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FINAL REPORT OF THE ROYAL COMMISSION ON MENTAL HYGIENE (Appointed under the "Public Inquiries Act" by… British Columbia. Legislative Assembly 1928

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 FINAL REPORT
OF THE
ROYAL COMMISSION
ON
MENTAL HYGIENE
(Appointed under the " Public Inquiries
Act " by Order in Council dated
December 30th, 1925)
TABLE OF CONTENTS.
Page.
Appointment of Commission  3
GENERAL REPORT:
Introduction and General Observations  4
Recommendations  5
Acknowledgments  6
APPENDICES: •
A—Vancouver School Board Statistics  8
B—Summary of the Problem  9
C—The General Role of an Institution for Mental Deficients  11
D—Mental Deficiency in England  13
E—Fate of Mentally Deficient Children  15
F—Mentally Defective Delinquents   16
G—Marriage of Defectives   17
H—Sterilization and Parole in California  18  Appointment of the Commission.
From Votes and Proceedings of the Legislative Assembly of British Columbia,
November 18th, 1925.
On the motion of the Hon. Mr. Sloan, seconded by Dr. Rothwell, it was Resolved,—■
Whereas,  in  accordance  with  the provisions  of  the  " British  North  America  Act,"  the
Province of British Columbia is maintaining a Mental Hospital:
And whereas the number of persons treated in the said Mental Hospital and its branches
is increasing to an alarming extent:
And whereas 66 per cent, of the inmates of the Mental Hospital are not Canadian-born and
90 per cent, not natives of this Province:
And whereas it is necessary to provide for the erection of further buildings to house the
increasing number of patients :
And whereas the cost to the people of this Province for the maintenance of the mentally
afflicted is now over $750,000 per annum, exclusive of capital charges:
And whereas the treatment and care of subnormal and mentally deficient children has also
become an urgent and very serious question:
Now, therefore, be it Resolved, That a Select Committee of this House be appointed to
investigate and report upon the following matters:—
(1.)  The reasons for the increase in the number of patients maintained in the Provincial
Mental Hospital and branches thereof:
(2.)  The causes and prevention of lunacy in the Province generally:
(3.)  The entry into the Province of insane, mentally deficient, and subnormal persons:
(4.)  The care and treatment of subnormal children:
(5.)  All such other matters and things relating to the subject of insanity, especially
as they affect the Province of British Columbia, as the said Committee may deem
pertinent to their inquiry.
The Resolution was carried unanimously.
From Votes and Proceedings, November 19th, 1925.
With the leave of the House, on the motion of the Hon. Mr. Sloan, seconded by the Hon.
Mr. Manson, it was Resolved,—
That under and by virtue of the terms of the Resolution unanimously passed by this
Legislature on November 18th, 1925, a Select Committee of this House, consisting of Messrs.
Rothwell, Odium, W. A. McKenzie, Hayward, and Harrison, be appointed to investigate and
report upon the following matters:—
(1.) The reasons for the increase in the number of patients maintained in the Provincial
Mental Hospital and branches thereof:
(2.)  The causes and prevention of lunacy in the Province generally:
(3.)  The entry into the Province of insane, mentally deficient, and subnormal persons:
(4.)  The care and treatment of subnormal children:
(5.) All such other matters and things relating to the subject of insanity, especially as
they affect the Province of British Columbia, as the said Committee may deem
pertinent to their inquiry.
That instruction be given to the said Committee to report its findings and recommendations
to this House;   and that the said Committee shall have power to call for the attendance of
persons, the production of books, papers, and to do all things necessary in carrying out a full
inquiry.
The members named proceeded with their inquiry as a Special Committee of the
House, and on December 17th, 1925, asked permission to continue their investigations and to report at the next Session of the Legislative Assembly. On December
30th, 1925, they were accordingly appointed Commissioners under the provisions
of the " Public Inquiries Act."
An interim report was submitted on February 28th, 1927, when the Commissioners were directed to continue their studies for another year, paying special
attention to the subject of Mental Deficiency. Report of Commission on Mental Hygiene.
To His Honour the Lieutenant-Governor in Council:
May it please Youe Honour :
Since submission of an interim report dated February 28th, 1927, your Commission has proceeded with its inquiry as directed and now begs to submit its second
and final report.
The work of the Commission during the past year has been largely concentrated,
as planned, on the problem of mental deficiency. However, inquiry into the other
fields of mental abnormality, particularly having regard to the latest developments
in methods of prevention and cure of the insanities, has not been neglected. Nothing
essentially at variance with the conclusions contained in the first report has been
found, and the report therefore may be regarded as covering the ground as fully
as can well be done by a Commission of this nature.
It is desirable again to stress the necessity of making a clear distinction between
the two broad classes of mentally abnormal persons:—
(a.)  The insane.    Insanity is a disease of a normally developed mind, and
is susceptible of cure in a large percentage of cases.    It does not
manifest itself, as a rule, until adolescence or later.
(&.)  The   mentally   deficient.    Mental   deficiency,   mental   defect,   feeblemindedness (the terms are generally synonymous), is a condition of
arrested mental development usually obtaining from birth or an early
age.    It is not curable.    The afflicted person always remains a child
in mentality, but its condition may be helped greatly by training
which will develop such manual ability as the individual may possess.
Broad inquiry in the field of mental deficiency has shown that in recent years
there has been, among experts in all parts of the world, a definite trend away from
the alarmist attitude common  about the opening of the present century.    The
percentage of the general population afflicted by mental deficiency is not increasing.
Moreover, it has been learned by experience that, if mental deficients are diagnosed
when they are young, if they are given training suited to individual needs, and if
they are supervised in the community when they leave school, the majority will
give little trouble to society.
The key-note of a constructive programme for mental deficients is training,
and nine-tenths of deficient children can be trained with greatest advantage in
the public-school system. The problem, therefore, is educational rather than
medical.
There will always be a small proportion of mental deficients of such low grade
as to require custodial care, but even of these most can benefit by simple training
which will teach them habits of cleanliness and perhaps enable them to wash,
dress, and feed themselves. Beyond that they cannot go. Also there will always
be a small proportion who, because of their defect, are unsocial and cannot be
allowed at large with safety to themselves or to the community.
.Neglect of mental deficients leaves them free to cause grave social evils by
their delinquencies and depredations, and to produce children who, in turn, may
be a like charge on the community.    Under proper treatment and by continuous ROYAL COMMISSION ON MENTAL HYGIENE. G 5
care and training it is possible to make them acceptable, happy, and to some extent
useful members of society.
Partial surveys in this Province—borne out by experience elsewhere—indicate
that 2 per cent, of school-children are incapable of benefiting by the ordinary school
curriculum. It may therefore be safely assumed that there are 2,000 children in
British Columbia who require special instruction. Their presence in the ordinary
class-room is not only of little use or benefit to themselves, but is a heavy and
costly handicap on all others.
According to general practice, the term " idiot" is used to denote mental
deficients with a " mental age " of 3 years or less; " imbecile " is used to indicate
individuals with a mental age of from 3 to 7; while the terms " moron " and
" feeble-minded " are applied to those whose mental ages are from 7 to 11 years.
Idiots and imbeciles are generally recognizable for what they are. The higher-
grade morons, however, are not so readily recognized. They are the great social
misfits. They contribute out of all numerical proportion to pauperism, delinquency,
criminality, promiscuity, and illegitimacy. As children they are " backward."
They are slow in learning to walk and talk; in school they are from two to four
years behind other children of the same age. Shamed by their failure to progress
with their fellows, they eventually drop out of school and go into the world
unequipped to meet the demands made upon them as citizens. Adults in years
and size, it is not generally realized that they are not responsible for their actions
and their failures; and it is, therefore, not strange that they so often find themselves
in the gaols, reformatories, and houses of refuge.
Dealing with these unfortunates in this way is exceedingly costly, to say
nothing of the great waste of human material that is involved.
Your Commissioners recognize the threefold nature of the problem:—
(a.) The custodial treatment of low-grade idiots and imbeciles:
(6.) The vocational training of higher-grade mental deficients:
(c.) The protection of the public against those of the latter class who
have dangerous anti-social instincts.
And we therefore recommend:—
1. The appointment of a Provincial Psychiatrist whose duties shall be those
of:—
(a.) Active medical and administrative head of the proposed Psychopathic
Hospital:
(5.) Adviser to the Provincial  Government on matters  connected with
mental hygiene.
2. The establishment of a Psychopathic Hospital in the largest centre of population, as recommended in the previous report of this Commission.
3. The establishment of special classes for mentally deficient children in all
school centres having a school population of 500 or more, on the general plan of
such classes now being operated in Vancouver, Victoria, and other Canadian cities;
and provision for a special grant from Provincial funds to the local school authority
equal to one-half of the extra cost of such special classes above the cost of ordinary
school classes of the same grade.
L The establishment, as required, and near the principal centres of population,
of vocational schools specially adapted to the training for remunerative occupation G 6 BRITISH COLUMBIA.
of suitable graduates from the special classes;   with Provincial grants for their
establishment and maintenance.
5. The eventual establishment of a Provincial Training School for Mental
Deficients, to care for:—
(a.)  Mentally deficient children from centres where the establishment of
special classes is not warranted by the school population:
(&.)  Special problem cases, from all centres, who are not suitable for
admission to the special classes in the public schools.
This Provincial Training School should not be extended to provide for low-
grade cases requiring purely custodial care.    These should be sent to a suitable
sub-unit at the Provincial Mental Hospital.
The Training School should:—
(a.) Be reasonably near the principal centre of population:
(&.)  Be established on rough land suitable for clearing, and for farming
and gardening when cleared:
(c.) Be built on the cottage system.
6. The creation, through general publicity and educational work among the
social-service organizations of the Province, guided and directed by the social
activities of the Psychopathic Hospital, of a proper public sentiment toward the
mentally handicapped which will eventually open to those suitable therefor avenues
of remunerative employment, and so ensure many of them adequate care and
supervision in the community when they graduate from the training school for
mental deficients and go out to face the task of making their own way in the world.
7. The enactment of a special Mental Deficiency Act defining those who should
come within its purview and the methods to be applied in their care and treatment,
basing such legislation on recent Acts of other Canadian Provinces and the English
" Mental Deficiency Act" of 1913 and amendments.
8. The enactment of legislation providing for a carefully restricted and safeguarded measure of permissive sexual sterilization of certain suitable and definitely
ascertained cases of mental abnormality, as set out in the previous report of this
Commission, with the object that such cases may be permitted safely to return to
their normal place in the community.
9. The acceptance by the Provincial Government of the generous offer of the
Canadian National Committee for Mental Hygiene to aid in prevention and treatment of mental abnormality in this Province, by:—■
(a.) Contributing the sum of $2,500 annually for a period of five years for
research in mental hygiene at the University of British Columbia, or
elsewhere in the Province under auspices of the University, provided
the Provincial Government will contribute an equal sum:
(&.) Arranging for a special course of training at suitable centres on this
continent, on the basis of a Rockefeller scholarship without cost to the
Province, for the man to be selected as Superintendent of the proposed
Training School for Mental Deficients.
The Commissioners desire to place on record their sincere appreciation of the
aid extended to them in the course of their inquiry by many individuals and organizations, among whom may be mentioned:— ROYAL COMMISSION ON MENTAL HYGIENE.
G 7
The Seguin Society, recently organized in Vancouver to befriend the feebleminded.
The Canadian National Committee for Mental Hygiene, with headquarters at
Toronto, which placed at the Commission's disposal the resources of their organization and arranged for a personal survey of its problems by their Medical
Director, Dr. C. M. Hincks, resulting in much valuable counsel and advice, and also
for the visit of Mr. I). M. LeBourdais, Director of the Division of Education, who
has been of great assistance to this Commission and has addressed many meetings
throughout the Province on the subject of mental hygiene.
The United States National Committee for Mental Hygiene, New York, which
has supplied the Commission with much valuable information, including expert
advice on some of its special problems, in addition to large quantities of literature
on every phase of the subject and detailed plans of representative institutions in
the United States.
The Canadian National Child Welfare Council.
The American Association for Study of the Feeble-minded.
The Central Association for Mental Welfare, London, Eng.
Officials of the Department of Institutions, State of California, and especially
Dr. F. O. Butler, Superintendent of Sonoma State Home, Eldridge, Calif.; and
Dr. Paul Popenoe, Pasadena, Calif.
Officials of the Vancouver School Board, and especially Miss A. Josephine
Dauphinee, Supervisor of Special Classes, and Miss R. A. Kerr, Psychologist.
Members of the medical profession of Vancouver and Victoria, and especially
Dr. J. G. McKay, Assistant Medical Director of the Canadian National Committee
for Mental Hygiene, Vancouver; Dr. W. A. Dobson, Vancouver; and Dr. F. C. Bell,
Superintendent of Vancouver General Hospital.
In conclusion, the Commissioners wish to record their profound sorrow and
sense of loss in the death of their former fellow-Commissioner and Chairman, the
late Dr. E. J. Rothwell, M.L.A. His zeal in the cause of mental hygiene and his
intimate knowledge of the subject were of the greatest value in all deliberations
and his death has proved a serious handicap to the work of the Commission.
Throughout the year the members of the Commission have served without
remuneration of any kind.
All of which is respectfully submitted.
P. P. HARRISON.
W. A. McKENZIE.
R. HAYWARD.
VICTOR W. ODLUM.
Victoria, B.C., March 9th, 1928. G 8 BRITISH COLUMBIA.
Appendix A.
Vancouver Statistics showing Need of a Training
School for Mentally Deficient Children.
Officers of the Psychological Department of the Vancouver City School Board having supervision of the Special Classes for subnormal children submitted to this Commission some time ago
evidence gathered from data contained in departmental records for the school-year 1924-25.
A check of more recent records has shown that the figures for that year are still fairly representative of existing conditions. It should be noted that the figures given cover only ithe City of
Vancouver proper, and do not include surrounding municipalities now embraced in the designation Greater Vancouver.
Summarized, these figures show :—
Cases in  Special  Classes needing institutional care,  or supervision  and
social control   121
Cases not in Special Classes, representing an average number of new cases
annually      30
Accompanying this statement was the following explanation of the data on which these
conclusions were based:—
" A Training School for the Feeble-minded, if established upon the modern and enlightened
policies for such an institution, would serve two purposes:—
"(1.)  It would afford permanent protection for persons unable to care for themselves
in the community:
"(2.)  It would provide supervision for those who, after training, might be considered
capable of caring for themselves with only occasional oversight.
" With these two functions the Training School would not only prove a haven for many of
the feeble-minded population who cannot be adjusted outside, but would also check the increase
in mental defect and thereby deal with one of the menacing social and economic problems with
which the Province is faced.
" With these two functions of a Training School in mind, the files of the Special Classes were
gone over carefully and three lists of children made.
" The first list was composed of children who, in the light of mental development, school
achievement, and social reactions, are considered as needing permanent care in an institution.
Of the 289 children enrolled in Special Classes for the year, thirty-six were placed in this list.
Of these, five were excluded from school as incapable of profiting even by special class-work.
Several others are under consideration for exclusion in the near future. The children on this
list are high-grade imbeciles or low-grade morons. Almost all are capable of some training in
manual work. In an institution they could do routine work of real value, toward self-support.
The parents of this type of child invariably desire more than custodial care for the child and
only send him to a custodial institution under circumstances which make it impossible to keep
the child at home.
" The second list of children contains those of higher intelligence than the first list. For
them training in an institution during the adolescent period is desirable either because of
temperament trends in themselves which made adjustments difficult, or because of lack of home
influences calculated to train them into socially acceptable habits. In this list there are thirty-
eight children.
" The third list contains children belonging to feeble-minded families. In many cases these
children are of a disposition to work steadily at some suitable and simple work and to care for
themselves in a simple environment. They have not the mentality, however, to meet situations
of any complexity and should not shoulder the responsibilities of parenthood. Belonging as they
do to defective families, the taint is almost certain to be passed on to their children.
" If the Province adopts the policy of sterilization these children should be sterilized. There
are on this list, which is conservative, forty-seven children. ROYAL COMMISSION ON MENTAL HYGIENE. G 9
" The three lists together total 121 children of the 289 in Special Classes. These lists
cannot be considered complete for the city as a whole as there are some schools not represented
in the Special Classes.
" In addition to children attending the Special Classes there are other cases coming to the
attention of the department. Nine children were excluded from schools as of too low grade
intelligence to profit by instruction. These were imbecile children. Thirteen others were tested
whose intelligence was so low as to make institutional care appear desirable, either permanently
or temporarily. More extensive knowledge of these thirteen cases would be necessary before
placing them in the three classifications mentioned above.
" Among delinquents examined for the Juvenile Court, Salvation Army, etc., seven cases
were so defective that permanent care is the only possible means of preventing them from continuing their delinquent careers. From outside the city three imbeciles were brought for
examination.
" The cases outside of special classes can be considered about an average of annual new
cases. During the seven and a half years since the clinic has been open (to June, 1925), we
would judge, fifty to seventy-five imbecile children have been excluded from Vancouver schools."
On February 6th, 1928, this statement was supplemented with the following:—
" Regarding your request for recent data on mental deficients, the former figures will still
stand, with the addition of thirty-odd imbeciles.
" For feeble-minded delinquents, the percentage of 8 to 10 per cent, of our Special Class
group remains fairly constant. This means from twenty-five to thirty per year, distributed
between the Girls' and Boys' Industrial Schools, and occasional ones (naming three) to the
penitentiary."
Appendix B.
Mental Deficiency.
A GENERAL SUMMARY OF THE PROBLEM, AUTHORIZED BY THE U.S. NATIONAL
COMMITTEE FOR MENTAL HYGIENE.
1. Feeble-mindedness is a condition of arrested mental development existing from birth or
an early age, in consequence of which the person affected is unable to direct his affairs with
reasonable prudence, or to perform his duties as a member of society in the position of life to
which he was born.
2. Feeble-mindedness is not due to poverty or the lack of opportunity for training and
education, but in all cases is the result either of such accidental causes as injuries or various
diseases, occurring at birth or at an early age—conditions which may happen to the best of user is hereditary.
3. In probably two-thirds of instances, feeble-mindedness is of hereditary origin, is the
result of defective germ plasm, the expression of defective family stocks which transmit this
condition from generation to generation in accordance with the well-known laws of heredity.
4. Feeble-mindedness is not curable. It is the result of incomplete brain development) of
abnormal brain conditions;   once feeble-minded, always feeble-minded. G 10 BRITISH COLUMBIA.
5. Feeble-minded persons are especially prolific and reproduce their kind with greater
frequency than do normal persons, and through such reproduction provide an endless stream
of defective progeny which are a serious drain on the resources of the nation.
6. Facts are now at hand from State-wide surveys and intensive studies which indicate that
feeble-mindedness is one of the largest single factors in hereditary pauperism, juvenile vice and
delinquency, adult crime and vagrancy, the spread of venereal disease, and the like.
Twenty-seven to thirty per cent, of the inmates of State prisons throughout this country
have been found feeble-minded; 30 per cent, of the inmates of training-schools, reformatories,
work-houses, homes of refuge, and the like, have been found feeble-minded.
The one outstanding and most important factor that complicates any programme for the
prevention of venereal disease is the high frequency of feeble-mindedness among prostitutes.
Of 243 women studied at the Massachusetts Reformatory for Women, which group included
the women in the institution in whose histories there had been commercialized promiscuous
sex immorality, 49 per cent, were found mentally defective.
Of 300 prostitutes examined by the Massachusetts Vice Commission, the mental defect of
50 per cent, was so pronounced as to warrant their legal commitment to an institution for the
feeble-minded.
Reports of studies of various groups in connection with the Municipal Court of Boston
showed that 58 per cent, of the chronic and habitual drinkers were found feeble-minded; 30 per
cent, of the women arrested for immoral conduct were found feeble-minded; 25 per cent, of the
individuals arrested for larceny were found feeble-minded; 36 per cent, of vagabonds were
found feeble-minded ;  23 per cent, of shoplifters were found feeble-minded.
In a study of mental defect in the State of Georgia, 40 per cent, of the inmates of the
almshouses were found feeble-minded; 40 per cent, of the inmates examined in county gaols;
17% per cent, of the male inmates of the State Prison and 42 per cent, of the women inmates
of the State Prison Farm; 43% per cent, of the immoral women examined in Courts, venereal
clinics, stockades, and the like; 17 per cent.,of the " run of the mine " of the Juvenile Court; 15
per cent, of the inmates of the Fulton County Reformatory for Boys; 24 per cent, of the State
Reformatory for Boys; 27 per cent, of the inmates of the Training School for Girls; 29 per
cent, of the children in orphanages—all these were found 'feeble-minded.
Finally, 3 per cent, of the children in the public schools of Georgia were found mentally
defective. It is these who form the grist for the mills of our future Courts, gaols, reformatories,
and State prisons to grind; it is these defective children that form the backbone of the vast
procession of paupers, prostitutes, and vagrants of to-morrow.
7. " There is one sensible and really efficient measure that can be carried out, and that is
to dam the stream near its source. As far as criminality in the feeble-minded person is concerned, there need be no criminality if the feeble-minded person as such is reckoned with early."
8. The late Dr. Walter Fernald (the great Massachusetts authority) said: "The key-note of a
practical programme is to be found in the fact that those defectives whose defects are recognized while
they are young children, and who receive proper care and training during their childhood, are as a
rule not especially troublesome after they have been safely guided through the period of early
adolescence."
Here we have the basis of an adequate State programme for handling mental defect. We
must recognize the needs of the mental defective while he is a child, educate him according to
his capacity, make him industrially efficient, teach him to acquire correct habits of living, protect
him from evil influences,- and when he has reached adult life continue to give him the friendly
help and guidance he needs. These advantages should be accessible to every feeble-minded
person in the State. ROYAL COMMISSION ON MENTAL HYGIENE. G 11
Appendix G.
General Role of an Institution for Mental
Deficients.
By Earl W. Fuller, M.D., Superintendent, Pennhurst State School,
Pennsylvania.
It is my belief that every one who works in institutions for mental defectives has found that
the average citizen knows nothing about mental defectives, or what is done for their betterment
and care.
The layman is not the only one who is lacking in this knowledge. Very few physicians are
familiar with the accepted methods of diagnosis of this condition and the great majority of
medical men, social workers, and special class teachers have absolutely no knowledge about the
institutional methods or aims.
Some consider an institution as a gaol in which the patient is to be kept for life, and that
the inmates are at least a serious menace to society. Others believe that the mental defective
is absolutely hopeless and the most that can be done for him is to keep him clothed, fairly well
fed, and see that he has a place to sleep. While, as a matter of fact, the above ideas apply to
some inmates of every institution, they come far'from applying to all.
Every institution has a small group of delinquent patients. In most cases these delinquents
have been the victims of some brighter person or persons and are delinquent because of improper
acquaintances or training. The idea that all mentally defective girls are " a menace," I believe
is absolutely wrong. Most subnormal girls are potential prostitutes, but only because of their
inability to say no to the approaches of the normal man or boy, and not because of any overdevelopment of the sex element in their mental or physical make-up.
When a proper environment, away from the temptations of the normals, can be found, these
so-called delinquent girls and boys usually react like others of their mentality.    .    .    .
The helpless or hopeless group for which but little can be done is also found in every
institution. They consist of those of very low mentality and the paralytics. These are the only
groups in the Institution that can be given only custodial care.
The school department of an institution is also greatly misunderstood. Most citizens believe
that academic work is all that there is to any school, and when an institution bears the name
of school the average individual expects that by the use of some secret process of teaching, which
the mental defective placed in the school will receive, it will be only a question of time before
the patient shows marked improvement or even cure.
On numerous occasions parents visiting their children have been disappointed to find the
child working at some manual occupation such as shoemaking, carpentry, or farm-work, and then
demanded of the superintendent the reason why their boy was not in school. At times it is
extremely difficult to convince these parents that the boy is receiving the best school instruction
possible for him, and that the school department does not include all the school-work, but every
department in which patients are employed is carrying on an excellent type of teaching.
When institutions for this type of humanity were first started the idea was to cure the
mental defective by special types of academic and other teaching, and it was believed that if
sufficient time was taken and sufficient patience used, the case could be brought to, or near to,
normal. It took many years for us to learn that the patient's mentality could not be improved
by any amount or kind of teaching, and that the best treatment that mentally defective individual
could receive is to give him as much academic knowledge as he would later make use of and as
much manual training along the line he is best fitted for as he is capable of receiving.
The younger and lower grades of children of course need habit, form, and sense training;
and those whose training and behaviour are not acceptable to society need behaviour-training
as well as the manual and vocational instruction.    .    .    . G 12 BRITISH COLUMBIA.
In an ideal institution the patient is admitted to an observation ward, where he is bathed
and a complete physical examination made of him, and where he is retained until there is no
possibility of his bringing into the institution any contagious disease or vermin. As soon as
he has become accustomed to his new environment a mental examination is made. This examination is not only the Binet tests, but performance and school tests and an inquiry into his
personality and a thorough examination into any peculiar mental traits that are brought out
during the psychiatrists' interviews or the notes made on him by the attendants on duty in the
reception ward. The correctable physical defects receive immediate attention. When the child
is ready to leave the observation ward, he is brought before a staff meeting and his case
thoroughly discussed by not only the physician, but by the psychologist, teachers, and supervisors.
He is then ready to be assigned to a ward of children who are approximately of his own mentality and age and his training is started. The history, examinations, and conclusions reached
at the staff meeting give the first clues as to what that training should be.
If the child is below school age or grade, the training must of necessity be elementary and
consist principally of teaching the patient to care for his bodily needs, dressing himself, etc.
If the case is of school grade the academic work suitable to his mentality, also manual training,
is started. If the case is above school age, but his academic school-work has been neglected, he
should receive enough instruction in academic subjects to give him as much knowledge as he
would use, but training along vocational lines should be principally considered.    .    .    .
When the training has been completed the next step is an attempt to return the case to the
community. Of course this is practicable only for the higher-grade cases. In some instances
the homes of the patients' relatives are of such a character that it is advisable to parole the
case directly to their home. However, in the majority of cases, the next step should be taken
through the boys' or girls' colony. The boys or girls who successfully live in colonies are
excellent material for parole when suitable homes can be found for them.
There have been many objections to the parole of mental defectives, but you should stop to
consider the fact that no State has sufficient institutional accommodation to care for all applicants, much less all the mental defectives in the State (even if such a thing were desirable),
and every State has thousands of mental defectives living useful, uneventful lives in the
community. The release of a well-trained institution case is not adding to the burden of the
community in any sense, but is really easing the community load by giving the community: a
self-supporting worker and making room in the institution for a mental defective who is in need
of the institutional training.    .    .    . ROYAL COMMISSION ON MENTAL HYGIENE. G 13
Appendix D.
Mental Deficiency in England—Summary of
the Law and Administration.
The existing system of dealing with mental deficients in England and Wales is the result
of the findings of a Royal Commission appointed in 1904 which pursued its studies for four years
and reported in 1908. The drafting legislation took upwards of two years, and the Mental
Deficiency Bill did not pass Parliament and become law until 1913. Necessary organization and
provisions for enforcement of the law were just getting under way when the war came and the
work was seriously interfered with. Since the war the financial condition of the country has
proved almost as great a handicap as the war itself. Local Authorities, on whom the bulk of
the responsibility falls under the Act, have been distressingly short of funds. Consequently,
many of these Local Authorities have neglected their statutory duty almost entirely, while even
those with the greatest desire to live up to the Act have fallen far short of its requirements.
The " Mental Deficiency Act" of 1913, and the system it seeks to set up, is probably on a
broader scale than anything of the kind ever before attempted anywhere. It goes to the very
root of the problem by providing that there should be " ascertainment" of every mental deficient
in the community and the system set up for this purpose is quite elaborate. Local education
authorities, with the co-operation of social agencies, the police, and others, are expected and
required to report any case of suspected mental deficiency to the Local Authority, which is then
required to ascertain, by expert examination, the true condition.
The Local Authority is then required to make suitable provision for every " ascertained "
and registered case. Institutional care and training is supposed to be provided for every case
requiring it, and there is also elaborate provision for " supervision " in the community for cases
that are not regarded as requiring segregation in an institution. All certified cases must be
reported to the Board of Control, which is the central authority for England and Wales, under
the Home Office, and which exercises general supervision of everything connected with mental
disease and mental deficiency, including regular inspection of all institutions of every kind.
In addition to the requirements of the " Mental Deficiency Act," there is provision in the
" Education Act" for a complete and compulsory system of special schools and special classes
for mentally deficient children of school age. These do not come under the purview of the
" Mental Deficiency Act " unless they are reported for certification by the local educational
authority.
INSTITUTIONS FOR MENTAL DEFICIENTS.
The Local Authority has a good deal of latitude as to the kind of institution to which any
case may be sent.    There are provided for in the Act and in actual operation in large numbers :—
(1.) State institutions—for defectives of dangerous or violent propensities, established
and maintained by the Board of Control.
(2.) Certified institutions—provided wholly or partially by various philanthropic
societies or associations, or by the local authority itself. In many cases these
are aided, both as to construction and maintenance, by Government grants dispensed by the Board of Control.
(3.) Certified houses—in which mental defectives are received by the owner thereof for
his private profit, and in respect of which a certificate has been granted by the
Board of Control.
(4.) Approved homes—in which defectives are received and supported wholly or partly
by voluntary contributions or for private profit, and in respect of which approval
has been granted by the Board of Control. G 14 BRITISH COLUMBIA.
(5.) Poor-law institutions—in which supposedly harmless but mostly helpless defectives
are still kept in considerable numbers. Few of these institutions are suited to
the purpose and the Board of Control is urging Local Authorities to concentrate
this class in one or two of their respective poor-law places, and bring these places
up to a better standard for this particular work.
SUPERVISION IN THE COMMUNITY.
From all English literature on mental deficiency, including the annual reports of the Board
of Control and the Central Association for Mental Welfare, it is apparent that in England, as
in the United States, there is a definite trend towards the belief that a very large proportion of
defectives do not really need permanent care in institutions, but can successfully occupy some
sort of place in the community, under proper supervision. This applies not only to those who
may have had some training in an institution, but also to many who have not had this training.
Licence.— (This is the official English term for what we know on the American continent
as " parole.") The principal use of this form of care is to test the ability of patients in institutions to live outside without harm to themselves or the community. Suitable cases are those
who, in the course of several years' training, have established good habits and some measure of
self-control; who have not recently displayed erotic, unstable, or violent tendencies; and who,
in the higher grades, have been trained to do some useful work. In all cases satisfactory
environment is essential. Licence may in some cases lead to complete discharge and in others
to guardianship under the Act, or to some form of supervision, but any patient under " licence "
is still under full legal control and may be brought back to the institution at any time for
cause shown.
Guardianship.—This form of care is of use for higher-grade defectives who, whether on
licence, in institutions, or elsewhere, have shown themselves able to live safely in the community,
but who require some measure of support or control. It may also be used for low-grade cases
as an alternative to institutional care or supervision where the home conditions are good or
where suitable guardians are available, and may be found useful in those cases where a small
regular payment enables parents to provide proper care for the defective at home.
Supervision.—Supervision provides for the regular friendly visitation of defectives and
ensures reports being sent to the local authority in the event of conditions and requirements
changing so as to render institutional care or guardianship desirable.
In Great Britain there is far greater organization of voluntary agencies aiding the mentally
unfortunate than is yet known in Canada or the United States. Over there the public seems
to realize some responsibility devolving upon itself; here, so far, the disposition seems to be to
leave the whole business to the Provincial or State Government. In England regularly organized
mental-welfare societies, with a governing association, undertake all kinds of voluntary work,
including visitation and supervision, provision of occupational training centres and of permanent
industrial centres for the defective who can earn a living under this supervision, but cannot
get along in the ordinary competitive conditions of the labour market. They undertake this
work for mental defectives, just as other similar organizations undertake " after-care " of cases
of mental disease discharged from mental hospitals or allowed out on " licence." Such a development may reasonably be looked for in Canada as time goes by. In Vancouver the recently
organized Seguin Society has for its present chief object the securing of institutional accommodation and training, but is already looking forward to the day when it can undertake such work
as has been described. ROYAL COMMISSION ON MENTAL HYGIENE. G 15
Appendix E.
The Fate of Mentally Defective Children.
(From Report of Birmingham, Eng., After-care Sub-committee.)
(The Lancet, January 14th, 1928.)
During the last quarter of a century over 4,000 Birmingham children have been pupils at
special schools for mental defectives, and a remarkable survey of their after-history has now
been issued.
Of 4,052 whose career was investigated, the following was ascertained:—
Died        239
Lost sight of       564
Doing remunerative work  1,618
Soldiers       18
Transferred to ordinary elementary schools      374
Transferred to other schools such as industrial and schools for the deaf....      34
In institutions for mental deficients (including 36 in asylums)     405
At poor-law and other institutions       156
Dismissed from special classes on account of physical or mental disability    269
At home, and said to be useful there      536
At home, and said to be useless        39
Excluding those who died or are untraced, these children may be tentatively assigned to
three main groups :—
(1.)   Those who seem to be socially efficient and self-supporting to a reasonable degree.
Among these may be placed the 1,618 paid workers and the 18 soldiers.    It also seems
reasonable to include the 174 children transferred to elementary schools, together with some,
say 20, of those who were sent to other special schools, and perhaps half of the 536 who are
described as " useful at home."    This makes a total of 2,098.
(2.)  Those suited for institutional care.
These include the 405 in institutions for mental defectives, the 156 in other institutions, the
269 dismissed as incapable from special schools, and the 39 useless at home.    In this group the
total would be 869.
(3.)   Those that might be left at home under supervision, although socially inefficient.
This would include the remaining half of those who are " useful at home " and the remaining
14 of those transferred to special schools, and gives a total of 282.
Thus of the 3,249 cases definitely ascertained, 2,098 (64 per cent.) are presumably satisfactory; 869 (26 per cent.) are only suitable for institutional care; and 282 (9 per cent.) belong
to the intermediate class and might remain at home under supervision. Appendix F.
Mentally Defective Delinquents.
(From Report of the Departmental Committee op the British Home Office on the
Treatment of Young Offenders, March, 1927.)
" It is important that young offenders who are mentally defective should be provided for
in institutions suited to their infirmity, and that they should not be sent to approved schools,
Borstal, prison, or other institutions for the treatment of normal offenders.
" The ' Mental Deficiency Act, 1913,' gave effect to this principle and provided machinery
by which offenders of this class could be dealt with either at the time of trial or by subsequent
transfer. We hope that the improved methods which we have recommended for the observation
of young offenders will ensure that all those who are mentally defective at the time of trial will
be dealt with as such by the Courts under the ' Mental Deficiency Act.'
" Unfortunately the intention of Parliament cannot be realized owing to the lack of accommodation. The war made it impossible for several years for Local Authorities to fulfil the
obligations imposed upon them, especially in view of the then financial position. The ground
thus lost has never been recovered, and although the temporary difficulties which arose owing to
the war can no longer be pleaded in extenuation, practically no progress is being made to grapple
with the problem.
" It is not any part of our function to consider the problem of mental defect as a whole, but
so far as the question concerns young men and women who are falling or have already fallen
into crime, the present position is a grave injustice to the unfortunate persons concerned and a
serious menace to the public interest. We desire to draw attention to the unsatisfactory position,
and to the paramount importance of coping with it."
In a summary of conclusions the following recommendation is made:—
" Immediate steps should be taken to cope with the serious lack of accommodation for mental
defectives." ROYAL COMMISSION ON MENTAL HYGIENE. G 17
Appendix G.
Marriage of Defectives.
(From the 1927 Report of the Board of Control for England and Wales.)
There can be no two opinions as to the undesirability of defectives marrying who have been
certified as unable to manage themselves and their affairs or as needing care, supervision, and
control. To place such persons in control of others, especially of helpless children, is the height
of unwisdom and the negation of the aims of a civilized community. The increasing numbers
of defectives under guardianship and of those allowed out on licence (parole) brings this question
prominently before us, and serious consideration should be given to the possibility of any useful
legislative action to improve methods of supervision outside an institution and to the cultivation
of a public opinion which would help and not hinder the carrying-out of any preventive measures.
The procreation of children by unmarried defectives, deplorable as it is, has not as a rule the
same evil consequences to the children as the marriage of defectives. In the former case the
children are generally brought up apart from their parents and at the present day are given the
chance of as full development as possible both morally, physically, and mentally. On the other
hand, those who are the offspring of married defectives remain under the control of persons who
are incapable of taking care of them, and they are consequently exposed to the hardships, neglect,
and ill-treatment that the mental condition of their parents renders inevitable.
It has been suggested that it be made a punishable offence to marry or connive at the
marriage of any person known to be certified as a mental defective under the " Mental Deficiency
Act," but if the law were so altered it is very doubtful if public opinion is sufficiently informed
to enforce it. We have instances where a Local Authority and visitors have suggested the
discharge of feeble-minded women in order that they might be married; and, if a girl has become
pregnant, public opinion would generally approve of her marriage and disapprove of her recall
to an institution.
One Local Authority tells us they have knowledge of six defectives where petitions have
been dismissed by the Judicial Authority in order to allow the defectives to get married, and
also of two others where the petitions were dismissed in order to allow two pregnant defective
girls to marry. These instances seem to show that public opinion has not yet realized that
the upbringing of children by defectives should be prevented as far as possible.
Much might even now be done to prevent the marriage of defectives by a more careful
selection of the persons to whose care they are entrusted, and we particularly desire to point
out the danger of licensing (paroling) cases of marriageable age to their parents or of placing
them under the guardianship of their parents. Many parents do not recognize that their
children are defective, or even if they do, they believe the best thing for them to do is to marry.
We have instances where parents have failed to report intimacies with the opposite sex, and
have deliberately encouraged marriage. This is not so likely to occur when the defective is
living with a suitable guardian. G 18
BRITISH COLUMBIA.
Appendix H.
Sterilization and Parole in California.
(Summary of Survey by Paul Popenoe.)
( Note.—A general survey of the question of sexual sterilization was contained in the previous
report of this Commission. It noted that the State of California had carried on permissive
sterilization of certain of the mentally abnormal in State institutions for a number of years and
on a larger scale than any other known community. At that time there had been no investigation
of the after-life of sterilized persons released on parole from California Institutions, and therefore
no accurate data on which to base conclusions as to what influence sterilization may have on the
condition and behaviour of the sterilized individual. Following is a summary of the results of
a survey made within the past year into the records of sterilized patients paroled since 1911
from the largest institution for mental deficients in California. This summary is from the report
of Mr. Paul Popenoe, a well-known investigator, who was the active director of the survey.)
In the course of a study of results of eugenic sterilization in the California State institutions,
financed and directed by E. S. Gosney, a philanthropist of Pasadena, and in consultation with
an advisory committee composed of authorities in many different fields, abstracts were made of
the records of 605 patients (mostly between 15 and 25 years of age with mean Intelligence
Quotient .60) who have been sterilized at the Sonoma State Home for the Feeble-minded,
Eldridge, Cal.
These represented two-thirds of the total number of sterilizations performed there since
1911. The remainder had not been out of the institution at the time of our investigation, hence
they could contribute little to this study, one of the principal objects of which was to determine
what influence, if any, the fact of sterilization exerts on the behaviour of persons paroled.
With the hearty co-operation of the State Department of Institutions, of the Superintendent
and staff of the Sonoma State Home, and of probation and parole officers and social workers
throughout the State, an attempt was made to get adequate histories of these sterilized patients,
the office files being supplemented by interviews and correspondence with County and State
officials elsewhere, particularly the probation and parole officers who had supervision of the
cases. The information given by officials and correspondents was checked and verified from as
many separate sources as possible.    The investigation extended over a period of eleven months.
We then classified the patients as to success by an arbitrary standard, adopted merely for
the purpose of this study. If a patient was well-behaved, self-supporting or supported from a
legitimate source, and apparently happy, the experiment was considered " successful." In other
words, success on parole meant primarily, for us, that the interests of society were as well
protected as if the patient had remained at Eldridge. The interests of the patient were of course
equally well protected; better, if it be assumed that most patients prefer freedom outside to
segregation inside the walls of even the best institution.
On this basis the history of our 605 cases is as follows:—
Males.
Females.
Number.
Per Cent.
Number.
Per Cent.
78
1
28
37
38
42.06
0.55
15.38
20.33
20.88
189
18
97
71
48
44.68
Doubtful _	
4.25
22.93
16.79
11.35
Totals	
182
100.00
423
100.00
Those " omitted " had not been out of the institution, unless merely for an occasional brief
holiday with relatives.   A few who had died or left the State were added to this group. ROYAL COMMISSION ON MENTAL HYGIENE. G 19
If we had no record of a patient within a year prior to the beginning of our investigation,
we marked him, or her, " unknown " unless the previous report was bad, in which our verdict
was " unsuccessful." Thus we assume that, if a patient was bad, he had not since become
good;   but that, if he was good, he may since have become bad.
The object of thus weighing the scales against the patient, so to speak, is to take the most
unfavourable view, in order not to let ourselves be deluded into making a more favourable
report than we should. In other words, we want to know the worst; to get the irreducible
minimum of success.
To form a just idea of the facts, one must leave out of account the unknown and the
omitted and recalculate the percentages. To make the picture as simple as possible, we have
also divided the doubtful equally between the successful and the unsuccessful. On this basis
the results of parole are :—■
Males. Females.
Per Cent. Per Cent.
Successful      72.89 65.35
Unsuccessful       27.11 34.65
The probable error in the case of boys is 4.29 per cent, and in the case of girls, 2.30 per cent.
So far as the facts are known, and in the light of our definitions, we feel justified in saying
confident y that at least two-thirds of the patients on parole have succeeded.
In none of the failures among the boys (save one doubtful case of exhibitionism) was there any
sexual element, and none of them gave evidence of being likely to become a focus for the dissemination of venereal diseases.
Of the seventy-eight successes among the boys, twenty-five were placed with relatives or
friends to do odd jobs or help around the home; twelve others are doing ranch-work or
gardening; the remaining forty-one successes are engaged in all sorts of unskilled or semiskilled labour, they are wholly or mostly self-supporting, and are an asset to the community
from an industrial point of view.
Of the 107 boys actually tested on parole with known results, there are only twenty-one
whose freedom was incompatible with public welfare.
Of the girls successful on parole, twenty-five are now occupied in the management of their
own homes. Eleven of these have a total of forty-five children which they had borne legitimately or otherwise before sterilization; the rest of them have married since. There have been
at least 100 marriages among the sterilized girls; many of them continue to work, as they have
no children to keep them at home, so we are grouping them with the other employed girls.
Of the ninety-seven unsuccessful girls, only nineteen cases represent the " sex problems."
Many of them did good work, but all of them lacked inhibitions. Altogether there are among
the failures about twenty-five cases in which sexual delinquency was evident. This is 8.22 per
cent, of the 304 female cases about which anything is known.
Bearing in mind the fact on which we have insisted throughout, that the Sonoma figures
cannot be contrasted closely with those of other institutions, we yet feel justified in drawing
the conclusion that it is possible to parole a large number of sterilized boys or girls and to get a
percentage of successes that compares favourably with any series of unsterilized cases of equal size
found elsewhere.
We have found no evidence that sterilization plays any part in the failure of patients on
parole. It does play some part in their success, for it enables marriage without fear of
offspring; and this is the most feasible way of stabilizing many girls and a few boys. If they
marry happily, we count it a success, whereas the same marriage in a State that does not
practise sterilization must be counted a failure from a eugenic point of view.
We were especially anxious to find whether any with weak inhibitions regarded sterility
as encouragement to illegitimate sexual experiences. In addition to diligent inquiry, we sent
a questionnaire to the parole and probation officers of the State, to the secretaries of the
Associated Charities, and others likely to be brought into contact with such girls, asking among
other things:—
" Have you known of any cases where the fact of sterility, with consequent absence of all
fear of pregnancy or bastardy, seemed to have acted as an incentive to promiscuity, adultery,
or other anti-social conduct that would not have occurred had it not been for the sterilization?
If so, how many and what was the nature of the conduct? " On this point twenty-two answers were received, from persons who had observed a total
of 2,154 women (some duplicates) over periods ranging up to fourteen years. The answer to
this question was negative except in two cases. One man replied: " One case—promiscuity,
female." Another man: " Not definitely, although in two or three cases there seemed to be
such tendencies." We ourselves learned of two cases in which girls who had previously been
promiscuous had spoken of their present advantage in freedom from possible pregnancy.
Assuming that these cases are all different, we have a suggestion of half a dozen in a series
of more than 2,000 female sterilizations—for our inquiries covered the insane as well as the
feeble-minded. In the two cases we ourselves found, the girls had been extremely promiscuous
before sterilization, and their conduct afterward, far from being worse, was vastly better than
before, since they were under supervision. Moreover, as soon as they showed signs of irregularity they were restored to custodial segregation.
No cases of this sort were found among 3,000 sterilized men.
Under the conditions in which sterilized feeble-minded patients have been paroled in
California, such parole does not tend to increase the amount of promiscuity in the population,
but greatly decreases it.
SUMMARY.
1. Of the sterilized feeble-minded paroled in California, about whom anything is known,
two-thirds have satisfied a reasonable definition of success.
2. The average length of time spent on parole by the subjects of this study was, twenty
months.
3. Little or no association is found between the success on parole and age, intelligence,
economic status, family history, or length of time spent outside the institution.
4. Those who have not been delinquent before commitment have a slightly better chance
to succeed on parole.
5. One in twelve of the girls on parole became sexually delinquent. (Nine in twelve of
these girls had been sexually delinquent before sterilization.)
6. There was no instance of sexual delinquency among the boys on parole.
7. Among 2,000 feeble-minded and insane women sterilized, five or six were reported to
consider their infertility as a possible asset, in freeing promiscuity from the fear of pregnancy.
8. No such instance was found among 3,000 men sterilized.
9. Sterilization favours the permanent stabilization of many paroled feeble-minded girls
through marriage.
10. As practised in California, parole of the feeble-minded after sterilization has not tended
to increase the amount of promiscuity in the community, or favoured the spread of venereal
diseases.    On the contrary, it has helped greatly to reduce both.
11. As practised in California, sterilization is a valuable adjunct to a system of parole for
the mentally defective.'
VICTORIA,   B.C. :
Printed by Charles F.  Banfield, Printer to the King's Most Excellent Majesty.
1928.
♦,500-428-1523

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