Past exam of the medicine course of the University of Oxford / 1864 / Second examination / Therapeutics / 3

What steps are required by the law of England to be taken before a person of unsound mind can be put under bodily restraint ?

For ordinary private asylum reception in England in 1864, the central safeguards were a proper reception order and two independent medical certificates. The legal question concerns deprivation of liberty under the contemporary lunacy legislation. It must also be distinguished from the separate justification for applying mechanical physical restraint to a person already in care. The relevant framework is the Lunacy Act 1845, amended by the two 1853 Acts and the Lunacy Acts Amendment Act 1862, rather than later Victorian legislation.

For a private patient entering a licensed house or registered hospital, obtain the prescribed order and accompanying particulars, normally signed by a relative or other responsible person, and two certificates from qualified, independent medical practitioners. Each practitioner must examine the person separately within seven clear days before reception. Each certificate distinguishes personally observed facts from information supplied by others, and certifies both unsoundness of mind and suitability for detention for care and treatment. Financial and professional conflicts disqualify specified signatories. Comparable documentary safeguards cover a paid single patient in an unlicensed house. Exceptionally, special circumstances stated with the order permit initial reception on one certificate; two further independent certificates, from two other practitioners, must follow within three clear days. That exception is not indefinite authority to continue confinement.^[ref]

The 1862 amendments add important timing and conflict safeguards. The order's signer must have seen the person within the preceding month and state when and where; the order ceases to authorise reception after one calendar month. The legislation further excludes specified financially interested persons and medical attendants from signing private reception documents. A relative's name and address should be entered where possible. The required admission documents go to the Commissioners within one clear day, subject to the Act's separate timing for the subsequent medical statement. That notification follows reception and is not a certificate that must already have been returned before it.^[ref]

There are distinct statutory routes for pauper patients, involving the appropriate justice's order and medical evidence, and for persons already found of unsound mind by inquisition. Therefore the two-certificate rule should not be asserted as the sole route for every legal category.^[ref][ref]

Finally, a reception order is not permission to tie down a patient merely because a certificate exists. The contemporary inspection records specifically called for the occasions, means, duration and reasons for restraint and seclusion to be recorded. Immediate protection during dangerous behaviour and continued institutional detention are different questions; a medical opinion alone cannot erase that distinction.^[ref] This describes historical Historical English asylum admission, not the law governing present-day detention.