Return of Expenditure for each Lunacy District on account of Pauper Table showing the Average Weekly Cost of Maintenance of Pauper Table showing the Weekly Rate of Maintenance for each mode of pro- Table showing the present Weekly Rates of Board in Royal and District Table showing the Expenditure by District Boards of Control during the Table showing the Expenditure of District Boards of Control on the Table showing the Quantity per Inmate of various Articles of Dietary, TENTH ANNUAL REPORT TO THE RIGHT HONOURABLE WILLIAM ADAMSON, M.P. His Majesty's Secretary for Scotland. SIR, GENERAL BOARD OF CONTROL FOR SCOTLAND, EDINBURGH. We, the General Board of Control for Scotland, have the honour to lay before you our Tenth Annual Report on the Condition and Management of Lunatics and Lunatic Asylums, and on the Protection and Control of Mental Defectives in Scotland. The working of the Mental Deficiency Act, which is still restricted by the limitation of the Grant to a definite number of certified institutional cases, has been progressive in respect of the action taken by a number of Local Authorities to deal with many cases on the understanding that no Grant will be payable beyond the limited amount referred to. Edinburgh District Board of Control are now transferring the 30 defectives from Craiglockhart Poorhouse to their new Institution at Gogarburn and are desirous of making this place the nucleus of an Institution for the training of juvenile defectives and the further training by means of a Colony system of adult defectives. The Paisley District Board of Control are considering plans for the erection in the first place of two Villas to accommodate 50 defectives of each sex on the same lines as the Edinburgh District Board of Control and with the same objects in view, namely, the establishment of a complete Educational Institution. At Stoneyetts additions are contemplated to meet the increasing number of adult mental defectives requiring care and treatment. The new Institution at Birkwood acquired by the Lanark District Board of Control has been opened, and there are at present 24 inmates. The total accommodation for 100 will, it is hoped, soon be available. At the defective Institution at the Southern General Hospital, Govan, the licensed accommodation has been increased to 68 beds. It is proposed to transfer the defectives in St. Charles' Institution, Glasgow, to Carstairs, where a Mansion House has been acquired with a large amount of ground. This new Institution will remove the disadvantages under which the adminstration of St. Charles' has suffered, and the excellent work which has been done at St. Charles' is more than likely to be maintained and made more effective in the new surroundings. An Institution similiar to St. Charles' has been acquired at Whitehill, near Edinburgh, and it is proposed to accommodate there 100 mentally defective Roman Catholic children. The Board are hopeful that the restrictions on the amount of the Mental Deficiency Grant at their disposal will in the near future be removed in view of the pressing need for accommodation for the mentally defective throughout Scotland. They recognise that this can only be done gradually. If the cases requiring Institutional care received the Grant provided under the Mental Deficiency Act, and favourable consideration were given to all questions of contributions towards the provision of pressing building schemes for the education and training of juvenile and adult defectives, a general advance would be recorded, and many defectives, who might drift into criminal habits, owing to absence of the necessary institutional care, would be cared for. The number of the Insane, Mentally Defective persons and Voluntary Inmates of Asylums under the supervision of the Board on 1st January, 1924, was 21,078. Of this number 18,389 persons were certified insane. This is an increase of 141 compared with the preceding year. Certified Mental Defectives have increased from 2,168 to 2,308. 381 Voluntary Inmates have been admitted to Asylums compared with 369 in 1922. Of the total number of 978 private patients admitted to Asylums 341 entered voluntarily. In addition 40 Voluntary Inmates were admitted to Asylums at the instance of Parish Authorities. The tendency to allow patients to enter Asylums voluntarily is one which has been encouraged by the Board as it gives the patients concerned an opportunity of undergoing treatment by persons skilled in the knowledge of mental disorders in the earlier stages of mental illness, when it is not confirmed, and the prospects of recovery are great. In one of the Royal Asylums this admission of voluntary private patients has proceeded to such an extent that the admission rate of voluntary patients now exceeds that of certified private patients. Voluntaryism on the part of pauper patients is handicapped by the fact that the Lunacy Grant of £115,000 is paid to Parish Councils towards the cost of certified lunatics. Consequently, a Parish Council is reluctant to pay for a voluntary inmate in an Asylum as the proportion of Grant amounting to about 2/9 weekly for each patient would be lost. It is noteworthy that 10 parishes in the district of Argyllshire have agreed to give facilities for any person in their districts who requires institutional care on account of mental condition to enter the District Asylum voluntarily as a rate-aided patient. This exception whereby public representatives place the interests of their insane charges above the question of rates is not unique. Several of the larger parishes follow a similar enlightened course by providing Observation Wards which have been referred to in former reports and to which further reference is made at a later stage in this report. It is reasonable to suppose that pauper patients, like private patients, would prefer to enter Asylums voluntarily and if they were permitted to do so by a rearrangement of the incidence of the Lunacy Grant the certification of patients, which is not necessary for medical purposes, would fall from the present level of about 100 per cent, to 60 per cent. or even less of the patients admitted to Asylums. Certification of the insane would then fall into its proper place of a social and legal necessity. The problem of providing additional accommodation for the increasing number of the insane has engaged the serious attention of the Board, and one addition has been passed which will increase the accommodation of an existing Institution. The difficulty of adequate accommodation arises mainly in the district which subserves the Glasgow Parish and the question of erecting a third Asylum in that district has been obviated by the establishment of the Observation Wards at Stobhill General Hospital and the proposal to extend the accommodation for mentally defective adults at Stoneyetts. Experience has shown that large Institutions, while more economically managed from an administrative point of view, are less efficient from that of the interests and welfare of the patients. The Board, therefore, examine very closely any proposal to extend Asylums where the number of patients beyond 700 will be exceeded. In such circumstances they ask the Local Authorities concerned to consider how far the necessity for increased accommodation may be obviated: (1) By the extension or establishment of Observation Wards. (3) By drawing attention to the necessity for separating all The last of these three considerations is one which has caused much confusion through the tendency which certain districts have to send mentally defective persons who have been reported to their several parishes by the Education Authority as ineducable under certificate to their District Asylums. This is a practice which the Board deprecates. Broadly speaking, the mentally defective are widely separated from the insane. The former have never reached a normal standard, and never will attain it. For a small minority of the mentally defective. institutional care is a permanent necessity, but for the great majority the process of education, whether in the Special Schools or Classes of |