Mental Health Matters

What are the M’Naghten Rules?

Published on 05/10/202105/11/2021 by Andrew Marshall6 Comments

Introduction

The M’Naghten rule (pronounced, and sometimes spelled, McNaughton) is any variant of the 1840s jury instruction in a criminal case when there is a defence of insanity:

that every man is to be presumed to be sane, and … that to establish a defence on the ground of insanity, it must be clearly proved that, at the time of the committing of the act, the party accused was labouring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing; or if he did know it, that he did not know he was doing what was wrong.

The rule was formulated as a reaction to the acquittal in 1843 of Daniel M’Naghten on the charge of murdering Edward Drummond. M’Naghten had shot Drummond after mistakenly identifying him as UK Prime Minister Robert Peel, who was the intended target. The House of Lords asked a panel of judges, presided over by Sir Nicolas Conyngham Tindal, Chief Justice of the Common Pleas, a series of hypothetical questions about the defence of insanity. The principles expounded by this panel have come to be known as the “M’Naghten Rules”, though they have gained any status only by usage in the common law and M’Naghten himself would have been found guilty if they had been applied at his trial.

The rules so formulated as M’Naghten’s Case 1843 10 C & F 200 have been a standard test for criminal liability in relation to mentally disordered defendants in common law jurisdictions ever since, with some minor adjustments. When the tests set out by the Rules are satisfied, the accused may be adjudged “not guilty by reason of insanity” or “guilty but insane” and the sentence may be a mandatory or discretionary (but usually indeterminate) period of treatment in a secure hospital facility, or otherwise at the discretion of the court (depending on the country and the offence charged) instead of a punitive disposal.

The insanity defence is recognised in Australia, Canada, England and Wales, Hong Kong, India, the Republic of Ireland, New Zealand, Norway and most US states with the exception of Idaho, Kansas, Montana, Utah, and Vermont but not all of these jurisdictions still use the M’Naghten Rules. States that disallow the insanity defence still allow defendants to demonstrate that they are not capable of forming intent to commit a crime as a result of mental illness.

Refer to Chronology of UK Mental Health Legislation, Diminished Responsibility (in English Law), Diminished Responsibility (General), and Insanity Defence.

Historical Development

There are various justifications for the exemption of the insane from criminal responsibility. When mental incapacity is successfully raised as a defence in a criminal trial it absolves a defendant from liability: it applies public policies in relation to criminal responsibility by applying a rationale of compassion, accepting that it is morally wrong to punish a person if that person is deprived permanently or temporarily of the capacity to form a necessary mental intent that the definition of a crime requires. Punishment of the obviously mentally ill by the state may undermine public confidence in the penal system. A utilitarian and humanitarian approach suggests that the interests of society are better served by treatment of the illness rather than punishment of the individual.

Historically, insanity was seen as grounds for leniency. In pre-Norman times in England there was no distinct criminal code – a murderer could pay compensation to the victim’s family under the principle of “buy off the spear or bear it”. The insane person’s family were expected to pay any compensation for the crime. In Norman times insanity was not seen as a defence in itself but a special circumstance in which the jury would deliver a guilty verdict and refer the defendant to the King for a pardon.

eo quod sensu carent et ratione, non-magis quam brutum animal iniuriam facere possunt nec feloniam, cum non-multum distent a brutis, secundum quod videri poterit in minore, qui si alium interficeret in minori ætate, iudicium non-sustineret. [Translation:] since they are without sense and reason and can no more commit a tort or a felony than a brute animal, since they are not far removed from brutes, as is evident in the case of a minor, for if he should kill another while under age he would not suffer judgment.

In R v Arnold 1724 16 How St. Tr. 765, the test for insanity was expressed in the following terms:

whether the accused is totally deprived of his understanding and memory and knew what he was doing “no more than a wild beast or a brute, or an infant”.

The next major advance occurred in Hadfield’s Trial 1800 27 How St. Tr. 765 in which the court decided that a crime committed under some delusion would be excused only if it would have been excusable had the delusion been true. This would deal with the situation, for example, when the accused imagines he is cutting through a loaf of bread, whereas in fact he is cutting through a person’s neck.

Each jurisdiction may have its own standards of the insanity defence. More than one standard can be applied to any case based on multiple jurisdictions.

The M’Naghten Rules

The House of Lords delivered the following exposition of the Rules:

the jurors ought to be told in all cases that every man is to be presumed to be sane, and to possess a sufficient degree of reason to be responsible for his crimes, until the contrary be proved to their satisfaction; and that to establish a defence on the ground of insanity, it must be clearly proved that, at the time of the committing of the act, the party accused was labouring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing; or, if he did know it, that he did not know he was doing what was wrong.

The central issue of this definition may be stated as “did the defendant know what he was doing, or, if so, that it was wrong?”, and the issues raised have been analysed in subsequent appellate decisions:

Presumption of Sanity and Burden of Proof

Sanity is a rebuttable presumption and the burden of proof is on the party denying it; the standard of proof is on a balance of probabilities, that is to say that mental incapacity is more likely than not. If this burden is successfully discharged, the party relying upon it is entitled to succeed. In Lord Denning’s judgement in Bratty v Attorney-General for Northern Ireland 1963 AC 386, whenever the defendant makes an issue of his state of mind, the prosecution can adduce evidence of insanity. However, this will normally only arise to negate the defence case when automatism or diminished responsibility is in issue. In practical terms, the defence will be more likely to raise the issue of mental incapacity to negate or minimise criminal liability. In R v Clarke 1972 1 All E R 219 a defendant charged with a shoplifting claimed she had no mens rea because she had absent-mindedly walked out of the shop without paying because she suffered from depression. When the prosecution attempted to adduce evidence that this constituted insanity within the Rules, she changed her plea to guilty, but on appeal the Court ruled that she had been merely denying mens rea rather than raising a defence under the Rules and her conviction was quashed. The general rule was stated that the Rules apply only to cases in which the defect of reason is substantial.

Disease of the Mind

Whether a particular condition amounts to a disease of the mind within the Rules is not a medical but a legal question to be decided in accordance with the ordinary rules of interpretation. It seems that any disease which produces a malfunctioning of the mind is a disease of the mind and need not be a disease of the brain itself. The term has been held to cover numerous conditions:

In R v Kemp [1957] 1 QB 399 arteriosclerosis or a hardening of the arteries caused loss of control during which the defendant attacked his wife with a hammer. This was an internal condition and a disease of the mind.
In R v Sullivan [1984] AC 156 during an epileptic episode, the defendant caused grievous bodily harm: epilepsy was an internal condition and a disease of the mind, and the fact that the state was transitory was irrelevant.
In R v Quick; R v Paddison [1973] QB 910 the defendant committed an assault while in a state of hypoglycaemia caused by the insulin he had taken, the alcohol he had consumed and not eating properly. It was ruled that the judge should have left the defence of automatism open to him, so his conviction was quashed (he had pleaded guilty rather than not guilty by reason of insanity). This was where the internal/external divide doctrine was first expressed, probably due to judicial reluctance to hospitalise someone for a condition that could be cured by a sugar lump. It is doubtful that a jury would have accepted a defence of automatism, but nonetheless the issue should have been left to them.
In R v Hennessy [1989] 1 WLR 287 a diabetic stole a car and drove it while suffering from a mild attack of hyperglycaemia caused by stress and a failure to take his insulin. Lane LCJ said at 294:
- In our judgment, stress, anxiety and depression can no doubt be the result of the operation of external factors, but they are not, it seems to us, in themselves separately or together external factors of the kind capable in law of causing or contributing to a state of automatism. They constitute a state of mind which is prone to recur. They lack the feature of novelty or accident, which is the basis of the distinction drawn by Lord Diplock in R v Sullivan 1984 AC 156, 172. It is contrary to the observations of Devlin J., to which we have just referred in Hill v Baxter (1958) 1 QB 277, 285. It does not, in our judgment, come within the scope of the exception of some external physical factor such as a blow on the head or the administration of an anaesthetic.
In Bratty v Attorney-General for Northern Ireland [1963] AC 386 Lord Denning observed obiter that a crime committed while sleepwalking would appear to him to be one committed as an automaton. However, the ruling in R v Sullivan that diseases of the mind need have no permanence led many academics to suggest that sleepwalkers might well be found to be suffering from a disease of the mind with internal causes unless there was clear evidence of an external causal factor.
In R v Burgess [1991] 2 QB 92 the Court of Appeal ruled that the defendant, who wounded a woman by hitting her with a video recorder while sleepwalking, was insane under the M’Naghten Rules. Lord Lane said, “We accept that sleep is a normal condition, but the evidence in the instant case indicates that sleepwalking, and particularly violence in sleep, is not normal.”

The courts have clearly drawn a distinction between internal and external factors affecting a defendant’s mental condition. This is partly based on risk of recurrence, whereby the High Court of Australia has expressed that the defence of automatism is unable to be considered when the mental disorder has been proved transient and as such not likely to recur. However, the distinction between insanity and automatism is difficult because the distinction between internal and external divide is difficult. Many diseases consist of a predisposition, considered an internal cause, combined with a precipitant, which would be considered an external cause. Actions committed while sleepwalking would normally be considered as “non-insane automatism”, but often alcohol and stress trigger bouts of sleepwalking and make them more likely to be violent. The diabetic who takes insulin but does not eat properly – is that an internal or external cause?

Nature and Quality of the Act

This phrase refers to the physical nature and quality of the act, rather than the moral quality. It covers the situation where the defendant does not know what he is physically doing. Two common examples used are:

The defendant cuts a woman’s throat under the delusion that he is cutting a loaf of bread,
The defendant chops off a sleeping man’s head because he has the deluded idea that it would be great fun to see the man looking for it when he wakes up.

The judges were specifically asked if a person could be excused if he committed an offence in consequence of an insane delusion. They replied that if he labours under such partial delusion only, and is not in other respects insane, “he must be considered in the same situation as to responsibility as if the facts with respect to which the delusion exists were real”. This rule requires the court to take the facts as the accused believed them to be and follows Hadfield’s Trial, above. If the delusions do not prevent the defendant from having mens rea there will be no defence. In R v Bell 1984 Crim. LR 685 the defendant smashed a van through the entrance gates of a holiday camp because “It was like a secret society in there, I wanted to do my bit against it” as instructed by God. It was held that, as the defendant had been aware of his actions, he could neither have been in a state of automatism nor insane, and the fact that he believed that God had told him to do this merely provided an explanation of his motive and did not prevent him from knowing that what he was doing was wrong in the legal sense.

Knowledge that the Act was Wrong

The interpretation of this clause is a subject of controversy among legal authorities, and different standards may apply in different jurisdictions.

“Wrong” was interpreted to mean legally wrong, rather than morally wrong, in the case of Windle 1952 2QB 826; 1952 2 All ER 1 246, where the defendant killed his wife with an overdose of aspirin; he telephoned the police and said, “I suppose they will hang me for this.” It was held that this was sufficient to show that although the defendant was suffering from a mental illness, he was aware that his act was wrong, and the defence was not allowed. Under this interpretation, there may be cases where the mentally ill know that their conduct is legally prohibited, but it is arguable that their mental condition prevents them making the connection between an act being legally prohibited and the societal requirement to conform their conduct to the requirements of the criminal law.

As an example of a contrasting interpretation in which defendant lacking knowledge that the act was morally wrong meets the M’Naghten standards, there are the instructions the judge is required to provide to the jury in cases in New York State when the defendant has raised an insanity plea as a defence:

… with respect to the term “wrong”, a person lacks substantial capacity to know or appreciate that conduct is wrong if that person, as a result of mental disease or defect, lacked substantial capacity to know or appreciate either that the conduct was against the law or that it was against commonly held moral principles, or both.

There is other support in the authorities for this interpretation of the standards enunciated in the findings presented to the House of Lords regarding M’Naghten’s case:

If it be accepted, as can hardly be denied, that the answers of the judges to the questions asked by the House of Lords in 1843 are to be read in the light of the then existing case-law and not as novel pronouncements of a legislative character, then the [Australian] High Court’s analysis in Stapleton’s Case is compelling. Their exhaustive examination of the extensive case-law concerning the defence of insanity prior to and at the time of the trial of M’Naughten establishes convincingly that it was morality and not legality which lay as a concept behind the judges’ use of “wrong” in the M’Naghten rules.

Offences of Strict Liability

In DPP v Harper (1997) it was held that insanity is not generally a defence to strict liability offences. In this instance, the accused was driving with excess alcohol. By definition, the accused is sufficiently aware of the nature of the activity to commit the actus reus of driving and presumably knows that driving while drunk is legally wrong. Any other feature of the accused’s knowledge is irrelevant.

The Function of the Jury

Section 1 of the Criminal Procedure (Insanity and Unfitness to Plead) Act 1991 provides that a jury shall not return a special verdict that “the accused is not guilty by reason of insanity” except on the written or oral evidence of two or more registered medical practitioners of whom at least one has special experience in the field of mental disorder. This may require the jury to decide between conflicting medical evidence which they are not necessarily equipped to do, but the law goes further and allows them to disagree with the experts if there are facts or surrounding circumstances which, in the opinion of the court, justify the jury in coming to that conclusion.

Sentencing

Under section 5 of the Criminal Procedure (Insanity) Act 1964 (as amended):

Where the sentence for the offence to which the finding relates is fixed by law (e.g. murder), the court must make a hospital order (see section 37 Mental Health Act 1983) with a restriction order limiting discharge and other rights (see section 41 Mental Health Act 1983).
In any other case the court may make:
- A hospital order (with or without a restriction order);
- A supervision order; or
- An order for absolute discharge.

Criticisms

There have been four major criticisms of the law as it currently stands:

Medical irrelevance: The legal definition of insanity has not advanced significantly since 1843; in 1953 evidence was given to the Royal Commission on Capital Punishment that doctors even then regarded the legal definition to be obsolete and misleading. This distinction has led to absurdities such as:
- Even though a legal definition suffices, mandatory hospitalisation can be ordered in cases of murder; if the defendant is not medically insane, there is little point in requiring medical treatment.
- Diabetes has been held to facilitate a defence of insanity when it causes hyperglycaemia, but not when it causes hypoglycaemia.
- Article 5 of the European Convention on Human Rights, imported into English law by the Human Rights Act 1998, provides that a person of unsound mind may be detained only where proper account of objective medical expertise has been taken. As yet, no cases have occurred in which this point has been argued.
Ineffectiveness: The rules currently do not distinguish between defendants who represent a public danger and those who do not. Illnesses such as diabetes and epilepsy can be controlled by medication such that sufferers are less likely to have temporary aberrations of mental capacity, but the law does not recognise this.
Sentencing for murder: A finding of insanity may well result in indefinite confinement in a hospital, whereas a conviction for murder may well result in a determinate sentence of between ten and 15 years; faced with this choice, it may be that defendants would prefer the certainty of the latter option. The defence of diminished responsibility in section 2(1) of the Homicide Act would reduce the conviction to voluntary manslaughter with more discretion on the part of the judge in regards to sentencing.
Scope: A practical issue is whether the fact that an accused is labouring under a “mental disability” should be a necessary but not sufficient condition for negating responsibility i.e. whether the test should also require an incapacity to understand what is being done, to know that what one is doing is wrong, or to control an impulse to do something and so demonstrate a causal link between the disability and the potentially criminal acts and omissions. For example, the Irish insanity defence comprises the M’Naghten Rules and a control test that asks whether the accused was debarred from refraining from committing the act because of a defect of reason due to mental illness (see Doyle v Wicklow County Council 1974) 55 IR 71. The Butler Committee recommended that proof of severe mental disorder should be sufficient to negate responsibility, in effect creating an irrebuttable presumption of irresponsibility arising from proof of a severe mental disorder. This has been criticized as it assumes a lack of criminal responsibility simply because there is evidence of some sort of mental dysfunction, rather than establishing a standard of criminal responsibility. According to this view, the law should be geared to culpability not mere psychiatric diagnosis.

Alternative Rules

The insanity defence article has a number of alternative tests that have been used at different times and places. As one example, the ALI test replaced the M’Naughten rule in many parts of the United States for many years until the 1980s; when in the aftermath of John Hinckley shooting President Ronald Reagan many ALI states returned to a variation of M’Naughten.

In Popular Culture

The M’Naghten rules are at the focus of John Grisham’s legal thriller A Time to Kill. The M’Naghten rules apply in the US State of Mississippi, where the plot is set, and using them is the only way for the lawyer protagonist to save his client.

What is Diminished Responsibility in English Law?

Published on 05/10/202105/11/2021 by Andrew Marshall4 Comments

Introduction

In English law, diminished responsibility is one of the partial defences that reduce the offence from murder to manslaughter if successful (termed “voluntary” manslaughter for these purposes).

This allows the judge sentencing discretion, e.g. to impose a hospital order under section 37 of the Mental Health Act 1983 to ensure treatment rather than punishment in appropriate cases. Thus, when the actus reus (Latin for “guilty act”) of death is accompanied by an objective or constructive version of mens rea (Latin for “guilty mind”), the subjective evidence that the defendant did intend to kill or cause grievous bodily harm because of a mental incapacity will partially excuse his conduct. Under s.2(2) of the Homicide Act 1957 the burden of proof is on the defendant to the balance of probabilities. The M’Naghten Rules lack a volitional limb of “irresistible impulse”; diminished responsibility is the volitional mental condition defence in English criminal law.

Refer to Chronology of UK Mental Health Legislation, Insanity Defence, and Diminished Responsibility (General).

The Statutory Provision

Section 2 of the Homicide Act 1957 states: (1) Where a person kills or is party to a killing of another, he shall not be convicted of murder if he was suffering from an abnormality of mental functioning which:

(a) arose from a medical condition;
(b) substantially impaired D’s ability to do one or more of the things mentioned in subsection (1A); and
(c) provides an explanation for D’s acts and omissions in doing or being a party to the killing.

(1A) Those things are:

(a) to understand the nature of D’s conduct;
(b) to form a rational judgment; and
(c) to exercise self-control.

(1B) For the purposes of subsection (1)(c), an abnormality of mental functioning provides and explanation of D’s conduct if it causes, or is a significant contributory factor in causing, D to carry out that conduct.

The defence has recently been amended by s. 52 of the Coroners and Justice Act 2009, which came into force on 4 October 2010.

How Substantial must the Impairment Be?

R v Golds¹ provides a recent authority from the Court of Appeal Criminal Division on how the courts will interpret the term ‘substantial’. At paragraph [55] of Elias LJ’s judgement (following the paragraphing from the neutral citation given below) two senses of the word ‘substantial’ are identified: (i) something substantial is more than something which is merely trivial or minimal owing to the fact that it has “substance”, or (ii) something substantial is big or large (e.g. in the sense that a substantial salary is a large one). At paragraph [72] Elias LJ concludes by opining that the court should (i) leave interpretation of the word ‘substantial’ to the jury, but if asked for further help should (ii) direct them under the second meaning of the term (i.e. substantial meaning big).

Diminished Responsibility and Voluntary Intoxication

Voluntary intoxication will not satisfy the criterion that there must be an abnormality of mental functioning arising from a recognised medical condition (s.2(1)(a) Homicide Act 1957) and therefore cannot be relied upon as grounds for the partial defence². However a person suffering from alcoholism that has led to an abnormality of mental function may have access to the partial defence³. In R v Gittens⁴ a defendant who suffered from depression killed his wife and stepdaughter after drinking and taking drugs for medication. The direction to a jury facing both diminished responsibility and drunkenness should be:

Would the defendant have killed as he did if he had not been drunk?
- and if the answer to that is yes,
Was he suffering from diminished responsibility when he did so?

The more chronic forms of alcoholism and the long-term use of heroin and cocaine (see R v Sanderson⁵) can become a relevant factor where a craving for drink or drugs causes an abnormality of mind. This must be distinguished from the situation in which the abnormality of mind causes a craving for drink or drugs . R v Tandy⁶ held that where a defendant could show that she was suffering from an abnormality of the mind, that it was induced by disease (namely alcoholism), and that it substantially impaired her responsibility for her actions, then the defence of diminished responsibility would be made out. In the actual case, the craving for alcohol did not render the use of alcohol involuntary. The defendant was in control when she began drinking, and the state of mind in which she killed her daughter was merely induced by the alcohol. In R v Dietschmann,⁷ the House of Lords held that where a defendant suffers from an abnormality of mind within s2(1) also consumes alcohol before the killing, the jury should find him or her guilty of manslaughter if they are satisfied that, notwithstanding the alcohol consumed and its effect, the abnormality of mind substantially impaired the mental responsibility for the fatal acts. The sub-section does not require the abnormality of mind to be the sole cause of the defendant’s acts; even if the defendant would not have killed if he had not consumed alcohol, the causative effect of the alcohol does not prevent an abnormality of mind suffered by the defendant from substantially impairing his mental responsibility for the fatal acts. Dietschmann was later applied by the Court of Appeal in R v Hendy⁸.

References

R v Golds[2014] EWCA Crim 748.
R v Fenton (1975) 61 Cr App Rep 261.
R v Tandy [1989] 1 WLR 350.
R v Gittens (1984) QB 698.
R v Sanderson (1994) 98 Cr. App. R. 325.
R v Tandy (1989) 1 AER 267.
R v Dietschmann [2003] UKHL 10.
R v Hendy [2006] EWCA Crim 819.

What is the Fixated Threat Assessment Centre?

Published on 05/09/202105/09/2021 by Andrew Marshall1 Comment

Introduction

The Fixated Threat Assessment Centre (FTAC) is a UK police/mental health unit, whose function is to manage the risk to public figures from stalkers and others fixated on celebrity.

It was formed in 2006 in acknowledgement that such offenders overwhelmingly suffered from psychosis, and could often be identified in advance from behavioural signs. Preventive treatment could then be applied, for the protection of the relevant public figures as well as the families and neighbours of the sufferer.

Refer to Chronology of UK Mental Health Legislation.

Rationale

The rationale for a joint police/mental health unit was the finding that the main danger of death or serious injury to politicians in Western Europe came from attacks by people suffering from a mental health illness, who had given warnings of what they might do in the form of inappropriate, harassing or threatening communications or approaches towards the politicians in question. A similar picture was found in a study of historical attacks on the British royal family. A separate detailed study of recent inappropriate communications and approaches to members of the royal family found that 83% of the individuals concerned were suffering from psychosis.

Similar findings have come from the United States, where Park Dietz has written: “Every instance of an attack on a public figure by a lone stranger in the United States for which adequate information has been made publicly available has been the work of a mentally disordered person who issued one or more pre-attack signals in the form of inappropriate letters, visits or statements….” The role of FTAC in the UK is to detect such signals, to evaluate the risks involved and to intervene to reduce them. Such intervention often entails the obtaining of treatment and care for the fixated individual from psychiatric and social services and general practitioners in their town of residence.

The Fixated

The word ‘fixated’ in the name of the unit indicates that the main motivational drives behind the stalking of public figures are pathologically intense fixations on individuals or causes, these being obsessive pre-occupations pursued to an abnormally intense degree. In the case of those pursuing the Royal Family, these fixations divide between beliefs that the individual was a member of the family or married to a member of the family; that the royal personage was involved in plots to persecute them; and that the Royal Family were culpable for failing to redress a particular grievance, often delusional, with which the individual was angrily obsessed.

Staffing and Role

FTAC was set up in 2006, jointly managed by the Home Office, the Department of Health and Metropolitan Police Service. It is staffed by ten police officers, three full-time senior forensic nurses, a full-time senior social worker and a number of senior forensic psychiatrists and psychologists from the Barnet Enfield and Haringey NHS Trust and the Oxleas NHS Foundation Trust. FTAC receives around 1,000 referrals a year of people who have engaged in threatening or harassing communications towards politicians or the Royal Family. Around half are assessed as being of low risk after initial enquiries. The remainder are investigated by FTAC staff. They may then be referred to local health services for further assessment and potential involuntary commitment. In some cases, they may be detained by police under the section 136 powers of the Mental Health Act 1983 prior to referral.

Although run by London’s Metropolitan Police Service, FTAC is responsible for dealing nationally with the stalking or harassment of public figures by lone individuals. According to its founder, David James, it attempts not only to provide protection for the subjects of obsessive attention, but also to help people with obsessions who have mental illnesses that might otherwise have gone undiagnosed or untreated. The basis of the approach arises from the fact that the majority of the fixated are driven by delusional beliefs based in potentially treatable mental disorders. Treating those with evident mental illness will have an important effect in reducing the level of risk to public figures, whilst at the same time improving the health and welfare of the individuals concerned. The strap-line on FTAC’s stationery is ‘Preventing Harm and Facilitating Care’.

According to a statement made in June 2007 by the then Minister of State at the Home Office, Tony McNulty,

“FTAC does not detain people in psychiatric hospitals. When it encounters an individual in need of mental health care it alerts their general practitioners and psychiatrists, who then provide appropriate help under existing legislation. FTAC may make use of police powers under section 136 of the Mental Health Act 1983 to take a person who appears to be suffering from mental disorder, and in immediate need of care or control, to a place of safety. When people are removed to hospital under section 136, they are examined by a registered medical practitioner and interviewed by an approved social worker, not associated with FTAC, in order to make any necessary arrangements for their treatment or care.

Activity

In a parliamentary reply made in June 2009, the then Minister of State for Security, Counter-Terrorism, Crime and Policing, David Hanson said: “Since 2006, when FTAC began operation, 246 people have been detained under the Mental Health Act following a referral from FTAC and a subsequent decision by local health services. No individual has received a custodial sentence as a result of FTAC involvement.”

He also stated that during that same period, 27 people had been conveyed to a “place of safety” by FTAC staff under section 136 of the Mental Health Act 1983.

FTAC published the details of its interventions in its first 100 cases in the Journal of Forensic Psychiatry & Psychology in 2010. Eighty-six per cent of those assessed by FTAC were diagnosed as suffering from psychotic illness; 57% of the sample group were subsequently admitted to hospital, and 26% treated in the community. In 80% of cases, the risk level was reduced to low by FTAC intervention, the remainder of cases remaining under continued FTAC management

In protection terms, FTAC’s activities are said to benefit the families of the fixated individuals and the general public as much as the public figures that they are hounding. This is because those close to the fixated are more regularly exposed to their irrational and threatening behaviour than the public figures they target. This finding is similar to that made in the USA by Dietz and Martell in a report prepared for the National Institute of Justice:

“The persons most at risk of violence from the individual mentally ill person who pursues public figures are not the public figures or those that protect them – assuming they have the necessary security arrangements – but rather the private citizens who are the family members and neighbours of the mentally disordered subject.”

Origins

The setting up of FTAC was the main recommendation of the report of Fixated Research Group (FRG) which undertook a major research project on behalf of the Home Office between 2003 and 2006. This looked at inappropriate communications and approaches to members of the Royal Family, and systematically examined 8,000 files held by SO14, the royalty protection division of the Metropolitan Police Service’s Protection Command. The Fixated Research Group was composed of forensic psychiatrists and psychologists from the UK, Australia and the USA, who are experts in the field of stalking. They included Paul Mullen and Michele Pathé from Australia, co-authors of ‘Stalkers and their Victims’, and J. Reid Meloy from San Diego, editor of The Psychology of Stalking. The series of research papers published by the group in peer-reviewed scientific journals forms the evidence base for the FTAC.

Other Applications of the Model

The researchers at FTAC contend that the joint police-NHS model has other possible applications within the UK, such as in police responses to stalking of ordinary people and in homicide prevention. In their view, a logical further development would be the modification of the role of NHS police-liaison psychiatric nurses, so that they become embedded in police responses at borough or county level in order to perform an enabling role, to the benefit of individual patients and of public protection.

Awards

FTAC won an Association of Chief Police Officers’ Excellence Award in 2009.

What is the Mental Health Tribunal for Scotland?

Published on 05/09/2021 by Andrew Marshall4 Comments

Introduction

The Mental Health Tribunal for Scotland is a tribunal of the Scottish Government to hear applications for, and appeals against, Compulsory Treatment Order, and appeals against Short Term Detention Certificates made under the Mental Health (Care and Treatment) (Scotland) Act 2003, and other matters in relation to that Act, for example, appeals against Compulsion and Restriction Orders.

Refer to Chronology of UK Mental Health Legislation and Mental Health Review Tribunal (England and Wales).

Background

The Mental Health Tribunal for Scotland was established on 05 October 2005, under the Mental Health (Care and Treatment) (Scotland) Act 2003.

Its headquarters are located in Hamilton, although it has staff who work throughout Scotland.

The Tribunal discharges its functions through panels of three members: a legal member (who acts as Convener), a medical member and a general member. The judicial arm of the Tribunal is supported in its functions by the staff of the Scottish Courts and Tribunals Service (SCTS).

The primary role of the Tribunal is to consider and determine applications for compulsory treatment orders (CTOs) under the 2003 Act and to operate in an appellate role to consider appeals against compulsory measures made under the 2003 Act. The Tribunal also plays a monitoring role by periodic review of compulsory measures.

You can find out more about the Tribunal here.

What is the Mental Health Review Tribunal (England and Wales)?

Published on 05/09/202105/09/2021 by Andrew Marshall2 Comments

Introduction

In England, the First-tier Tribunal (Mental Health), more commonly known as the Mental Health Tribunal, is an independent quasi-judicial body established to safeguard the rights of persons subject to the Mental Health Act 1983. It provides for consideration of appeals against the medical detention or forced treatment of a person who was deemed to be suffering from a mental disorder that was associated with a risk to the health or safety of that person or others.

Prior to an overhaul of the tribunal system in 2008, its functions were carried out by the Mental Health Review Tribunal, which was a standalone body. In 2008 the Mental Health Review Tribunal was formally abolished as a standalone body and merged with the Health and Social Care Chamber of the newly established First-tier Tribunal (FTT). A new Upper Tribunal was also created, which hears appeals against decisions by the FTT. In Wales, the corresponding body is the Mental Health Review Tribunal for Wales.

Refer to Chronology of UK Mental Health Legislation and Mental Health Tribunal for Scotland.

Tribunal Hearings

Mental Health Tribunals are independent quasi-judicial bodies that operate under the provisions of the Mental Health Act 1983 and the Mental Health Review Tribunal Rules 1983. A Tribunal’s main purpose is to review the case of a patient detained under the Mental Health Act and to direct the discharge of any patient for whom the statutory criteria for discharge have been satisfied. In some cases, the Tribunal also has the discretion to discharge a patient who does not meet the statutory criteria. Such cases usually involve making a balanced judgement on a number of serious issues such as the freedom of the individual, the protection of the public and the best interests of the patient.

Tribunal Panel Members

The Lord Chancellor makes appointments to the panels of members for each region. In the case of medical and specialist members, the Secretary of State for Health (for cases in England) or the Secretary of State for Wales is also consulted. The Regional Chairperson’s appoint the members who are to sit at a particular hearing and there must be a legal member, a medical member and a specialist member appointed for each Tribunal hearing to form a legal quorum. In the event that one or two members are not present, the third member can technically open the tribunal and then immediately adjourn the hearing until another two members are able to attend. Any decisions formed by the tribunal are that of the tribunal, rather than the particular judicial member. There will be no dissenting judgement.

Role of the Legal Member (Legal Judge)

The legal member’s role is to preside (i.e. take the chair) at all tribunal hearings. They are known as the president and will sign all decisions, documents, recommendations and judgments as the president, on behalf of the whole tribunal. Their responsibilities also include making sure that the proceedings are conducted fairly, that the legal requirements of the Mental Health Act 1983 are properly observed within the rule of law and advise on any questions of law which may arise. They are also responsible, in consultation with other judges of the Tribunal, for drafting the reasons for the decision, and for signing the record of the decision. The legal members are required to have “such legal experience, as the Lord Chancellor considers suitable”. They are normally senior legal practitioners such as solicitors or barristers, but in ‘restricted patient panel’ (RPP) cases (also known as forensic cases) the level must be that of a Circuit Judge or higher. A small number of Recorders, who are also Queen’s Counsel might sit as RPP members.

Role of the Specialist Member (Specialist Judge)

The specialist member undertakes a check and balance role to the Tribunal under the Tribunal Rules. They will be a professional outside the legal and medical profession, but might hold legal or healthcare qualifications. Most specialist judges are senior or experienced practitioners or therapists with at least 5-7 years standing and will hold a range of experience within the mental health sector. Most specialist members are educated to postgraduate level in mental health, they may hold an advanced degree in psychology or forensics in RPP cases. The specialist judge will have extensive background knowledge of professional practice within the mental health field, health and/or social services. Members can be drawn from the NHS, voluntary organisations, adult social services or the private health sector. Specialist judges may also be mental health social workers, probation officers, approved mental health professionals, psychologists, mental health nurses and occupational therapists. They will be able to offer information to the other judges of the Tribunal on matters relating to health and social care matters and often healthcare legal matters in context (i.e. Codes of Practice, best practice etc.). Generally, specialist judges are appointed in office for a term of 5 years and this is reviewed every 5 years until the age of 70, which is the statutory retirement age for all judges.

Role of the Medical Member (Medical Judge)

The medical member has a dual role to perform. They are required by the Tribunal Rules to carry out an examination of the patient before the hearing and to take any steps that they consider necessary to form an opinion of the patient’s mental condition. In England, the pre-medical examination is not a requirement to hear a case. At the hearing they, together with the other judges, have the judicial responsibility of deciding whether or not the patient should continue to be detained or remain on a community treatment order. If the medical member’s opinion of the patient differs significantly from other medical witnesses then this should be made known at the beginning of the hearing. This is because it would be unfair and contrary to a basic principle of natural justice if the Tribunal members were to take notice of information that had not been shared with all the other parties at the hearing. The medical member is invariably a consultant psychiatrist of several years’ standing. He or she will be able to advise the other members of the Tribunal on any medical matters. Medical members are generally senior doctors, with at least 7 years experience and are often drawn in from Consultant level. Generally, medical judges are appointed in office for a term of 5 years and this is reviewed every 5 years until the age of 70, which is the statutory retirement age for all judges.

Course of the Tribunal

Tribunals normally sit in private and take place in the hospital or community unit where the patient is detained. Physical location aside, the tribunals resemble court hearings, during which appropriate witnesses are invited to speak in turn. These include the detained person, their solicitor, the member of the multi-disciplinary team responsible for the detained person’s care in hospital, known as the Responsible Clinician (RC, usually a consultant psychiatrist), a representative of the nursing staff at the hospital and the Approved Mental Health Professional (AMHP). Additionally, the RC and AMHP (or more frequently the patient’s care coordinator) are required to submit written reports on the person’s state of health to the Tribunal in advance of the hearing. Sometimes the primary inpatient nurse for the patient may also submit a written report.

How the Decision is Made

Each member of the Tribunal is entitled to an equal voice on questions of law, procedure and substance. All the members participate in the making of decisions and, although the legal member is expected to draft and sign the written record, this is done only after taking into account the contributions of the other members. If the members do not all agree then a decision of the majority of members of the Tribunal is taken as the decision of the Tribunal.

The Tribunal will consider the case and the patient as presented on the day. The Tribunal cannot question the circumstances that gave rise to the detention. The Tribunal decides whether or not to end the patient’s detention in hospital. The Tribunal has the power to order a deferred discharge which may be conditional (for example that an aftercare package is put in place).

Decisions of the Tribunal can be appealed to the Administrative Appeals Chamber of the Upper Tribunal, or to the High Court, by way of Judicial Review.

Organisation and Oversight

The Bodies

Technically the Mental Health Review Tribunal consists of two distinct bodies, within a single non-departmental public body.

The first body is the Judicial Tribunal itself with the responsibility for hearing applications or references concerning people detained under the Mental Health Act 1983.
- The Tribunal members are appointed by the Ministry of Justice.
- There is a Liaison Judge appointed to the Tribunal to lead its development.
The second body is the Mental Health Review Tribunal Secretariat.
- This is staffed by members of the Department of Health, and has responsibility for the administration of the Tribunals.

Regional Chairperson

There is a Regional Chairperson appointed for each of the two Tribunal regions (the North Region and the South Region), based in London and Manchester. Regional Chairperson’s responsibilities include appointing members to particular hearings, ensuring that all the statutory requirements are complied with, making judicial decisions and giving such directions as are necessary to ensure the speedy and just determination of every case. Regional Chairperson’s are also responsible for organising training for members, for overseeing the members’ appraisal and mentoring scheme and for handling complaints about a member’s conduct.

Organisation of the Tribunal

The Secretary of State for Health is responsible for meeting the expenses of Tribunals in England and for providing accommodation and staff. Administration is carried out at the Secretariat offices in Leicester. The Welsh Assembly has similar responsibilities for Tribunals in Wales and administration is carried out at the Secretariat office in Cardiff. All the Secretariat staff are civil servants and are completely independent of the hospital authorities. The Regional Chairperson and the Secretariat work closely together to make sure that the whole Tribunal process is closely managed. The role of the Home Office is confined to cases involving ‘restricted patients’.

Tribunals operate independently of all Government Departments.

Fairness of Decisions

A study in 2017 by Jewell and Colleagues, looked at the correlation between a number of predictors and the outcome of the MHRT decisions: The study commented that their “findings imply that decisions at MHRT are not biased in terms of age, sex, ethnicity, mental health diagnosis, or even index offence”, rather its findings “suggest that by reducing levels of agitated behaviour, verbal aggression and physical violence on the ward, working towards being granted unescorted community leave, and specifically targeting items on the HCR-20 risk assessment” patients can increase their chance of discharge.

Reference

Jewell, A., Dean, K., Fahy, T. & Cullen, A.E. (2017) Predictors of Mental Health Review Tribunal (MHRT) outcome in a forensic inpatient population: a prospective cohort study. BMC Psychiatry. Springer Science and Business Media LLC. 17(1). doi:10.1186/s12888-016-1188-8.

What was the Board of Control for Lunacy and Mental Deficiency?

Published on 05/09/2021 by Andrew Marshall2 Comments

Introduction

The Board of Control for Lunacy and Mental Deficiency was a body overseeing the treatment of the mentally ill in England and Wales.

Background

It was created by the Mental Deficiency Act 1913 to replace the Commissioners in Lunacy, under the Home Office however it was independent in that it reported to the Lord Chancellor who had responsibility for investigating breaches of care and integrity. The Board was transferred to the Ministry of Health by the Ministry of Health Act 1919, and reorganised in 1930.

The Board consisted of a Chairman, two Senior Medical Commissioners, one Senior Legal Commissioner, six Commissioners including lawyers and doctors, six Inspectors and administrative staff. By law, at least one of these had to be a woman. The Commissioners of the Board travelled around England and Wales ensuring that those detained under mental health legislation were legally in custody, their care was appropriate, and moneys and other properties owned by patients were not being misused or stolen.

The Board was based in Northumberland Avenue, London, until 1939 when it was moved to Hobart House, Grosvenor Place.

Its functions were transferred to the Minister of Health by the National Health Service Act 1946.

Refer to Chronology of UK Mental Health Legislation, Commissioners in Lunacy, Commissioners in Lunacy for Scotland, and Commissioners in Lunacy for Ireland.

Members

Announcements of members were carried in the major national newspapers, including The Times.

On inception of the Board in 1913, the chairman was Sir William Byrne with Arthur Rotherham and Mary Dendy joining the ex officio members of the previous Lunacy Commissioners; C.H. Bond, Marriott Cooke, S. Coupland, B.T. Hodgson, S.J.F. MacLeod, F. Needham L.L. Shadwell, and A.H. Trevor.
In 1916, due to Sir William Byrne moving on, Marriott Cooke became acting chairman, and Robert Welsh Braithwaite was appointed to the board.
In 1921, Dr Ruth Darwin was appointed to the Board
In 1926 due to Robert Welsh Braithwaite’s retirement, Robert Cunyngham Brown was appointed a commissioner.
In 1928, due to the retirement of the chairman, Sir Frederick Willis, Laurence George Brock was appointed chairman.
In 1929, Dr Bedford Pierce was appointed a commissioner.
From the start of 1931, the Board was reconstituted, with a chairman and four other members.
- L.G. Brock continued as chairman, with S.J. Fraser MacLeod, C. Hubert Bond, Arthur Rotherham, Ellen Pinsent.
William Rees-Thomas was appointed to the Board in 1931.
In 1931, Dr Isabel Wilson was appointed as a Commissioner, holding the position until 1948.
- From 1949 to 1960 she was a Senior Commissioner, after which the Board was abolished and her position was changed to the Principal Medical Officer, Ministry of Health.

What was the Madhouses Act 1774?

Published on 05/09/2021 by Andrew Marshall2 Comments

Introduction

The Madhouses Act 1774 (14 Geo. 3 c.49) was an Act of the Parliament of Great Britain, which set out a legal framework for regulating “madhouses” (insane asylums).

Refer to Chronology of UK Mental Health Legislation.

Background

By the mid-eighteenth century, the common methods in the United Kingdom for dealing with the insane were either to keep them in the family home, or to put them in a “madhouse”, which was simply a private house whose proprietor was paid to detain their residents, and ran it as a commercial concern with little or no medical involvement. This led to two forms of abuse: the first was the keeping of “legitimately” insane people in atrocious conditions, and the second the detention of those who were falsely claimed to be insane – in effect, private imprisonment.

At this stage, there was no legislation to regulate the incarceration of anyone other than a Chancery lunatic or a pauper; there was only a vaguely defined common law power to “confine a person disordered in mind, who seems disposed to do mischief to himself, or another person”.

In a case in the mid-1750s, a woman came to suspect that her son-in-law had committed his wife to a madhouse in Hoxton; with the aid of a Justice of the Peace, she secured the release of her daughter after obtaining a confession from the husband. A similar case in 1762 saw a man trying to obtain the release of an acquaintance, one Mrs Hawley, who he suspected had been confined in a madhouse. His initial application to Lord Mansfield for a writ of habeas corpus was rejected because he was not a relative and so had no standing, but the judge arranged for a doctor to visit the house and speak to the woman. On his report, a writ was granted; she was brought before the court, and discharged.

A Select Committee of the House of Commons, chaired by Thomas Townshend, was set up in 1763 to study the problem of unlawful detention in private madhouses and focused on the Hawley case. It found that she had been committed to the house solely on the word of her husband, who paid two guineas (two pounds and two shillings) a month for her board, and that she was unable to leave the house or communicate with anybody outside it. The inmates were treated as insane, but the agent who arranged their entry freely admitted that he had not committed a single insane person to the house in the past six years. No-one who would pay was turned away, no physicians attended the inmates, and no register was kept of their names. This was, the Committee stated, a common situation; they noted that a number of similar cases could have been studied, and they recommended that some form of legislative intervention was needed. The Commons ordered the committee to prepare a bill, but it appears this was never brought in.

The issue was next addressed in 1773 when Townshend’s son, also named Thomas Townshend, sponsored a bill to regulate private madhouses; within seven miles of London, this would be the responsibility of the Royal College of Physicians; and outside that, magistrates in county towns. The bill passed the Commons but was rejected by the Lords.

Legislative History

In 1774, Thomas Townshend again reintroduced the Madhouses Bill. The Bill was presented to the Commons for its first reading on 02 March, and was amended in committee on 23 March. The Lords voted on it on 21 April, and made two amendments (the addition of s.19 and s.31) on 06 May, before the bill returned to the Commons on 10 May. The bill received Royal Assent on 20 May.

Provisions

The Act required that all madhouses be licensed by a committee of the Royal College of Physicians. This license would permit the holder to maintain a single house for accommodating lunatics, and would have to be renewed each year. All houses were to be inspected at least once per year by the committee, who would also keep a central register of all the confined lunatics in order that people could locate them; outside London, the task of inspecting them would fall to the local quarter sessions.

The penalty for “concealing or confining” more than one insane person without a license was set at £500, and every keeper of such a house who took in a patient without an order from a doctor was liable to a fine of £100.

Implementation

The Act took effect on 20 November 1774, six months after receiving Royal Assent, and was originally stated to remain in force for five years and then until the end of the next Parliamentary session.

It was continued for a further seven years by the Madhouse Continuation Act 1779 (19 Geo. 3 c.15);
Then continued indefinitely by the Madhouse Law Perpetuation Act 1786 (26 Geo. 3 c.91); and
It remained in force until repealed by the Madhouses Act 1828.

What were the Commissioners in Lunacy for Scotland?

Published on 05/09/202105/09/2021 by Andrew Marshall5 Comments

Introduction

The Commissioners in Lunacy for Scotland or Lunacy Commission for Scotland were a public body established by the Lunacy (Scotland) Act 1857 to oversee asylums and the welfare of mentally ill people in Scotland.

Refer to Chronology of UK Mental Health Legislation, Commissioners in Lunacy for Ireland, and Commissioners in Lunacy.

Previous Bodies

The Madhouses (Scotland) Act 1815 established the right of Scottish Sheriffs to order the inspection of madhouses.

Establishment

The Board of Commissioners in Lunacy for Scotland was established in 1857 by the Lunacy (Scotland) Act 1857. There were two Commissioners of Lunacy each paid £1,200 a year and two Deputy Commissioners each paid £600 a year.

Asylums Commissioned

The legislation created a General Board of Commissioners in Lunacy for Scotland. It also created district boards with the power to establish and operate publicly funded “district asylums” for patients who could not afford the fees charged by existing private and charitable “Royal Asylums”. These existing “Royal Asylums” (with Royal Charters) were the Aberdeen Royal Lunatic Asylum, the Crichton Royal Institution, the Dundee Royal Lunatic Asylum, the Royal Edinburgh Lunatic Asylum, the Glasgow Royal Lunatic Asylum, the Montrose Royal Lunatic Asylum and James Murray’s Royal Lunatic Asylum. The aim of the legislation was to establish a network of “district asylums” with coverage throughout Scotland.

The following asylums were commissioned under the auspices of the Commissioners in Lunacy for Scotland:

Aberdeen District Asylum, 1904.
Argyll and Bute District Asylum, 1863.
Ayrshire District Asylum, 1869.
Banff District Asylum, 1865.
East Lothian District Asylum, 1866.
Edinburgh District Asylum, 1906.
Elgin District Asylum, 1835.
Fife and Kinross District Asylum, 1866.
City of Glasgow District Asylum, 1896.
Glasgow Woodilee District Asylum, 1875.
Govan District Asylum, 1895.
Inverness District Asylum, 1864.
Kirklands District Asylum, 1881.
Lanark District Asylum, 1895.
Midlothian District Asylum, 1874.
Paisley District Asylum, 1876.
Perth District Asylum, 1864.
Renfrew District Asylum, 1909.
Roxburgh District Asylum, 1872.
Stirling District Asylum, 1869.

In addition the Southern Counties Asylum, which was intended to provide facilities for paupers, was erected on the site of the Crichton Royal Institution (which focused on fee paying patients) in 1849 but subsequently amalgamated with the Crichton Royal Institution. Likewise the Dundee District Asylum, which was intended to provide facilities for paupers, was established alongside the Dundee Royal Lunatic Asylum (which focused on fee paying patients) in 1903 but subsequently amalgamated with the Dundee Royal Lunatic Asylum.

Successor Body

The Mental Deficiency and Lunacy (Scotland) Act 1913 replaced the Commission with the General Board of Control for Scotland.

What were the Commissioners in Lunacy for Ireland?

Published on 05/09/202105/09/2021 by Andrew Marshall5 Comments

Introduction

The Commissioners in Lunacy for Ireland or Lunacy Commission for Ireland were a public body established by the Lunacy (Ireland) Act 1821 to oversee asylums and the welfare of mentally ill people in Ireland.

Refer to Chronology of UK Mental Health Legislation, Commissioners in Lunacy for Scotland, and Commissioners in Lunacy.

Establishment

The Board of Commissioners in Lunacy for Ireland, more strictly known as the “Commission of General Control and Correspondence”, was established in 1821 by the Lunacy (Ireland) Act 1821. The commission consisted of four doctors and four lay members. It was responsible for designating the districts to be served by the asylums, selecting the locations and approving the designs.

Asylums Commissioned

The Eglinton Asylum in Cork and the Richmond Asylum in Dublin existed at the time the legislation was enacted and were incorporated into the new district asylum system as the Cork Asylum and the Dublin Asylum in 1830 and 1845 respectively. The new asylums that were commissioned under the auspices of the Commissioners in Lunacy for Ireland included:

Antrim Asylum, 1899.
Armagh Asylum, 1825.
Connacht Asylum, 1833.
Belfast Asylum, 1829.
Carlow Asylum, 1832.
Castlebar Asylum, 1866.
Clonmel Asylum, 1835.
Donegal Asylum, 1866.
Down Asylum, 1869.
Ennis Asylum, 1868.
Enniscorthy Asylum, 1868.
Killarney Asylum, 1852.
Kilkenny Asylum, 1852.
Limerick Asylum, 1827.
Londonderry Asylum, 1829.
Maryborough Asylum, 1833.
Monaghan Asylum, 1869.
Mullingar Asylum 1855.
Omagh Asylum, 1853.
Portrane Asylum, 1903.
Sligo Asylum, 1855.
Waterford Asylum, 1835.

What were the Commissioners in Lunacy?

Published on 05/09/202105/09/2021 by Andrew Marshall8 Comments

Introduction

The Commissioners in Lunacy or Lunacy Commission were a public body established by the Lunacy Act 1845 to oversee asylums and the welfare of mentally ill people in England and Wales.

It succeeded the Metropolitan Commissioners in Lunacy.

Refer to Chronology of UK Mental Health Legislation, Commissioners in Lunacy for Scotland, and Commissioners in Lunacy for Ireland.

Previous Bodies

The predecessors of the Commissioners in Lunacy were the Metropolitan Commissioners in Lunacy, dating back to the Madhouses Act 1774, and established as such by the Madhouses Act 1828.

By 1842 their remit had been extended from London to cover the whole country.

The Lord Chancellor’s jurisdiction over lunatics so found by writ of De Lunatico Inquirendo had been delegated to two Masters-in-Chancery.

By the Lunacy Act 1842 (5&6 Vict. c.64), these were established as the Commissioners in Lunacy and after 1845 they were retitled Masters in Lunacy.

Establishment

Anthony Ashley-Cooper, Seventh Earl of Shaftesbury was the head of the Commission from its founding in 1845 until his death in 1885. The Lunacy Commission was made up of eleven Metropolitan Commissioners: three medical, three legal and five laymen.

The Commission was monumental as it was not only a full-time commission, but it was also salaried for six of its members. The six members of the commission who were full-time and salaried were the three members of the legal system and the three members of the medical community. The other five lay members of the commission were all honorary members who simply had to attend board meetings.

The duty of the Commission was to carry out the provisions of the Act, reporting to the Poor Law Commissioners (in the case of workhouses) and to the Lord Chancellor. The first Secretary to the Commissioners was Robert Wilfred Skeffington Lutwidge, a barrister and uncle of Lewis Carroll. He had previously been one of the Metropolitan Commissioners, and later become an Inspector of the Commission.

A Master in Lunacy ranked next after a Master in Chancery in the order of precedence.

Asylums Commissioned

The following asylums were commissioned under the auspices of the Commissioners in Lunacy (or their predecessors):

English County Asylums

First Bedford County Asylum (Bedford), 1812.
Second Bedfordshire County Asylum (Fairfield), 1860.
Berkshire County Asylum (Moulsford), 1870.
Buckinghamshire County Asylum (Stone), 1853.
Cambridgeshire County Asylum (Fulbourn), 1858.
First Cheshire County Asylum (Chester), 1829.
Second Cheshire County Asylum (Macclesfield), 1871.
Cornwall County Asylum (Bodmin), 1818.
Cumberland and Westmorland County Asylum (Carleton), 1862.
Derbyshire County Asylum (Mickleover), 1851.
Devon County Asylum (Exminster), 1845.
Dorset County Asylum (Charminster), 1863.
Durham County Asylum (Sedgefield), 1858.
East Riding County Asylum (Walkington), 1871.
East Sussex County Asylum (Hellingly), 1898.
First Essex County Asylum (Brentwood), 1853.
Second Essex County Asylum (Colchester), 1913.
First Gloucestershire County Asylum (Gloucester), 1823.
Second Gloucestershire County Asylum (Gloucester), 1883.
First Hampshire County Asylum (Knowle), 1852.
Second Hampshire County Asylum (Basingstoke), 1917.
Herefordshire County Asylum (Burghill), 1868.
Hertfordshire County Asylum (St Albans), 1899.
Isle of Wight County Asylum (Gatcombe), 1896.
First Kent County Asylum (Barming Heath), 1833.
Second Kent County Asylum (Chartham), 1875.
Kesteven County Asylum (Quarrington, 1897.
First Lancashire County Asylum (Lancaster), 1816.
Second Lancashire County Asylum (Prestwich), 1851.
Third Lancashire County Asylum (Rainhill), 1851.
Fourth Lancashire County Asylum (Whittingham), 1873.
Fifth Lancashire County Asylum (Winwick), 1897.
Sixth Lancashire County Asylum (Whalley), 1915.
Leicestershire County Asylum (Leicester), 1837.
Lincolnshire County Asylum (Bracebridge Heath), 1852.
First London County Asylum (Hanwell), 1831.
Second London County Asylum (Colney Hatch), 1849.
Third London County Asylum (Belmont), 1877.
Fourth London County Asylum (Coulsdon), 1882.
Fifth London County Asylum (Woodford Bridge), 1893.
Sixth London County Asylum (Epsom), 1899.
Seventh London County Asylum (Dartford Heath), 1898.
Eighth London County Asylum (Epsom), 1902.
Ninth London County Asylum (Epsom), 1904.
Tenth London County Asylum (Epsom), 1907.
Eleventh London County Asylum (Epsom), 1921.
Norfolk County Asylum (Norwich), 1814.
Northamptonshire County Asylum (Duston), 1876.
Northumberland County Asylum (Morpeth), 1859.
North Riding County Asylum (Clifton), 1847.
First Nottinghamshire County Asylum (Sneinton), 1812.
Second Nottinghamshire County Asylum (Radcliffe-on-Trent), 1902.
Oxfordshire County Asylum (Littlemore), 1846.
Shropshire County Asylum (Shelton), 1845.
First Somerset County Asylum (Horrington), 1848.
Second Somerset County Asylum (Norton Fitzwarren), 1897.
First Staffordshire County Asylum (Stafford), 1818.
Second Staffordshire County Asylum (Cheddleton), 1892.
Suffolk County Asylum (Melton), 1827.
First Surrey County Asylum (Tooting), 1840.
Second Surrey County Asylum (Woking), 1867.
Third Surrey County Asylum (Hooley), 1905.
Sussex County Asylum (Haywards Heath), 1859.
Warwickshire County Asylum (Hatton), 1852.
First West Riding County Asylum (Wakefield), 1818.
Second West Riding County Asylum (Middlewood), 1872.
Third West Riding County Asylum (Menston), 1885.
Fourth West Riding County Asylum (Storthes Hall), 1904.
Fifth West Riding County Asylum (Burley in Wharfedale), 1902.
West Sussex County Asylum (Chichester), 1894.
Wiltshire County Asylum (Devizes), 1849.
First Worcestershire County Asylum (Powick), 1847.
Second Worcestershire County Asylum (Bromsgrove), 1907.

“New” Mental Hospitals Established Later by Middlesex County Council

First Middlesex County Mental Hospital.
- The First Surrey County Asylum at Tooting (see above) was transferred to Middlesex County Council in 1888 and became the First Middlesex County Mental Hospital in the early 20th century.
Second Middlesex County Mental Hospital (London Colney), 1905.
Third Middlesex County Mental Hospital (Shenley), 1934.

English Borough Asylums

Croydon Borough Asylum, 1903.
First Birmingham City Asylum, 1850.
Second Birmingham City Asylum, 1882.
Third Birmingham City Asylum, 1905.
Bristol City Asylum, 1861.
Canterbury Borough Asylum, 1902.
Derby Borough Asylum, 1888.
East Ham Borough Asylum, 1937.
Exeter City Asylum, 1886.
Gateshead Borough Asylum, 1914.
Ipswich Borough Asylum, 1870.
Kingston upon Hull Borough Asylum, 1883.
Leicester Borough Asylum, 1869.
Lincoln Borough Asylum, 1817.
Middlesbrough Borough Asylum, 1898.
Newcastle upon Tyne Borough Asylum, 1869.
City of London Asylum, 1866.
Norwich Borough Asylum, 1828.
Nottingham Borough Asylum, 1880.
Plymouth Borough Asylum, 1891.
Portsmouth Borough Asylum, 1879.
Sunderland Borough Asylum, 1895.
West Ham Borough Asylum, 1901.
York Borough Asylum, 1906.

Metropolitan Asylums Board Asylums (Established for Chronic Cases)

Caterham Asylum, 1870.
Darenth Asylum, 1878.
Leavesden Asylum, 1870.
Tooting Bec Asylum, 1903.

Welsh County Asylums

Brecon and Radnor County Asylum (Talgarth), 1903.
Carmarthenshire, Cardigan and Pembrokeshire County Asylum (Carmarthen), 1865.
Denbighshire County Asylum (Denbigh), 1844.
First Glamorgan County Asylum (Pen-y-fai), 1864.
Second Glamorgan County Asylum (Bridgend), 1886.
Monmouthshire County Asylum (Abergavenny), 1851.

Welsh Borough Asylums

Cardiff City Asylum, 1908.
Newport Borough Asylum, 1906.
Swansea Borough Mental Hospital, 1932.

Successor Body

The Mental Deficiency Act 1913 replaced the Commission with the Board of Control for Lunacy and Mental Deficiency.