ABSTRACT
Asylums could only take certified patients; and patients could not be certified until the illness had reached a stage where it was obvious to a lay authority—the justice of the peace. The treatment of neurosis developed in the consulting-rooms and the out-patient clinics of the nineteen-twenties and thirties. The barrier of certification and the emphasis on custodialism which resulted from the 1890 Lunacy Act undoubtedly contributed to the decline in standards of care and treatment; but there were other factors involved also. The medical superintendent was now bound to a heavy burden of paper-work which involved the repeated notification of details concerning every individual case to a central authority in London. War-time economy establishes an unusual series of priorities. The chief recommendation was that there should be treatment for limited periods without certification. Within a year of its inception, the Ministry of Health took over powers in the control of lunacy and mental deficiency.
