admissions than the percentage of the total population. For the entire city (exclusive of Richmond, which is practically negligible) Table I indicates the admissions and percentages: TABLE I. TOTAL ADMISSIONS TO THE PSYCHOPATHIC Wards, In view of what has been said regarding the unusually large total admissions to Bellevue Hospital for the year 1918-1919, it might be advisable to make sufficient allowance for the increase over the preceding year by setting the total admissions at about what they were in 1917-1918. In any event, the percentage of Jewish admissions for the entire city would not average over 16.5 per cent, which is considerably less than 25.8 per cent, the proportion of Jews in the general population of New York City. III. METHODS OF COMMITTING PATIENTS TO STATE HOSPITALS (a) Legal Provisions for Commitment. The patients admitted to the psychopathic wards of Bellevue Hospital came from various sources, usually being brought there by the special ambulance attached to the psychopathic service of the hospital. The transference of the patients to the hospital is carried out under authority of Section 87, of Article 4, Chapter 27 of the Consolidated Laws known as the "Insanity Law" relative to the transfer of alleged insane persons to the psychopathic wards of Bellevue Hispital, the law reading as follows: It shall be the duty of such trustees of Bellevue and Allied Hospitals... to see that the proceedings are taken for the determination of the mental condition of any such person in the boroughs or counties mentioned, who comes under their observation or is reported to them as apparently insane, and, when necessary, to see that proceedings are instituted for the commitment of such person to an institution for the care of the insane; provided that such report is made by any person with whom such alleged person may reside, or at whose house he may be, or by the father, mother, husband, wife, brother, sister, or child of any such person, or next of kin available, or by any duly licensed physician, or by any police officer, or by the representative of any incorporated society doing charitable or philanthropic work. When the trustees of Bellevue and Allied Hospitals are thus informed of an apparently insane person, residing in the boroughs of Manhattan or the Bronx. . . it shall be the duty of these authorities .. to send a nurse or a medical examiner in lunacy attached to the psychopathic ward of their institution, or both, to the place where the alleged insane person resides or is to be found. If, in the judgment of the chief resident alienist of the psychopathic ward or of the medical examiner thus sent, the person is in immediate need of care and treatment or observation for the purpose of ascertaining his mental condition, he shall be removed to the psychopathic ward for a period not to exceed ten days, and the person or persons most nearly related to him, so far as the same can be readily ascertained by such trustees . . . shall be notified of such removal. This section of the law went into effect March 5, 1912, when the old law was amended. Prior to the amendment, patients were brought to the psychopathic wards by the police as prisoners, or committed for examination by city magistrates. Such procedure greatly aggravated the mental infirmities, which require more tender, skillful and gentle handling than medical and surgical cases. Since this measure has became operative and experienced nurses and a special ambulance are sent for the patients, thus eliminating the police as arresting agents and the court procedures, the number of excited and disturbed patients received in the psychopathic wards has greatly decreased, and straps, handcuffs, and police patrol wagons have been altogether done away with.1 The legal right of the hospital authorities to go into a home and forcibly remove a patient against his own will was questioned for a time by those interested in the matter of personal rights. The opinion of the Corporation Counsel of the City of New York regarding the interpretation of this section is appended.2 The obvious purpose of Section 87 is to sanction and permit the summary removal to the hospitals of alleged insane persons who, by their actions, evince symptoms of insanity, or whose conduct, in the judgment of the medical examiner sent pursuant to its provisions, is such that it would be dangerous to themselves or to the community to allow them to remain unrestrained or would disturb the public peace, and to afford alleged insane persons, in whose cases these elements of danger or disorder are lacking, opportunity to be heard before depriving them of their liberty. In this view I am of the opinion and advise that it is not contemplated or required by Section 87 that a person alleged to be insane should be forcibly brought to the hospital, unless such person has acted in a disorderly manner, has committed an overt act, or is apparently an immediate source of danger to himself or to the community, and that in other cases, 1 1 Bellevue and Allied Hospitals, New York City, A. R., 1912, pp. 68-69. 2 Ibid., A. R., 1913, p. 64. recourse should be had to that provision of Section 87 which reads: "Whenever in the City of New York an information is laid before a magistrate that a person is apparently insane, the magistrate must issue a warrant directed to the sheriff of the county in which the information is made, or any marshal or policeman in the City of New York, reciting the substance of the information and commanding the officer forthwith to arrest the person alleged to be insane and bring him before the magistrate issuing the warrant." It should be remembered that the procedure of summarily removing a person to the hospital against his will for examination as to his mental condition would seem to deprive the person of his liberty without due process of law, in violation of the fundamental law of the land. However, this section of the statute authorizes this procedure as a police measure, so that whenever there is no element of danger to the individual himself or any danger or disturbance to the community, it would not be within the purport of the law to bring a patient to the hospital in this summary manner. This is particularly applicable to the paranoid types of mental disease, which will be discussed in another part of this chapter. (b) Social Workers and Commitment of Patients. In applying the various provisions of the law, if any difference of opinion exists in the family regarding the mental condition of the patient or his transfer to the hospital for examination, extreme caution must of necessity be exercised in removing him from his residence. When the "request comes from a physician or a "representative of an incorporated society doing charitable or philanthropic work," without the consent of the family or relatives of the patient, it is usually inadvisable and frequently fraught with harm to remove him summarily from his home. The ease with which patients may be brought to the hospital might become too great a temptation to social workers and representatives of charitable organizations to hasten patients to the hospital for examination. While in a number of instances such a method is most desirable and beneficial, many neurotic and borderline patients might become greatly upset from the shock incident to such transfer. Every effort should always be made to bring the milder cases of mental trouble to the hospital as voluntary patients, or to take them to mental hygiene clinics in order to ascertain their mental condition and the advisability of transferring them to the hospital for further examination. The intent of this section of the law, empowering representatives of charitable or philanthropic agencies to apply for the mental examination of persons in the psychopathic wards, is altogether a praiseworthy one. However, unless organizations specializing in the care of the mentally sick are specifically called upon, there is, as pointed out above, too much left to the judgment of workers nearly always without training in the observation, care, and understanding of mental cases. Several training schools for social workers have realized this fact and are instituting both theoretical and practical courses for the training of psychiatric social workers. (c) The Police and Mental Cases. As a result of much experience it has been found advisable to have a police officer present at the house of the patient when the ambulance arrives, especially if the patient is unduly excited and liable to do harm to himself or to others if he should see the ambulance and nurses. The presence of a police officer is also at times necessary when the patient has no friends or relatives residing with him; in such instances the duty of the officer is to take care of the personal effects and property of the patient after his removal to the hospital. |