of all imbeciles from workhouses, the Central Authority, observing that the advisability of this step had been repeatedly brought to its notice by guardians and others, declared that the question must be deferred.

Resources

Notes and References

1. Sidney Webb and Beatrice Webb, “English Poor Law Policy” (1913), Longmans, Green and Co., London, New York, Bombay and Calcuta.

See Also

Resources

Notes and References

1. Sidney Webb and Beatrice Webb, “English Poor Law Policy” (1913), Longmans, Green and Co., London, New York, Bombay and Calcuta.

See Also

Persons of Unsound Mind and the Local Government Board

In this issue about persons of unsound mind, the book “English Poor Law Policy” [1] reads as follows: It does not seem necessary to trace the slight changes in the law relating to pauper lunatics, or in the orders and circulars of the Central Authority. There appears to have been no alteration in the relation of the Central Authority to the Lunacy Commissioners, practically no steps being taken to initiate policy except upon the suggestion of the latter, whose standard of accommodation and treatment continues steadily to rise for pauper as for non-pauper lunatics.

The only point of interest is the continuance, virtually unchanged, of the three methods of treatment, viz. maintenance in the workhouse, treatment in a lunatic asylum, or grant of outdoor relief.

The number of persons of unsound mind in the workhouse continued practically undiminished, without any steps being taken to prevent their retention among the aged, the sick, and the children, who came more and more to make up the workhouse population. There were, in fact, three classes of cases in which a lunatic might be detained in a workhouse. Firstly, there is the old provision, under which “the visitors of any asylum may, with the consent of the Local Government Board and the Commissioners, and subject to such regulations as they respectively prescribe, make arrangements with the guardians of any union for the reception into the workhouse of any chronic lunatics, not being dangerous, who are in the asylum, and have been selected and certified by the manager of the asylum as proper to be removed to the workhouse.” Secondly, “where a pauper lunatic is discharged from an institution for lunatics, and the medical officer of the institution is of opinion that the lunatic has not recovered, and is a proper person to be kept in a workhouse as a lunatic, the medical officer shall certify such opinion, and the lunatic may thereupon be received and detained against his will in a workhouse without further order, if the medical officer of the workhouse certifies in writing that the accommodation in the workhouse is sufficient.” Thirdly, if it is necessary for the welfare of a lunatic, or for the public safety, that he should immediately be placed under care and control, pending regular proceedings for his removal, he may be taken to a workhouse (if there is proper accommodation therein) by a constable, relieving officer, or overseer, and may be detained there for three days, during which time the proceedings are to be taken; and in any case in which a summary reception order has been or might be made, he may be further detained on a justice’s order till he can be removed, provided that the period does not exceed fourteen days. Moreover, any other lunatic might be “allowed to remain in a workhouse as a lunatic” if “the medical officer of the workhouse certifies in writing: (a) that such a person is a lunatic, with the grounds for the opinion; and (b) that he is a proper person to be allowed to remain in a workhouse as a lunatic; and (c) that the accommodation in the workhouse is sufficient for his proper care and treatment, separate from the inmates of the workhouse not lunatics, unless the medical officer certifies that the lunatic’s condition is such that it is not necessary for the convenience of the lunatic or of the other inmates that he should be kept separate.” Such a certificate signed by the medical officer is sufficient authority for detaining the lunatic in a workhouse for fourteen days, but no longer, unless within that time a justice signs an order for his detention. Failing such a certificate, or, after fourteen days, such an order, or if at any time the lunatic ceases to be “a proper person to be allowed to remain in a workhouse,” he becomes “a proper person to be sent to an asylum,” and proceedings are to be taken accordingly.

Meanwhile the Central Authority continued to permit the grant of outdoor relief in cases of lunacy; and about 5000 were always so maintained.

Regulations for the boarding-out of pauper lunatics first appear in the Act of 1889. “Where application is made to the committee of visitors of an asylum by any relative or friend of a pauper lunatic confined therein that he may be delivered over to the custody of such relative or friend, the committee may, upon being satisfied that the application has been approved by the guardians of the union to which the lunatic is chargeable, and, in case the proposed residence is outside the limits of the said union, then also by a justice having jurisdiction in the place where the relative or friend resides, and that the lunatic will be properly taken care of, order the lunatic to be delivered over accordingly.” The authority liable for such a lunatic’s maintenance is to pay an allowance for his support to the person who undertakes his care; the medical officer of the district is to visit him and report to the visiting committee every quarter, and two visitors may at any time order the lunatic to be removed to the asylum. Any two Commissioners have also the right to visit any pauper lunatic or alleged lunatic not in an institution for lunatics or in a workhouse, and call in a medical practitioner; if the latter signs a certificate, and they think fit, the Lord Chancellor may direct that the lunatic be received into an institution.

For the paupers of unsound mind in the Metropolis there was even a fourth alternative, namely, the “district asylums” of the Metropolitan Asylum Board. On the opening of the Darenth Asylum, the Central Authority quoted, without disapproval, the following remarks of the Lunacy Commissioners: “The withdrawal, for proper care, of helpless children of this kind from the households of many of the industrious and deserving poor is a frequent means of warding off pauperism in the parents.” We do not find, however, any more explicit statement on this point. What the Central Authority continued to press on the Boards of Guardians was, not so much the importance of relieving the struggling poor from the burden of their insane or idiotic dependants, nor yet the freeing of the workhouses from the presence of persons of unsound mind; but rather of appropriate discrimination. “It is of great importance not merely to exclude from the asylums those who, by reason of violence or irritability, are proper subjects for the county asylum, but also those who, from old age or disease, are unfit for the journey to the asylum, or who, from the slight degree to which their mind is affected, might more properly remain in the workhouse.” “The removal of helpless, bedridden persons, whose mental weakness is, in many cases, the result of old age, to asylums situated a considerable distance from the Metropolis, is calculated, on the one hand, to be injurious to the persons thus removed, and, on the other, to occupy the district asylums with a different class of persons from that for which they were constructed.” Imbecile children are to be kept in the workhouse till they are five years old, and may then be sent to the asylum at Darenth. Outside the Metropolis there is no specialised Poor Law provision for idiots, who, if not received into the county asylum, must either be placed in non-Poor-Law institutions at considerable expense, or detained in the workhouse. In 1885 the Central Authority even suggested that harmless and aged lunatics had, on grounds of economy, better be retained in the workhouse, rather than removed to an asylum. We hear incidentally of a Special Order in 1900 under which certain chronic lunatics were actually transferred from the Suffolk County Asylum to the workhouse of the Mildenhall Union. As late as 1905 we find the Central Authority expressing regret that so many cases of senile imbecility were removed from the workhouses to asylums.

Under this policy the number of paupers of unsound mind receiving outdoor relief diminished very slightly, being 4736 on 1st January 1906; those in the asylums of the Metropolitan Asylums Board and in county and borough lunatic asylums rose to no fewer than 92,409; whilst those in workhouses nevertheless did not fall off from the total of thirty-five years previously, being, in fact, on 1st January 1906, 11,484, or an average of nineteen in each workhouse.

Towards the latter part of the time we begin to find the inspectors, somewhat in disaccord with the suggestions of the Central Authority itself, protesting against the presence in the workhouses even of the chronic lunatic, the harmless idiot, or the senile imbecile, on the new ground that their presence caused annoyance to the sane inmates-annoyance which had, for seventy years, been apparently either unnoticed or not considered. “I am sorry to say,” reported Mr. Preston-Thomas in 1901, “that in all but six of the workhouses in my district imbeciles mix freely with the other workhouse inmates. Many of them are mischievous, noisy, or physically offensive.

In some instances, even if their bodily ailment is very slight, they sleep in the sick wards in order that they may come under the supervision of the nurses, and they frequently disturb other patients at night. By day they are a source of much irritation and annoyance, and in a small workhouse I have known the lives of a number of old men made seriously uncomfortable by a mischievous idiot for whom no place could be found in an asylum…. I am much afraid,” prophetically continued Mr. Preston-Thomas, “that … the question will be postponed indefinitely, and six or eight years hence the idiots will still be worrying the sane inmates of workhouses…. It is in the country workhouses, sometimes with only a dozen imbeciles or less, divided among the sexes, that the chief difficulty arises…. A good many are often found useful in the laundry and other domestic work of the institution, but I do not think this consideration ought to outweigh what may almost be characterised as the cruelty of requiring sane persons to associate, by day and by night, with gibbering idiots.” When the Select Committee on the Bill to establish Cottage Homes for the Aged Poor in 1900 strongly recommended the removal of all imbeciles from workhouses, the Central Authority, observing that the advisability of this step had been repeatedly brought to its notice by guardians and others, declared that the question must be deferred.

Resources

Notes and References

1. Sidney Webb and Beatrice Webb, “English Poor Law Policy” (1913), Longmans, Green and Co., London, New York, Bombay and Calcuta.

See Also

Resources

Notes and References

1. Sidney Webb and Beatrice Webb, “English Poor Law Policy” (1913), Longmans, Green and Co., London, New York, Bombay and Calcuta.

See Also